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diff --git a/59609-0.txt b/59609-0.txt new file mode 100644 index 0000000..c7e8572 --- /dev/null +++ b/59609-0.txt @@ -0,0 +1,563 @@ +*** START OF THE PROJECT GUTENBERG EBOOK 59609 *** + + + + + + + + + + + + + But the patient lived + + BY HARRY WARNER, JR. + + _When helping people to die is required + medical ethics----what can an unethical + doctor who_ cures _them do_? + + [Transcriber's Note: This etext was produced from + Worlds of If Science Fiction, December 1956. + Extensive research did not uncover any evidence that + the U.S. copyright on this publication was renewed.] + + +The receptionist ushered the patient into Dr. Walter Needzak's office. +She punched her glasses higher onto the bridge of her nose, patted the +bun of hair at the back of her head, and said: + +"This is Mr. Stallings, doctor." + +Dr. Needzak motioned the patient to a chair. Stallings sat down, slowly +but limberly. He still held his hat, and placed it in the precise +center of his lap. The receptionist handed a form to Dr. Needzak and +returned to the waiting room, after looking once over her shoulder. + +"You're only 125, Mr. Stallings?" Dr. Needzak asked. The patient nodded +sadly. "Well, you should be hale and hearty for another 50 years, +judging by the report on your preliminary exam. Are you sure that it's +any use for you to consult me?" + +"I wouldn't bother you," Stallings said, age showing only in the high +pitch of his voice, "except for the funny feeling in my chest the other +day. I had to visit an office on the twelfth story. The elevator wasn't +running, so I walked up. Just as an experiment, I went as fast as I +could. The way my chest felt got me so interested and excited that I +forgot what I wanted at the office, once I was there. So I thought that +that was a hopeful enough sign for me to come around and see you." + +Dr. Needzak, a young man at 50 and who looked even younger, hoisted +the stethoscope amplifier onto his desk, turned it on, and signalled +for Stallings to unbutton his shirt. He placed the stethoscope against +the bony chest. The bumping of the heart filled the room, drew a wild +pattern on the unfolding strip of paper in the visual section of the +amplifier, and created magnetic patterns on the tape. + +Dr. Needzak listened for two minutes, then thumbed through a reference +listing of visual heart patterns. Finally he switched off the +amplifier, and said: + +"You have no history of heart trouble." + +"I'm afraid not." + +"Well, I don't want to raise false hopes. The only thing that I can +suggest is more physical exertion. Really vigorous exertion, the kind +that makes you pant and tremble and get a bit dizzy. Try that every +day for a month and come back to see me. There's just a trace of a +flutter now, and we might be able to speed up its development." + +The old man smiled for the first time, at something that his eyes saw +behind the white plaster of the far wall. Finally, Stallings rose to +leave. Buttoning himself up, he said: "You'll send the bill?" + +Dr. Needzak laughed genially. "I can see that you aren't accustomed to +visiting doctors, young man. The better the doctor, the more risky it +is to send the bill. My policy is to request full payment before the +patient leaves the office, just in case I've given the right sort of +advice. In cases where I prescribe medicine, of course, you may pay for +the prescription and the consultation fee simultaneously. Before taking +the medicine, you understand." Again he laughed. + +"I understand. I should have guessed. I work in a bank myself. I hate +the work. I'm tired of everything, in fact. But I know how important it +is to pay promptly." + +The doctor had just filed away Stallings' physical record when the +receptionist ushered in an extremely elderly woman. Dr. Needzak smiled +broadly, and said: + +"Mrs. Watkins! I didn't expect to see you again so soon." He waved in +annoyance at the receptionist, who hovered behind the new patient. She +left, reluctantly. + +Mrs. Watkins groped her way to the chair, wincing when the receptionist +slammed the door. The old woman rubbed her bony forehead with a mottled +hand that trembled and said: + +"I know that I wasn't supposed to come back for another three months. +But did you realize that I'll have my 190th birthday before those three +months are up? When a person gets to be that old, she looks forward +to seeing the doctor more than she used to look forward for Santa to +arrive back in the old days." + +"No symptoms since your last visit?" Dr. Needzak spoke more loudly than +usual in deference to her failing hearing, and turned up the light to +aid weak, old eyes. + +"None." She spat out the word. "I'm going to change doctors, if this +keeps up. I've heard of a couple of doctors who aren't as scrupulous as +you are. After living all this time, I think that I could be permitted +one little crime, lying to them about a symptom. Then I know that I'd +be made happy. What's the use being moral when you're too frail and +tottery to enjoy life?" + +Dr. Needzak shook his head, disapprovingly. "I don't think you're quite +as miserable as you think you are. Don't go to those quack doctors. +Suppose you're caught, halfway through a crime? You might linger for +decades, half-well, half-sick, from the effects of what they'd give +you. Even the quacks won't supply you with strychnine, you know." + +"I know. I shouldn't have suggested it. But I get so tired of living." + +"Well, I can't see any physical trouble that could have developed +enough to warrant a complete exam since your last one. Maybe those +arteries will start hardening by the time you have that 190th +birthday. Or you could take up chemistry as a hobby. Just think what a +fine explosion you might get mixed up in!" + +"I thought of that." A couple of tears trickled down the wrinkled +cheeks of Mrs. Watkins. "But the thrice-great-grandchildren watch +me like a hawk. They don't let me do anything that might hurt me. I +suppose I'll just have to wait, and hope, and wait, and pray." + +She rose, very suddenly. Then she shook her head disgustedly. "I don't +even get dizzy when I do that, like most people my age. Thank you, +anyway, doctor." Mrs. Watkins walked out with dignity. + +Dr. Needzak noticed that his waiting room was filling rapidly, during +the two seconds that Mrs. Watkins opened the door to leave. He fumed +inwardly at his patience in dealing at length with cases like the last +two, whom he couldn't possibly be sure of helping. + +But his ill-humor was replaced by astonishment. The receptionist +introduced a woman even younger than he. She was very pale, but Dr. +Needzak guessed that that pallor derived from tension, not some rare +organic disturbance. + +"Are you sure that you haven't made a mistake, Miss Tillett?" He +asked the question quietly, trying to catch her eyes. She kept them +resolutely on her hands, which were folding and unfolding in her lap. + +"I talked with several good friends before coming to you, doctor," the +girl said. Her voice was very low. "You had been a good doctor for +their grandparents or great-grandparents. They told me that you could +help me, if anybody could." + +"But your preliminary examination shows nothing whatsoever wrong with +you," the doctor said. "It'll be another century before you would +normally develop the slightest symptom on which I'd be allowed to work. +And people of your age just don't go to doctors. It's only when you're +past the century mark, and know that decade after decade stretches out +ahead of you, that you start feeling that a doctor might--" + +"Please," she interrupted, almost inaudibly. "I don't think that a +physician should allow the consideration of a patient's age to enter +into his course of action. For personal reasons, I may need a doctor +more than the average person six times my age." + +"Will you tell me something about yourself? I'm not curious, except as +far as knowledge might affect my recommendations." + +"I don't care to discuss personal problems. Now, doctor, your assistant +who gave the preliminary examination overlooked the reason for my +coming to you. Right here," and she carefully touched a spot on the +well-tailored dress. "I think that it might be a tumor." + +"What good does it do to come to a doctor for that?" Dr. Needzak said. +"Tumors are so rare that there's very little chance that it's more than +your imagination. And the best physician can't speed up the growth of a +tumor, or change it from benign to malign." + +"A physician can diagnose," she answered. "If it's malign, I'll be +able to have patience. I won't need to break the law." Unexpectedly, +grotesquely, she drew one finger across her throat in a cutting +gesture, and looked squarely at him for the first time. + +Dr. Needzak walked softly to the door that led to the reception room. +He drew noiselessly a bolt across the jamb, locking it. Then he pointed +to another door, telling the girl: "Go in there and undress. I'll be +ready for you in a moment." + +He whistled softly under his breath, as he pulled instruments and jars +of colored substances from the deepest recesses of a cupboard. + +The girl already lay calmly on a metal table in the inner room when Dr. +Needzak entered. He staggered a trifle under a precariously balanced +pile of equipment in his arms. He explained: + +"I should let the receptionist do the hard work like this. But I don't +let her snoop around in this private room." + +"Will you really need all those things?" the girl asked, uncertainly. +"I thought that you just snip out a tiny specimen with a little gadget, +to make a diagnosis." + +"I could probably get along with just that one gadget," the doctor +said. He pulled a mask from a drawer and snapped on the sterilite. +"But I'm an old boy scout at heart. Always prepared." Unexpectedly, +he plopped the mask squarely over the girl's face. Her cry was almost +inaudible, as the thick gauze clamped itself over her mouth, clung +tightly beneath the jaw. + +Dr. Needzak pinioned her shoulders to the table, while her legs kicked +wildly for a few seconds. The anesthetic stopped the kicking within +five seconds. He waited for a count of ten, before he wrenched the mask +free. Turning up the sterilite to full strength, Dr. Needzak began to +line up surgical instruments in a neat row, humming under his breath. + + * * * * * + +Fifteen minutes later, the physician made a pair of injections into +the girl's upper arm. Then he swished oxygen into her face until she +recovered consciousness. + +"Wonderful stuff, this new anesthetic," he told her placidly. "It works +fast, wears off just as fast, doesn't leave the patient retching. Now, +you can sit up slowly. If you don't try anything strenuous for the next +day or two, you'll never know that you've had an operation." + +Miss Tillett's eyes widened. "Operation! I came here for a diagnosis. I +didn't authorize--" + +"I'm sorry. I operated without your consent. But I had a good reason. +It wasn't even a benign tumor that you had. It was only a cyst. If +I had merely diagnosed, and told you the truth, you would have kept +clinging to the hope that it might be a malign tumor. You wouldn't have +let me take it out. It would have grown big enough to disfigure you, +not big enough to cause you any physical damage. You would have gone +through the years with a new trouble, that of deformity, and you might +have been mentally warped in the delusion that you had a fatal disease. +You're as sound as a rock." + +Something inside the girl seemed to turn into liquid. She sat with +slumped shoulders, arms dangling limply at her side, and head sunk so +far that her chin rested against her chest. + +After a moment, she rose and walked slowly into the dressing cubicle. +When she emerged, she ignored the doctor, unlocked the door with her +own hands, and walked into the reception room, sobbing softly. + +Dr. Needzak cleaned up rapidly, and hustled into his main office to see +his next patient. No one was there. He grumbled to himself and opened +the door into the reception room. Blinking, he saw that it was empty. +It had been filling rapidly, not a half-hour earlier. + +The doctor had heard no noises indicating a commotion on the street +outside; and that was the only reason he could think of for the sudden +disappearance of his patients. To make sure, he strode through the +reception room, walked briskly down the short hall, and stuck his head +through the door leading into the street. Everything appeared normal in +the bustling business district, until a large, black sedan ground to a +stop at the curb in a no-parking zone. The receptionist climbed from +the vehicle, two men behind her. + +"Miss Waters!" Dr. Needzak exploded, when she reached the building's +entrance. "What do you mean by leaving without my permission? All my +patients have left. They must have thought that office hours were over." + +The receptionist gave him one baleful look, and shoved past him into +the building. And Dr. Needzak suddenly recognized the two men. + +"Bill Carson! And Pop Manville! What brings you big doctors down here +to see a small-time pill-dealer like me?" + +"Let's go into your office," Pop said, softly. He was old, tall and +gaunt with a perpetual look of worry. Dr. Carson, younger and bustling, +evaded Dr. Needzak's eyes. + +Miss Waters was shoveling personal belongings from her desk into a +giant handbag, when they reached the reception room. Dr. Needzak felt +her eyes upon him, as the other two physicians kept him moving by the +sheer impetus of their bodies into his consultation room. + +"Where is it, Walt?" Dr. Manville asked, looking gloomily around the +consultation room. + +"Where's what, Pop? The drinks? I keep them--" + +"The door to your operating room," Dr. Carson interrupted, hurriedly. +"Let's not drag this thing out. It's going to be painful enough, among +old friends. Your private office has been wired for sight and sound for +the past three weeks. You shouldn't have tried to get away with that +kind of practice in a big city." + +Dr. Needzak felt the blood draining from his face. He reached for a +drawer. Dr. Manville grabbed his arm with a tight, claw-like grasp, +before it could touch the handle. + +"It's all right, Pop," he said. "Nothing but gin in there. I'm not the +violent type." + +Dr. Carson pulled open the drawer toward which he had reached. He +pulled out the tall bottle, slipped off the patent top, and sniffled. +Handing it to Dr. Needzak, he said: + +"Okay. You need some. Then save the rest for us. We'll feel like it, +too, when we're done." + +Dr. Needzak coughed after three large swallows. He looked at the other +two doctors. "Who ratted?" + +Dr. Carson nodded toward the reception room. Dr. Needzak instinctively +clenched his fists. He half-rose from his chair, then sank back slowly. +"I thought you guys were my friends," he said. + +"We are, Walt," Dr. Manville said thoughtfully. "But this is +business. When someone charges violation of medical ethics, we're the +investigation committee. It looks like a simple investigation this +time, with those tapes on file." + +"What does she have against you, anyway?" Dr. Carson asked. "Usually +a receptionist will go through hell to cover up little flubs for her +boss. Were you mixed up with her in a personal way?" + +"Mixed up with her?" Dr. Needzak laughed mirthlessly. "She's worked for +me fifteen years. I've never made a pass at her." + +Dr. Manville nodded sadly. "That was your mistake, Walt. Frustration. +Disappointment. Worse than jealousy. Now, why not tell us everything?" + +"There's nothing to tell. Those tapes give a false impression, +sometimes. I just take difficult cases back there where I'm sure there +won't be any disturbance." + +"No use," Dr. Carson interrupted. "Things will be harder for you, +if we lose patience with you. We know you've been curing illness +against the patient's wishes, time after time. We just saw you take +out a tumor. The poor kid will probably drag through another hundred +years before she develops anything else serious. You prescribed +anticoagulants to a man with an obvious blood clot. You even talked a +couple with weak lungs into moving to Denver." + +"All right, it was a tumor," Dr. Needzak admitted. "It was malign and +it would have killed her in two or three years. But she's too young +to make a decision for herself. Five years from now, she may have a +different outlook on her personal problems. I have ethics, and I can't +help it if they don't correspond in some details with the association's +ethics." + +"You were given your medical license under an oath to respect the +ethics of the profession," Dr. Manville said slowly, emphatically. "The +license did not give you the right to practice under ethics of your own +invention." + +"Ethics!" Dr. Needzak looked as if he wanted to spit. "Ethics is just a +word. There was a time when physicians spent their time curing diseases +and preventing them. They called that ethics. Now that there aren't +enough illnesses left to give us work, now that people live long past +the time when they want to go on living, now that we make our money +helping people commit suicide the legal way, we call that ethics." + +"You can't annihilate a concept simply by thinking it's only a word," +Dr. Manville said. "There was a time when physicians used leeches for +almost every patient. They fitted that nasty habit into their ethics. +You wouldn't want to introduce leeches into this century, would you? +But you should, if you're so consistently opposed to anything that +sounds like changes in ethics." + +"But I've done my part to get rid of human miseries," Dr. Needzak said, +nodding toward a filing cabinet. "I can show you the data on hundreds +of my patients. Old folks, who just got tired of living; I helped +them die legally. Even younger people, who had a genuine reason for +being tired of life. I couldn't have my fine home or pay rent in this +building, if I went around curing every patient. There's no money in +that." + +"You wouldn't keep a filing cabinet for the times you disobeyed the +medical code," Dr. Carson broke in. "But we have some of those cases on +tape. You didn't refuse to handle the cases. You went ahead and played +God, going directly against the direct will of your patients. Did you +follow up all of the patients who aren't in your file cabinets? We +traced the later records of some of them. Several suicided right out +in the open. Their families haven't gotten back on their feet from the +disgrace yet." + +Dr. Needzak took two more deep swallows from the bottle. He looked +glumly at the low level of the liquid through its dark side, saying: + +"You fellows are enjoying this conversation more than old friends +should enjoy the job of taking action against a fellow-doctor. And +I'll tell you why you aren't too unhappy about it. You're jealous of +me. You're jealous of the fact that I've been following a physician's +natural instincts and healing people. You're angry with me for doing +the things that you'd really love to do yourselves, if you had the +guts. You aren't worried about that girl; you're peeved because you'd +give your shirts for a chance to take out a genuine tumor yourself." + +"Admitted," Dr. Carson said cheerfully. "I haven't seen a live tumor in +three or four years. They're scarce. But we can't sit here chatting. We +don't want to end up arguing." + +Dr. Needzak rose. "What do I do, then?" + +"The best action would be to come along with us to the association +headquarters," Dr. Manville advised, avoiding Dr. Needzak's eyes. +"In a half-hour or so, you can sign enough statements to avoid weeks +of hearings. Otherwise, we'll be forced to bother lots of other +physicians, hunt up your old patients, endure newspaper publicity, and +have a general mess." + +"After that, I start pounding the pavements, hunting a job." Dr. +Needzak flexed his long, lean fingers. "Is it hard to learn how to +operate ditch diggers?" + +Dr. Carson stood up and slapped him on the back. "It isn't that bad. +You can find a place in any pharmacy in the country, if we get through +this disbarment without publicity. You'll never be rich, handing out +irritants and hyper-stimulants, but--" + +Dr. Needzak was already striding toward the street. The other two +doctors trailed after him, waiting while he locked up carefully. They +glanced at one another significantly, noting that he had unconsciously +brought along his little black bag. Dr. Needzak explained as they began +the two-block walk to association headquarters: + +"The kids are married and away from home. I suppose that I can get +enough income from sub-leasing the office to keep the wife and me +eating until I find--" + +A grating crash broke into his sentence. The three doctors whirled +simultaneously. Thin wails drifted through the constant rumble of +traffic, from somewhere around a corner. People erupted from buildings, +running toward the source of the noise. The doctors instinctively +trotted after them. + + * * * * * + +They turned the corner, coming upon a rare sight. It was a motor +vehicle accident, first in the business district for months. A school +bus lay on its side, just short of the intersection. Children were +clambering cautiously from the emergency door. The uniformed driver was +ignoring his passengers, staring in disbelief at the radar controls at +the street corner, which had failed a moment earlier. + +The other vehicle involved in the crash was wrapped around a power +pole. It was an auto of antique vintage, produced before full automatic +driving provisions. There weren't more than a dozen such vehicles +remaining on the streets of the city. The radar controls almost +never went on the blink. Only the combination of the vehicle and the +inoperative controls could have created an accident. + +Dr. Needzak led the other doctors through the thickening crowd, to the +side of the bus. Kids were no longer climbing through the emergency +exit, but noises were coming from within the vehicle. His bag under +his left arm, he hauled himself atop the overturned bus, and dropped +through the emergency exit into its half-dark interior. He saw the +other two doctors outlined against the sky, as they perched on the +horizontal side of the vehicle, peering down, helpless without their +bags. + +Dr. Needzak found a small boy sprawled awkwardly around a seat, +bleeding rapidly from the leg, face ashen, unconscious. The physician +clipped off the trousers leg, bound the leg tightly above the deep +gash, and slipped on a bandage. Then he lifted the small boy up to Dr. +Carson. + +A girl was struggling to raise herself from the next seat, obviously +unaware that the leg wouldn't support her because it had suffered a +compound fracture. Dr. Needzak forced a grin when he attracted her +attention. He persuaded her to lie flat. With one quick motion, he +rough-set the leg. Then he boosted her out of the vehicle, and looked +down to investigate the source of the plucking at his coat. + +It was a small, chubby boy, standing beside him. "I'm hurt real bad," +the boy said. Needzak ran his hands over the boy's body to make sure +the bones were sound. "You better take care of me real quick," the +child said, looking more worried than ever. + +Dr. Needzak made sure that the blood on the boy's cheek came from only +a scratch, and found the heartbeat normal. So he pulled a sugar wafer +from his bag and ordered the boy to swallow it. + +"Think you can climb out now?" Dr. Needzak asked. The youngster, face +brightening, leaped to the door and went out unassisted. + +The only child remaining in the vehicle hadn't uttered a sound. But the +doctor sensed that her breathing was heavier. He bent over her, and +pushed back the lid of her half-closed eye. When he saw the back of her +head, he stopped his hasty examination. Her words were barely audible. +"Am I hurt bad?" + +"Why, there won't even be any pain," Dr. Needzak told her cheerfully. +Before he could yell to the other doctors to call for a stretcher, the +girl's breathing stopped. + +Slowly, as if suddenly tired, Dr. Needzak climbed out of the vehicle. + +Police had already dispersed the crowd. Tow trucks were waiting to haul +away the vehicles. The injured children were gone. The three doctors +resumed their walk. + +Dr. Needzak felt the eyes of the other two men on him, lost patience +after a moment, and said irritably: + +"Go ahead, start bawling me out. But I've not signed anything yet. I'm +still a licensed physician. I had every right to help those kids." + +The other two doctors stopped, looking at one another, as if trying +to probe each other's thoughts. Simultaneous smiles spread over their +faces. Dr. Needzak stopped walking, when he heard them starting to +laugh. He pushed between them with a frown, asking: + +"Look, if you--" + +Dr. Carson slapped him on the back, hard. Dr. Manville grasped Dr. +Needzak's hand and squeezed it with unexpected strength. + +"The same thing hit us both at the same time, I'll bet," the older +doctor said. "It would be the ideal thing for you." + +Dr. Carson was pumping Dr. Needzak's other hand up and down. "Sure. +Emergency physician! I don't know why we didn't think of that in the +first place. Accidents still happen now and then. It isn't easy to find +doctors who are willing to specialize in them, because it isn't steady +income and it doesn't pay a whole lot. But you have those screwball +ideas about helping people to get well. And that's just what an +emergency physician must do." + +"I'll talk to a couple of the men on the association board as soon as +I can get to a telephone," Dr. Manville said. "I think I can persuade +them to assign you to accidents without going through a disbarring +procedure, as long as you agree to stay away from general practice. +You're willing, I assume?" + +Dr. Needzak pulled his hands free and looked at the spots of dried +blood that remained on the fingers and palms. He hadn't been able to +wash up after the accident. He saw surgeon's hands, healing hands, +hands that would never be satisfied to wrap up syrups or count pills. + +"I suppose that it's the best thing in a bad deal. But I'm wondering +about accidents. Just the other day, I read an insurance company +statement. The insurance statisticians said that accidents have become +so scarce in the past decade that they'll be virtually non-existent, +in another half-century. I'll be 100 by that time, just in the prime of +life. If there aren't any more accident victims, what will I do for a +living? I couldn't find a job at that age, you know." + +The other two doctors shrugged their shoulders, in unison. With the +wisdom of age, Dr. Manville said: + +"Well, if you find yourself in that situation, you can always go to see +a doctor." + + + + + +End of the Project Gutenberg EBook of But the Patient Lived, by Harry Warner + +*** END OF THE PROJECT GUTENBERG EBOOK 59609 *** |