Michael Crichton - A Case of Need

The surgeon reached into the chest and began to massage. He did it smoothly, contracting his little finger first, then all the others in his hand up to the index finger, expelling blood from the heart. He squeezed very hard and grunted rhythmically.

Someone had slapped on a blood-pressure cuff and Hammond pumped it up to take a reading. He watched the needle for a moment, then said, “Nothing.”

“He’s fibrillating,” the resident said, holding the heart. “No epinephrine. Let’s wait.”

The massage continued for one minute, then two. Roman’s color turned darker still.

“Getting weaker. Give me five cc’s in one to a thousand.”

A syringe was prepared. The surgeon injected it directly into the heart, then continued squeezing. Several more minutes passed. I watched the squeezing heart, and the rhythmic inflation of the lungs from the respirator. But the patient was declining. Finally, they stopped.

“That’s it,” the surgeon said. He removed his hand from the chest, looked at Roman Jones, and stripped off his gloves. He examined the lacerations across the chest and arms and the dent in the skull. “Probably primary respiratory arrest,” he said. “He was hit pretty hard over the head.” To Hammond: “You going to do the death certificate?”

“Yeah,” Hammond said, “I’ll do it.”

At that moment, a nurse burst into the room. “Dr. Hammond,” she said, “Dr. Jorgensen needs you. They’ve got a girl in hemorrhagic shock.”

OUT IN THE HALL, the first one I saw was Peterson. He was standing there in a suit, looking both confused and annoyed. When he saw me he did a double take and plucked at my sleeve.

“Say, Berry—”

“Later,” I said.

I was following Hammond and the nurse down to another treatment room. A girl was there, lying flat, very pale. Her wrists were bandaged. She was conscious, but just barely—her head rolled back and forth, and she made moaning sounds.

Jorgensen, the intern, was bent over her. “Got a suicide here,” he said to Hammond. “Slashed wrists. We’ve stopped the bleeding and we’re getting whole blood in.”

He was finding a vein for the IV feeder. Working on the leg.

“She’s cross-matched,” he said, slipping the needle in. “We’re getting more blood from the bank. She’ll take at least two units. Hematocrit’s O.K., but that doesn’t mean anything.”

“Why the legs?” Hammond said, nodding to the IV.

“Had to bandage her wrists. Don’t want to fool with upper extremities.”

I stepped forward. The girl was Angela Harding. She did not look so pretty now; her face was the color of chalk, with a grayish tinge around the mouth.

“What do you think?” Hammond said to Jorgensen.

“We’ll keep her,” he said. “Unless something goes wrong.”

Hammond examined the wrists, which were bandaged.

“Is this the lesion?”

“Yes. Both sides. We’ve sutured it.”

He looked at the hands. The fingers were stained dark brown. He looked at me. “Is this the girl you were talking about?”

“Yes,” I said, “Angela Harding.”

“Heavy smoker,” Hammond said.

“Try again.”

Hammond picked up one hand and smelled the stained fingers.

“These aren’t tobacco,” he said.

“That’s right.”

“Then…”

I nodded. “That’s right.”

“…she’s a nurse.”

“Yes.”

The stains were from tincture of iodine, used as a disinfectant. It was a brownish-yellowish liquid, and it stained tissues it came in contact with. It was employed for scrubbing a surgical incision before cutting, and for such other practices as introduction of an IV feeder.

“I don’t get it,” Hammond said.

I held up her hands. The balls of the thumb and the backs of the hands were covered with minute slashes which were not deep enough to draw blood.

“What do you make of this?”

“Testing.” A classic finding in suicides by wrist-slashing is one or more preliminary cuts on the hand as if the suicide victim wishes to test the sharpness of the blade or the intensity of the pain that would result.

“No,” I said.

“Then what?”

“Ever seen a fellow who’s been in a knife fight?”

Hammond shook his head. Undoubtedly, he never had. It was the kind of experience one had only as a pathologist: small cuts on the hands were the hallmark of a knife fight. The victim held up his hands to ward off the knife; he ended up with small cuts.

“Is this the pattern?”

“Yes.”

“You mean she was in a knife fight?”

“Yes.”

“But why?”

“Tell you later,” I said.

I went back to Roman Jones. He was still in the same room, along with Peterson and another man in a suit, examining the eyes of the body.

“Berry,” Peterson said, “you show up at the damnedest times.”

“So do you.”

“Yeah,” Peterson said, “but it’s my job.”

He nodded toward the other man in the room.

“Since you were so worried the last time, I brought a doctor along. A police doctor. This is a coroner’s case now, you know.”

“I know.”

“Fellow by the name of Roman Jones. We got that from the wallet.”

“Where’d you find him?”

“Lying on the street. A nice quiet street in Beacon Hill. With his skull bashed in. Must have fallen on his head. There was a broken window two floors up, in an apartment owned by a girl named Angela Harding. She’s here, too.”

“I know.”

“You know a lot tonight, don’t you?”

I ignored him. My headache was worse; it was throbbing badly, and I felt terribly tired. I was ready to lie down and go to sleep for a long, long time. But I wasn’t relaxed; my stomach was churning.

I bent over the body of Roman Jones. Someone had stripped off the clothing to expose multiple, deep lacerations of the trunk and upper arms. The legs were untouched. That, I thought, was characteristic.

The doctor straightened and looked at Peterson. “Hard to tell now what the cause of death was,” he said. He nodded to the gaping chest wound. “They’ve messed it up pretty bad. But I’d say crush injury to the cranium. You said he fell from a window?”

“That’s the way we figure it,” Peterson said, glancing at me.

“I’ll handle the forms,” the doctor said. “Give me the wallet.”

Peterson gave him Roman Jones’ wallet. The doctor began to write on a clipboard at one side of the room. I continued to look at the body. I was particularly interested in the skull. I touched the indentation, and Peterson said, “What’re you doing?”

“Examining the body.”

“On whose authority?”

I sighed. “Whose authority do I need?”

He looked confused then.

I said, “I’d like your permission to conduct a superficial examination of the body.”

As I said it, I glanced over at the doctor. He was making notes from the wallet, but I was sure he was listening.

“There’ll be an autopsy,” Peterson said.

“I’d like your permission,” I said.

“You can’t have it.”

At that point, the doctor said, “Oh, for shit’s sake, Jack.”

Peterson looked from the police doctor, to me, and back again. Finally he said, “Okay, Berry. Examine. But don’t disturb anything.”

I looked at the skull lesion. It was a cup-shaped indentation roughly the size of a man’s fist, but it hadn’t been made by any fist. It had been made by the end of a stick, or a pipe, swung with considerable force. I looked more closely and saw small brown slivers of wood sticking to the bloody scalp. I didn’t touch them.

“You say this skull fracture was caused by a fall?”

“Yes,” Peterson said. “Why?”

“Just asking.”