Internal Medicine: A Doctor's Stories (29 page)

“As I looked over the sheet of notes I had scribbled while learning so very little, it occurred to me that I might already know all I needed to get Schott bounced out of the state. He had said the project involved leukemia. Ewing’s, even though it arises from an anatomically related structure, has nothing to do with the leukemias: in dragging poor Robert into his laboratory, Schott was treating something he had no license to treat, even under the lax provisions governing cancer chemotherapy then as now. In signing on to a specific research protocol, he had tied his own hands. And now, I hoped, I could use the same rope to hang him.

“I had no idea how to go about this. All I knew was that I had to get Schott out of this hospital before he killed somebody else. Because I had also learned in the course of my inquiries that in the six months since our encounter in the parking lot Schott had been involved in six more cases in which the patients, ranging in age from thirty-four months to fifteen years, had died, either from the diseases he was putatively treating, or the chemicals used in his experiments. That brought the total since his arrival to (at least) fourteen.

“The mortuary tally grew by a pathetic one the following week, when Robert, under the influence of what Schott had described to the father as ‘one more cocktail,’ had vomited without interruption for seventy-two hours through massive doses of prochlorperazine and phenobarbital, until a Boerhaave lesion ruptured his esophagus. It took him several hours after that to die. Two of the nurses on the case had gone on medical leave.

“When I heard this news I actually saw red. I’ve never experienced the sensation before or since, and at this distance it’s a little astonishing to me, but it’s true. As I hung up the phone my field of vision vanished in a scarlet haze. It was as if my eyes had filled with blood. Before my vision had cleared I set out in search of Schott, even though I knew it was a bad idea.

“I found him in his office on the second floor. The door hit the wall as I came through with a bang that startled me, and cracked the frosted glass. That crack was still there several years later, although by then there was a different name painted on the glass.

“He looked up, far less surprised to find me there than I was. Now what? I remember asking myself, but by then my capacity for rational reflection was severely impaired. I was seriously worried that I was going to commit an assault, which would get me into much hotter water than I had planned for him. That restrained me, enough at least to restrict my activities to waving my arms in the air.

“I accused him of a variety of things. Murder. Fraud. Violation of the Hippocratic oath got in there somewhere, and it was a measure of how serious things had gotten that neither one of us found it funny. But no matter what I flung at him, he seemed untouched by it. Not that he looked pleased with himself. He looked miserable, in fact, but not because of anything I had said. He had been that way when I arrived.

“My inability to touch him with any of my own outrage made me even wilder, so wild that eventually I couldn’t say anything. I could only stand there, vibrating with suppressed violence, frustrated by my inability to change the self-pitying expression in those watery eyes.

“At last I dredged up the only thing I could think of that might get underneath whatever he was excoriating himself with: ‘Have you ever helped
anybody
?’ I screamed at him. I thought then, and still do, that the worst assessment a doctor could make at the end of his life would be that he had never helped anybody. I wanted to give him that at least.

“By luck, or through some instinctive understanding, I had found a lever. It left his face working visibly as whatever worm I had wakened twisted within him.

“He looked at me, recoiling as though I had offered to strike him, and lifted up a wavering hand to ward the blow. And he said again what he had said in the parking lot half a year before, only this time his tone wasn’t wistful. It was beseeching. He said in a half whisper, and clearly not addressed to me, “There was one.” And then his face fell apart and for a moment I mistook the expression for imminent tears, and recoiled in disgust. But it wasn’t tears.

“ ‘Tortured’ was what it was. I had never seen it before, for all the agony I had witnessed in my brief career, but I knew it when I saw it. And as that word occurred to me something else flashed through the haze still dimming my vision, cracking it into an appalling clarity. I knew what I was looking at.

“ ‘My God,’ I remember saying. ‘It’s the Grand Inquisitor.’ All of a sudden I was thinking about Dostoyevsky. I’d never been able to make head or tail of that part of the book, but the question that introduces it had always stuck in my mind. It goes something like this: If you could usher in the Millenium—end all human suffering, forever and ever—if you could do that, but only by torturing to death a human infant, would you do it?
Could
you do it?

“I didn’t understand, when I read it the first time, if there was any point to the question: it just seemed another of Dostoyevsky’s grotesque Christian paradoxes. But that was before I met Schott, before I came face-to-face with someone who had also heard the question—and answered it.

“He actually rose to his feet when I said this: rose, and staggered back into the wall. I knew he understood exactly what I meant, and that he understood it because he had already had the same thought. He had made a bargain with the devil. And now had come the only thing that could make that bargain worse: he had been caught with the contract in his grasp, the ink still fresh, steaming where it stained his hands with a child’s indelible blood.

“I stayed long enough to register my triumph. I had nailed him indeed. I knew what he was, and he knew. And oddly, at that moment, that was enough for me. Far too much, as it turned out. I stayed just long enough to register the deed, and then I turned and fled that room as though the devil was after me as well.

“Two weeks later, they found Schott’s body hanging from the rafters in his attic. He had been there, the coroner estimated, about two weeks: in that weather it was hard to know, but it had been that long since anyone had seen him, and the physical findings were not inconsistent with the interval.”

T
HERE WAS A RUMBLE
from the darkness behind the couch. We all turned to look as the head and shoulders of Clark, radiology, heaved themselves into view. His shock of white hair and frozen, chiseled features gave him a spectral quality.

“Cripes, Hawley,” he said.

Hawley turned his gaze in that direction. His eyes were open, but the flatness of his expression made you feel he wasn’t looking through them.

“Yes?” he said mildly.

“When did you say all this happened?”

A long pause. It was like waiting for some antique clockwork to perform.

“Sixty-two.” He said at last. “Does it matter?”

“Yes, it matters.” Clark straightened impressively. The two disheveled surgeons slumped on the couch goggled up at him. “It matters because it’s all a load of crap,” he said. “I came here in ’64. Are you trying to tell me somebody
hanged
himself two years before that, and this is the first I’ve heard of it?”

He raked the rest of us with a glare that suggested we were gullible fools.

“You’re filling these children’s heads with lies, Hawley. None of this—” He waved a large hand in our direction. “None of this is true.”

He settled back into his dark trench, muttering something we couldn’t catch before falling silent.

In the stillness that followed, we all turned to look at Hawley. That bland, moonlike face beamed at us undisturbed.

“For a man who spends his days reading shadows, he’s awfully definite. Don’t you think?” He twinkled at us then, and I had a brief, queasy insight into why his patients were so taken with him. “What does truth have to do with it?” he said, quietly, more to himself than us. “Of course it isn’t
true.
It’s lies, all of it. It never really happened. I never said it did.” He shook himself then, settled back in his chair, and as he sank back into his Buddha-trance we saw to our horror that he was about to start up again.

“N
O ONE KNEW WHAT
to make of it at first. Oh, I thought I knew—was afraid I knew. When I heard he left a note, I was afraid I might have figured in it somehow. I shouldn’t have worried. The note was in German: it took the medical examiner a while to find someone who could translate it. All it said was,
I pay my debt
. And from there the whole mystery started to unravel.

“In the desk was more. A box in the lower drawer held a small collection of personal effects, the only items in the entire ill-furnished house that shed any light on the man who had maintained an existence there. There were letters, and photographs, and a few legal documents, enough to piece together a history, although as far as I know no one ever did much to substantiate it.

“There had been a wife, and a child, and it seemed both were still living back in Göttingen, although there had been no communication since Schott’s coming to the States five years earlier—at which time, apparently, there had been some irrevocable rupture. There had been previous training in oncology, that much was clear from academic certificates found filed elsewhere, but there had been difficulties with licensure; it had probably been necessary to begin all over again in America.

“But the story of Schott’s queer mission had its beginnings before then. There
had
been one. And as I gazed at the photograph, blurry, sunstruck, of a slight child squinting at the camera, the bald head just beginning to grow the strange fuzz of the survivor, and then at the series of later images, these much clearer, of that child grown taller, straighter, far more substantial, his head sprouting an unruly mop of otherwise ordinary hair, and of the woman hovering at his side in a half crouch of perpetual protection, I knew that I was looking at the one. His own child, who had somehow, miraculously, survived.

“Had he treated his own son? Was this how it began? And how long had it taken him, how many treatment failures followed that one impossible cure, before he had realized that he was doomed? He was doomed to go on no matter how high the numbers mounted, as doomed as the innocent victims he must torture if he was ever to pay his debt.

“How it had become a debt I thought I could understand. We are not supposed to use our gifts that way: not for ourselves. There was something illicit about it, and that first, miraculous success could only have confirmed, perversely, its essential wrongness. The only way to right the balance was to find someone for whom the cure might be an act of grace freely given, and not of selfish need. His only hope was that someday, somehow, it might all come right. Then all those victims would have died for a good reason. I could understand his thinking at least that much. Which is something else I would rather not ponder too deeply. There’s enough about this case that gives me bad nights even now.”

H
AWLEY’S VOICE, WHICH HAD
been sinking for the past hour into a half-audible whisper, finally wound down. The room was sunk in silence even thicker than the gloom. From the corner Benson’s soft snores were the only sound. Everyone else, I realized, was still awake.

Hawley sat quietly for a minute, poised and introspective, before he sprang into motion with an odd abruptness, like some kind of clockwork figure whose hour had rung. He reached down and plucked an antique pager from his belt, peered at it with a puzzled expression, held it to one ear, and shook it as if it were his pocket watch and it had stopped. He stood, took a general inspection of the room, and said with a deliberate sort of inconsequentiality, “I should start my rounds. There’s probably something going on.”

I looked at my watch. It wasn’t yet four. What rounds? I wondered. Nobody rounds at four.

Hawley took one more glance at Benson sleeping in the corner. “Somebody should wake him up,” he said as he sidled toward the door. I didn’t know then that this was the last time I would see him.

As soon as the door closed behind him, Benson rolled over.

“The old fraud,” he said. He revealed the phone clutched in his hand. “I’ve been paging him for the last half hour. To his own PICU, no less. ‘Start my rounds.’ The old fool would rather bore us to death than see a patient.”

There was a general muttering of irritable agreement, cut off when with a rush of air and activity the door was flung open. It was Jawanda from the ER, looking harried and annoyed.

“What’s wrong with you idiots?” he demanded. “The paging system’s been down for two hours. The whole hospital’s been on PA paging but one of you geniuses turned it off in here, didn’t you? Benson? It was you, wasn’t it?”

Benson did what I never saw him do before or since, which was blush, and slouched quickly toward the door. Jawanda scowled over the anesthesiologist’s scuttling form. “And the rest of you have three dozen patients piled up in my ER waiting to be admitted.” He raked us all with vivid scorn before flinging the door shut behind him. In his wake, the lot of us sat befuddled, staring at our pagers as though they might tell us something useful, but we saw nothing that their unnaturally prolonged silence shouldn’t have told us long ago.

It was close to noon before I finished my admissions. And by the time I made my way out into the world, where the ice-shattered sunlight struck me blind, I had almost forgotten everything before then.

It was only two weeks later, when the news came of Hawley’s death—he had been found slumped over a chart at the Peds nursing station, a massive MI that he must have recognized, because there was an empty bottle of nitro found in one hand—that I remembered his implausible story of Schott and how he had paid his debt. At the time, I remembered it, as I imagine the rest of us did, as one last hurrah in a career memorable for little more than eccentricity. But that story, and the odd coincidence of its teller’s death two weeks later, the same interval that had elapsed while Schott’s body swung unnoticed in his attic, kept returning to me. It seemed to say something about how Hawley had come to be there, scribbling one of his inscrutable progress notes at two in the morning, on a night when he was not on call. There was something in Hawley’s career, in its old-school devotion to service, that seemed to have about it its own element of expiation. Was there some debt he had tried to repay? I believe so, although of course by then it was too late to learn what it was, or if he had managed to settle it.