Apr/May 2004  •   Fiction

The Hit Doctor

by Thomas J. Hubschman

Art by Janet L. Snell

Art by Janet L. Snell

The truth is, I never pretended to be other than what I was. If people made me into something more, whose fault was that? Power is the perception of power. That's as true in my own profession as it is in yours. I did nothing different from what my blameless colleagues were doing every day at countless bedsides all around the world. Only, I did it consciously and, of course, for even larger sums of money than I could ordinarily expected to have received.

It is not true, by the way, what you said in court about my "soon learning the heinous nature of [my] crimes while in the state of social deprivation which society reserves for malefactors" such as myself (Wherever did you come by such a baroque way of expressing yourself?). If your point was prison would give me ample time to realize what I did was morally wrong, I think you'll find you were mistaken. For one thing, the physical milieu here is not all that uncongenial. And if you had in mind the kind of bullying and worse men like myself can expect to find in places like this, you may be interested to learn I am actually held in considerable respect and am consulted professionally by the inmates on a regular basis. Only the lawyer on the tier above my own is in greater demand. One untoward remark toward my person from anyone, inmate or guard, and the rest of the population comes down on him like a brick wall. So much for your fantasy of my brutalization.

But I am not writing to kick dirt in your face. I don't hold you personally responsible for my present state. You were simply performing your job, just as I performed mine for all those years before I realized by doing intentionally what I had been doing for three decades inadvertently, I could make a mark for myself in the annals of medicine. I like to think of my so-called crimes as being not very different from what members of your own profession agree to when they take on the defense of a vicious rapist or serial killer.

What made my conviction inevitable, I see now, was not my guilt (and I don't deny responsibility for my actions) but the prospect which gradually emerged during the course of the trial that what I did was no different in kind from what every other member of my profession does every time someone walks into his or her examining room. True, I took the process further, "abused" my powers, as the prosecutor was fond of putting it. But the dirty little secret remains and was hovering palpably over that courtroom throughout the trial: If you officially recognized the validity of my defense, you would have to hold every physician responsible for the same misdeeds of which you sought to convict me. What saved you from this embarrassing, even frightening acknowledgment was merely the degree to which I had deliberately executed the powers you and everyone else had vested in me. You had all collectively created a monster and did not dare admit it even to yourselves. But the monster in this case was not the malformed creature we associate with the mad product of Dr. Frankenstein, but rather the good doctor himself!

Take that business about Morris Green. I bore no animus toward Mr. Green. Quite the contrary, I found him to be a genial if pathetic old duffer. He had a bad heart, true, but he might have shuffled along for another five years or more. But Morris made the mistake of incurring the displeasure of certain powers-that-be (his ambition, like my own, exceeded his instinct for security). I was treating him with standard anti-arrhythmia medications and, with a bit of encouragement, he was doing well. He would, I knew, eventually deteriorate, and there would be a nice check in it for me when I had finally "done all I could" and received the aggrieved family's heartfelt thanks.

Enter Mr. Scolioni. Not a likable fellow, I admit, but a businessman at heart. Unfortunately, his business was of an extra-legal nature and, given the impossibility of recourse to legal means of redressing the grievance between himself and his business partner Morris Green, he felt obliged to seek remedy by other means. How he came to choose me as the instrument of his retribution is a long and circuitous tale which you can read about in the book I have contracted to write. Suffice it to say, when Scolioni approached me with a proposition which he did not believe I could refuse, I made him a counter offer in terms which he himself found impossible to turn down: If I succeeded, he would recompense me according to the stipulations of his own first, generous offer. If I failed, he would owe me nothing and would then be free to solicit the services of a physician with fewer scruples (or less at stake professionally).

For, you see, I had long suspected if not actually believed at least half the cures I and my colleagues effected were largely the result of the confidence we had in our own curative powers duly communicated, however subtly, to our patients. How else could you account for the way one patient, who received the same treatment and seemed to be afflicted to the same degree as another patient, pulled through a life-threatening illness or injury when his double did not? You will say "genes." Perhaps. But in my opinion "genes" have become the "evil humours" of our current state of pseudo-scientific knowledge, a catch-all to explain the inexplicable. On the other hand, we have well-documented evidence that even the words spoken by a surgeon in an operating room penetrate the unconscious mind of the patient. Why not, then, the words, gestures and all the other signs and symbols communicated to a patient who is conscious, or even to those close to him by the caring family physician or specialist?

But while I had long suspected the encouraging word could work wonders with a patient whose malady could take a turn either way, I had never given serious thought to the possibility the reverse might be just as true until my meeting with Mr. Scolioni: If words and gestures could cure, could they not perhaps also kill? Had I hastened the demise of patients whose prognosis I signaled, however inadvertently, as being hopeless?

You must admit, the possibility is intriguing, setting aside the ethics of the particular experiment I decided to embark upon.

"Experiment" is not an inappropriate term for the way I viewed what I was about to attempt. I never had any intention of accepting Mr. Scolioni's money on the original, clearly criminal grounds he offered it. If he had quadrupled the figure, it still would not have exceeded six months of my own professional fees. I had no outstanding gambling debts, no blackmailer sending me threatening notes—nothing, in fact, to be blackmailed about. So I was not so foolish as to risk, however distantly, a thriving and lucrative career for the sake of a hefty injection into my bank account.

My motives were purely scientific. I knew, should I succeed, Scolioni could easily welsh on me, contending there was no way to prove Green would not have died anyway. What would I do in that event? Sue him for breach of contract? I put a simple proposition to him: Give me a few weeks, a couple months. If Green is still alive at the end of that period, you owe me nothing. He agreed reluctantly—he was a man used to having his way a good deal more quickly than that but, being a man of some intelligence, he also saw the advantage of total impunity if I succeeded.

Happily, or perhaps unhappily, depending on how much value you place on the life of someone like Morris Green, I succeeded. Starting with just a frown and a mild shake of the head as I removed the stethoscope from his flabby chest, I methodically implanted in his mind a sense of the hopelessness of his condition. But I was indeed surprised by the rapidity with which my hints began to have an effect. His blood pressure began to climb. The arrhythmia, under control until Scolioni's proposition, reoccurred more and more frequently. The patient began to complain of shortness of breath, mild chest pain. I increased his medication. I even spoke words of encouragement, but chose them carefully to ensure they could be taken as meaning their opposite.

You must understand all of this was not very different from the manner in which I had been conducting my practice for the past 25 years. Had I wanted to prolong rather than end Mr. Green's life, I might indeed have arranged his treatment a bit differently. But in every essential clinical matter I would have altered nothing.

How many times, I thought during the course of those two months, had I, either because I found a particular patient to be disagreeable, insufficiently insured or even physically repugnant, successfully if unwittingly willed his or her demise? I began thinking about old cases, recalling (as is not difficult for me; I have a superb memory) the specific treatments and medications I had prescribed and the resulting improvements or degenerations. To a remarkable degree, I found those patients whom I had either spontaneously liked or induced myself to like because of the fees they would be capable of paying over a prolonged life span invariably had done much better than those toward whom I had felt nothing positive. I even began to wonder if my cure and morbidity rate could be credited to anything other than the prognoses I had privately come to see for them.

I want to reiterate that even at the height of my career as "faith killer," I never neglected to order a dose of penicillin or whatever medication was indicated. But I did begin to see how someone less intelligent and less scrupulous than myself, even an untrained, deluded yokel who possessed uncommon charismatic powers, could "cure" merely by a laying on of hands or prayer. We know it works in so-called primitive societies. Why should it not in our own supposedly sophisticated culture? And why should the opposite not work as well?

Morris Green died five weeks after Mr. Scolioni and I came to our understanding. By the terms of our agreement, Scolioni owed me a considerable sum of money. To my surprise, he paid his bill promptly, more promptly than do most of the people responsible for the medical debts of the deceased. It is as if death, however inevitable, constitutes a kind of de facto malpractice which absolves them morally, if not legally, from paying the fees of physicians who attend at the bedside of their departed relative. Or, as a lawyer friend of mine who specializes in malpractice suits put it, "Dying is un-American."

More assignments followed. For a while they came exclusively from Mr. Scolioni. You can understand my reluctance to get any more deeply involved in a "practice" I only took on as an antidote to the boredom of treating the same maladies day in and day out for the better part of three decades. But just as any satisfied patient will recommend a physician to friends, Mr. Scolioni apparently spoke well of me to his own associates who, probably thinking my methods to be less subtle than they actually were but still undetectable by any pathologist, also solicited my services, hesitantly at first but, as I began to prove my worth, with growing eagerness. I turned down many of these requests. The attention was flattering but dangerous. For 25 years I had been a highly respected member of my profession, a full professor at a world-renowned teaching hospital, a diplomate and board member of several professional organizations. To jeopardize all this by suddenly becoming a tool of organized crime would have been foolish in the extreme. I flattered myself to the extent I believed I could carry out the wishes of these men (they were mostly men, with a couple exceptions who sought out my services for personal rather than professional reasons) while protecting myself from any untoward consequences.

I never agreed to anything in writing. I suppose that goes without saying. But I also never actually "agreed" to anything. A word in my ear that this or that don or so-and-so's cousin seemed to be afflicted with a terminal illness, a referral from someone who had employed my services in the past, in one case merely an expression of premature bereavement, any of these was enough to signify I was being tasked to do for the patient in question what I had done so effectively for the late Mr. Green. The fee would, as if out of the blue, turn up a few days after the unfortunate had breathed his last. In cash, of course.

The character of these requests for services was sometimes of such a subtle nature, I had to rely exclusively on the identity of the patient to determine what was expected of me. I may even have misread these intentions once or twice. The only way I could tell for sure was if I did not receive the usual fee following the funeral.

Throughout this period 95 percent of my practice continued to remain wholly legitimate. I lost patients just as I always had, although now, even in those cases where I would gain nothing by their demise, I could usually predict, if not indeed will, those who would meet their maker sooner than the rest. On these patients I honed the skills I employed more lucratively for Mr. Scolioni and friends. But, of course, I did so, as it were, pro bono.

I now turn my attention to the final event, which has prompted the writing of this letter. My intention here has not been to vindicate or exonerate myself. As I hope I have already made clear, what I did was morally reprehensible only to the extent I acted consciously, while my colleagues go about daily effecting the same results without ever realizing their powers. The publication of my research when it appears later this year will save far more lives than the discovery of any miracle drug. My name will go down in the annals of medicine next to Harvey and Salk. The unpleasant means by which I proved my theory will soon be forgotten or merely serve as a footnote.

As it happened, Mr. Scolioni himself fell ill. I noticed the symptoms myself during one of our rare personal interviews. His color was off and, when I insisted on taking his pulse, I found it to be both rapid and irregular. I suggested he stop by my office for a thorough checkup. He demurred—not an uncommon reaction among men of his age and background, self-made men with little formal education. But it was only as I watched the extraordinary agitation which resulted from my suggestion that I realized what was really perturbing him.

"Surely you don't think I would..." I assured him as he struggled into his expensive top-coat.

"I gotta run."

How dense of me! He was perfectly right to be suspicious. According to the way business was conducted in the world where he made his living, I could easily have been recruited by a rival to do for him what he himself had asked me to do for Mr. Green and several others. Yet nothing could have been further from my thoughts. I had come to like Scolioni, and that fact alone would have made difficult the process of hastening his demise by methods I used with patients who either meant nothing to me or whom I found for one reason or another to be obnoxious.

But the idea of doing mischief to him also never crossed my mind because he was a business associate. I looked upon him as I would a fellow professional—not another physician, of course, but perhaps a lawyer or personal accountant. He was an intelligent man. I often thought that, had he chosen one of the more orthodox professions, he might have risen to the very top. From the moment I conceived of publishing the results of the experiment he had helped me launch, I always intended to accord him the portion of immortality he deserved. After all, the chances of my research ever being repeated on human subjects is, you will admit, remote.

I was therefore much distressed when I heard Mr. Scolioni had suffered a stroke. My instinct both as friend and physician was to do what I could to help him. He had been taken to a hospital near his home, an area of considerable property values but less than topnotch medical facilities. I paid him a visit there but found him unable to communicate. I introduced myself to his family and inquired what sort of treatment he was receiving. His wife, a small and remarkably attractive woman, told me the family physician was in the process of calling in a specialist. I then offered what encouraging words I could, gave her my home telephone, and told her to contact me anytime if I could be of help. She pressed my hand tightly, tears glistening in her large, dark eyes.

Mr. Scolioni's condition improved for a time, then abruptly deteriorated. I won't go into details, but the course of the illness followed a familiar pattern. I myself would have started him a bit earlier on blood thinners, but the hospital where he was being treated simply did not have the medical sophistication of a large teaching institution such as my own. I don't mean to criticize, but proper treatment of a cerebral event such as Mr. Scolioni suffered can require rather advanced techniques.

In the event, he succumbed, and all I could do was offer my condolences which, at the time, the family gave every sign of gratefully accepting.

But the following week I received, almost simultaneously, a large sum of cash from an anonymous source and then a telephone call from someone identifying himself as a close friend of the Scolioni family, advising me I was "a dead man."

What happened next Your Honor is well aware of. Realizing my life was in danger and, with it, the possibility of publishing the medical findings I now expect to see safely into print, I approached the district attorney's office and confessed to the murder of Rudolph Scolioni, a crime which I did not, of course, commit.

I had, of course, no knowledge at that point Mr. Scolioni did not actually die of a second stroke as I had originally assumed but from a lethal injection of morphine. I only learned this information during the course of the assistant district attorney's interrogation. My full "confession" then followed. And here I am, not for the life sentence which would surely have been my legal due if I—if anyone—could be convicted of "willing" all those unfortunates to their premature deaths, but for a mere 15 years maximum for a crime I did not commit (eight years with good behavior). I will use my time here to expand upon my theory of "Cognitive Diagnosis" and make indelible my mark upon the history of medical science.

I am most grateful to yourself, to the state, and to the incompetents at the district attorney's office for providing me with this safe haven. I have everything I need, including conjugal visits from my new wife, the former Mrs. Scolioni. The story of how we met, fell in love, and how I had to regain her trust after confessing to the murder of her husband is the stuff of fairy tale and well beyond my meager literary powers. I intend to sell the rights to that charming story, as well as to my autobiography, to a major publishing house sometime in the coming weeks. I hope Your Honor will do me the great favor of accepting autographed first editions of both these volumes when they appear, in small token of appreciation for all you have done for me.