A Case of Need

by Michael Crichton

Sometimes his anger was directed against the thoracic man, sometimes against the nurses, sometimes against the pump technicians. But oddly enough, never against Conway. “If I live to be a hundred,” Conway hissed through his teeth, “I’ll never find a decent anes man. Never. They don’t exist. Stupid, shit-eating bastards, all of them.”

Because Frank Conway was good, because he was an eight-percenter, a man with lucky hands, a man with the touch, everyone put up with his temper tantrums, his moments of anger and destructiveness. Once he kicked over a path microscope and did a hundred dollars’ worth of damage. Nobody blinked, because Conway was an eight-percenter.

Like most practicing doctors, he tends to be a little too authoritarian, a little too autocratic. He thinks he knows what’s best, and nobody can know that all the time. Maybe he goes overboard, but I can’t really knock him. He serves a very important function. After all, somebody around here has to do the abortions.

He shook his head. “No trouble.” “Well, you know how it looks.” “Yes,” he said. “It looks like I’m performing abortions.” His voice was low, almost dead calm. He was looking directly at me. It gave me a strange feeling. “We’d better have a talk,” he said. “Are you free for a drink about six tonight?” “I guess so.”

“Listen,” he said. “Morality must keep up with technology, because if a person is faced with the choice of being moral and dead or immoral and alive, they’ll choose life every time. People today know that abortions are safe and easy. They know it isn’t a long, tedious, dangerous operation. They know it’s simple and they want the personal happiness it can give them. They demand it.

ART WAS LOCKED IN A NICE CELL. It was tidy and didn’t smell much. Actually, Boston has some of the nicest cells in America. They have to: lots of famous people have spent time in those cells. Mayors, public officials, people like that. You can’t expect a man to run a decent campaign for reelection if he’s in a lousy cell, can you?

“I’ve been arrested,” Art said. “For murder.” “So I gathered. Why did you call me?” “Because you know about these things.” “About murder? I don’t know anything.” “You went to law school.” “For a year,” I said. “That was ten years ago. I almost flunked out, and I don’t remember a thing I learned.”

WHEN I GOT OUTSIDE into the October drizzle, I decided this was a hell of a time to quit smoking. Peterson had unnerved me; I smoked two cigarettes as I walked to the drugstore to buy another pack. I had expected him to be stupid and pointlessly tough. He was neither of those things. If what he had said was true, then he had a case.

Yet even with the precautions, you worry. As you do the post, there is always that fear, that dreadful thought at the back of your mind that the prosecution or the defense will demand some piece of information, some crucial bit of evidence either positive or negative, that you cannot supply because you did not consider all the possibilities, all the variables, all the differentials.

Hendricks shook his head and bit his lip. Gaffen was giving him the business. I would have objected but this was standard procedure. Browbeating often passes for teaching in medicine. Hendricks knew it. I knew it. Gaffen knew it.

AUTOPSIES ARE NEVER VERY PRETTY. They are particularly depressing when the deceased is as young and as attractive as Karen Randall was. She lay nude on her back, her blonde hair streaming down in the water. Her clear blue eyes stared up at the ceiling.

I HAVE TROUBLE BUYING LIFE INSURANCE. Most pathologists do: the companies take one look at you and shudder—constant exposure to tuberculosis, malignancies, and lethal infectious disease makes you a very poor risk.

THE LAST TIME ANYONE COUNTED, there were 25,000 named diseases of man, and cures for 5,000 of them. Yet it remains the dream of every young doctor to discover a new disease. That is the fastest and surest way to gain prominence within the medical profession.

A few moments later, Carr arrived. He wore a white lab coat, open at the front (a clinical professor would never button his lab coat) and a stethoscope around his neck. His shirt collar was frayed (clinical professors aren’t paid much), but his black shoes gleamed (clinical professors are careful about things that really count). As usual, his manner was very cool, very collected, very political.

“Are you content to clean up after the abortionists and let it go?” “We are trying to restore people to health. That’s all. A doctor can’t make value judgments. We clean up after a lot of bad drivers and mean drunks, too. But it isn’t our job to slap anybody’s hand and give them a lecture on driving or alcohol. We just try to make them well again.”

There were sixteen people in the room below me, including four surgeons. Everyone was moving, working, checking in smooth, coordinated movements, like a kind of ballet, like a surrealistic ballet. The patient, draped in green, was dwarfed by the heart-lung machine alongside him, a giant complex as large as an automobile, shining steel, with smoothly moving cylinders and wheels.

The machine did all that for him. It pumped his blood, oxygenated it, removed the carbon dioxide. In its present form, the machine had been in use for about ten years. The people below me did not seem in awe of the machine or the surgical procedure. They worked matter-of-factly at their jobs. I suppose that was one reason why it all seemed so fantastic.

For a fleeting moment I was angry with him. He was soaking in self-pity, despite his natural fright. But I wanted to tell him he’d better get used to the idea of people dying in front of him, lots of people. And he’d better get used to the idea that he could make a mistake, because they happened. Sometimes the mistakes were balder than others, but it was just degree.

I stood. The boy was under stress and almost on the verge of tears. All he could see was a promising medical career jeopardized because he had made a mistake with the daughter of a prominent physician. In his anger and frustration and self-pity, he, too, was looking for a goat. And he needed one worse than most.

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.

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.

“In a way, you see,” he said, “I’m doing a disservice to society. I haven’t lost anybody in abortion, so I’m keeping those death figures down. That’s good for my patients, of course, but bad for society as a whole. Society will only act out of fear and gross guilt. We are attuned to large figures; small statistics don’t impress us.

I drove up the long gravel drive and parked in the turnabout next to two Porsches, one black, the other canary-yellow. Apparently the whole family drove Porsches. There was a garage tucked back to the left of the house with a gray Mercedes sedan. That was probably for the servants.

What is important about Hammond, and the few other young doctors like him, is that they are breaking old patterns without rebelling against the Establishment. Hammond is not trying to antagonize anyone with his hair, his habits, or his motorcycle; he simply doesn’t give a damn what the other doctors think of him.

It is natural to expect innovation from the young, but in medicine this has not been easy, for the old doctors train the young ones, and too often the students become carbon copies of their teachers. Then, too, there is a kind of antagonism between generations in medicine, particularly now.

I suppose in any profession you meet men who despise themselves and their colleagues. But Art is an extreme example. It is almost as if he went into medicine to spite himself, to make himself unhappy and angry and sad.

I feel that a man’s reasons for doing something are less important than the ultimate value of what he does. It is a historical truth that a man may do the wrong thing for the right reasons. In that case he loses. Or he may do the right thing for the wrong reasons. In that case, he is a hero.

Blake collects arguments on medical philosophy. He is never happier than when he is logically demonstrating to a surgeon that he has no right to operate, or to an internist that he is ethically bound to kill every patient he can. Blake likes words and tosses around ideas the way small children play softball in the street.

I drank the vodka and thought about what I had seen. As Wilson had said, everything pointed to Peter Randall. There had been blood on his car, and he had destroyed the car. I had no doubt that a gallon of gasoline on the front seat would eliminate all evidence. He was clean, now—or would be, if we hadn’t seen him burning the car.

And then I remembered something Peterson had said: “You doctors certainly stick together.” I realized he, and Wilson, were right. I wanted to believe that Peter was innocent. Partly because he was a doctor, partly because I liked him. Even in the face of serious evidence, I wanted to believe he was innocent.