Michael Crichton - A Case of Need

“Were you treating her addiction?”

“You mean, was I supplying her?”

“I mean, were you treating her?”

“No,” he said. “I knew it was beyond me. I considered it, of course, but I knew that I couldn’t handle it, and I might make things worse. I urged her to go for treatment, but…”

He shrugged.

“So instead, you visited her frequently.”

“Just to try and help her over the rough time. It was the least I could do.”

“And Thursday night?”

“He was already there when I arrived. I heard scuffling and shouts, so I opened the door, and found him chasing her with a razor. She had a kitchen knife—a long one, the kind you use for bread—and she was fighting back. He was trying to kill her because she was a witness. He said that, over and over. ‘You’re a witness, baby,’ in a low voice. I don’t remember exactly what happened next. I had always been fond of Angela. He said something to me, some words, and started at me with the razor. He looked terrible; Angela had already cut him with the knife, or at least, his clothes…”

“So you picked up the chair.”

“No. I backed off. He went after Angela. He was facing her, away from me. That was when…I picked up the chair.”

I pointed to his fingers. “And your cuts?”

“I don’t remember. I guess he did it. There was a little slash on the sleeve of my coat, too, when I got home. But I don’t remember.”

“After the chair—”

“He fell down. Unconscious. Just fell.”

“What did you do then?”

“Angela was afraid for me. She told me to leave immediately, that she could take care of everything. She was terrified that I would be involved. And I…”

“You left,” I said.

He looked at his hands. “Yes.”

“Was Roman dead when you left?”

“I don’t really know. He had fallen near the window. I guess she just pushed him out and then wiped up. But I don’t know for sure. I don’t know for sure.”

I looked at his face, at the lines in the skin and the white of the hair, and remembered how he had been as a teacher, how he had prodded and pushed and cajoled, how I had respected him, how he had taken the residents every Thursday afternoon to a nearby bar for drinks and talk, how he used to bring a big birthday cake in every year on his birthday and share it with everyone on the floor. It all came back, the jokes, the good times, the bad times, the questions and explanations, the long hours in the dissecting room, the points of fact and the matters of uncertainty.

“Well,” he said with a sad smile, “there it is.”

I lit another cigarette, cupping my hands around it and ducking my head, though there was no breeze in the room. It was stifling and hot and airless, like a greenhouse for delicate plants.

Weston didn’t ask the question. He didn’t have to.

“You might get off,” I said, “with self-defense.”

“Yes,” he said, very slowly. “I might.”

OUTSIDE, cold autumnal sun splashed over the bare branches of the skeletal trees along Massachusetts Avenue. As I came down the steps of Mallory, an ambulance drove past me toward the Boston City EW. As it passed I glimpsed a face propped up on a bed in the back, with an oxygen mask being held in place by an attendant. I could see no features to the face; I could not even tell if it was a man or a woman.

Several other people on the street had paused to watch the ambulance go by. Their expressions were fixed into attitudes of concern, or curiosity, or pity. But they all stopped for a moment, to look, and to think their private thoughts.

You could tell they were wondering who the person was, and what the disease was, and whether the person would ever leave the hospital again. They had no way of knowing the answers to those questions, but I did.

This particular ambulance had its light flashing, but the siren was off, and it moved with almost casual slowness. That meant the passenger was not very sick.

Or else he was already dead. It was impossible to tell which.

For a moment, I felt a strange, compelling curiosity, almost an obligation to go to the EW and find out who the patient was and what the prognosis was.

But I didn’t. Instead I walked down the street, got into my car, and drove home. I tried to forget about the ambulance, because there were millions of ambulances, and millions of people, every day, at every hospital. Eventually, I did forget. Then I was all right.

PART OF ANY PATHOLOGIST’S JOB is to describe what he sees quickly and precisely; a good path report will allow the reader to see in his mind exactly what the pathologist saw. In order to do this, many pathologists have taken to describing diseased organs as if they were food, earning themselves the name, delicatessen pathologists.

Other pathologists are revolted by the practice; they deplore path reports that read like restaurant menus. But the device is so convenient and useful that nearly all pathologists use it, at one time or another.

Thus there are currant jelly clots and postmortem chicken-fat clots. There is ripe raspberry mucosa or strawberry gallbladder mucosa, which indicates the presence of cholesterol. There are nutmeg livers of congestive heart failure and Swiss-cheese endometria of hyperplasia. Even something as unpleasant as cancer may be described as food, as in the case of oat-cell carcinoma of the lung.

DOCTORS ARE GENERALLY MISTRUSTFUL of the police and try to avoid police business. One reason:

A brilliant resident at the General was called out of bed one night to examine a drunk brought in by the police. The police may know that certain medical disorders—such as diabetic coma—may closely imitate inebriation, even including an “alcoholic” breath. So this was routine. The man was examined, pronounced medically sound, and carted off to jail.

He died during the night. At autopsy, he was found to have a ruptured spleen. The family sued the resident for negligence, and the police were extraordinarily helpful to the family in attempting to put the blame on the doctor. At the trial, it was decided that the doctor had indeed been negligent, but no damages were awarded.

This doctor later tried to obtain certification from the Virginia State Board to practice in that state, and succeeded only with the greatest difficulty. This incident will follow him for the rest of his life.

While it is possible that he missed the enlarged or ruptured spleen in his examination, it is highly unlikely considering the nature of the injury and extremely high caliber of doctor. The conclusion of the hospital staff was that probably the man had received a good kick in the stomach by the police, after he had been examined.

There is, of course, no proof either way. But enough incidents such as this have occurred that doctors mistrust police almost as a matter of general policy.

THROUGHOUT HISTORY, surgery and war have been intimately related. Even today, of all doctors, young surgeons are the ones who least object to being sent to the battlefield. For it is there that surgeons and surgery have traditionally developed, innovated, and matured.

The earliest surgeons were not doctors at all; they were barbers. Their surgery was primitive, consisting largely of amputations, blood-letting, and wound-dressing. Barbers accompanied the troops during major campaigns and gradually came to learn more of their restorative art. They were hampered, however, by a lack of anesthesia; until 1890, the only anesthetics available were a bullet clenched between the victim’s teeth and a shot of whiskey in his stomach. The surgeons were always looked down on by the medical doctors, men who did not deign to treat patients with their hands, but took a more lofty and intellectual approach. The attitude, to some extent, persists to the present day.