Crime du Jour: 31 Days of Malfeasance, Misconduct, and Immorality
One crime story per day, all the way through October. Ebook to be published Nov 1. This will be under my mystery/crime pen name, Diane R. Thompson!
Crime du Jour #4: Bribery
MONA LISA SMILE
It started innocently enough. Caroline Byam, MD, an oncologist, worked for a multi-specialty physician practice, Grossman Associates, an affiliate of Freedom Health, in Massachusetts. She was one of the new breed of doctors, the kind who stop to double-check drug interactions on their smart phones mid-visit. Caroline had charmingly crooked teeth, deep-set eyes, and a tendency to pull out most of the hair on her eyebrows, like Mona Lisa. You couldn’t have called her pretty, though, and she didn’t have the right kind of smile. She had a boyfriend but she had never had much luck with men. They walked all over her.
One off-Saturday, she came in with a handful of other doctors to meet with some pharmaceutical reps. They were hustling a new brand of fentanyl, a transdermal skin patch of synthetic opioid more addictive than heroin, as being a reasonably safe alternative to the current patch dominating the market.
Caroline’s supervisor advised the doctors to consider using the new patch, Moradine Transdermal, instead of the front-runner brand-name one. Top prescribers would be considered to speak at a conference in Hawaii the following December, no vacation time necessary, all expenses paid. A bonus might be in the offering.
Caroline told herself she would try switching a couple of prescriptions. Cautiously. Some of these pharmaceutical reps were pushy, borderline unethical. But she would give the new drug a fair shot. The studies the reps had presented did look legit.
She prescribed the patch for several of her patients, and they responded well. Soon she had stopped proscribing the original patch altogether.
Until the day one of them, Fred Sweetser, started hallucinating while he was in her exam room.
“Almira,” he said, taking her hand gently in his, “you’ve come back.”
“I’m sorry?” she asked. “My name is Caroline.”
Almira was an unusual name; it had been her grandmother’s middle name, back in Pennsylvania.
“You have her smile,” Mr. Sweetser insisted.
She smiled at him. Mr. Sweetser was an old man, about eighty, and his prognosis wasn’t good. He had recently lost almost twenty-five pounds and had had to be brought into her office in a wheelchair. But he was stubborn, not ready to relinquish himself to either hospital or hospice care. He lived in an assisted living facility nearby.
“Thank you,” she said. “Do I remind you of your wife?”
Mr. Sweetser smiled broadly, still holding her hand. He rubbed his silky, bony, almost printless thumb over the backs of her knuckles. “Did you think I wouldn’t recognize you? Even after all this time?”
She checked his chart: he was listed as widowed, his records linked to a Liz Sweetser, a former patient of Freedom Health (deceased). “Almira” could be anyone. A daughter, a former mistress.
“Are you in any pain, Mr. Sweetser?”
“Not as much as I used to be.”
One of the rarer side effects of the transdermal patch was auditory and visual hallucinations, but she wasn’t sure whether Mr. Sweetser’s delusion could be considered as such. He might only have dementia. Or simply be deluding himself over a fond memory and a faint resemblance.
“Have you had enough to drink today?”
He waved a hand casually. “I’ll wait until I get back to the old folks’ home. I don’t like to wet myself in front of pretty girls.”
“Are you feeling nauseated?”
He lowered his voice. “I’ve been constipated. The nurses are all trying to shove go-juice down my throat. You know, the stuff with prunes. And it gives me gas.”
She would lower the dose on the Moradine patch, she decided. Mr. Sweetser had lost a good deal of weight. She scrawled a note that the patches should be lowered to 50 mcg/hr, but to contact her if Mr. Sweetser experienced any pain.
“But, Almira,” Mr. Sweetser said, “All of that isn’t important. I want you to tell Caroline that there is trouble coming.”
“I’m sorry?” Caroline asked.
Mr. Sweetser tapped his temple with his free hand. His watery blue eyes were distant, looking straight through her. “Caroline is being bribed to prescribe certain drugs to her patients. You know I’ve always had the sight. If she doesn’t stop now, then some of her patients will die.”
Caroline’s heart seemed to stop beating. Her ears roared and she swayed on her wheeled stool.
Mr. Sweetser’s hand tightened on hers. “I’m sorry. I’m not saying this just to hurt you. Tell her not to go to that conference. The one in Hawaii. That’s where they really pull her in, get her to start dealing to rich kids with too much time on their hands.” Mr. Sweetser brought her hand to his dry lips and kissed it. “And that that boyfriend of hers. It’s either kick him out of the house now, or arrange for him to OD on some of those patches later. He’s a barnacle, and you got to scrape those off from time to time. Like you did me.”
“She’s not a bad girl, Almira. She’s like you. A good heart but no angel. I’m sorry I did you wrong, Almira, but I wouldn’t lie to you now. Promise me, Almira. For old time’s sake.”
“I—I promise,” Caroline said.
Forewarned had been forearmed. Caroline avoided the opioid scandals that crashed Grossman Associates in 2018, established a reputation for integrity, and been hired on to a much better position elsewhere. Her boyfriend had screamed when his rich doctor girlfriend scraped him off her life like the barnacle he was, but she only smiled: he had no idea of the fate he’d avoided.
On Caroline’s next visit, her mother denied ever having heard about a “Fred Sweetser.” The visit after that, though, one whole photo album was missing from her shelves.
Since then, people stop to look at her wherever she goes. It’s that half-satisfied, half-ironic look of hers. She’s not pretty, but she has the right kind of smile.
That Mona Lisa smile.
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