Michael Crichton - A Case of Need

It takes a certain kind of man to assume this burden, to set his sights on such a distant goal. By the time he is ready to begin surgery on his own, he has become another person, almost a new breed, estranged by his experience and his dedication from other men. In a sense, that is part of the training: surgeons are lonely men.

I thought of this as I looked down through the glass-overhead viewing booth into OR 9. The booth was built into the ceiling, allowing you a good view of the entire room, the staff, and the procedure. Students and residents often sat up here and watched. There was a microphone in the OR, so that you heard everything—the clink of instruments, the rhythmic hiss of the respirator, the quiet voices—and there was a button you could press to talk to the people below. Otherwise they could not hear you.

I had come to this room after going to J. D. Randall’s office. I had wanted to see the chart on Karen, but Randall’s secretary said she didn’t have it. J. D. had it, and J. D. was in surgery now. That had surprised me. I had thought he would have taken the day off, considering. But apparently it had not entered his mind.

The secretary said the operation was probably almost over, but one look through the glass told me it was not. The chest of the patient was still open and the heart was still incised; they had not even begun suturing. There I was not going to interrupt them; I’d have to come back later to try and get the chart.

But I stayed a moment to watch. There is something compelling about open-heart surgery, something fantastic and fabulous, a mixture of dream and nightmare, all come true. There were sixteen people in the room below me, including four surgeons. Everyone was moving, working, checking in smooth, coordinated movements, like a kind of ballet, like a surrealistic ballet. The patient, draped in green, was dwarfed by the heart-lung machine alongside him, a giant complex as large as an automobile, shining steel, with smoothly moving cylinders and wheels.

At the head of the patient was the anesthetist, surrounded by equipment. There were several nurses, two pump technicians who monitored the dials and gauges on the machine, nurses, orderlies, and the surgeons. I tried to tell which was Randall, but I could not; in their gowns and masks, they all looked the same, impersonal, interchangeable. That was not true, of course. One of those four men had responsibility for everything, for the conduct of all sixteen workers present. And responsibility for the seventeenth person in that room, the man whose heart was stopped.

In one corner, displayed on a television, was the electrocardiogram. The normal EKG is a briskly bouncing line, with spikes for every heartbeat, every wave of electrical energy that fires the heart muscle. This one was flat: just a meaningless squiggle. That meant that according to one major criterion of medicine, the patient was dead. I looked at the pink lungs through the open chest; they were not moving. The patient was not breathing.

The machine did all that for him. It pumped his blood, oxygenated it, removed the carbon dioxide. In its present form, the machine had been in use for about ten years.

The people below me did not seem in awe of the machine or the surgical procedure. They worked matter-of-factly at their jobs. I suppose that was one reason why it all seemed so fantastic.

I watched for five minutes without realizing the time. Then I left. Outside, in the corridor, two residents slouched in a doorway, still wearing their caps with their masks hanging loosely around their necks. They were eating doughnuts and coffee, and laughing about a blind date.

ROGER WHITING, M.D., lived near the hospital in a third-floor walk-up on the sleazy side of Beacon Hill, where they dump the garbage from Louisburg Square. His wife answered the door. She was a plain girl, about seven months’ pregnant. She looked worried.

“What do you want?”

“I’d like to talk to your husband. My name’s Berry. I’m a pathologist at the Lincoln.”

She gave me a hard suspicious glance. “My husband is trying to sleep. He’s been on call for the last two days, and he’s tired. He’s trying to sleep.”

“It’s very important.”

A slim young man in white ducks appeared behind her. He looked more than tired; he looked exhausted and afraid. He said, “What is it?”

“I’d like to talk to you about Karen Randall.”

“I’ve been over it,” he said, “a dozen times. Talk to Dr. Carr about it.”

“I did.”

Whiting ran his hands through his hair, then said to his wife, “It’s O.K., honey. Get me some coffee, would you?” He turned to me. “Want some coffee?”

“Please,” I said.

We sat in the living room. The apartment was small, the furniture cheap and rickety. But I felt at home: it had been only a few years since I had done my own internship. I knew all about the money problems, the stresses, the hellish hours, and the slop work you had to do. I knew about the irritating calls from nurses in the middle of the night, asking you to okay another aspirin for patient Jones. I knew how you could drag yourself out of bed to see a patient and how you could, in the small hours of the morning, make a mistake. I had nearly killed an old man with heart failure when I was an intern. With three hours of sleep during the last two days, you could do anything and not give a damn.

“I know you’re tired,” I said. “I won’t stay long.”

“No, no,” he said very earnestly. “Anything I can do to help. I mean, now…”

The wife came in with two cups of coffee. She looked at me angrily. The coffee was weak.

“My questions,” I said, “have to do with the girl when she first arrived. Were you in the ward?”

“No. I was trying to sleep. They called me.”

“What time was this?”

“Almost exactly four.”

“Describe what happened.”

“I was sleeping in my clothes, in that little room just off the OPD. I wasn’t asleep long when they called me; I’d just gotten through putting another IV into a lady who pulls them out. She says she doesn’t, but she does.” He sighed. “Anyway, when they called me, I was bleary as hell. I got up and dunked my head in cold water, then toweled off. When I got to the ward, they were bringing the girl in on a stretcher.”

“Was she conscious?”

“Yes, but disoriented. She was pale, and she’d lost a lot of blood. She was feverish and delirious. We couldn’t get a good temperature because she kept gnashing her teeth, so we figured it was about 102 and got to work on the cross-matching.”

“What else was done?”

“The nurses got a blanket over her and propped her feet up with shock blocks. [28] Shock blocks are simply wooden blocks used to elevate the legs in cases of shock, helping to get blood to the head. Then I examined the lesion. It was very clearly vaginal hemorrhage and we diagnosed it as miscarriage.”

“About the bleeding,” I said, “was there any discharge accompanying it?”

He shook his head. “Just blood.”

“No tissue? No signs of a placenta?”

“No. But she’d been bleeding for a long time. Her clothes…” He looked across the room, seeing it again in his mind. “Her clothes were very heavy. The nurses had trouble getting them off.”

“During this time, did the girl say anything coherent?”

“Not really. She was mumbling every once in a while. Something about an old man, I think. Her old man, or an old man. But it wasn’t clear, and nobody was really paying any attention.”

“Did she say anything else?”

He shook his head. “Just when they were cutting her clothes off her. She would try to pull them back. Once she said ‘You can’t do this to me.’ And then later she said, ‘Where am I?’ But that was just delirious talk. She wasn’t really coherent.”