Blind Eye: How the Medical Establishment Let a Doctor Get Away with Murder

Blind Eye: How the Medical Establishment Let a Doctor Get Away with Murder

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by James B. Stewart

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With features on "20/20" on August 18 and "Good Morning America," on August 19, the buzz is building for this terrifying true tale. The bestselling author of Den of Thieves and Blood Sport returns with another revealing, shocking, era-defining story of deception and misdeeds. This time around, Pulitzer Prize-winner James B. Stewart follows the path of…  See more details below


With features on "20/20" on August 18 and "Good Morning America," on August 19, the buzz is building for this terrifying true tale. The bestselling author of Den of Thieves and Blood Sport returns with another revealing, shocking, era-defining story of deception and misdeeds. This time around, Pulitzer Prize-winner James B. Stewart follows the path of one Michael Swango, a serial killer in a doctor's coat. Stewart slips inside America's cloistered medical establishment to find out how a convicted criminal could keep finding employment with prestigious hospitals and medical schools across the country.

Editorial Reviews

Bill Vourvoulias

Poisoning is the most intelligent -- as well as the most cowardly -- form of murder, because it's nearly impossible to prove. That helps explain the FBI's troubles in the notorious case of Michael Swango, who is suspected of having fatally poisoned some 60 people between 1984 and 1997 as an intern or resident at a number of hospitals and health-care establishments. In Blind Eye, journalist James B. Stewart (Blood Sport, Den of Thieves) painstakingly recounts Swango's life and crimes in a clipped, matter-of-fact tone. Stewart discovers signs of psychosis (e.g., notebooks with newspaper clippings about train wrecks and car crashes) in Swango's childhood in Quincy, Ill., and traces the way they blossomed into an avocation.

Swango's poisonous ways began at the Ohio State University Hospitals in Columbus. Three witnesses saw the young intern inject a substance into a patient's IV moments before she suffered a life-threatening seizure. Swango gave conflicting accounts of the incident, but the senior doctor assigned to investigate took his word over that of the witnesses (none of whom were doctors), and the hospital dropped the matter. After completing his internship, Swango spent the summer of 1984 in Quincy working at an EMF unit, where he often bought doughnuts and drinks for his co-workers. When a number of paramedics came down with violent flu-like symptoms, they had a glass of iced tea tested; it contained arsenic. The evidence was strong enough to convict Swango of battery.

After his release from jail in August 1987, his life became curiously repetitive: He'd secure a residency by falsifying records; mysterious deaths that were circumstantially traceable to him would follow; hospital officials would become concerned but do little; they'd learn about his past, usually through the media, and revoke his privileges; and Swango would find another hospital willing to hire him. This pattern held even after an FBI investigation forced him to seek work at a clinic in Zimbabwe. En route to a job in Saudi Arabia in June 1997, he was finally arrested, not for murder but for fraud. He was sentenced to 42 months in prison and could be freed as soon as July 2000. His story still has, as Hugh Downs put it in a 1986 20/20 segment, "an ending that leaves room for a sequel."

It's a credit to the grace and authority of Stewart's writing that despite Swango's never having been convicted of murder, the reader does not question his capacity to kill. Stewart lays the blame for Swango's success at getting job after job on the medical peer-review process, which accepts only the judgment of experts -- i.e., other doctors -- as to whether a practitioner is guilty of malpractice or, in this case, malevolence. The notion is fatally undermined, he argues, by the siege mentality that rising numbers of malpractice suits have brought on: "The loyalty among physicians makes police officers' famous 'blue wall of silence' seem porous by comparison." He also excoriates the American Medical Association for opposing the National Practitioner Data Bank, a federal clearinghouse for information on disciplinary actions against doctors.

But he doesn't go far enough in condemning the medical fraternity. The fact that this clubbiness begins in medical schools deserves more than the passing mention it gets. And while Stewart notes that most of the hospitals where Swango worked were not legally obligated either to check with the Data Bank or to report him (because of his status as an intern), he says nothing about the dubious wisdom of letting doctors whose training wheels have yet to come off act as primary caregivers to large numbers of patients.

His examination of Swango's psyche is meticulous and convincing. But when it comes to creating a more general picture of serial killers, he's stymied, relying on Freudian psychopathology theories that, as he admits, haven't proved useful in treatment. Though he mentions that fully half of this country's serial and mass killings have occurred since 1970, the possibilities that the rise of popular culture or newer psychological theories might help explain the psychopathic mind never appear in the book. Which is a shame, really, since Blind Eye might have been more than a simple -- if artfully executed -- true-crime story with voyeuristic thrills and easy outrage. It was a timely opportunity to understand a horrifying and increasingly large part of our shared experience.

Lance Morrow
...chillingly thorough and superbly matter-of-fact...wonderfully done...An elaborate journalistic reconstruction that has the fascination of an acutely observed and troubling novel...
New York Times
Michael Kenney
When Michael Swango arrived for his morning shift with the Adams County, Ill., Ambulance Corps in September 1984, the other paramedics thought he must be feeling particularly generous. He had a box of Honey Maid doughnuts for the crew. As they ate, however, Swango's colleagues became violently ill and rushed from the room. ''What did you do, Mike, poison us?'' one joked later. Swango looked incredulous and issued a vehement denial.

But, as James B. Stewart documents in ''Blind Eye: How the Medical Establishment Let a Doctor Get Away With Murder,'' that was the moment when Swango's double life began to unravel. In a meticulously researched book, Stewart makes the case that Swango was a serial killer in a white coat - a doctor who does plenty of harm.

A former editor of The Wall Street Journal, Stewart won the Pulitzer Prize in 1988 for his reporting on the stock market crash and insider trading. In ''Blind Eye,'' he follows Swango's progress through medical school at Southern Illinois University, to a residency at Ohio State University, to a job as a missionary doctor in Zimbabwe. Through interviews with doctors, patients, relatives of victims, and nurses, Stewart penetrates the hermetically sealed world of medicine. In the process, he exposes the arrogance and the fraudulent professional courtesies that allowed Swango to move ahead unchallenged. In other words, Stewart does the work that hospital administrators and supervising physicians in Ohio, South Dakota, and New York should have done.

The tally is grim. Stewart writes: ''My own investigation has found circumstantial evidence that links him to the deaths of five patients at SIU, five at Ohio State, and five at the VA hospital in Northport, Long Island, for a total of 15 in the United States. In Africa, he became either more prolific or more reckless or both.'' By some law enforcement accounts, Swango may have dispatched as many as 60 patients.

It's hard to pinpoint the making of a monster in Swango's small-town Midwestern upbringing, but Stewart amasses telling evidence. His father was a Vietnam veteran who was rarely home and who apparently passed on a fascination with violent death to his son. (Both kept clippings about car accidents.) Swango's mother was a rigid woman who did her best to keep a family of four boys together. Her special focus on Michael, Stewart suggests, might have contributed to his narcissism. This kind of diagnosis at a distance is always risky, however, and Stewart would have done well to avoid it.

At SIU, Swango's medical career got off to a rocky start. He flunked his OB/GYN rotation in medical school and couldn't graduate with his class. In fact, serious concerns were raised about his fitness to practice. Fearing a lawsuit, the school pulled its punches in its written evaluation, and Swango snagged a prestigious residency in neurosurgery at Ohio State University in Columbus.

Trouble seemed to follow the blond, clean-cut resident, and nurses began to take notice. Patients died suddenly after his visits, and one woman was mysteriously paralyzed. Academic politics trumped sound medical practice, however, and OSU made only a cursory investigation. Despite suspicions, Swango was licensed as a physician in Ohio.

Stewart finds dangerous gaps in the use of the National Practitioner Data Bank, a monitoring system that took effect in 1990: Swango was accepted as a doctor in Sioux Falls, S.D., and at the State University of New York-Stony Brook because officials never checked his history. According to a federal report obtained by Stewart, about 75 percent of all hospitals in the United States never reported adverse actions to the data bank. ''In other words,'' Stewart writes, ''three-quarters of the nation's hospitals over a three-year period either took no disciplinary action against any physician - something that strains credulity - or failed to report to the data bank when they did, as required by law.'' When Stewart called the data bank to ask about Swango, he was told indignantly that such information was confidential.

Given the rise in serial killings generally, and in hospitals specifically, it seems inevitable that more Swangos will surface,'' Stewart writes, "and it thus seems all the more critical that criminal physicians be monitored and prevented from having access to patients."

When the law finally caught up with Swango, it barely nicked him. In 1994, federal authorities issued a warrant for his arrest on charges that he gained admission to the Stony Brook residency program by making false statements. The assistant US attorney amended the indictment to include distribution of controlled substances; conviction carried a maximum prison term of three years. Swango was arrested when he returned to the States from Africa, on his way to yet another hospital, in Saudi Arabia. Rather than face a trial, he agreed last year to plead guilty.

In 1998, he was sentenced to 42 months. But unless authorities build a murder case, Stewart's story may have a chilling coda: Swango will be eligible to move to a halfway house by next January.
Boston Globe

Scott Tobias

From 1984 to '97, Dr. Michael Swango was responsible for the fatal poisoning of roughly 60 patients, placing him among the most prolific serial killers in American history, but his crimes are not the most unsettling aspect of James B. Stewart's riveting Blind Eye. Using Swango as a grisly case study for a larger and more common problem, Stewart reveals just how easily dangerous or grossly incompetent physicians can slip through the system and continue to practice medicine. Only part of the Quincy, Illinois, native's elusiveness can be attributed to his brilliance in covering up past transgressions --including a felony conviction for lacing his colleagues' food and drink with arsenic--or the simple fact that death, no matter how sudden and inexplicable, is a regular occurrence at hospitals. With resounding clarity and force, Stewart levels equal blame on a medical establishment that cares more about financial liability than patient welfare, lacks an effective national system for red-flagging poor physicians, and supports the arrogant fraternity of hospital doctors and administrators. There's no more potent example of this than an incident at Ohio State in which three people--elderly patients Rena Cooper and Iwonia Utz and student nurse Karolyn Beery--witnessed Swango injecting a foreign substance into Cooper's IV line, causing a near-instant seizure and resulting in paralysis. A half-hearted internal investigation followed, but as more reports of suspicious deaths surfaced, administrators, fearing liability, chose to disbelieve the witnesses, shut out campus-police inquiries, and quietly relieve the doctor of his duties. As he follows Swango's zigzagging path through various hospitals in America, ending in a remote community facility in Zimbabwe, Stewart observes with astonishment and indignation as the cover-up at Ohio State repeats itself again and again. At their worst, true-crime books revel in grotesque pathology. But while Swango has plenty to offer in that regard--the perverse enjoyment he got from informing family members of the newly deceased, his obsessive clippings of articles on violent deaths--Stewart understands that he's an anomaly and insists on putting his horrible actions in context. An urgent, scrupulously researched piece of reportage, Blind Eye is a wake-up call to both the medical community and the vulnerable public-at-large.

Publishers Weekly - Publisher's Weekly
In a harrowing and exhaustively researched account of neglect by the medical profession, a Pulitzer Prize-winning editor and author (Den of Thieves) presents convincing evidence that alleged serial killer Michael Swango injected a minimum of 35 patients with various toxic substances during the 15 years he was a medical student at Southern Illinois University, an intern at Ohio State University Medical Center and a physician at various hospitals in the U.S. and in Africa. In addition, the author makes a strong case that Swango, who has been described by many as charismatic, was responsible for the severe digestive upsets that plagued his colleagues and friends due to poisoned food and drink. Since Swango has never been evaluated by a psychologist, Stewart relies on the work of medical researchers who view serial killers as psychopathic narcissists. The major strength of Stewart's study, however, rests on his expos of poor medical monitoring practices. For example, when female nursing personnel linked mysterious patient deaths to Swango's injections, male physicians dismissed their suspicions. Swango was finally sent to prison in 1985 after being convicted of poisoning his co-workers while he was employed as a paramedic. After his release, he found work at other teaching hospitals because they were not required to check with the national practitioners' data bank, a self-monitoring mechanism endorsed by the AMA that Stewart considers inadequate. Currently serving time in prison on fraud charges, Swango faces an FBI investigation for murder. Agent, Amanda Urban; 9-city author tour; TV satellite tour. (Sept.) Copyright 1999 Cahners Business Information.
Library Journal
Pulitzer Prize-winning journalist Stewart, noted for Den of Thieves, elevates the story of a peripatetic doctor who leaves behind a trail of dead patients beyond the true-crime genre. This compelling look at one bad seed becomes an indictment of an industry that ignores and even covers up the errors of its own. (LJ 9/15/99) Copyright 2000 Cahners Business Information.
Talk Magazine
Blind Eye follows the professional and criminal career of Michael Swango, a physician who poisoned dozens of people. It's a true crime book, a very good and important one.

Talk Magazine's 10 Best Books of November

Kirkus Reviews
The shocking story of Dr. Michael Swango, who, despite being a convicted felon suspected of murdering dozens of his patients, was allowed to practice medicine. Best-selling author Stewart (Den of Thieves, 1991, etc.) brings us inside the life of a killer who thrived in a medical establishment where doctors typically cover up for other doctors, where hospital administrators live in constant fear of litigation, and where regulatory agencies don't share crucial information. At Southern Illinois University's medical school, Swango kept to himself, but classmates noticed that patients who came into contact with him tended to die. After graduating, Swango got a prestigious medical internship at Ohio State University. In February 1984 at Ohio State, patient Ruth Barrick died immediately after Swango treated her. Later a nurse saw Swango injecting a patient with a syringe; the patient almost died. The nurse who accused Swango was ignored and, in a pattern that would repeatedly benefit Swango, other doctors circled the wagons to defend their colleague. As more patients died, Ohio State initiated an in-house investigation, led by a fellow doctor, that fully exonerated Swango. Hospital administrators refused to even reprimand him, because they "didn't want to be sued by Swango as a result of unfounded charges and nurses' gossip." When his internship was up, Swango worked as a paramedic in his hometown of Quincy, Ill. He related fantasies to his co-workers about killing people. When Swango brought in donuts, his co-workers got sick. After a few more poisonings, Swango was arrested and convicted. A felon, he nonetheless went on to practice medicine in South Dakota, New York, and Africa. In eachplace, patients died mysteriously under Swango's care. Finally, upon his return from Africa, the FBI arrested the young doctor for falsifying medical records. He's currently in prison, but could be released within three years. Although Stewart writes skillfully about the medical establishment's unforgivable "code of silence," he never quite succeeds in taking us very far into Swango's warped mind. Thus, we're left to guess about his psychotic motives and thought processes.

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Simon & Schuster
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Keneas Mzezewa had dozed off for a nap that May afternoon, but was awakened at about two p.m. when he felt someone removing his loose-fitting pajama trousers. He lifted his head, still a bit groggy from sleep, and saw that it was Dr. Mike. The handsome American doctor had a syringe in his hand, and seemed about to give him an injection, so Mzezewa, eager to help, pulled down his trousers and turned on his side. Then the doctor plunged the unusually large needle into his right buttock. Mzezewa saw that after he finished the injection, the doctor concealed the used syringe in the pocket of his white medical coat.

"Good-bye," Dr. Mike said softly, pausing briefly to look back at Mzezewa.

Then he left the hospital ward.

Howard Mpofu, the director of hospitals for the Evangelical Lutheran Church in Zimbabwe, liked the new doctor the minute he met him, in November 1994, when he picked him up at the Bulawayo city airport. Michael Swango looked like the American athletes Mpofu had seen on television. He was blond and blue-eyed, taller than Mpofu, with a ready smile. According to the résumé the church had received, he was forty years old, but he looked younger. Mpofu tried to help Swango with his duffel bags, but the doctor wouldn't hear of it. He quickly hoisted the heavy bags and insisted on carrying them to the car himself.

On the ride into the city, Swango was garrulous, flushed with excitement at his new assignment. Mpofu asked why Swango had wanted to come to Zimbabwe to take up a post that would pay him a small fraction of what he could earn in the United States. After all, Swango was an honor student; he'd graduated from an American medical school and had completed an internship at the prestigious Ohio State University Hospitals, which meant he could go anywhere. "All my life," Swango told him, "I have dreamed of helping the poor and the disadvantaged." He said America had plenty of doctors, but in Africa, he would be truly needed. Mpofu couldn't argue with that.

When they reached the Lutheran church headquarters in central Bulawayo, they walked up one flight of stairs to the church offices, and Mpofu introduced Swango to the Lutheran bishop of Zimbabwe. To the amazement of the church officials, Swango knelt before the bishop and kissed the floor. He said he was so grateful to have been hired and to be in Zimbabwe at last.

The bishop seemed equally delighted. Indeed, he and Mpofu were overjoyed simply to have succeeded in recruiting an American doctor for one of their mission hospitals, let alone one willing to kiss the ground at their feet. Before Swango, the only European or American doctors the church had succeeded in bringing to Zimbabwe were Evangelical Lutherans from church headquarters in Sweden, and none of them stayed more than a few years.

Not many foreign doctors -- even from places like Eastern Europe and Asia -- wanted to come to Zimbabwe, the former British colony of Rhodesia, which lies between Mozambique and Botswana, just north of South Africa. Before the end of the white supremacist regime of Ian Smith and the holding of supervised elections in 1980, the country had endured a prolonged civil war. And after independence came the consolidation of dictatorial power by the mercurial Robert Mugabe, who, among other controversial pronouncements, has denounced homosexuals as "perverts" who are "worse than dogs and pigs." Since independence, the country has experienced the suppression of human rights, the collapse of its currency, a steep decline in the standard of living, and the emigration of much of its white population. Fully 25 percent of the adult population of Zimbabwe is estimated to be infected with HIV, the highest infection rate in the world. At times the country's hospital system has been plunged into turmoil, and there is a critical shortage of doctors.

With a population of about 650,000, Bulawayo is Zimbabwe's second-largest city, the capital of the province of Matabeleland, once a powerful African nation in its own right. For the most part, the local population speaks Ndebele, a linguistic cousin of Zulu, whereas the Zimbabwean majority speaks Shona. A debilitating civil war between the two ethnic groups broke out almost immediately after Zimbabwe gained independence, and though a truce was reached, simmering tensions persist.

Bulawayo residents complain that the city has been neglected by the national government because of continuing ethnic discrimination against the Ndebele. But a result of that neglect has been that the colonial-era architecture and city plan have been largely unmarred by the building boom that has swept Harare, the nation's capital. Even the cars generally date from the fifties and sixties, owing to years of international economic embargo during white-supremacist rule and the collapse of the Zimbabwean dollar following independence. Many people in Bulawayo seem to prefer the atmosphere of faded gentility, especially the fifty thousand or so remaining whites, most of British descent. These days few live lavishly; there is little conspicuous wealth. But they praise the city's unhurried pace (nearly all businesses seem to close by three p.m.); the nearly ideal climate of the high African veldt, in which even summer temperatures almost never reach ninety degrees; the gracious residential neighborhoods of walled villas and jacaranda-lined streets. Most white people still return home for a lunch prepared by black servants. They congregate at the Bulawayo Golf Club, the oldest club in Zimbabwe, with manicured fairways and a swimming pool, and the Bulawayo Club, an imposing beaux-arts mansion downtown.

By contrast, the orderly grid of colonial Bulawayo is surrounded by scores of "settlements," in which thousands of black people live crowded into small houses and shanties along dirt roads that seem to have been laid down at random. Many commute into the city on aging, diesel-fume-spewing buses, and the central bus terminal is a colorful and chaotic mass of shouting passengers, piles of goods and luggage, buses, taxis, bicycles, and handcarts. There is an almost eerie sense of a time warp in Bulawayo. In the award-winning 1988 film A World Apart, it stood in for 1960s Johannesburg.

Swango spent his first night in Zimbabwe at the Selborne, a colonial-era hotel whose wide verandah overlooks the city's bustling central square. The next morning, Mpofu picked him up for the drive to the church's mission hospital at Mnene. Mpofu had made the six-hour drive many times, and he was accustomed to the dismay of first-time visitors as the pavement gave way to a dirt road so rough that a four-wheel-drive vehicle or truck is required. Yet Swango voiced no complaints as they ventured ever farther from what most Americans would consider civilization.

Mnene -- a cluster of buildings -- can't be found on many maps. It lies in the region of Mberengwa in south-central Zimbabwe, in what in colonial times were known as the tribal lands of Belingwe, in the heart of the bush. Inhabitants identify themselves by the name of their tribal chief; the land is still owned communally, and the local people's life of subsistence farming has changed little for generations. There are no towns to speak of, scant electricity, almost no telephones. Most people live in extended family units in clusters of mud-walled buildings with thatched roofs. The landscape is often stunningly beautiful: verdant valleys give way to distant panoramas of mountain ranges. Drought and malaria are constant threats, in part because the lower elevation makes the climate more tropical than it is on the high plateau where most of the white population lives.

The region is served by three hospitals, one of them also called Mnene, all founded in the early part of the century by Evangelical Lutheran missionaries. Mnene Mission hospital, a cluster of one-story whitewashed buildings with corrugated metal roofs and wide verandahs, is set atop a hill with distant views and refreshing breezes. The buildings look much the same as they do in a photograph taken in 1927, when the hospital was built.

When Mpofu and Swango finally arrived, Dr. Christopher Zshiri, the hospital director, hurried out to greet them. He introduced Swango to Dr. Jan Larsson, a Swedish missionary doctor who was the other member of Mnene's medical staff, and showed Swango to his quarters, a spacious bungalow with a verandah, adjacent to the hospital. Zshiri is a native Zimbabwean. Under the country's system of socialized health care, he reported to the provincial medical administrator in Gweru and was paid by the government, even though nominally he worked for the Lutheran church. Even more than the others, Zshiri thought it was almost too good to be true that they had managed to recruit an American doctor to a place like Mnene.

Zshiri and Swango soon became friends. Zshiri couldn't get over how talkative Swango was, always eager for conversation and filled with curiosity. After his arrival, Swango had garnered glowing reports from patients and staff members. He was soon known to everyone as "Dr. Mike." It was true that he lacked experience in general surgery and obstetrics, two areas most in demand at Mnene. After a month at Mnene, Zshiri sent him to Mpilo Hospital in Bulawayo, where Swango spent the next five months gaining additional clinical experience. The doctors at Mpilo wrote glowing recommendations, and Swango was far more confident and proficient when he returned to Mnene in late May. He was seen as a nearly tireless worker, able to complete forty-eight-hour stints without sleep. He even worked extra shifts, giving up his free time. Of course, at Mnene, there was little else to do. Even the indefatigably cheerful Swango finally complained about the isolation, asking Zshiri if the church could possibly provide him with use of a car, since he couldn't afford one. Fearful that Swango might decide to leave, Zshiri wrote church officials a letter asking whether there wasn't some way they could accommodate him.

Swango often made extra rounds to check on his patients, sometimes at night or during afternoons when he was otherwise off-duty. So when Dr. Swango arrived in the surgery recovery room one May afternoon in 1995 to check on Keneas Mzezewa, the only patient there, no one thought it unusual, even though Swango had already completed his rounds that morning, and technically Mzezewa wasn't his patient.

Mzezewa had recently had his foot amputated by Dr. Larsson. A farmer in the Mberengwa area who was also a part-time laborer at the nearby Sandawana emerald mine, Mzezewa had come to the hospital the previous week complaining about severe pains in his leg. A tall, slender man with a wide smile, Mzezewa had reacted calmly to the news that his infected foot would be amputated. The doctor reassured him that he would be fitted with a prosthesis and should be able to lead a normal life once he returned to his farmstead. The operation had been uneventful, but Mzezewa had been kept in the recovery ward for close monitoring, which was routine in amputation cases. Dr. Larsson had been pleased with his progress, and mentioned to Zshiri how well Mzezewa was doing.

That afternoon Mzezewa was awakened from his nap by the new doctor, Dr. Mike. Before the doctor gave him the injection, Mzezewa noticed, he neglected to swab the skin with disinfectant. Mzezewa also noticed that when Dr. Mike put the used syringe in his jacket pocket, the needle's cover fell to the floor near his bed.

Still, it seemed a routine visit. Despite the large size of the needle, Mzezewa didn't mind the pain. He relaxed and lay back on his bed, prepared to resume his nap. But as the drug given him by the doctor spread through his body, he began to feel a strange loss of sensation in all his muscles. With mounting alarm, he realized that he couldn't turn over and couldn't move his arms or legs. He wanted to speak or cry out, but his jaws, tongue, and throat wouldn't respond. Then the room, brightly lit by the afternoon sun, grew dim. Soon all was darkness.

Mzezewa didn't know how much time passed while he lay there, alive and conscious but paralyzed and terrified. But then the darkness began to lift; he could see, though he still couldn't move his head. A nurse's aide entered the recovery ward and came over to his bedside. She held a thermometer and told him it was time to take his temperature. Mzezewa's mind was racing. His heart beat furiously. He wanted to cry out, but he couldn't make a sound. He could hear the aide, but he couldn't move; his muscles wouldn't respond. She asked him to move his arm so she could put the thermometer in his armpit. He lay motionless. She asked him again. Suddenly the aide looked alarmed, and ran from the ward.

Moments later, Mzezewa regained his voice. He screamed and began shouting to attract attention, though he still could not produce recognizable words. A nurse came rushing into the ward, followed by the aide. She came and stroked his hand, trying to calm him, asking him what had happened. But he was still unable to speak. Two more nurses arrived.

Slowly Mzezewa regained his voice. "Dr. Mike gave me an injection," he finally gasped. The nurses were puzzled, for while Mzezewa was taking oral painkilling medication, he was not scheduled for any injections. In any event, injections were administered by the nursing staff, not by the doctors.

Then Swango himself came into the ward, coolly appraising the commotion. Mzezewa looked terrified. The nurses fell silent.

"Did you give him an injection?" a nurse finally asked. "What was it?"

Swango seemed mystified. "He must be delirious," he said. "I didn't give him any injection."

Copyright c 1999 by James B. Stewart

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