Michael Crichton: A Case of Need

I cut a slice of the white lump and quick-froze it. There was only one way to be certain if the mass was benign or malignant, and that was to check it under the microscope. Quick-freezing the tissue allowed a thin section to be rapidly prepared. Normally, to make a microscope slide, you had to dunk your stuff into six or seven baths; it took at least six hours, sometimes days. The surgeons couldn’t wait. When the tissue was frozen hard, I cranked out a section with the microtome, stained the slice, and took it to the microscope. I didn’t even need to go to high dry: under the low-power objective, I could see the lacy network of lung tissue formed into delicate alveolar sacs for exchange of gas between blood and air. The white mass was something else again. I stepped on the floor button. “Micro examination, frozen section. The whitish mass appears composed of undifferentiated parenchyma cells which have invaded the normal surrounding tissue. The cells show many irregular, hyperchromatic nuclei and large numbers of mitoses. There are some multinucleate giant cells. There is no clearly defined capsule. Impression is primary malignant cancer of the lung. Note marked degree of anthracosis in surrounding tissue.”

Anthracosis is accumulation of carbon particles in the lung. Once you gulp carbon down, either as cigarette smoke or city dirt, your body never gets rid of it. It just stays in your lungs.

The telephone rang. I knew it would be Scanlon down in the OR, wetting his pants because we hadn’t gotten back to him in thirty seconds flat. Scanlon is like all surgeons. If he’s not cutting, he’s not happy. He hates to stand around and look at the big hole he’s chopped in the guy while he waits for the report. He never stops to think that after he takes a biopsy and drops it into a steel dish, an orderly has to bring it all the way from the surgical wing to the path labs before we can look at it. Scanlon also doesn’t figure that there are eleven other operating rooms in the hospital, all going like hell between seven and eleven in the morning. We have four residents and pathologists at work during those hours, but biopsies get backed up. There’s nothing we can do about it—unless they want to risk a misdiagnosis by us.

And they don’t. They just want to bitch, like Conway. It gives them something to do. All surgeons have persecution complexes anyway. Ask the psychiatrists.

As I went to the phone, I stripped off one rubber glove. My hand was sweaty; I wiped it on the seat of my pants, then picked up the receiver. We are careful about the phone, but just to be safe it gets swabbed with alcohol and Formalin at the end of each day. “Berry speaking.”

“Berry, what’s going on up there”?” After Conway, I felt like taking him on, but I didn’t. I just said, “You’ve got a malignancy.”

“I thought so,” Scanlon said as if the whole path work-up had been a waste of time. “Yeah,” I said and hung up. I wanted a cigarette badly. I’d only had one at breakfast, and I usually have two.

Returning to my table, I saw three specimens were waiting: a kidney, a gallbladder, and an appendix. I started to pull my glove back on when the intercom clicked.

“Dr. Berry?”

“Yes?”

The intercom has a high pickup. You can speak in a normal voice anywhere in the room, and the girl will hear you. They mount the microphone high up, near the ceiling, because the new residents usually rush over and shout into it, not knowing how sensitive it is. That blasts the ears off the girl at the other end.

“Dr. Berry, your wife is on the telephone.”

I paused. Judith and I have an understanding: no calls in the morning. I’m always busy from seven to eleven, six days a week, sometimes seven if one of the staff gets sick. She’s usually very good about it. She didn’t even call when Johnny drove his tricycle into the back of a truck and had to have fifteen stitches in his forehead.

“All right,” I said, “I’ll take it.” I looked down at my hand. The glove was half on. I stripped it off and went back to the phone.

“Hello?”

“John?” Her voice was trembling. I hadn’t heard her sound that way in years. Not since her father died.

“What is it?”

“John, Arthur Lee just called.”

Art Lee was an obstetrician friend of ours; he had been best man at our wedding.

“What’s the problem?”

“He called here asking for you. He’s in trouble.”

“What kind of trouble?” As I spoke, I waved to a resident to take my place at the table. We had to keep those surgical specimens moving.

“I don’t know,” Judith said, “but he’s in jail.” My first thought was that it was some kind of mistake. “Are you sure?”

“Yes. He just called. John, is it something about– ?”

“I don’t know,” I said. “I don’t know any more than you do.” I cradled the phone in my shoulder and stripped away my other glove. I threw them both in the vinyl-lined wastebasket. “I’ll go see him now,” I said. “You sit tight and don’t worry. It’s probably a minor thing. Maybe he was drinking again.”

“All right,” she said in a low voice.

“Don’t worry,” I repeated.

“All right.”

“I’ll speak to you soon.”

I hung up, untied my apron, and placed it on the peg by the door. Then I went down the hall to Sanderson’s office. Sanderson was chief of the path labs. He was very dignified looking; at forty-eight, his hair was just turning gray at the temples. He had a jowly, thoughtful face. He also had as much to fear as I did.

“Art’s in jail,” I said.

He was in the middle of reviewing an autopsy case. He shut the file. “Why?”

“I don’t know. I’m going to see him.”

“Do you want me to come with you?”

“No,” I said. “It’s better if I go alone.”

“Call me,” Sanderson said, peering over his half frames, “when you know.”

“I will.”

He nodded. When I left him, he had opened the file again, and was reading the case. If he had been upset by the news, he wasn’t showing it. But then Sanderson never did.

In the hospital lobby I reached into my pocket for my car keys, then realized I didn’t know where they were holding Art, so I went to the information desk to call Judith and ask her. The girl at the desk was Sally Planck, a good-natured blonde whose name was the subject of endless jokes among the residents. I phoned Judith and asked where Art was; she didn’t know. It hadn’t occurred to her to ask. So I called Arthur’s wife, Betty, a beautiful and efficient girl with a Ph.D. in biochem from Stanford. Until a few years ago, Betty had done research at Harvard, but she stopped when she had her third child. She was usually very calm. The only time I had seen her upset was when George Kovacs had gotten drunk and urinated all over her patio.

Betty answered the phone in a state of stony shock. She told me they had Arthur downtown, on Charles Street. He had been arrested in his home that morning, just as he was leaving for the office. The kids were very upset, and she had kept them home from school that day, and now what did she do with them? What was she supposed to tell them, for Pete’s sake?

I told her to say it was all a mistake and hung up.

I DROVE MY VOLKSWAGEN out of the doctors’ parking lot, past all the shiny Cadillacs. The big cars are all owned by practicing physicians; pathologists are paid by the hospital and can’t afford all those glistening horses.

It was 8:45, right in the middle of rush-hour traffic, which in Boston means a life-and-death proposition. Boston has the highest accident rate in the U.S., even higher than Los Angeles, as any EW [5] Emergency ward. intern can tell you. Or pathologists: we see a lot of automobile trauma at autopsy. They drive like maniacs; like sitting in the EW as the bodies come in, you think there’s a war going on. Judith says it’s because they’re repressed. Art has always said it was because they’re Catholic and think God will look after them as they wander across the double stripe, but Art is a cynic. Once, at a medical party, a surgeon explained how many eye injuries occur from plastic dashboard figurines. People get into accidents, pitch forward, and have their eyes put out by the six-inch Madonna. It happens a lot; Art thought it was the funniest thing he had ever heard.