Michael Crichton - A Case of Need

“What’s that?”

“Never take a position unless you are certain it can be defended against any onslaught. That may sound like good advice to a general,” he said, smiling, “but then, a courtroom is nothing more than a very civilized war.”

I HAD TO SEE SANDERSON. I had promised to see him, and now I needed his advice badly. But as I entered the lobby of the Lincoln Hospital, the first person I saw was Harry Fallon.

He was slinking down a corridor, wearing a raincoat and hat pulled down over his forehead. Harry is an internist with a large suburban practice in Newton; he is also a former actor and something of a clown. I greeted him and he raised the brim of his hat slowly. His eyes were bloodshot and his face sallow.

“I hab a code,” Harry said.

“Who are you seeing?”

“Gordon. The cheeb residend.” He took out a Kleenex and blew his nose loudly. “Aboud my bat code.”

I laughed. “You sound like you’ve swallowed cotton.”

“Thang you bery mugh.” He sniffled. “This is no labbing madder.”

He was right, of course. All practicing doctors feared getting sick. Even small colds were considered bad for your image, for what is loosely called “patient rapport,” and any serious illness became a matter for the utmost secrecy. When old Henley finally developed chronic glomerulonephritis, he went to elaborate lengths to be sure his patients never found out; he would visit his doctor in the middle of the night, sneaking about like a thief.

“It doesn’t sound like a bad cold,” I told Harry.

“Hah. You thingh so? Listen to me.” He blew his nose again, a long, honking sound, somewhere between a foghorn and the death rattle of a hippopotamus.

“How long have you had it?”

“Du days. Du miberable, miberable days. My padends are nodicing.”

“What are you taking for it?”

“Hod toddies,” he said. “Besd thing for a virus. Bud the world is againsd me, John. Today, on tob ov my code, I got a tickud.”

“A thickud?”

“Yes. For double-barking.”

I laughed, but at the back of my mind, something was bothering me, something I knew I should be remembering and thinking about, something I had forgotten and ignored.

It was a strange and irritating feeling.

I MET SANDERSON IN THE PATH LIBRARY. It’s a square room with lots of chairs, the folding kind, and a projector and screen. Path conferences are held here, in which autopsies are reviewed, and they are so frequent you can practically never get in to use the library books.

On the shelves, in boxes, were autopsy reports for every person done in the Lincoln since 1923, the year we began to keep good records. Prior to that time, nobody had a very good idea of how many people were dying from what diseases, but as knowledge of medicine and the human body increased that information became vitally important. One proof of increased interest was the number of autopsies performed in 1923 all the reports filled one slim box—but by 1965 it required half a shelf for all the records. At present, more than seventy percent of all patients who died in the hospital were autopsied, and there was talk of microfilming the reports for the library.

In one corner of the room was a portable electric coffeepot, a bowl of sugar, a stack of paper cups, and a sign that said, “5 cents a cup. Scout’s honor.” Sanderson was fussing with the pot, trying to get it to work. The pot represented an ancient challenge: it was said nobody was permitted to finish his path residency at the Lincoln until he had mastered its workings.

“Someday,” Sanderson muttered, “I’m going to electrocute myself on this damned thing.” He plugged it in; crackling sounds were heard. “Me, or some other poor bastard. Cream and sugar?”

“Please,” I said.

Sanderson filled two cups, holding the pot at arm’s length. Sanderson was notoriously bad with anything mechanical. He had a superb, almost instinctive understanding of the human body and its functions of flesh and bone, but mechanical, steel, and electrical objects were beyond him. He lived in constant fear that his car, or his TV, or his stereo would break down; he regarded them all as potential traitors and deserters.

He was a tall, powerfully built man who had once rowed stroke for the Harvard heavyweights. His forearms and wrists were as thick as most men’s calves. He had a solemn, thoughtful face: he might have been a judge, or an excellent poker player.

“Did Weston say anything else?” he asked.

“No.”

“You sound unhappy.”

“Let’s say I’m worried.”

Sanderson shook his head. “I think you’re barking up the wrong tree here,” he said. “Weston wouldn’t fake a report for anybody. If he says he was unsure, then he was.”

“Maybe you should examine the slides yourself.”

“I’d like to,” Sanderson said, “but you know that’s impossible.”

He was right. If he showed up at Mallory and asked to see the slides, it would be taken as a personal insult by Weston. That kind of thing just wasn’t done.

I said, “Maybe if he asked you…”

“Why should he?”

“I don’t know.”

“Weston has made his diagnosis and signed his name to it. The matter closes there, unless it comes up again during the trial.”

I felt a sinking feeling. Over the past days, I had come to believe very strongly that there must not be a trial. Any trial, even an acquittal, would seriously damage Art’s reputation, his standing, and his practice. A trial had to be prevented.

“But you think she was hypopit,” Sanderson said.

“Yes.”

“Etiology?”

“Neoplasm, I think.”

“Adenoma?” [48] A chromophobe adenoma is the most common tumor of the pituitary. It is slow-growing and relatively benign, but it presses on the optic nerve, causing visual symptoms, and it may create endocrine dysfunction.

“I imagine. Maybe craniopharyngioma.”

“How long?”

“It couldn’t be very long,” I said. “X rays four months ago were normal. No enlargement or erosion of the sella turcica. But she did complain of vision trouble.”

“What about pseudotumor?”

Pseudotumor cerebri is a disorder of women and young children. Patients get all the symptoms of a tumor, but don’t actually have one. It is related to withdrawal of steroid therapy; women sometimes get it when taking birth-control pills. But as far as I knew, Karen wasn’t taking pills. I told Sanderson.

“Too bad we don’t have slides of the brain,” he said.

I nodded.

“On the other hand,” Sanderson said, “an abortion was performed. We can’t forget that.”

“I know,” I said. “But it’s just another indicator that Art didn’t do it. He wouldn’t have aborted her without doing a bunny test first, and such a test would have been negative.”

“That’s only circumstantial evidence, at best.”

“I know,” I said, “but it’s something. A start.”

“There is another possibility,” Sanderson said. “Supposing the abortionist was willing to take Karen’s word that she was pregnant.”

I frowned. “I don’t understand. Art didn’t know the girl; he had never seen her before. He would never—”

“I’m not thinking of Art,” Sanderson said. He was staring at his feet, as if he had something embarrassing on his mind.

“What do you mean?”

“Well, this is all highly speculative.…”

I waited for him.

“A lot of muck has been thrown already. I hate to add to it,” he said.

I said nothing.

“I never knew it before,” Sanderson continued. “I thought I was pretty well informed about these things, but I never knew it until today. As you can imagine, the whole medical community is buzzing. J. D. Randall’s girl dies from an abortion—you can’t keep other doctors from talking about that.” He sighed. “Anyway, it was something one of the wives told my wife. I don’t even know if it’s true.”