Due Diligence (28 page)

Flo pointed the flashlight down the smaller channel. There wasn't much to see, because it curved sharply to the right. She aimed the beam down the main tunnel. There were guardrails on either side.

“Let's try the main path first,” Flo said, and off we went.

Thirty feet down the path there was an opening to the left, in front of which was a sign that stated: “The Throne Room of the Gods.” The room was dominated by a humongous stalagmite that rose twenty feet off the cave floor in roughly the shape of a throne. It was surrounded by other smaller, similarly shaped stalagmites. It didn't take much imagination to envision Zeus and his court seated on the limestone formations.

We kept on the path, and soon came to what the sign announced was the Spaghetti Chamber—an outlandish room that was literally filled with thousands of long, thin, strawlike stalactites that hung from the ceiling and reached almost to the floor. We stayed on the path, which took us past other striking formations, each bearing the name Mordecai Jacobs had given it. There was the Curtain of Creation, Satan's Waterfall, the Bottomless Pit, the Executioner's Playground, and the Aztec Sacrifice Room.

Although several of the stalactites or stalagmites in each room had broken off (or been broken off), the rooms were otherwise in great shape. Out of curiosity, Benny tried to pick up one of the broken stalactites. It was about the size of a baseball bat but, from the strain on his face, obviously much heavier.

“Feels like a sledgehammer,” he grunted as he let it drop.

We also saw living animals—weird, colorless versions of animals on the surface. In the pond in front of Satan's Waterfall were dozens of small, pale fish that appeared to have no eyes. Elsewhere along the route we came across pallid, eyeless salamanders, ghostly millipedes with elongated antennae, and spindly white spiders.

Another fifty feet down the tunnel brought us to the Saber Tooth Cemetery, with the reassembled skeleton arranged in a ferocious attack stance. The placard in front of the skeleton boasted of the importance and sheer volume of mammal bones from the Pleistocene era that had been discovered in that portion of the cave.

“You know what's almost as remarkable as these formations?” Flo said as we returned to the main path and kept walking.

“What?”

“Look at these signs and markers. This cave has been closed for more than thirty years, but these things are in pristine condition.”

“That's not surprising,” Benny said. “There's no wind, no rain, no sun. The climate stays exactly the same all year round. Remember those Stone Age cave paintings in France and Spain? They were still in perfect condition after twelve thousand years. Compared to that, thirty years is barely a heartbeat.”

I pinched Benny in the side. “Thank you, Mr. Wizard.”

“Hey,” he protested, “it's true. That's why a cave is a good place to store documents.”

“Apparently not in this branch,” Flo said as we stopped. She shined the flashlight in front of us. “God.”

We were staring at what had once been the broad stairway entrance down into the cave. The highway construction crews had dumped construction debris, old bricks, excess cement and concrete, and other junk into the cave mouth as landfill before they sealed it off on top with several slabs of cement. The rubble reached to the ceiling and completely filled the passageway. With all the flotsam sticking out at odd angles, it looked almost like a work of modern art.

“Well,” Flo said as we turned to retrace our steps, “that's strike two.”

“Three's a charm,” I said. “Come on, guys. I bet the documents are down that other branch.”

“If
there are documents,” Benny grumbled.

Once again, we retraced our steps. “That beam is getting weak,” I said when we got back to the branch. “Let's change batteries.”

We did it as carefully as we could, getting the new batteries ready in my hand before Flo turned off the flashlight and quickly unscrewed the bottom. Nevertheless, the resulting thirty seconds of fumbling in total darkness as we inserted the new batteries was so eerie that even after the flashlight beam returned, it took a few moments before my heartbeat returned to normal.

“I definitely did not enjoy that,” I said, my voice still shaky.

“Me, neither,” Flo said. “How do these animals live down here?”

“Be careful with that flashlight,” I said. “I wish we'd brought a backup.”

“Let's just find the fucking documents,” Benny said, “and get the hell out of here.”

We started down the narrow passageway that curved sharply to the right. Once we got around the bend the cave began to widen a bit and curved to the left. We followed the curve. As we came around the corner, the walls opened onto a large chamber. Flo swept the flashlight beam back and forth.

At first I thought we were looking at a dramatic stalagmite formation that consisted of several dozen large, brown, flat-topped columns, each about six feet tall, lining the sides of the chamber. But then Flo held the beam steady on one of the columns.

“All right!” Benny hollered.

They were boxes. Columns of boxes, neatly stacked six high, each stack sitting on its own wooden pallet. There were at least thirty stacks, arranged in groups of two or three columns each along the walls.

We ran toward the first stack of boxes. Flo shined the light on the top box. There was a neatly typed label taped to the side of the box:

JACOBS CADILLAC—SALES RECORDS: 1/1/64-12/31/64

The label on the box below it read:

JACOBS CADILLAC—SALES RECORDS: 1/1/63—12/31/63

Below that were boxes for 1962, 1961, 1960, and 1959. There were two more stacks of boxes grouped together with the first one. According to the labels, they contained more financial records from Jacobs Cadillac.

The next two stacks of boxes contained the records of his dry cleaning business in Belleville, Illinois. Then there were three stacks of boxes of records from his tarpaulin manufacturing company down in Crystal City. We kept moving from stack to stack, checking the labels on each box. The first group of three stacks of boxes on the back wall contained documents on his warehouse operations.

And then we came to two stacks of five boxes each. Flo shined the light on the top box of the first stack. The label read:

BETH SHALOM—1972 TO 1984—DECEASED
MEDICAL FILES: ABRAMAWITZ TO BRAUNSTEIN

“At last,” I said, exultant.

“What's the significance of the dates?” Benny asked.

“Jacobs bought it in 1972,” I explained, “and he merged it into the Jewish Center for the Aged in 1984. The medical files of the living residents would have been transferred to the Jewish Center for the Aged. The rest would have stayed.”

The label on the box below it read:

BETH SHALOM—1972 TO 1984—DECEASED
MEDICAL FILES: CHOSID TO EISENBERG

And the box below that:

BETH SHALOM—1972 TO 1984—DECEASED
MEDICAL FILES: EMMERT TO GILDEN

I turned to Flo with a big smile. “We found them.”

Benny reached up and grabbed hold of the top box. With a grunt, he lifted it off the pile and set it on the ground. Straightening up, he said, “Ladies, let's get busy.”

Chapter Thirty

Once again, the starting point was Ruth Abrams.

We found her medical file in the first box of documents. Her papers were in a brown loose-leaf notebook that had ring binders at the top, so that it opened from the bottom up instead of from the side. The cover had the patient's name and, in Ruth's case, stated that she was allergic to penicillin. As Flo held the flashlight steady, I paged slowly through Ruth's file.

The first page, entitled ADMISSION AND DISCHARGE RECORD, contained the basic biographical information: Husband deceased. Two adult daughters, both married, one living in Los Angeles, the other in New Canaan, Connecticut. One sister, Rose, unmarried, alive when Ruth entered Beth Shalom on March 4, 1969, died July 29, 1972.

The medical portion of Ruth's file began with a routine exam two days after she entered Beth Shalom. During the next three years at Beth Shalom, Ruth saw a physician roughly once a month. Based on the signatures on her charts, four different physicians saw her during that period. During those years she had what seemed like typical complaints for an elderly patient: arthritis, occasional constipation, indigestion.

Beginning in 1973, the frequency of her physician visits increased to the second and fourth Wednesday of each month. Most of her symptoms remained constant, although she was having more and more problems with arthritis. During this period she saw two different physicians: John Montaldo and Harry Silber.

But on Wednesday, January 16, 1974, two noteworthy changes took place in Ruth's file. First, she began seeing a physician once a week. Second, she began seeing a new physician. His name was Douglas Armstrong. I flipped through her medical records for the remaining eight months of her life. Throughout that period, the only physician whose name appeared on her file was Douglas Armstrong.

I looked back at Benny, who was peering at the records over my shoulder, and then over at Flo.

Flo nodded grimly. “Go back to her first visit with Armstrong,” she said.

I turned back to January 16, 1974. As had her prior physicians, Armstrong used the same format for taking notes of patient visits. His notes of the January 16 visit were as follows:

Problem 1: Indigestion

S—“stomach ache,” “heartburn,” Pt. complains of “gas”

O—BP: 160/90, P: 73; Abd: soft, nondistended, no organomegaly

A—Dyspepsia

P—Maalox PRN; Upper GI X-ray if no response

“Do you understand what this S-O-A-P format is?” I asked Flo.

She nodded. “It's the standard format used by physicians. The ‘S' stands for ‘subjective.' That's where the doctor records the patient's description of her symptoms. The ‘O' is for objective.' Here”—she pointed to the chart—“is where he recorded her blood pressure and pulse and the results of his examination of her belly. Those are the objective descriptions of her symptoms and condition. The ‘A' is for ‘assessment.' That's where he sets down his diagnosis of the problem. Finally, the ‘P' is where he records his plan for dealing with the problem. So for this one,” she said, pointing at the “A” and “P” entries, “his assessment was that she had dyspepsia, and his plan of action was for her to start taking Maalox.”

I skimmed through the rest of the notes for that first visit on January 16, 1974. In addition to indigestion, Ruth Abrams complained of constipation, and arthritis. Armstrong seemed to pay the most attention to her third complaint:

Problem 3: Arthritis

S—“right knee is swollen,” “can't get my ring off,” “having trouble with buttons,” “difficulty getting out of bed,” “sore and stiff” in morning

O—Rt knee: decreased range of motion, effusion present—general swelling and heat Lt wrist: pain with movement Rt and Lt PIP joints—rheumatoid deformities, pain with motion, decreased range of motion Neuro: reflexes 2/2 thru out-sensation normal

A—Rheumatoid Arthritis—severe, appears to have accelerated

P—Start Rx treatment

“Poor gal,” Flo said. “She had it bad.”

“What's the ‘Rx treatment' mean?” Benny asked.

“It means some medication,” Flo said, “but it doesn't say which one.”

Slowly, I paged through Ruth's medical records while Flo and Benny looked on. Although there were occasional notations by one of the nurses on other days of the week, every Wednesday we found the S-O-A-P notes in Douglas Armstrong's increasingly familiar handwriting. From January through May of 1974, Ruth Abrams' constipation and dyspepsia seemed to fluctuate in random fashion—better some weeks, worse others. During April she developed insomnia, which Armstrong successfully treated with Valium; by early May, her sleeping problems were gone.

But the rheumatoid arthritis—Ruth Abrams' most painful and seemingly intractable medical problem—began to dramatically improve in the middle of February. By the third week in March, her arthritis S-O-A-P notes read:

S—less pain—“feel great,” swelling gone, “can play piano,” “can get dressed by myself,” Pt. able to walk without pain, “can fit my wedding ring back on my hand”

O—Improved range of motion—decreased swelling; no effusion and decreased crepitus

A—Rheumatoid Arthritis—marked improvement

P—Continue same Rx treatment

“Amazing,” Benny said.

Flo nodded. “Her symptoms have practically disappeared.”

By the end of March, they had completely disappeared. Under “A,” Armstrong had written
“Rheumatoid Arthritis
—
complete remission
.” From that point forward, there was no further mention of her arthritis.

During June and July of 1974, Armstrong focused his efforts on Ruth's mild constipation and dyspepsia, neither of which seemed of much concern to either the patient or her doctor. Nevertheless, Armstrong continued to see her every Wednesday. Perhaps that was just standard practice with a patient her age.

The first sign of trouble came on Wednesday, August 14, 1974. Armstrong's S-O-A-P notes for that day focused on a new concern:

S—“feel weak,” “hard to brush hair,” “dropping spoon,” “tingling or numb in hands and feet,” “tripping—foot dropping,” “vision blurred.”

O—Tachycardiac; Neuro: reflexes weaker, right Babinski reflex decreased sensation to pin prick and light touch; strength: distal 4/5, proximal 5/5

A—Weakness—possible peripheral neuropathy

P—Check Vitamin B-12 Level

“What's happening to her?” Benny asked Flo.

Flo studied the notes. “I don't know. He doesn't either.”

I pointed to one entry. “What's the Babinski reflex?”

“It's a simple test,” she explained. “The doctor scratches the bottom of your foot. The normal response for an adult is to curl your big toe down. A Babinski response means her toe went up instead of down.”

“Which means?” Benny asked.

Flo shook her head. “Not good. Back at my old firm we once had a malpractice case that involved an abnormal response. It's a sign of potentially significant change in the patient's nervous system.”

I flipped to the next visit, which was on Wednesday, August 21. The S-O-A-P notes showed a deteriorating condition:

S– “hard to get out of bed,” “can't lift head up,” “can't move legs,” “short of breath,” “coughing.”

O– Neuro: Reflexes 0/2;
â
sens. to pin and light touch. Strength: distal 3/5, proximal 4/5

A—Ascending paralysis and numbness, peripheral neuropathy getting worse, markedly affecting strength

P—Observe closely—transfer to hospital if conditions worsen—Is this Guillain-Barré? Is this lead poisoning?

Two days later, Ruth Abrams died.

I closed her binder with a puzzled look.

“There's that goddamn Guillain-Barré again,” Benny said.

“What do you think?” I asked Flo.

She shrugged. “Let's look at the other files.”

Forty-five minutes later, we had two piles of medical records: one for all the Beth Shalom residents who were listed under the P/S column and one for all the residents listed under the P/A column. Although we had reviewed the files fairly quickly—we were starting to get concerned about our battery supply—we found definite patterns:

All twenty-four patients on the Beth Shalom list were women, and all suffered from severe rheumatoid arthritis.

On Wednesday, January 16, 1974, all twenty-four got a new physician: Douglas Armstrong. From that point forward, he saw each of them every Wednesday.

All twelve women under the P/A column began showing dramatic improvement in their rheumatoid arthritis by the end of February, and all were apparently cured by the end of March.

All twelve women under the P/S column showed more gradual improvement in their rheumatoid arthritis by the middle of March. Although the symptoms never disappeared completely, by June of 1974 all twelve under the P/S column were experiencing much greater range of movement and much less swelling.

Ten of the twelve women under the P/A column (including Ruth Abrams) rapidly developed symptoms of Guillain-Barré syndrome during August of 1974. Eight died. Two were hospitalized and recovered.

None of the twelve women under the P/S column developed any symptoms of Guillain-Barré or other form of peripheral neuropathy.

Although Douglas Armstrong continued to see the two surviving P/A women and the twelve P/S women through the end of the year, by October all fourteen of the women had begun to suffer again from increasingly severe symptoms of rheumatoid arthritis.

“Summarize, please,” Benny said when we were through.

“Well,” I started, “if we're right about those abbreviations—the P/S and the P/A—then the first column of women were secretly given Phrenom and the second column were secretly given Primax. The first group did okay—the drug helped alleviate the symptoms. The second group did terrific, until a horrible side effect killed almost all of them. Assuming that Armstrong's associate, Peter Todorovich, was doing the same thing during the same time frame at Labadie Gardens, the same pattern must have held. Remember, six of the twelve women in the P/A column at Labadie Gardens died during the same period, while none in the other column died.”

Flo frowned as she mulled it over.

“What?” I asked.

“There must be more in those files.”

“What do you mean?”

“How was he keeping track of which woman got which drug?”

“With that list,” I said.

“Maybe,” she said skeptically, “but he didn't have it typed before his first day there. Moreover, what if he forgot the list one day? Or what if he didn't want to refer to it? Don't forget, if we're right, the man was conducting illegal drug tests on unsuspecting human subjects. He would have more than enough concerns without having to worry about pausing at each patient's bed to pull out his cheat sheet, especially with the risk that a nurse might walk in on him.”

I reached for the Ruth Abrams binder. “But where?” I said, opening the binder. “He kept it totally opaque in his physician notes. Look at this entry. ‘Continue same Rx treatment.' That's what it says in every one of those files.” I lifted the page to the next set of Armstrong notes and pointed to the entry. “See?” I lifted that page to reveal the next set of Armstrong notes. “Same again.”

Flo held the beam steady on the page of notes. Then she squinted and leaned forward. “What the hell?”

“What?”

“Look.” She had moved the beam up slightly, so that it was shining on the back side of the page of notes from the preceding Wednesday's examination. In the upper right corner were pencil jottings in Douglas Armstrong's handwriting. I leaned close to the page to read them:

Primax 25 mg IM

“Oh, shit,” Flo said.

“What?” Benny asked.

“We've got him,” she said.

“What does ‘IM' mean?” I asked.

She turned to me. “Intramuscular. It's medical jargon for a shot. This is his note. It means he gave that woman an injection of twenty-five milligrams of Primax. Holy shit, Rachel.” Flo raised her eyebrows. “We finally nailed the son of a bitch. Check the next page.”

The same note was jotted in pencil on the back of that page:
Primax
25
mg IM
. And on the page after that. And the page after that. By March, he was using the abbreviation “Pri,” and by June he was using the abbreviation for the generic drug that appeared on the Beth Shalom/Labadie Gardens list, “P/A.”

We quickly checked a sampling of other medical files. The pattern remained constant. The files for the patients receiving injections of Primax had the same back-of-the-page notations as Ruth Abrams' file. The ones receiving Phrenom had a similar notation, except that the entry started as “Phrenom” and by March became “Phre” and eventually became “P/S.”

Two of the files contained additional corroboration. The nurse notations actually made reference to the injections. On April 29, 1974, Anna Mittelman told the nurse that Dr. Armstrong was giving her “magic shots from the fountain of youth.” The nurse's comment: “Pt. seems disoriented.” Four months later, Anna Mittelman was dead. According to her death certificate, the immediate cause of death was “respiratory failure,” and the underlying cause was “acute ascending peripheral neuropathy.”

The other patient was Freida Perlmutter, one of the Phrenom recipients. On November 4, 1974, she complained to the nurse of the recurrence of her arthritis symptoms: “Pt. claimed that R.A. symptoms returned after Dr. stopped weekly shots.” The nurse's comment: “File shows no IM treatment. Pt. must be confused over recent flu vaccinations.”

“He must have carried them in his doctor's bag,” Flo said.

“Carried what?” Benny asked.

“The shots. He'd visit the patient in her room, do the examination, and then give her a shot before he left.” Flo shined the flashlight on her wristwatch. “Let's get out of here.”