Michael Crichton - A Case of Need

The telephone rang. It was Sanderson, head of the path labs at the Lincoln. The first thing he said was, “I’m calling from the hospital phone.”

“O.K.,” I said.

The hospital phone had at least six extensions. In the evening, anyone could listen in.

“How was your day?” Sanderson said.

“Interesting,” I said. “How was yours?”

“It had its moments,” Sanderson said.

I could imagine. Anyone who wanted me out of his hair would put the squeeze on Sanderson. It was the most logical thing to do, and it could be managed quite subtly. A few jokes: “Say, I hear you’re shorthanded these days.” A few earnest inquiries: “What’s this I hear about Berry being sick? Oh? I heard that he was. But he hasn’t been in, has he?” Then a few choice words from the chiefs of service: “Sanderson, how the hell do you expect me to keep my medical staff in line when you’re letting your path people take off all the time?” And finally someone from the administration: “We run a shipshape hospital here, everybody has his job and everybody does it, no deadwood on board.”

The net effect would be an intense pressure to get me back in the lab or find a new man.

“Tell them I’ve got tertiary syphilis,” I said. “That should hold them.”

Sanderson laughed. “There’s no problem,” he said. “Yet. I’ve got a pretty tough old neck. I can keep it stuck out a while longer.”

Then he paused, and said, “How much longer do you think it will be?”

“I don’t know,” I said. “It’s complicated.”

“Come by and see me tomorrow,” he said. “We can discuss it.”

“Good,” I said. “Maybe by then I’ll know more. Right now, it’s just as bad as the Peru case.”

“I see,” Sanderson said. “Tomorrow, then.”

“Right.”

I hung up, certain he knew what I was talking about. I had meant that there was something wrong with the Karen Randall business, something out of place. It was like a case we had three months ago, a rare thing called agranulocytosis, the complete absence of white cells in the blood. It’s a serious condition because without white cells, you can’t fight infection. Most people are carrying disease organisms around in their mouth or body normally—staph or strep, sometimes diphtheria and pneumococcus—and if your bodily defenses go down, you infect yourself.

Anyhow, the patient was American, a doctor working for the Public Health Service in Peru. He was taking a Peruvian drug for asthma, and one day he began to get sick. He had sores in his mouth and a temperature, and he felt lousy. He went to a doctor in Lima and had a blood test. His white count was 600. [32] Normal white count is 4-9,000 cells/cubic centimeter. With infection, this may double or triple. The next day it was down to 100, and the next day it was zero. He got a plane to Boston and checked into our hospital.

They did a bone-marrow biopsy, sticking a hollow needle into his sternum [33] Breastbone. and drawing out some marrow. I looked at it microscopically and was puzzled. He had lots of immature cells of the granulocyte series in his marrow, and while it was abnormal, it was not terribly bad. I thought, “Hell, something is wrong here,” so I went to see his doctor.

His doctor had been tracing the Peruvian drug the patient was taking. It turned out to contain a substance removed from the American market in 1942 because it suppressed white-cell formation.

The doctor figured this was what was wrong with his patient—he had suppressed his own white cells, and now he was infecting himself. The treatment was simple: take him off the drug, do nothing, and wait for his marrow to recover.

I told the doctor that the marrow didn’t look so bad on the slide. We went to see the patient and found he was still sick. He had ulcers in his mouth, and staph infections on his legs and back. He had a high fever, was lethargic, and answered questions slowly.

We couldn’t understand why his marrow should seem so basically normal when he was so damned sick; we puzzled over this for most of the afternoon. Finally, about four, I asked the doctor if there had been any infection at the site of biopsy, where they had made the puncture to draw marrow. The doctor said he hadn’t checked. We went to the patient and examined his chest.

Surprise: unpunctured. The marrow biopsy hadn’t been taken from this patient. One of the nurses or residents had screwed up the tags, mislabeling a marrow sample from a man with suspected leukemia. We immediately drew a sample from our patient and found a very suppressed marrow indeed.

The patient later recovered, but I would never forget our puzzling over the lab results.

I HAD THE SAME FEELING NOW—something was wrong, something was out of place. I couldn’t put my finger on it, but I had the suspicion that people were working at cross-purposes, almost as if we were talking about different things. My own position was clear: Art was innocent until proven guilty, and that wasn’t proven yet.

Nobody else seemed to care whether Art was guilty or not. The issue that was crucial to me was irrelevant to them.

Now why was that?

WHEN I AWOKE IT FELT LIKE A NORMAL DAY. I was exhausted and it was drizzling outside, cold, gray, and uninviting. I pulled off my pajamas and took a hot shower. While I was shaving, Judith came in and kissed me, then went to the kitchen to make breakfast. I smiled into the mirror and caught myself wondering what the surgical schedule would be like.

Then I remembered: I wasn’t going to the hospital today. The whole business came back to me.

It was not a normal day.

I went to the window and stared at the drizzle on the glass. I wondered then for the first time whether I ought to drop everything and go back to work. The prospect of driving to the lab, parking in the lot, hanging up my coat, and putting on my apron and gloves—all the familiar details of routine—seemed suddenly very appealing, almost enticing. It was my job; I was comfortable at it; there were no stresses or strains; it was what I was trained to do. I had no business playing amateur detective. In the cold morning light, the idea seemed ludicrous.

Then I began to remember the faces I had seen. Art’s face, and the face of J. D. Randall, and Bradford’s smug confidence. And I knew that if I didn’t help Art, nobody would.

In one sense, it was a frightening, almost terrifying thought.

JUDITH SAT WITH ME AT BREAKFAST. The kids were still asleep; we were alone.

“What are you planning today?” she said.

“I’m not sure.”

I had been asking myself that very question. I had to find out more, lots more. About Karen, and Mrs. Randall particularly. I still didn’t know very much about either of them.

“I’ll start with the girl,” I said.

“Why?”

“From what I’ve been told, she was all sweetness and light. Everybody loved her; she was a wonderful girl.”

“Maybe she was.”

“Yes,” I said, “but it might be good to get the opinion of someone besides her brother and her father.”

“How?”

“I’ll begin,” I said, “with Smith College.”

SMITH COLLEGE, Northampton, Massachusetts, 2,200 girls getting an exclusive education in the middle of nowhere. It was two hours on the turnpike to the Holyoke exit; another half-hour on small roads until I passed under the train tracks and came into the town. I’ve never liked Northampton. It has a peculiarly repressed atmosphere for a college town; you can almost smell irritation and frustration in the air, the heavy combined frustration of 2,200 pretty girls consigned to the wilderness for four years, and the combined irritation of the natives who are forced to put up with them for that time.