Do No Harm

In a twisted way the fact that he was in prison made sense, maybe. Leonard took advantage of his court imposed extended free time to study irony and paradox. Yes, he had broken the law and thereby compromised his right to freedom. But it was a bad law. He was being punished for trying to save a life.

Irony.

How can fear and greed act together as the underpinnings of a healthcare system that was supposed to help people?

Paradox.

Wrapped in mental body armor hewn from the savagery of prison Leonard walked the yard, hands in the pockets of his bright unicolor jumpsuit, broad shoulders humped against the bracing wind. No wonder inmates who did their time and reentered the world outside the brick walls and barbed wire were hardened and isolated.

Leonard chuckled to himself muttering, “You want to see a real “Tough Man” competition? Take a shower in this fucking this place.”

Fortunately for him, Leonard was a strong man. An athlete throughout high school and college, he continued hard physical training despite the grueling demands of medical school. The large tattoo on his mammoth right bicep said, “Do No Harm”. When Leonard completed his residency at Mayo he had the ink skillfully applied in large block letters to confirm his dedication to medicine and saving lives with the skills he had mastered. The “Do No Harm” tattoo garnered him some respect in prison, interpreted as “Do Me No Harm or Suffer the Consequences”.

DoNoHarm

Paradox, irony.

But it was the symbol of Caduceus on the opposing forearm that earned him a unique hierarchical position during his incarceration. Early on in his prison career he had to defend himself against a vicious predator as the pecking order was delineated. To survive he had crushed the man’s face against a cement wall and destroyed one of his attacker’s eyes. The horror of what he had done and subsequent perpetual self-admonition were his daily burden and to pay penance he had the Caduceus painfully inked by a prison artist. Now they left him alone. Neither prey nor predator, Leonard had become the go to guy for information, advice and help. Even in prison, Leonard’s role was that of healer. That small truth gave him comfort and he privately clung to it like a frightened child to his favorite security blanket as he paid his dues to society.

A bell rang and Leonard dutifully turned to reenter the dank building that had been his home for nearly five years and would remain so for three more months. Before being labeled by his peers as a criminal he had lived in a humble three-bedroom ranch house in Minneapolis with his wife, Jenai, and their one-year old daughter, Jen. Despite post-residency opportunities at prestigious medical institutes and phenomenal compensations packages in the biomedical industry, Leonard, a microbiome specialist, had chosen a different path. He went deeper into debt by purchasing his own medical equipment and a motor home, which he had converted to a mobile human repair center. His operations were funded by his wife’s income at a stockbroker and the occasional philanthropic donation as he traveled to underprivileged neighborhoods offering high-end medical service to the needy. It was in this context that he discovered that the relatively economical treatment of fecal transplantation cured or improved a vast spectrum of conditions from IBS and Crohn’s disease to persistent C. difficile infection. He was in touch with companies working on identifying and creating formulations of the bacteria in the stools that mitigated or cured a variety of illnesses, but while they struggled with the FDA and clinical trials, Leonard helped thousands of individual patients on the street. For the time being this was permitted because fecal transplantation flew under the radar of the arcane and insidiously lethargic machine of health provision regulation.

Then Janai, a lupus sufferer, got sick. She had endured lupus attacks many times but this flare up was particularly harsh and her heart and kidneys were under attack by her own immune system. Thanks to massive infusions of prednisone she barely pulled through but before Leonard could breathe a sigh of relief he got a call from a friend in pathology.

“Are you sure?” Leonard had asked through tearing eyes.

“Metastatic squamous cell carcinoma, so sorry man,” the pathologist replied.

He had remained in their small study for hours wrestling with the stark truth and staring at his hands, now useless instruments of healing. Janai had cancer, an aggressive and lethal cancer. Knowing full well how barbaric and pointless it was, Leonard had supported and even helped administer the radiation treatments and chemotherapy. In reflective moments he asked himself, “Is this the state of the art in medicine? Kill every dividing cells in the body, but on slightly different time scales so that, if good fortune prevails, there are enough healthy cells left to support life?”

He watched, helpless as he poisoned the woman he loved. He was killing her.

With just weeks to live Janai whispered through cisplatin ravaged throat and vocal cords, “Leonard, you look after Jen and don’t take too long finding a partner to help you. Our daughter needs a mother and I am so sorry I can’t do that from where I am going.”

Leonard became desperate and thought long and hard about an idea percolating in his brain that was completely untested, unorthodox, and probably illegal to put into practice. Then, in the throes of a philosophical epiphany he decided to do it. He retrieved Jenai’s frozen tumor tissue from the pathology lab, homogenized it in sterile saline containing an adjuvant to enhance an immune response, and injected it into his wife’s body. Most physicians would caution that the last thing Janai needed was an infusion of foreign and possibly contaminated biomaterial into her immunologically compromised system. Leonard disagreed. If her tendency to create antibodies against “self” was aggravated maybe she would create anti-cancer antibodies that would tip the scales in favor of survival.

Then he got caught. In the era of sensationalized reporting and YouTube he became the successor to Dr. “Death” Kevorkian, the practitioner who helped people undergo self-inflicted euthanasia. Leonard was tried, convicted, and sentenced to five long years in prison for carrying out an illegal and unsanctioned human clinical trial.

It was visiting day at the prison. Leonard took a deep breath, closed his eyes with head bowed, and sent up a brief but heartfelt “thank you” to the cosmos. He entered the visiting area and looked through the glass at his beautiful daughter, Jen, now six years old.

“Hi Daddy,” Jen said.

Choking back tears, as always, Leonard said, “Hi baby, you look beautiful! How are you doing?”

“I’m fine Dad, and guess what, I got a trampoline!” the little girl stated with a brilliant voice.

“You did?” exclaimed Leonard.

“Yup!” Jen replied. “Mommy said you wouldn’t mind.”

Leonard lifted his eyes from his daughter to the radiant face of his wife. Her color was perfect, her skin tone and muscle tone ideal. She was the picture of health and, beyond his wildest theorizing, she no longer manifest the symptoms of lupus.

“I am so happy you are going to be getting out of here,” Janai said with tears streaming down her cheeks. “We will get back to normal, finally, and I am so, so sorry that it went this way, Len.”

Leonard tried to talk past the pain forming in his throat, but couldn’t. He put his hands against the glass while Janai and Jen did the same. Leonard just stared at his family and wept openly.

His release was big news for a fifteen-minute Warhol moment. Reporters swarmed him as he exited the prison gates and attempted to head to the car in which Janai and Jen were waiting. A small but tenacious woman from CNN stood directly in front of him and said, “Dr. Kwon, are you sorry for what you’ve done? Do you feel like the punishment matched the crime?”

Leonard stopped short, looked straight at the young reporter, then exploring the whole gaggle of information spin doctors he said, “I am absolutely not sorry for saving my wife’s life.”

He took a breath, and said, “Furthermore, the punishment did not match the crime, since there was no crime other than practicing scientifically sound, if unorthodox, medicine. Finally, I can only hope that self-involved politicians and fear-driven FDA regulators gleaned from this story at least a glimmer of the fact that greed and fear are no foundation for the thoughtful practice of medicine for humans beings who are suffering unnecessarily.”

Leonard began to step around the aggressive reporter when she stopped him with a hand on his chest. Looking down and controlling his natural reaction to remove the hand and the body to which is was attached, Dr. Leonard Kwon stopped and said, “I will answer one more question, after you remove your hand from my body.”

The reporter sensed the underlying threat and snapped her hand away. Her voice quivering slightly she said, “Dr. Kwon, after serving a five-year sentence in a high security prison, would you ever do something like this again?”

He looked at his beaming wife and child, then back to the reporter and said, “In a heartbeat.”

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