Michael Crichton - A Case of Need

“Yes,” I said, “I do.”

The whites came, and I climbed into them. It was an odd feeling; I hadn’t worn whites for years. I’d been proud of it then. Now the fabric seemed stiff and uncomfortable.

They found my shoes, wet and bloody; I wiped them off and put them on. I felt weak and tired, but I had to keep going. It was all going to be finished tonight. I was certain of it.

I got some coffee and a sandwich. I couldn’t taste it, it was like eating newspaper, but I thought the food was necessary. Hammond stayed with me.

“By the way,” he said, “I checked on Roman Jones for you.”

“And?”

“He was only seen once. In the GU [50] Genitourinary. clinic. Came in with what sounded like renal colic, so they did a urinalysis.”

“Yes?”

“He had hematuria, all right. Nucleated red cells.”

“I see.”

It was a classic story. Patients often showed up in clinic complaining of severe pain in the lower abdomen and decreased urine output. The most likely diagnosis was a kidney stone, one of the five most painful conditions there are; morphine is given almost immediately when the diagnosis is made. But in order to prove it, one asks for a urine sample and examines it for slight blood. Kidney stones are usually irritating and cause a little bleeding in the urinary tract.

Morphine addicts, knowing the relative ease of getting morphine for kidney stones, often try to mimic renal colic. Some of them are very good at it; they know the symptoms and can reproduce them exactly. Then when they’re asked for a urine sample, they go into the bathroom, collect the sample, prick their fingers, and allow a small drop of blood to fall in.

But some of them are squeamish. Instead of using their own blood, they use the blood of an animal, like a chicken. The only trouble is that chicken red cells have nuclei, while those of humans do not. So nucleated red cells in a patient with renal colic almost always meant someone faking the symptoms, and that usually meant an addict.

“Was he examined for needle marks?”

“No. When the doctor confronted him, he left the clinic. He’s never been seen again.”

“Interesting. Then he probably is an addict.”

“Yes. Probably.”

After the food, I felt better. I got to my feet, feeling the exhaustion and the pain. I called Judith and told her I was at the Mem OPD and that I was fine, not to worry. I didn’t mention the beating or the cut. I knew she would have a fit when I got home, but I wasn’t going to excite her now.

I walked down the corridor with Hammond, trying not to wince from the pain. He kept asking me how I felt, and I kept telling him I felt fine. In fact, I didn’t. The food was beginning to make me nauseated, and my headache was worse standing up. But the worst thing was the fatigue. I was terribly, terribly tired.

We went to the emergency entrance of the EW. It was a kind of stall, an open-ended garage where the ambulances backed up and unloaded their cargoes. Swinging, automatic doors, operated by foot-pressure pads, led into the hospital. We walked out and breathed the cool night air. It was a rainy, misty night, but the cool air felt good to me.

Hammond said, “You’re pale.”

“I’m O.K.”

“We haven’t even begun to evaluate you for internal hemorrhage.”

“I’m O.K.,” I said.

“Tell me if you’re not,” Hammond said. “Don’t be a hero.”

“I’m not a hero,” I said.

We waited there. An occasional automobile drove past us, tires hissing on the wet streets; otherwise it was silent.

“What’s going to happen?” Hammond said.

“I’m not sure. But I think they’re going to bring in a Negro and a girl.”

“Roman Jones? Is he involved in all this?”

“I think so.”

In fact, I was almost certain that it had been Roman Jones who had beaten me up. I didn’t remember exactly any more; the events right before the accident were hazy. I might have expected that. I didn’t have true retrograde amnesia, which is common with concussions and extends back for fifteen minutes before the accident. But I was a little confused.

It must have been Roman, I thought. He was the only logical one. Roman had been heading for Beacon Hill. And there was only one logical reason for that, too.

We would have to wait.

“How do you feel?”

“You keep asking,” I said. “And I keep telling you I’m fine.”

“You looked tired.”

“I am tired. I’ve been tired all week.”

“No. I mean you look drowsy.”

“Don’t jump the gun,” I said. I glanced at my watch. Nearly two hours had passed since I had been beaten up. That was plenty of time. More than enough time.

I began to wonder if something had gone wrong.

At that moment, a police car came around the corner, tires squealing, siren going, blue light flashing. Immediately afterward an ambulance pulled up, followed by a third car. As the ambulance backed in, two men in business suits jumped out of the third car: reporters. You could tell by their eager little faces. One had a camera.

“No pictures,” I said.

The ambulance doors were opened and a body on a stretcher was brought out. The first thing I saw was the clothes—slashed and ripped across the trunk and upper limbs, as if the body had been caught in some kind of monstrous machine. Then, in the cold fluorescent light of the EW entrance, I saw the face: Roman Jones. His skull was caved in on the right side like a deflated football, and his lips were purple-black. The flashbulbs popped.

Right there in the alleyway, Hammond went to work. He was quick: in a single movement, he picked up the wrist with his left hand, put his ear over the chest, and felt the carotids in the neck with his right hand. Then he straightened and without a word began to pound the chest. He did it with one hand flat and the heel of the other thumping against the flat hand in sharp, hard, rhythmic beats.

“Call anesthesia,” he said, “and get the surgical resident. Get an arrest cart here. I want aramine, one-in-a-thousand solution. Oxygen by mask. Positive pressure. Let’s go.”

We moved him inside the EW and down to one of the little treatment rooms. Hammond continued the cardiac massage all the time, not breaking his rhythm. When we got to the room the surgical resident was there. “Arrested?”

“Yes,” Hammond said. “Apneic, no pulses anywhere.”

The surgeon picked up a paper packet of size-eight gloves. He didn’t wait for the nurse to open them for him; he took them out of the paper himself and yanked them over his fingers. He never took his eyes off the motionless figure of Roman Jones.

“We’ll open him up,” the surgeon said, flexing his fingers in the gloves.

Hammond nodded, continuing his pounding of the chest. It didn’t seem to be doing much good: Roman’s lips and tongue were blacker. His skin, especially in the face and ears, was blotchy and dark.

An oxygen mask was slapped on.

“How much, sir?” said the nurse.

“Seven liters,” said the surgeon. He was given a scalpel. Roman’s already shredded clothes were torn away from his chest; nobody bothered to strip him down completely. The surgeon stepped forward, his face blank, the scalpel held tightly in his right hand with his index finger over the blade.

“All right,” he said and made the incision, sloping, across the ribs on the left side. It was a deep incision and there was bleeding, which he ignored. He exposed the whitish glistening ribs, cut between them, and then applied retractors. The retractors were pulled wide and there was a crunching, snapping sound as the ribs snapped. Through the gaping incision, we could see Roman’s lungs, collapsed and wrinkled-looking, and his heart, large, bluish, not beating, but wriggling like a bag of worms.