Robin Cook (32 page)

“But now we may have a new problem,” said Dr. Nachman. “If the patient is dead, no one can examine the body. We can't let anyone find the implants. We must find him at once.”

The phone rang, and Dr. Mitchell answered. After listening and saying “good” several times, he turned to Nachman with a thumbs-up sign.

“Your idea of covering the airport was a good one,” he said. “Burkett says the patient and Mr. Schonberg were sighted and are being picked up by the ambulance medics.”

“What if they were already in the ambulance when the stimulus was given?” asked Nachman.

“It could have been big trouble. I think we'd better search the road between here and the airport.”

Dr. Nachman threw up his hands. “When is this going to end?”

• • •

Adam had no doubt that Alan's psychotic episodes were due to remote stimulation, and he prayed that once they were airborne Alan would be out of range. Their one hope was to get aboard, but Adam was now afraid they both looked so bad that the Delta agents might turn them away. There were only five more minutes until their flight was due to take off.

Adam washed his face quickly and tried to wipe Alan's hands, which were coated with blood. Worse still, there were several raw patches on his head, where Alan had torn out clumps of his hair. Adam mopped at them with little result. Well, there was nothing more he could do. He lifted Alan onto the wheelchair and was about to push him out the door when he spotted a full hypodermic lying on the floor. He picked it up, deciding it would be useful if Alan had another fit.

As he approached the gate, Adam saw the plane was in the final boarding process.

“Hold it,” he yelled. Two Delta agents eyed him curiously. Then one of them said, “Are you the two who were stranded on the sailboat?”

“That's right,” said Adam, handing over the tickets.

“The agent at the ticket counter said to expect you. We thought that perhaps you'd changed your minds.”

“Heavens, no,” said Adam. “It's just been hard getting my friend motivated.”

The agent looked at Alan, whose head was lolling sideways. “He's not drunk, is he?”

“Hell, no,” said Adam. “He got pretty scraped up when we capsized. They had to give him a painkiller, and it seems to have knocked him out.”

“Oh, I see,” said the agent, handing Adam the boarding cards. “Seats 2A and 2B. Will you need a wheelchair in Atlanta?”

“That would be nice,” said Adam. “Actually, we'll be going on to Washington. Could you make those arrangements for us?”

“Absolutely,” said the agent.

Adam wheeled Alan down the jetway with a sense of relief. The stewardesses were less than enthusiastic when they saw the pair board, but they helped Alan out of the wheelchair and listened politely as Adam ran through his shipwreck story one more time. The plane was only half full, and most of the other passengers were asleep. Adam decided to close his eyes too and slept all the way to Atlanta except for the few minutes when he woke to wolf down breakfast.

Adam dreaded the transfer, thinking that there might be trouble. But a Delta agent had a wheelchair waiting and ticketed them straight through to Washington. The layover was only forty minutes, but it gave Adam a chance to call Jennifer. Luckily, she answered herself.

“Jennifer, everything is going to be all right. I can explain everything.”

“Oh,” she said vaguely.

“Just promise me you won't have the abortion until I get there.”

“The hearing is this morning,” said Jennifer, “and I won't do anything today, but if you're not here by tomorrow . . .” Her voice trailed off.

“Jennifer, I love you. I have to get to the plane now. We're just taking off from Atlanta.”

“Atlanta?” said Jennifer, completely confused. “And who's ‘we'?”

• • •

“Adam?” asked Margaret Weintrob, her nimble fingers coming to an abrupt halt on her typewriter. “Is that you?”

Arm in arm, like drunken buddies, Adam and Alan staggered past the startled secretary's desk.

“Adam!” shouted Mrs. Weintrob, starting to rise. “You can't go in your father's office. He has . . .”

But Adam had already opened the door.

The two well-dressed men sitting across from Dr. Schonberg turned in surprise. Momentarily speechless, Dr. Schonberg sat helplessly as Adam asked the two men to wait outside.

“Adam,” said Dr. Schonberg finally, “what on earth is the meaning of this?”

“Did you take any action on the charges we discussed the last time I was here?” asked Adam.

“No, not yet.”

“I'm not surprised,” said Adam. “You said that you needed more evidence. Well, I've brought all the proof you'll ever want. Come over here and meet Dr. Alan Jackson of the University of California. He has just come from one of the famous Arolen cruises. And made a short stop at the research center in Puerto Rico.”

“Is the man drunk?” asked Dr. Schonberg.

“No,” said Adam. “Drugged and a victim of psychosurgery. Come over here. I'll show you.”

Dr. Schonberg approached Alan cautiously, as if he expected the man to leap suddenly out of his chair.

Adam gently tilted Alan's head so his father could see the small incisions where the electrodes had been implanted.

“They implanted some kind of remote-control
device there,” said Adam, his voice softer and shaded with compassion. “But I got Alan out before they ‘conditioned' him. As soon as his drug wears off, he'll be able to tell you at least some of what happened. And I know he will agree to have the electrodes removed and examined.”

Dr. Schonberg looked up at his son after examining the incisions on the sides of Alan's head. He was silent for a moment and then turned on the intercom and said, “Margaret, I want you to call Bernard Niepold at the Justice Department. Tell him it is urgent that I see him immediately. And call the Bethesda Naval Hospital and tell them to expect a confidential patient under my signature. And I want a twenty-four-hour guard.”

Jennifer was exhausted. Despite all of the childbirth classes she'd attended, she'd not been prepared for the real thing. Giving birth was both better and worse than she'd expected. No amount of reading or hearing about other women's experiences could have readied her for this unique and passionate event.

The pain of labor had been intense yet strangely thrilling, but as the hours had gone by, she had felt progressively drained. She wondered if she would find the strength. Then the pain came more often and for longer periods until finally, from somewhere deep in her being, came a new burst of energy. She felt an irresistible urge, half voluntary, half involuntary, to push and bear down. A crescendo of pressure made her feel she was stretched to her limit, yet still she pushed and held her breath.

Suddenly, there was an almost sensuous release, accompanied by a gush of fluid and the thrilling squeal of a newborn infant exercising its vocal cords for the first time.

Opening her eyes, Jennifer gripped Adam's hand with what little strength she had remaining. Looking up into his face, she could see that his attention was directed down between her outstretched legs. With a terrible feeling of dread, she watched him. No test had been able to dispel the worry she had about the health and well-being of the child within her. Doctors at University Hospital had repeated the amniocentesis and had reported that the baby was normal, but with all that had happened, Jennifer had had trouble believing it.

She watched Adam to see what glimpse of disaster would register on his face. She wanted to know how their child was from him, not from seeing for herself. As she expected, he didn't smile and didn't blink. After what seemed too long a time, he lowered his eyes to meet hers, cradling her head with his hands as he did so. He spoke softly, sensitive to her feelings. First he told her he loved her!

Jennifer's heart seemed to stop. She held her breath, although the physical pain had ceased, and waited for the inevitable, dreaded news. In her heart she had known all along. She shouldn't have listened to anyone, she told herself. She'd had a bad feeling ever since the mixup at the Julian lab, never mind that it had been done on purpose.

Adam wetted his dry lips with the tip of his tongue. “We have a beautiful, healthy boy, Jennifer. Luckily, he looks like you.”

It took a moment for Adam's words to sink in. When she finally comprehended, tears of happiness and thanksgiving welled in her eyes. She tried to speak but couldn't. She swallowed. Then she reached up and pulled Adam down and hugged his head as hard as she could. His laugh gave voice to
the joy and relief in her heart. All she could think to do was thank God.

• • •

Adam collected himself, smoothed out his surgical scrub suit, and stepped from the delivery area into University Hospital's obstetrical waiting room. One glance was enough. It was hard to believe, but the message he'd gotten during the last stages of Jennifer's labor had been correct. Sitting among a group of expectant fathers was his own, Dr. David Schonberg.

Dr. Schonberg met his son as soon as he entered the room.

“Hello, Adam,” he said in his usual cool manner.

“Hello, father,” said Adam.

Dr. Schonberg adjusted his glasses higher on his nose. “What's it like being back in medical school?”

“Just fine,” said Adam. “I'm so glad to be back. I've hardly minded the catch-up work.”

“That's good to hear,” said Dr. Schonberg. “How's Jennifer?”

Adam stared at his father. It was the first time the man had ever called Jennifer by name.

“She's just fine,” answered Adam.

“And what about the baby?”

“The baby's a healthy, beautiful boy,” said Adam.

To Adam's utter astonishment he saw something he'd never seen before: tears in his father's eyes. Before the shock could register, his father's arms were around him, hugging him. Another first. Adam hugged back. Tears formed in Adam's eyes as well, and the two men stood there, holding each other for so long that some of the soon-to-be fathers began to stare.

Finally, a somewhat embarrassed Dr. Schonberg pushed Adam back, but lovingly held onto his arms. Each looked at the other's tears, then both laughed.

“I wasn't crying,” said Dr. Schonberg.

“Neither was I,” said Adam.

“You know what I think?” said Dr. Schonberg.

“What?” asked Adam.

“I think we're both lousy liars.”

“I think I'd have to agree.”

Since I graduated from medical school in 1966, I have heard the term “crisis in medicine” so often that it conjures up the allegory of the shepherd boy who cried wolf too many times. But until now the crises have all been voiced by particular interest groups and were often contradictory: too few hospital beds, too many hospital beds; not enough physicians, too many physicians. It was enough to make anyone confused and apathetic.

But now I have come to believe that “crisis in medicine” is applicable in a truly general sense. Unfortunately, because so many people have cried wolf in the past, the media have only just begun to take note of this very real crisis. What we are witnessing today is the gradual but quickening pace of the intrusion of business into medicine. It must be understood that the corporate mentality of the balance sheet is diametrically opposed to the traditional aspects of altruism that have formed the foundation of the practice of medicine, and this dichotomy augers disaster for the moral and ethical foundations of the profession. Big Business
views the medical field as a high-cash-flow, high-profit, low-risk, and low-capital investment industry that is now particularly ripe for takeover.

Evidence of this shift toward business interests in the medical field is reflected in the newly interlocking ownership of proprietary (for profit) hospitals and nursing home chains, medical suppliers, and a deluge of other health-care organizations like dialysis centers, surgi-centers, etc. Even research has gone in the direction of business as evidenced by the new biotech companies.

Response to this activity has been surprisingly slight, despite the insidious effect it has on the practice of medicine. Professional journals have viewed the process with curious academic disinterest, doctors have either joined the entrepreneurial bandwagon or ignored it, the public has remained silent, and the media have only just begun to run articles sounding the alarm. It is my hope that
Mindbend
will help focus public attention. By couching the problem in an emotional framework, it brings the process into personal perspective and allows the reader to understand the implications of the situation through identification with the main character, which I believe is one of the key values of fiction.

For me, the realization of the intrusion of business into medicine came with a letter I received from a hospital, informing me that its census was low and that I should admit more patients for surgery, as if I had a group of people in the wings who were being denied appropriate operations. That letter, more than any other experience, made me realize that our medical system had inadvertently been constructed to depend upon and reward
overutilization of facilities and services, thereby fostering its own rising costs. No wonder businessmen became interested.

For
Mindbend
I chose the drug industry as the focal point not because it has been any worse than any other group, but because it has been around longer than most businesses associated with medicine and it exerts a powerful and growing influence. The important point is that the drug firms are corporations which do not exist for the public weal, no matter how much they try to convince the public otherwise. Their goal is to provide a return on their investors' capital.

The overriding commercial interest of the drug firms is underlined by the ungodly amount of money (billions of dollars per year) that they spend on promotion of their products, primarily attempting to influence the physician, who unfortunately is rather easy prey. There are very few doctors who have not accepted some gift or service from the drug industry. I still have the black bag given to me as a third-year medical student, and I have attended a number of symposia sponsored by a drug company. The drug industry currently spends more on promotion and advertising each year than it does on research! According to
Pills, Profits, and Politics,
the amount is also more than the total spent on all educational activities conducted by all the medical schools in the United States to train medical students.

It would be unfair to suggest that the pharmaceutical industry has not contributed to society. But this has been the by-product, not the goal. And there have been cases in which the public good has been ignored. One need only to mention the
thalidomide disaster or the DES calamity to recognize that the record is variegated and that commercial interests can have unfortunate consequences. Drug companies have marketed products that they knew might be dangerous or ineffective or both merely to turn a profit.

Medical practice as it has been known in this country for the last thirty years or so is changing. The doctor-patient relationship used to be the fulcrum, but it is losing ground to economic and business interests. The American public has a right and an obligation to know what kind of system is evolving.

For those people interested in pursuing the issue, I recommend the following books:

Ainsworth, T. H., M.D.,
Live or Die
(Macmillan, 1983). Written by a physician who looks at the problem from the vantage point of having been both a practitioner and a hospital medical director, this book is particularly poignant in its appeal for physicians to recognize what is happening to the profession and to reexert their leadership.

Silverman, Milton, et al.,
Pills, Profits, and Politics
(University of California Press, 1974). This book gives an overall view of the pharmaceutical industry, and it makes for interesting reading. I'm confident it will arouse some unexpected emotions. Although it was written over ten years ago, it is still strikingly relevant.

Starr, Paul,
The Social Transformation of American Medicine
(Basic Books, 1982). This book provides an impressive overview of the history of medicine in America and gives one a realistic comprehension of how the current situation has developed.

Wohl, Stanley, M.D.,
The Medical Industrial Complex
(Harmony Books, 1984). This readable, concise book discusses the issues with few embellishments.