Another patient in the room, observing thrashing and hearing choking noises from the adjoining bed, pressed a bell push urgently to call back the nurse. But when she came Kurt Wyrazik had already died-unaided and alone. The nurse immediately paged a resident. She also paged Dr. Townsend in the hope that he was still in the hospital. He was, and arrived first. Townsend took charge, and again the reasoning behind his actions had to be conjectured. What seemed most likely was that a realization of what had happened penetrated his befuddled state and, with an effort of will, he cleared his bead and began what--except for Andrew's intervention later-would have been a successful cover-up. It must have been clear to him that the nurse did not know about the penicillin allergy. It was also possible that, with some extraordinary luck, the two incriminating items-tbe earlier entry on the patient's chart concerning the allergy, and the penicillin injection-might not be connected. So if he could pass off the death as occurring from natural causes, the true cause might not attract attention. It also could not have escaped Townsend's notice that Kurt Wyrazik was without close friends, the kind likely to ask prying questions. "Poor fellow!" Townsend told the nurse.”His heart gave out. I was afraid it might happen. He had a weak heart, you know.”
"Yes, Doctor.”
The young nurse was immediately relieved that she was not being blamed for anything. Also, even now, Noah Townsend was an impressive, seasoned figure of authority whose pronouncement she did not question. Nor was it questioned by the resident who had been called, and who returned to other duties after finding there was an "attending" on the scene; therefore he was not needed. Townsend sighed and addressed the nurse.”There are things we have to do after a death, young lady. Let's you and me get on with them.”
One of the things was to complete a death certificate in which Noah Townsend recorded the death as due to "acute heart failure secondary to pneumonia.”
Andrew learned about Kurt Wyrazik's death by chance on Thursday morning. Passing through the office reception area which he, Townsend, and Dr. Aarons shared, Andrew heard Peggy, the receptionist who had replaced the departed Violet Parsons, refer on the telephone to "Dr. Townsend's patient who died last night.”
Soon after, Andrew encountered Townsend and said sympathetically, "I hear you lost a patient.”
The older man nodded.”Very sad. It was a young fellow; you saw him once for me. Wyrazik. He had a bad case of pneumonia, also a weak heart. His heart gave out. I was afraid it might.”
Andrew might have thought no more about the matter; the death of a patient, while regrettable, was not unusual. But there was something awkward in Townsend's manner which aroused a sense of vague disquiet. The feeling prompted Andrew, an hour or so later when Townsend had left the office, to pull out Wyrazik's medical file and read it. Yes, now he remembered the patient and, going through the file, Andrew noticed two things. One was a notation about a penicillin allergy, which did not seem significant. The other was the absence of any reference to heart disease, which did. Still not overly concerned, but curious, Andrew decided to make discreet inquiries about Wyrazik's death at the hospital later in the day. That afternoon he went to the records office at St. Bede's. Wyrazik's chart aiid other documents had been sent there from the medical floor after the patient's death. Andrew read the last entry on the medical chart first--the cause of death, as recorded by Dr. Townsend-then worked backward through the file. Almost at once the order, in Townsend's handwriting, for six hundred thousand units of penicillin leaped out at him, striking Andrew like a thunderbolt. Equally shattering was the nurse's notation that the penicillin had been administered and, as time sequences showed, it was shortly before Wyrazik died. Andrew read the rest of' the file-including the intern's note about penicillin allergy and the earlier order for erythromycin-in a daze. When he returned the file to a records clerk his hand was shaking, his head pounding. Questions hurled themselves.”at to do? Where to go next? Andrew went to the morgue to view Wyrazik's body. In death the eyes were closed, the dead man's features composed. Except for a slight bluish, cyanotic tinge to the skin which could have been from other causes, there were no telltale signs of the anaphylactic shock which, Andrew now believed, had killed this young man needlessly, He asked the morgue attendant who accompanied him, "Has an autopsy been ordcred?" "No, sir.”
Then the man added, "There's a sister who's supposed to be coming from Kansas. There's to be cremation after she gets here.”
Andrew's thoughts were in turmoil. Remembering his earlier experience with the hospital administrator, he was stilt' uncertain about what to do next. Clearly, something must be done, but what? Should he sound a warning about the need for an autopsy? One thing Andrew was sure of: an autopsy would show,there had been no heart failure. But even without an autopsy the entries on the patient's chart were damning evidence. By now it was early evening, most senior people in the hospital had gone home, and there was little choice but to wait until next day. Throughout that night, while Celia slept beside him, unaware of her husband's problem, he lay awake as courses of action chased themselves around his mind. Ought he to go before colleagues in the hospital with what he knew, or would impartial proceedings be more assurt,-d if he went to authorities outside? Should he confront Noah Townsend first and hear Noah's explanation? But then Andrew realized the futility of this, as Noah's personality had clearly changed, even more than appeared on the surface-the result of his drug addiction over years. The Noah Andrew had once known and respected, and at moments loved, was upright and honorable, holding the strongest views about ethics and medicine, so that he would never have condoned in himself or others the awful professional negligence, followed by subterfuge, which he had just practiced. The old Noah Townsend would have stood up, confessed and taken the consequences, no matter how harsh. No, a personal confrontation would accomplish nothing. Over it all, Andrew had a sense of great sadness and of loss. In the end he decided wearily that he would keep what he knew within the family of the hospital. If other, outside action needed to be taken, then others in the hospital must decide. Next morning in his office he took time to write a detailed summation of what he knew. Then, shortly before noon, he went to St. Bede's and confronted the administrator.
If he closed his eyes, Andrew thought, he might well imagine he was at a PTA meeting at the children's school, or perhaps in the boardroom of a nuts-and-bolts industrial company making everyday, routine decisions. The words flowed past him. "May I have a resolution on that?" - "Mr. Chairman, I propose "Is there a seconder?" second that.”
been proposed and seconded... Those in favor of the res- olution...” A chorus of "aye. "Against?" Silence. “.
...declare the resolution carried By unanimous decision the hospital privileges of Dr. Noah Townsend are suspended...” Could this truly be the way it happened? This prosaic, formal, minor-key accompaniment to deepest tragedy. Were these petty, pecksnifflan phrases the best that could be found to signal the sudden, grievous ending of a lifetime's work, a once dedicated man's career? Andrew was not ashamed to find that tears were coursing down his face. Aware that others seated around the hospital boardroom table were watching, he made no attempt to hide them.