Michael Crichton - A Case of Need

I lit a cigarette and thought to myself that I wouldn’t like to be that intern now.

“Probably,” Carr said, “the girl would have died anyway. We don’t know that for sure, but there’s every reason to think that at admission her blood loss already approached fifty percent. That seems to be the cut-off, as you know—the shock is usually irreversible. So we probably couldn’t have kept her. Of course, that doesn’t change anything.”

I said, “Why’d the intern give penicillin in the first place?”

“That’s a peculiarity of hospital procedure,” Carr said. “It’s a kind of routine around here for certain presenting symptoms. Normally when we get a girl with evidence of a vaginal bleed and a high fever—possible infection—we give the girl a D & C, put her to bed, and stick her a shot of antibiotic. Send her home the next day, usually. And it goes down on the charts as miscarriage.”

“Is that the final diagnosis on Karen Randall’s record? Miscarriage?”

Carr nodded. “Spontaneous. We always put it down that way, because if we do that, we don’t have to fool with the police. We see quite a few self-induced or illegally induced abortions here. Sometimes the girls come in with so much vaginal soap they foam like overloaded dishwashers. Other times, it’s bleeding. In every case, the girl is hysterical and full of wild lies. We just take care of it quietly and send her on her way.”

“And never report it to the police?” [26] See Appendix II: Cops and Doctors.

“We’re doctors, not law-enforcement officers. We see about a hundred girls a year this way. If we reported every one, we’d all spend our time in court testifying and not practicing medicine.”

“But doesn’t the law require—”

“Of course,” Carr said quickly. “The law requires that we report it. The law also requires that we report assaults, but if we reported every drunk who got into a bar brawl, we’d never hear the end of it. No emergency ward reports everything it should. You just can’t operate on that basis.”

“But if there’s been an abortion—”

“Look at it logically,” Carr said. “A significant number of these cases are spontaneous miscarriages. A significant number aren’t, but it doesn’t make sense for us to treat it any other way. Suppose you know that the butcher of Barcelona worked on a girl; suppose you call in the police. They show up the next day and the girl tells them it was spontaneous. Or she tells them she tried it on herself. But either way she won’t talk, so the police are annoyed. Mostly, with you, because you called them in.”

“Does this happen?”

“Yes,” Carr said, “I’ve seen it happen twice myself. Both times, the girl showed up crazy with fear, convinced she was going to die. She wanted to nail the abortionist, so she demanded the police be called in. But by morning, she was feeling fine, she’d had a nice hospital D & C, and she realized her problems were over. She didn’t want to fool with the police; she didn’t want to get involved. So when the cops came, she pretended it was all a big mistake.”

“Are you content to clean up after the abortionists and let it go?”

“We are trying to restore people to health. That’s all. A doctor can’t make value judgments. We clean up after a lot of bad drivers and mean drunks, too. But it isn’t our job to slap anybody’s hand and give them a lecture on driving or alcohol. We just try to make them well again.”

I wasn’t going to argue with him; I knew it wouldn’t do any good. So I changed the subject.

“What about the charges against Lee? What happened there?”

“When the girl died,” Carr said, “Mrs. Randall became hysterical. She started to scream, so they gave her a tranquilizer and sedative. After that, she settled down, but she continued to claim that her daughter had named Lee as the abortionist. So she called the police.”

“Mrs. Randall did?”

“That’s right.”

“What about the hospital diagnosis?”

“It remains miscarriage. This is a legitimate medical interpretation. The change to illegal abortion is made on nonclinical grounds, so far as we are concerned. The autopsy will show whether an abortion was performed.”

“The autopsy showed it,” I said. “Quite a good abortion, too, except for a single laceration of the endornetrium. It was done by someone with skill—but not quite enough skill.”

“Have you talked with Lee?”

“This morning,” I said. “He claims he didn’t do it. On the basis of that autopsy, I believe him.”

“A mistake—”

“I don’t think so. Art’s too good, too capable.”

Carr removed the stethoscope from his pocket and played with it, looked uncomfortable. “This is a very messy thing,” he said. “Very messy.”

“It has to be cleared up,” I said. “We can’t hide our heads in the sand and let Lee go to hell.”

“No, of course not,” Carr said. “But J. D. was very upset.”

“I imagine so.”

“He practically killed that poor intern when he saw what treatment had been given. I was there, and I thought he was going to strangle the kid with his bare hands.”

“Who was the intern?”

“Kid named Roger Whiting. Nice kid, even though he went to P & S.”

“Where is he now?”

“At home, probably. He went off at eight this morning.” Carr frowned and fiddled once more with his stethoscope. “John,” he said, “are you sure you want to get involved in this?”

“I don’t want anything to do with it,” I said. “If I had my choice, I’d be back in my lab now. But I don’t see any choice.”

“The trouble is,” Carr said slowly, “that this thing has gotten out of control. J. D. is very upset.”

“You said that before.”

“I’m just trying to help you understand how things are.” Carr rearranged things on his desk and did not look at me. Finally he said, “The case is in the proper hands. And I understand Lee has a good lawyer.”

“There are a lot of dangling questions. I want to be sure they’re all cleaned up.”

“It’s in the proper hands,” Carr said again.

“Whose hands? The Randalls? The goons I saw down at the police station?”

“We have an excellent police force in Boston,” Carr said.

“Bullshit.”

He sighed patiently and said, “What can you hope to prove?”

“That Lee didn’t do it.”

Carr shook his head. “That’s not the point.”

“It seems to me that’s precisely the point.”

“No,” Carr said. “The point is that the daughter of J. D. Randall was killed by an abortionist, and somebody has to pay. Lee’s an abortionist—that won’t be hard to prove in court. In a Boston court, the jury is likely to be more than half Catholic. They’ll convict him on general principles.”

“On general principles?”

“You know what I mean,” Carr said, shifting in his chair.

“You mean Lee’s the goat.”

“That’s right. Lee’s the goat.”

“Is that the official word?”

“More or less,” Carr said.

“And what are your feelings about it?”

“A man who performs abortions puts himself in danger. He’s breaking the law. When he aborts the daughter of a famous Boston physician—”

“Lee says he didn’t do it.”

Carr gave a sad smile. “Does it matter?”

IT TAKES THIRTEEN YEARS from the time you leave college to the time you become a cardiac surgeon. You have four years of medical school, a year of internship, three of general surgery, two of thoracic surgery, two of cardiac surgery. Somewhere along the line, you spend two years working for Uncle Sam. [27] See Appendix III: Battlefields and Barberpoles.