Michael Crichton - A Case of Need

“What did you do about the bleeding?”

“I tried to localize it. It was hard, and things were pretty rushed. And we couldn’t angle the lights down properly. Finally I decided to pack it with gauze pads and concentrate on getting her blood volume back up.”

“Where was Mrs. Randall during all this?”

“She waited by the door. She seemed all right until we had to tell her what had happened. Then she went to pieces. Just went to pieces.”

“What about Karen’s records? Had she ever been admitted to the hospital before?”

“I didn’t see her chart,” he said, “until… later. They had to be pulled from the record room. But she had been in before. Papp smears every year since she was fifteen. Usual blood tests from her twice-yearly physicals. She was well looked after medically, as you might expect.”

“Was there anything unusual in her past history? Besides the hypersensitivity, I mean.”

He gave a sad smile. “Isn’t that enough?”

For a fleeting moment I was angry with him. He was soaking in self-pity, despite his natural fright. But I wanted to tell him he’d better get used to the idea of people dying in front of him, lots of people. And he’d better get used to the idea that he could make a mistake, because they happened. Sometimes the mistakes were balder than others, but it was just degree. I wanted to tell him if he’d asked Mrs. Randall about Karen’s hypersensitivity, and she’d said the girl was O.K., that Whiting would have been free and clear. The girl would still have died, of course, but Whiting would be clear. His mistake was not killing Karen Randall; it was not asking permission first.

I thought about saying this, but I didn’t.

“Any indication in the chart of psychiatric problems?” I asked.

“No.”

“Nothing unusual at all?”

“No.” Then he frowned. “Wait a minute. There was one strange thing. A complete set of skull films were ordered about six months ago.”

“Did you see the films?”

“No. I just read the radiologist’s dx.”

“And what was that?”

“Normal. No pathology.”

“Why were the films taken?”

“It didn’t say.”

“Was she in an accident of some kind? A fall, or an auto accident?”

“Not that I know of.”

“Who ordered the films?”

“Probably Dr. Randall. Peter Randall, that is. He was her doctor.”

“And you don’t know why the X rays were taken?”

“No.”

“But there must be a reason,” I said.

“Yes,” he said, but he didn’t seem very interested. He stared moodily at his coffee, then sipped it. Finally he said, “I hope they take that abortionist and screw him to the wall. Whatever he gets, he deserves worse.”

I stood. The boy was under stress and almost on the verge of tears. All he could see was a promising medical career jeopardized because he had made a mistake with the daughter of a prominent physician. In his anger and frustration and self-pity, he, too, was looking for a goat. And he needed one worse than most.

“Are you planning to settle in Boston?” I asked.

“I was,” he said with a wry look.

WHEN I LEFT THE INTERN I called Lewis Carr. I wanted to see Karen Randall’s chart more than ever. I had to find out about those X rays.

“Lew,” I said, “I’m going to need your help again.”

“Oh?” He sounded thrilled by the prospect.

“Yes. I’ve got to get her chart. It’s imperative.”

“I thought we went over that.”

“Yes, but something new has come up. This thing is getting crazier by the minute. Why were X rays ordered—”

“I’m sorry,” Carr said. “I can’t help you.”

“Lew, even if Randall does have the chart, he cant keep—”

“I’m sorry, John. I’m going to be tied up here for the rest of the day and most of tomorrow. I’m just not going to have time.”

He was speaking formally, a man counting his words, repeating the sentences over to himself before speaking them aloud.

“What happened? Randall get to you and button your mouth?”

“I feel,” Carr said, “that the case should be left in the hands of those best equipped to deal with it. I’m not, and I don’t think other doctors are, either.”

I knew what he was saying and what he meant. Art Lee used to laugh about the elaborate way doctors back out of things, leaving behind a spoor of double-talk. Art called it The Pilate Maneuver.

“O.K.,” I said, “if that’s the way you feel.”

I hung up.

In a way, I should have expected it. Lewis Carr always played the game, following all the rules just like a good boy. That was the way he always had been, and the way he always would be.

MY ROUTE FROM WHITING to the medical school took me past the Lincoln Hospital. Standing out in front near the taxi stand was Frank Conway, hunched over, his hands in his pockets, looking down at the pavement. Something about his stance conveyed sadness and a deep, dulling fatigue. I pulled over to the curb.

“Need a ride?”

“I’m going to Children’s,” he said. He seemed surprised that I had stopped. Conway and I aren’t close friends. He is a fine doctor but not pleasant as a man. His first two wives had divorced him, the second after only six months.

“Children’s is on the way,” I said.

It wasn’t, but I’d take him anyway. I wanted to talk to him. He got in and I pulled out into traffic.

“What takes you to Children’s?” I said.

“Conference. They have a congenital CPC once a week. You?”

“Just a visit,” I said. “Lunch with a friend.”

He nodded and sat back. Conway was young, only thirty-five. He had breezed through his residencies, working under the best men in the country. Now he was better than any of them, or so it was said. You couldn’t be sure about a man like Conway: he was one of the few doctors who become so famous so fast that they take on some aspects of politicians and movie stars; they acquire blindly loyal fans and blindly antagonistic critics; one either loves them or loathes them. Physically, Conway was a commanding presence, a stocky, powerful man with gray-flecked hair and deep, piercing blue eyes.

“I wanted to apologize,” Conway said, “about this morning. I didn’t mean to blow up that way.”

“It’s O.K.”

“I have to apologize to Herbie. I said some things…”

“He’ll understand.”

“I feel like hell,” Conway said. “But when you watch a patient just collapse under you, just fall apart before your very eyes…. You don’t know how it is.”

“I don’t,” I admitted.

We drove for a while in silence, then I said, “Can I ask you a favor?”

“Sure.”

“Tell me about J. D. Randall.”

He paused. “Why?”

“Just curious.”

“Bullshit.”

“All right,” I said.

“They got Lee, didn’t they?” Conway said.

“Yes.”

“Did he do it?”

“No.”

“Are you sure?”

“I believe what he tells me,” I said. Conway sighed.

“John,” he said, “you’re not a fool. Suppose somebody hung this thing on you. Wouldn’t you deny it?”

“That’s not the question.”

“Sure it is. Anybody’d deny it.”

“Isn’t it possible Art didn’t do it?”

“It’s not merely possible. It’s likely.”

“Well then?”

Conway shook his head. “You’re forgetting the way it works. J. D. is a big man. J. D. lost a daughter. There happens to be a convenient Chinaman in the neighborhood, who is known to do the nasty deed. A perfect situation.”

“I’ve heard that theory before. I don’t buy it.”

“Then you don’t know J. D. Randall.”