Longreads

Hospitals nationwide are experiencing drug shortages, including critical nutrients needed to keep premature babies and other patients alive. Are drug manufacturers and the FDA both at fault?

"Some hospitals have resorted to bartering with one another to secure even a small supply of nutrients, and many are rationing.

"At least one NICU in the District is administering some trace elements only three days a week instead of seven. At Atticus’s hospital, no patients heavier than 2½ kilograms (5½ pounds), including NICU babies, are getting intravenous phosphorous. 'You could have a brand-new, full-term baby and they don’t qualify,' a staff member says. 'There are really sick babies and one-, two-, three-year-olds that don’t get anything at all because we’re rationing it for our tiniest preemies.'

"'It almost makes me cry—our patients are starving because of drug shortages. How can this happen in this country?' says ASPEN past president Jay Mirtallo, a professor of clinical pharmacy at Ohio State University. 'In the last three years, there hasn’t been one PN product that hasn’t been in short supply. I’ve traveled all over the world talking about parenteral nutrition, and our colleagues in Europe, South America, and Asia just look astounded and ask how this can be such a significant problem when they have no issue whatsoever in any of their countries.'"

At Horace Mann—the prestigious Bronx private school rocked by allegations of sexual abuse from the 1960s into the 1990s—former students recall a pattern of abuse from one eccentric English teacher:

"And what about Mr. Berman—this odd, secretive man who frightened away many students, yet retired to a house that former students bought for him? He wasn’t mentioned in the Times stories, but he may have been the greatest enigma of all. I talked to more than a hundred alumni, to many teachers who worked with him in the sixties and seventies, and to administrators who dealt with complaints about teachers. Berman stood out for his extraordinary control over boys’ lives. Several of his former students have spent decades trying to grasp why they yearned to be close to him, and why they remained silent for so long after, by their accounts, he abused them. 'Berman counted on everyone’s silence,' one of the men who lived with him after graduating from Horace Mann told me. Like some of the others, he asked not to be named. 'He assumed that our own humiliation would keep us quiet,' he said."

The number of Americans on disability has skyrocketed in the last three decades, and the Social Security Administration says the reserves in the disability insurance program are on track to run out in 2016:

"Scott tried school for a while, but hated it. So he took the advice of the rogue staffer who told him to suck all the benefits he could out of the system. He had a heart attack after the mill closed and figured, 'Since I've had a bypass, maybe I can get on disability, and then I won't have worry to about this stuff anymore.' It worked; Scott is now on disability.

"Scott's dad had a heart attack and went back to work in the mill. If there'd been a mill for Scott to go back to work in, he says, he'd have done that too. But there wasn't a mill, so he went on disability. It wasn't just Scott. I talked to a bunch of mill guys who took this path -- one who shattered the bones in his ankle and leg, one with diabetes, another with a heart attack. When the mill shut down, they all went on disability."

An undercover officer for the Drug Enforcement Administration ends up in prison when the drug war becomes personal:

"'A lot of people disappear in Mexico,' he says. 'They are buried where no one will find them. Some are eaten by tigers and some by sharks. There are also big tanks with acid in them.' He pauses for a long time between the sentences.

"'We didn't manage to catch all the bad guys. In those cases, we gave the Mexicans their names and said, 'Do what you need to do.' The Mexicans made those people disappear.'

"Martinez sits in his car, holding the steering wheel firmly with both hands. He looks frightened by the memories of his own life. 'Come on, let's go to the cemetery,' he says."

A Navy intelligence analyst reports a rape and finds herself ostracized. She's not the only one, and the U.S. military still has not taken serious steps to address a culture that condones sex abuse:

"The scandal of rape in the U.S. Armed Forces, across all of its uniformed ser­vices, has become inescapable. Last year saw the military's biggest sex-abuse scandal in a decade, when an investigation at Lackland Air Force Base in San Antonio revealed that 32 basic-training instructors preyed on at least 59 recruits. In Fort Bragg, North Carolina, Army Brig. Gen. Jeffrey Sinclair is currently facing court-martial for sex-crimes charges, including forcible sodomy, for alleged misconduct against five women. In October, an Air Force technical sergeant filed an administrative complaint describing a work environment of comprehensive harassment – in which all women are 'bitches'; and claimed that during a routine meeting in a commander's office, she was instructed to take off her blouse and 'relax' – edged with menace and punctuated by violent assaults. In December, a Department of Defense report revealed that rape is rampant at the nation's military academies, where 12 percent of female cadets experienced 'unwanted sexual contact.' And an explosive series of federal lawsuits filed against top DOD brass on behalf of 59 ­service members (including Rebecca Blumer) allege that the leadership has done nothing to stop the cycle of rape and ­impunity – and that by failing to condemn sexual assault, the military has created a predators' playground."

How Facebook, computer scientists at MIT, and members of Anonymous are finding ways to address cyberbullying:

"Lieberman is most interested in catching the egregious instances of bullying and conflict that go destructively viral. So another of the tools he has created is a kind of air-traffic-control program for social-networking sites, with a dashboard that could show administrators where in the network an episode of bullying is turning into a pileup, with many users adding to a stream of comments—à la Let’s Start Drama. 'Sites like Facebook and Formspring aren’t interested in every little incident, but they do care about the pileups,' Lieberman told me. 'For example, the week before prom, every year, you can see a spike in bullying against LGBT kids. With our tool, you can analyze how that spreads—you can make an epidemiological map. And then the social-network site can target its limited resources. They can also trace the outbreak back to its source.' Lieberman’s dashboard could similarly track the escalation of an assault on one kid to the mounting threat of a gang war. That kind of data could be highly useful to schools and community groups as well as the sites themselves. (Lieberman is leery of seeing his program used in such a way that it would release the kids’ names beyond the social networks to real-world authorities, though plenty of teenagers have social-media profiles that are public or semipublic—meaning their behavior is as well.)"

[Sci-fi, Fiction] A man comes home from a war transformed:

"Her husband’s hands came home on a Friday. Rebecca had received word of the attack, which had claimed the lives of seven other soldiers in his unit and reduced three others to similar, minimal fractions of themselves: One man missing above the waist, another missing below, a third neatly halved, like a bisected man on display in an anatomy lab.

"The Veteran’s Administration had told her it could have been worse. The notification officer had reminded her of Tatum, the neighbor’s daughter so completely expunged by her own moment under fire that only a strip of skin and muscle remained: A section of her thigh, about the size and shape of a cigarette pack, returned to her parents in a box and now living in their upstairs room, where it made a living proofreading articles on the internet. That’s no life, the notification officer said."

A former certified nursing assistant recalls what it was like working in an understaffed nursing home, and what happened when she and her fellow CNAs asked for better working conditions:

"A few days later I was called to Sabrina’s office, where she, another administrator, and my charge nurse played good cop, bad cop.

"'We are trying to help you. People have thrown you under the bus by naming you. Why do you want to protect them? They don’t deserve it. You don’t have to sacrifice yourself like this. If you tell us their names, you won’t be the only one taking the blame.'

"'If you don’t tell me who the others are, we will fire you.'

'Are you going to let the others off for ratting you out?'

"'You know, you and all the other people involved are breaking federal law by doing this. You are exposing the conditions of the private lives of the residents. You are violating HIPA. This is illegal. You can be fired and jailed. You can lose your license.'

"My refusals and denials invoked only fiery glares."

What end-of-life options do the terminally ill have? Should they be offered "aid in dying?"

"When a patient in the Northeast contacts Compassion & Choices, he is referred to Schwarz, whose first order of business is to find out who the patient is and what his current medical situation entails. Then, Schwarz attempts to get a sense of what the patient is looking for. She tries to provide information to all callers, but to qualify for help, patients should be able to make their own decisions and be suffering, whether in a terminal stage of illness or not.

"'There’s a lot of misunderstanding about what we do,' Schwarz said. 'What we do is provide information about end-of-life choices to help patients make informed decisions that reflect their values and wishes. We don’t provide the means. We don’t administer. We don’t encourage or coerce. We have no agenda other than to provide complete and accurate information about end-of-life options.'

"And in doing this, Schwarz’s role is to help a patient navigate the end of his life so he can maintain some control over it, instead of leaving it to doctors who are trained not only to lessen suffering but also to keep him alive and death at bay."