BAD MEDICINE
BY
KEITH LAUFENBERG



A physician is a person who pours drugs of which he knows little into a body of which he knows less.---Voltaire. (Helps, Friends in Council, ii, 10.)




Teresa Stein shrugged her shoulders reflexively and tried to smile at Dr. Sam Berger, a former classmate of hers at NYU, several years in the past. She was a 31-year old journalist, a freelance writer working on a half-finished novel and Berger had once dated her and was well-aware that she was working on a novel that had a deadline in less than a month. He also knew that she had recently broken up with her long-time boyfriend, also a close friend and former classmate of the doctor's.
'Sam, I'm, I'm just tired.'�
'Teresa, you're more than just tired, aren't you?'�
Teresa Stein smiled, almost ghoulishly.
'Well, aw'right then, I'm exhausted.'�
'You know what I mean, Tee. It's Steve, isn't it?'�
Teresa Stein shook her head but her eyes betrayed her, and she hissed:
'Well, I am depressed a lot of the time Sam. And my work is suffering, I need to finish my book on deadline or I'll lose a big bonus. Can you give me something?'�
'For your depression?'�
'Well'�'�'�'�'�'�yes.'�
'I can give you some Nardil, I think it might help. Just be sure to follow the instructions and don't drink or take any other medications, alright Tee?'�
'Surely Sam, surely.'�

*********

Teresa Stein sat at her word processor and stared at the blank screen, wondering where she was at in the story. She glanced at the small plastic container that housed the pills that her doctor had prescribed for her, 15 mg. tablets that she was to take three times a day. She reached for the container and stared at it absently. She had been taking them for almost two weeks and the result had been to calm her nerves enough so that she was nearing the last chapter in her book, an exciting thought to her, because it would finally bring to a conclusion almost a year of research and writing, and also earn her a $15,000 bonus. But Teresa Stein was agitated and sat staring at the pill container, wondering when she had last taken one, as Berger had doubled her dose after she had complained of an increased amount of stress that she was experiencing as she got closer to finishing her novel. As she stared at the small container of Phenelzine, her agitation turned to confusion and her forehead became shiny with sweat, while her fingers began sticking to each other. 'How could she write,' she thought, 'with clammy hands and damp skin?' She reached for the container, twisted off the cap, and popped a tablet into her mouth, then reached for a glass of water and frowned when it wasn't where she had thought it to be. She stood up and her head began spinning, even as her heart began pounding irregularly. Suddenly, she had an immense craving for something sweet and remembered that there was some leftover cake in her refrigerator. She quickly retrieved it, but, as she sat down to begin to eat the cake, she tried to remember what food restrictions went with her prescription. 'Funny,' she thought, she had just been re-reading the sheet of restrictions that very morning, as a new one had been enclosed with her new prescription, but, now, she couldn't, for the life of her, remember where she had put it.

-2-
THE PLAYERS


It sounds like a joke, but a hospital is no place for a sick person to be. Dr. Lowell Levin, Yale University.




Betty Cusher answered the telephone on the third ring, even though she was holding another phone on her other ear and had two lines blinking, on hold, on her desk.
'We Care, this is Betty speaking. An R-ah-N, for the eleven to seven shift? No problem, none at all believe me, she'll be there by ten forty-five, yes, what's that? Her name, oh-ah'rah-ah Terry, Terry McCallum. Right, okay then, bye.'� Cusher, the founder and CEO of We Care, a temporary nursing agency, located just outside of Ft. Lauderdale, quickly turned to the other phone and barked:
'Terry, I need you at Long General at eleven.'�
'Wha...what? Betty, I just got off a sixteen hour shift?'�
'They need an R-N at Long and I have no one else.'�
'Betty, you know I'm an LPN?'�
'Girl, now, I told you about this, don't worry, don't worry, just show up. I'll give you a fifty dollar bonus?'�
' Cash money?'�
'Of course, now get over to Long.'�
'Well, well, aw'right, but'�'�'�'�'�'�'�'�'�TerryMcCallum frowned and held the telephone at arm's length; it had gone dead, as Cusher had already disconnected her and was already on another phone to another one of her nurses, replicating the conversation she had just had, with McCallum, to another nurse.
As she hung up the phone, Cusher smiled greedily; she was being paid handsomely to provide temporary nursing care to dozens of hospitals and nursing homes around the state and, with an annual gross income of almost seven million dollars, she would provide that care, one way or another, and at any and all costs.

*********

Dr. Peter Paulsen hurried down the hallway and nodded pleasantly at a trio of nurses, receiving cordial smiles and greeting's in return. Paulsen had been a medic in Vietnam for two tours and would have gone back for a third tour if he hadn't been wounded, taking shrapnel in his head, neck and back. He had attended medical school for almost a year but could not concentrate, with flashbacks of the Nam, along with his wounds, severely limiting his ability to earn the medical degree that he had so eagerly sought before the war. And so, he had quit medical school and had travelled overseas for several months, drinking and spending all his money. But, it was late one night in Manila, in the Philippines, that Paulsen had seen the light, the answer to all his concentration problems and the stumbling blocks separating him from becoming a doctor, when he had purchased a medical degree for 200 pesos, about five bucks, on Recto Street, from a counterfeiter who, for another 200 pesos, would give Paulsen an internship at a large hospital in Manila, with more necessary stamps, seals, praises, recommendations and signatures than any one human being could ever have reasonably been expected to receive. Paulsen would stay intoxicated for almost a year before deciding, just before the millennium came in, that he would make an attempt to use his forged documents and had sent copies of his sealed diplomas, official praises and glowing recommendations to a large hospital in Florida, that was so desperate for doctors that they advertised in medical journals, where Paulsen had first become aware of the severe shortage. He was drunk when he sent an application but was sober when he received an answer; to report, posthaste, to Long General, where he would become the chief surgeon, being as he had such glowing letters of recommendation and such sterling qualifications, which, of course, were never checked out, to see if they were or were not the blatant forgeries that they actually were.

*********

Linda Black was a pharmacy technician, she helped pharmacists do their job, even though she had never had any pharmacological training whatsoever. Mostly, she just handed out pills, that she bagged from a large supply in the pharmacy at Long General, and performed other menial jobs at the pharmacist's behest. She was only 18-years old, had quit high school in the tenth grade, and was much more interested in the latest pop star than learning anything about pharmaceutical work; nevertheless she had been employed at Long General for nearly three months even though she was not considered a valued employee, for she was a necessary one, one who was being paid the minimum wage, the only prerequisite one needed these days at Long General, as the hospital desperately sought to cut labor costs and lighten the exhausted staff pharmacists' work load's.

*********


Gina Zerba smiled at several nurses and walked into the hospital cafeteria. She was masquerading as a CRNA, that is a certified registered nurse, who specialized in anesthesiology, when, in reality, she was nothing more than a LPN, a licensed practical nurse, with a two year degree in nursing. But, she was also being paid a handsome sum by none other than Betty Cusher, of We Care, who had bribed her on other occasion's into accepting a nursing position and shift's that she was not qualified to handle; this one being not only illegal but exceptionally dangerous, to the hospital patients and potential hospital patients that she would come in contact with, over the next eight hours. Zerba had done it before but never as a CRNA, which she knew was a nurse with specialized skills far beyond her scope, but also knew that they always worked under the direct supervision of an anesthesiologist and she wasn't about to turn away from the hundred dollar bonus she was getting for the charade, in cash.

*********

Dr. Anthony Hall smiled at Mrs. Timothy Wade, comforting her as best he could. Her husband, a diabetic for the past three decades, had blood poisoning in his left leg and had to have it amputated and it was scheduled to be done that evening, at Long General.
'I foresee no problems Mrs. Wade, really I don't.'�
'Do, do you know the surgeon, Doctor Hall?'�
'Well, I know Doctor Stemway is on shift there tonight and he is a fine surgeon. I went to med-school with him.'�
'Oh that's good. Can, can I go and see Tim tonight?'�
'Well, his surgery's scheduled for nine. I could call over for you, or you could go over, if you wish?'�
Wanda Wade, a 66-year old retired teacher, sighed.
'No, no that's not necessary, I want to go.'�
'Well, okay then. I'd be glad to drop in later in the evening, if I get the chance.'�
'Oh, thank you so much Doctor.'�
Hall stood up and smiled.
'No problem Missus Wade, no problem at all. '

********

Terry McCallum sat her tray down next to Gina Zerba and Linda Black and smiled. McCallum, masquerading as an RN, felt she was accorded much more respect by her peers when they thought her to be an RN. She chatted cordially with Zerba, who she took to be a CRNA, and whose mind-set verily matched McCallum's, as they both accorded the other the respect their positions demanded, while trading 'shop-talk,' as Linda Black, who was accorded the title of pharmacy technician, even though she barely knew the difference between an aspirin tablet and a cube of sugar, sat silently by, awed to be in the presence of two obvious professionals, whom she thought to be doctors.

-3-
NIGHTSHIFT



For the world, I count it not an inn, but an hospital, and a place, not to live, but to die in.
Sir Thomas Browne, Religio Medici. Pt. ii, sec. 11.

You know not what the night will bring.
Varro. Title of satire. (Aulus Gellius, Noctes Atticae, i, 22.)




As the head night-shift nurse, Ellen Crews felt she was overworked and underpaid but, nevertheless, she plowed on. She had become a nurse to fulfill a life-long desire to help people but wondered if it was possible in such a volatile environment as Long General, where germs seemed to spread so quickly and pervasively that many healthy people visiting there would return as patients, catching a virus in the very institution they would return to, seeking a cure. She stifled a cough, the flu was everywhere in the hospital and you couldn't walk the corridors as she did, without inhaling the germs, and, even though she had just had a flu shot, the germs, some immune to any medications, made their way into her lungs and nostrils, forcing out short hacking coughs. She spied the chief surgeon and approached him quickly.
'Doctor, there is a patient in the operating room.'�
'Doctor Stemway is the attending physician tonight.'�
Ellen Crews frowned at Dr. Peter Paulsen and shook her head.
'Sir, Doctor Stemway had a heart attack this afternoon. He's in surgery at this very moment, at Sacred Memorial.'�
Paulsen frowned. In the week he had been there, he hadn't had to do anything, even though he was the chief surgeon, other than give advice and be available to assist the attending physician, or to take charge when needed.
'Doctor, you're the only surgeon in the hospital and this patient has been waiting since nine and it's now eleven.'�
'Well, what are we waiting for then? Hah! Let's go nurse. Hah! Lead the way; I will operate MYSELF!'�


*********



Teresa Stein smiled at the maitre d', who returned it.
'One?'�
'Ah, ah I want something sweet, something really sweet, like a, yah-oohhh.'� Stein fainted and the maitre d' glanced up at an inquisitive waiter and shrieked:
Call nine-one-one Jose, NOW!'�

*********

Terry McCallum stared at the respiratory therapist.
'Is this the one who needs his respirator shut off?'�
The respiratory therapist handed McCallum a clipboard and pointed at a name, then spat:
'Yes it is. Higgins, James, see. Shut it off for me willyah please?'� She scurried out of the ward and McCallum stared at her retreating backside and hissed:
'Who does she think she's talking to? Hah!'� Then she turned the ventilator off and moved her eyes to the next patient, as James Higgins, suffering from severe emphysema, quickly lapsed into cardiac arrest. She strolled out of the ward and an orderly quickly accosted her.
'Say nurse, a patient in six-oh-one needs an RN.'�
McCallum spied the room, just adjacent where they stood, and frowned but went in.
'You called for a nurse?'�
The patient, a slender woman with light blonde hair, handed her a small container and smiled:
'Ah yes, I wonder if I could get this re-filled. My doctor is on the front there, Sam Berger. It's Nardil.'�
McCallum's face broke into a lordly sneer.
'That's the brand name Miss, it's actually Phenelzine. I'll fill it for you Miss Stein. Take a couple of minutes.'�
Teresa Stein suddenly relaxed and smiled.
'Oh, thank you nurse.'�

*********

Linda Black stared at the container and easily filled it with four dozen pills of Phenelzine and decided that it was not risking anything, especially as the nurse had said that it was all right for her to fill it. She then smiled at the next person wishing to fill a prescription and said:
'Can I help you?'�
'Oh, oh, can you fill this prescription please?'�
Black didn't hesitate, she liked filling prescriptions, it was so easy, and she smiled as she put two dozen of the same pills into the container before seeing that it was not Phenelzine Sulfate that was on the prescription but Perphenazine , so she quickly switched to that, mixing the pills together without realizing it and even putting some Phenobarbital in the same container, jabbering away as she slipped the pills, that would easily kill the 67-year old patient within hours of mixing them, into the container. As Linda Black smiled at the next customer, she decided she was beginning to like pharmaceutical work; after all it was so easy and uncomplicated and, besides, pharmacists made good money.

*********

Terry McCallum handed the pill container to Teresa Stein, who thanked her and quickly slipped one into her mouth and swallowed it, just as Dr. Peter Paulsen strolled into the room. He smiled and glanced at Stein's chart.
'Ah, I see you have a high temperature young lady. What seems to be the problem? I'm Doctor Paulsen, by the way.'�
'Oh, yes, I passed out this afternoon, in a restaurant. I, that is, I really feel bad but well, I have this pain in my head and sometimes
Paulsen waved his hand in the air, as if at a troublesome fly and smiled at McCallum, then barked:
'Give her some Demerol nurse.'�
'Doctor, I think I need to see my physician. Doctor Berger, Sam Berger. He's in Coral Springs?'�
'Why, whatever for, dear girl? It's two a.m.?'�
'Oh? It is? Well, I'm taking Nardil you know?'�
Paulsen smiled at McCallum, who hissed:
'Phenelzine, Doctor.'�
'Ummm-hmmm. Well, I just want to help your pain, young lady, alright? Meperidine will do you some good, okay?'�
'Well, if you say so?'�
'I do.'�
Paulsen nodded at McCallum, who went to get the Meperidine Hydrochloride, also known by its brand name as Demerol. When taken with the Nardil, the Demerol was potent enough to kill an average male, much less a frail female, as it would do, to Teresa Stein this early morning in the summer of the year 2000. But Paulsen wasn't finished, he was on a roll, having just come from surgically removing 69-year old Tim Wade's right leg. It hadn't been as bad as it could have been, considering Paulsen's lack of training and without the assistance of a first year intern it certainly could have caused Wade's death, which might have served Wade better, considering he still had his diseased left leg, as Paulsen had amputated the wrong one. Walking out of the room, Paulsen was paged; an emergency, a man with a malignant tumor in his lone, remaining kidney was being prepped for surgery, as a healthy kidney had just arrived. Paulsen hurried down the hallway, idly wondering just exactly where the kidney's were anyway, but, he worried needlessly, for just seconds before he was to have begun the operation, Dr. Stanley Crushhorn, an alcoholic anesthesiologist, who had had his license to practice medicine pulled in three states but, nevertheless was legally practicing at Long General, and was ably assisted by Gina Zerba, one of We Care's imposter's, administered enough anesthesia to kill the man ten times over, but, of course, once was enough, and it seemed that not only Paulsen was on a roll but that Long General Hospital was on a roll, a roll that would vacate some much-needed patient suites, patient suites that would be filled the same day that they became available by, of course, some really sick people.

EPILOGUE
BAD MEDICINE



As long as capitalism remains in existence, poverty, misery and insecurity will continue to undermine the health of young and old alike.
Nathan Karp, Health Care Reforms Aim to Serve profit Interests, The People, 5/1/93.




Yes, Long General was on a roll this humid, starry, South Florida evening and would go on to roll up a human death toll of 13 human beings, a baker's dozen.
Besides James Higgins, who was mistaken for Jerome Higgins, another patient, who died within an hour of his respirator being shut off and Teresa Stein, who would die within two hours of taking Demerol just after taking Nardil, and three patients Linda Black would poison by mixing prescription drugs together, and the patient that Dr. Stanley Crushhorn, with the help of Gina Zerba, would anesthetize to death, seven more unlucky humans would meet their deaths, three at the hands of the imposter Dr. Peter Paulsen and four at the hands of various and assorted other imposters, some who would be caught and fined or imprisoned and some who would escape totally unscathed.
There would be lawsuits, recriminations, back-stabbing's and finger-pointing's ad infinitum but nothing would really change, as the system would continue unabated, feeding off itself, when the temp agencies, insurance adjusters and hospital administrators attacked and tore at each other, becoming pitiful, primitive caricatures of the human race, as they were pitted against each other by the human sharks that are more commonly known as lawyers, who would pit employee against employee, each one blaming the other, as bankruptcy filings were bandied about and the sharks at the top of the food chain, the lawyers, kept the rivalries alive, lining their pockets with more and more gold, as they swam around in the ocean, also known as a courtroom, biting and tearing at each other, on behalf of their clients and the system that they had helped create and would continue to revere, as long as they could legally continue to beg, bargain and steal to their gain.

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