No Cure for Murder (10 page)

Jacob bit his lower lip. His eyes filled. “Don’t dare tell me I don’t appreciate modern therapeutics. Do you think I’ll ever forget standing helpless at the bedside of child after child dying with acute lymphocytic leukemia? Today, 85 percent plus, survive.

“I remember when you came to Brier, Warren, and the many problems that came with each highly touted drug. I know our intentions were honorable, but then I remember George Bernard Shaw: ‘The way to hell is paved with good intentions.’”

Jacob paused, and then continued, “The original therapeutic nihilists were early 19th-century French clinicians who decided that the therapies available then were worse than useless. Since their treatments included bleeding, purging, puking, and the use of toxic substances such as arsenic and mercury; they’re surely looking good now.”

“How can you equate what we do now with those outmoded practices?” asked Arnie Roth.

“Practices are deemed outmoded only in retrospect, Arnie. Just like us, they thought they were practicing medicine at the highest level.”

“Times have changed,” said Warren.

“You think so. Let me cite just a few statistics: Pharmaceutical drugs kill more people than die in traffic accidents each year in the United States. Studies in the late 90s show that more than two million hospitalized Americans suffered an adverse drug reaction in the study year and over one hundred thousand died as the result. That didn’t include one hundred thousand deaths from overdosage and errors in administration.”

“We know the horror stories, Jacob,” said Warren. “That’s why we have QA and pharmacy review committees.”

Jacob scanned the room. “Let me give you one more statistic, and then I’ll shut up. Public health researchers have concluded that adverse drug reactions are now the fourth leading cause of death in the United States after heart disease, cancer, and stroke.”

Jack looked around the silent room and smiled. “Therapeutic nihilists, line up on the right.”

Jacob stood beside his patient while the nurse brought in a syringe filled with clear fluid and prepared to inject it intravenously. “What’s that?”

This was another minor modification of his orders by Zoe of late. He also noted that on several occasions, Zoe wrote orders for diagnostic tests that he’d already written.

“I don’t mind if you change my orders, Zoe, especially if I make a mistake or if our patients will benefit, that is if you have good reason.”

Zoe paled. “I’m so sorry, Jacob. I was just trying too hard to help, and…” she hesitated, “to prove myself to you. Please forgive me.”

“You don’t have to prove anything to me, Zoe. You’re a great doc and I expect to benefit from your recent training. Maybe I’m getting too sensitive in my old age or perhaps I’ve practiced alone too long.”

“God no, Jacob. You’re the best. I’ll do better. I promise.”

Chapter Sixteen

Ahmad Kadir came from Nablus on the West Bank. His father Habib taught history and his mother Jasmine was a bank officer.

The family had originally lived in Gaza where Ahmad Kadir’s father thought his son had avoided the infectious militancy of the Palestinian youth that spread over the Gaza community in the years before its overt expression in the intifada.

Ahmad confronted his father. “How can you work with them? They’re killing us. It’s every Palestinian’s obligation to wage war to the death against the Zionists.”

“It saddens me to think that after all I’ve taught you that you choose to absorb the shallow, destructive beliefs of the ignorant jihadists. You’re a Christian, not a Muslim. How do you think they feel about you?”

Ahmad’s face turned red. He stared at his feet, and in the tradition of this patriarchal culture, said nothing.

“The struggle against aggressive Zionism is legitimate, but our means are worlds apart.”

In the months to come, Habib resigned his position at Al-Athar University and moved his family to Nablus where he accepted a new position at Al Najah University. He had few illusions about his son and his beliefs or Ahmad’s frequent unexplained absences, as militancy abided no geographic limits in the occupied territories.

After medical school at Yale, Ahmad planned to return to the Middle East to complete his training, but the ongoing intifada made him decide to remain in the states. The Kadir family was among the 1.6 percent of Palestinians who were Christians and suffered as Arabs in the west and as Christians among the Islamists. The entire family eventually fled to the U.S.

Ahmad noted the discomfort among his classmates to his Arabic appearance, but this became insignificant compared to the reaction to him after 9/11.

Ahmad sat with his roommate, Jerry Towns. “It’s getting impossible. Some people cross to the other side of the street when they see me coming. They stare at me in public places like I’m carrying a bomb.”

“Be smart, Ahmad, don’t say Jews, say Israelis. You can get into this with your close friends, but otherwise, I’d keep my mouth shut.”

When an opportunity in the internal medicine program at UC San Francisco arose, Ahmad decided to move to the more tolerant bay area. Once in the program, Ahmad became fascinated with the excitement of intensive care. He was fortunate to discover an opening in their intensivist program.

Marion Krupp knocked on her nursing care coordinator’s door.

“Come in,” said Gail Sergeant. “Marion, what can I...”

“I demand an answer to my complaint against Weizman,” she interrupted.

“If you think rude behavior will get you anywhere with me, Marion, you’re nuts. If you can’t be civil, then get the hell out of my office.”

“I talked with Arnie Roth, the chairman of the QA committee. They discussed your complaints and dismissed them. Physicians remain responsible for prescribing medication and most health professionals don’t deny the risk in sedating an elderly hospitalized patient. Absent some adverse effect from prescribing or not prescribing medication, they’ll always come down on the side of the doctor’s autonomy.”

“Weizman...look at the old guy. He doesn’t know what he’s doing half the time. They’re allowing him to practice at Brier...ridiculous.”

Gail stared at Marion and saw the glassy-eyed stare of the true believer. “I don’t know where all that’s coming from, Marion. Jacob may be old, but his mind is twice as quick as yours and mine put together. He has his own way of doing things, but if I or anyone in my family was sick, Jacob Weizman is near the top of my list for a physician.”

“I think your friendship with Weizman is blinding you.”

“Your position at Brier is already tenuous, Marion. Nobody wants to work with you. I’ve had several patient complaints. You may be a good nurse, but you’re so disruptive that I may have to let you go.”

Marion rose, sneering at Gail. “Should I call my union rep?”

Gail reddened. “Your union rep? Do as you damn well please. Now get out.”

Chapter Seventeen

Ginny Harrison was just about to enter the medication room on the fifth floor medical ward when Thomas Wells closed the door behind him. “Tommy, what are you doing in there?”

“Oh, hi, Ginny,” he replied, eyes narrowing, “I just needed some alcohol wipes for my tray. I need to draw Mrs. Cohen in 512.”

“The supply cart in the utility room has a ton of wipes, Tommy. You shouldn’t be in here.”

Tommy reddened. “No big deal. Check the medication cabinet. It’s still locked. I didn’t take anything, and I resent your implication.”

“I’m not implying anything, Tommy. The medication room is off limits to anyone but physicians and nurses. You know that.”

“I’m sorry. It was just more convenient. I won’t do it again...all right?”

“I’m sorry too, Tommy. Nursing administration is paranoid about medication theft at Brier. I have a stack of memos to prove it. Let’s just forget about it.”

“Thanks Ginny. I’m not looking for trouble. It won’t happen again.”

As Tommy turned to walk away, he reached into his pocket, felt the key to the medication cabinet, and smiled.

When Ginny entered the room, she scanned its contents and checked the doors on the medication cabinet. They were all locked. If anything’s missing, Ginny thought, it would show up in the medication count done at the beginning of each shift.

Sarah Hughes and her most recent boyfriend, Kevin Meeks, were parked in his family’s Land Cruiser on Grizzly Peak in the Berkeley Hills. They were so busy groping each other they didn’t notice the car, headlights off, approaching from the rear.

The rapping of something hard against the steam-covered driver’s seat window brought them back to reality. “Open up. Berkeley Police.”

When the phone rang at 11:30 that night, Marilyn Hughes picked up the handset at once. Sarah had again defied curfew. “Mrs. Hughes? This is Sergeant Peterson, Berkeley P.D. We have your daughter Sarah under arrest for an open container violation and possession of marijuana.”

After they bailed her out the next morning, their sullen and angry daughter sat in silence, arms crossed, in the back seat as they drove home.

“Don’t say anything,” Sarah suddenly shouted. “This is bullshit. We weren’t doing anything wrong.”

“Good,” said Robert, “Then you can handle this yourself.”

The Robert Hughes hired an attorney and he got the court to agree to refer Sarah to the Berkeley Woman’s Mental Health Clinic for evaluation and treatment in lieu of prosecution.

On their way out of court, Robert turned to his daughter. “Please, Sarah, try to do something constructive with this opportunity.”

“Some great opportunity. I don’t know how much more of this crap I can take.”

Chapter Eighteen

Lola sat with Jacob at breakfast. “What’s happening to Joshua Friedman?”

Jacob stared through their west-facing window. Dark clouds drifted toward the city, covering the Marin highlands, and blanketing San Francisco Bay. He shook his head. “His family couldn’t handle him at home. He’s back at Brier.”

Josh Friedman was one of Jacob’s first patients. They had grown old together.

When they first met, Josh worked as a park ranger. He lived in Berkeley, but spent weeks at a time in the Sierras. He’d been a vigorous, athletic man who stood six feet four inches and weighed a solid two hundred forty pounds.

He retired as regional director and lectured locally at all levels from elementary school to the university. Eighteen months ago, he came to see Jacob complaining of trouble swallowing. He pointed to the lower edge of his breastbone. “Whatever I eat stops here.”