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At first Andrew had only partial, disconnected information. But soon afterward, because of his suspicions and inquiries, he was able to piece events together in their proper sequence. They began on Tuesday afternoon. A twenty-nine-year-old man, Kurt Wyrazik, appeared in Dr. Townsend's office complaining of a sore throat, nausea, persistent coughing and feeling feverish. An examination showed his throat to be inflamed; temperature was 102 and respiration rapid. Through his stethoscope, Noah Townsend's clinical notes revealed, he heard suppressed breath sounds, lung rales, and a pleural friction rub. He diagnosed pneumonia and instructed Wyrazik to go to St. Bede's Hospital where he would be admitted immediately and where Townsend would see him again, later in the day. Wyrazik was not a new patient. He had been in the office several times before, beginning three years earlier. On that first occasion he had also had an inflamed throat and Townsend had given him, there and then, a shot of penicillin. In the days that followed the injection, Wyrazik's throat returned to normal but he developed an itchy body rash. The rash indicated that he was hypersensitive to penicillin; therefore that particular drug should not be given him again because future side effects might be severe or even catastrophic. Dr. Townsend made a prominent, red-starred note of this in the patient's medical record. Wyrazik had not, until that time, known about his allergy to penicillin.

On a second occasion, when Wyrazik arrived with a minor ailmtnt, Noah Townsend was away and Andrew saw him. Reading the patient's file, Andrew observed the warning about penicillin. At that point it did not apply, since Andrew prescribed no medication. That-about a year and a half earlier-was the last time Andrew saw VVyrazik alive. After Noah Townsend sent Wyrazik to St. Bede's, Wyrazik was installed in a hospital room where there were three other patients. Soon afterward he was given a normal workup by an intern who took a medical history. This was routine. One of the questions the intern asked was, "Are you allergic to anything?" Wyrazik replied, "Yes-to penicillin.”

The question and answer were recorded on the patient's hospital chart. Dr. Townsend kept his promise to see Wyrazik later at the hospital, but before that he telephoned St. Bede's, instructing that the patient be given the drug erythromycin. The intern complied with the order. Since, with most patients, it was normal to use penicillin to treat pneumonia, it appeared that Townsend had either read the allergy warning in his file, or had remembered it-perhaps both. That same day, when he visited Wyrazik in the hospital, Townsend would have-or should have-read the intern's notes, thus receiving a further reminder about the penicillin allergy. The patient's own background had some relevance to what happened, or failed to happen, later. Kurt Wyrazik was a mild, unobtrusive person, unmarried and without close friends. Employed as a shipping clerk, he lived alone and was in every sense a "loner.”

No one visited him while he was in the hospital. Wyrazik was American-born; his parents had been Polish immigrants. His mother was dead. His father lived in a small town in Kansas with Kurt's older sister, also unmarried. The two were the only people in the world with whom Kurt Wyrazik had close ties. However, he did not inform them that he was ill and in St. Bede's. Thus the situation remained until the second day of Wyrazik's stay in the hospital. On the evening of that second day, around 8 p.m., he was seen again by Dr. Townsend. At this point also, Andrew had some indirect connection with the case. Noah Townsend, of late, had taken to visiting his hospital patients at unorthodox hours. As Andrew and others reasoned afterward, he may have done so to avoid meeting medical colleagues in the daytime, or it may have been his general disorientation due to drugs. It so happened that Andrew was also at St. Bede's that evening, dealing with an emergency for which he had been called from home. Andrew was about to leave the hospital as Townsend arrived, and they spoke briefly. Andrew knew at once from Noah Townsend's demeanor and speech that the older physician was under the influence of drugs and had probably taken some quite recently. Andrew hesitated but, since he had been living with the situation for so long, reasoned that nothing harmful would happen; therefore he did nothing. Later Andrew would blame himself bitterly for that omission. As Andrew drove away, Townsend took an elevator to the medical floor where he saw several patients. The young man, Wyrazik, was the last. What went on in Townsend's mind at that point could only be guessed at. What was known was that Wyrazik's condition, while not critical, had worsened slightly, with his temperature higher and breathing difficult. It seemed likely that Townsend, in his befuddled state, decided the earlier medication he had prescribed was not working and should be changed. He wrote out new orders and, leaving Wyrazik, delivered them personally to the nursing station. The new orders were for six hundred thousand units of penicillin every six hours, injected intramuscularly, with the first injection to be given at once. Because of the absence, through illness, of a senior nurse, the night nurse on duty was junior and new. She was also busy.

Seeing nothing unusual in Dr. Townsend's order, she carried it out promptly. She had not seen, nor did she read then, the earlier notes in the patient's chart; hence she was unaware of the warning about penicillin allergy. Wyrazik himself, when the nurse reached him, was both feverish and sleepy. He did not ask what was being injected into him, nor did the nurse volunteer the information. Immediately after giving the injection the nurse left Wyrazik's room. What happened next had to be partly conjecture; the other part was based on a report from another patient in the room. Given the known effects of penicillin in the circumstances, Wyrazik would, within moments, have experienced severe apprehension accompanied by sudden itching all over his body, and his skin would have turned fiery red. In a continuing swift process he would have gone into anaphylactic shock with rapid swelling and distortion of his face, eyes, mouth, tongue and larynx, all accompanied by sounds of choking, wheezing and other desperate noises from the chest. The swelling of the larynx, most critical of all, would have blocked the airway to the lungs, preventing breathing, followed -mercifully, after pain and terror--by unconsciousness, then death. The entire process would occupy five minutes or perhaps a little more. If emergency treatment had been used, it would have consisted of a massive injection of adrenaline and an urgent tracheotomy-a surgical cut through the neck into the windpipe-to get air into the lungs. But it was never called for, and when help arrived it was too late.