A Case of Need: A Novel (19 page)

“You will,” Hammond said. “Just don’t take any prisoners.”

I smiled. “That’s against Geneva Conventions.”

“This,” Hammond said, “is a very limited war.”

T
HE PARTY WAS HELD BY GEORGE MORRIS
, chief resident in medicine at the Lincoln. Morris was about to finish his residency and begin private practice, so it was a kind of coming-out party, given for himself. It was done very well, with an understated comfortability that must have cost him more than he could afford. I was reminded of those lavish parties given by manufacturers to launch a new product, or a new line. In a sense, that was what it was.

George Morris, twenty-eight, with a wife and two children, was deeply in debt: any doctor in his position would be. Now he was about to start burrowing out from under, and to do that he needed patients. Referrals. Consults. In short, he needed the good will and help of established physicians in the area, and that was why he had invited 200 of them to his home and filled them to the neck with the best booze he could buy and the best canapés the caterers could provide.

As a pathologist, I was flattered to have received an invitation. I couldn’t do anything for Morris; pathologists deal with corpses and corpses don’t need referrals. Morris had invited Judith and me because we were friends.

I think we were his only friends at the party that night.

I looked around the room: the chiefs of service from most of the big hospitals were there. So were the residents, and so were the wives. The wives had clustered in a corner, talking babies; the doctors were clustered into smaller groups, by hospital or by specialty. It was a kind of occupational division, very striking to see.

In one corner, Emery was arguing the therapeutic advantage of lower I
¹³¹
doses in hyperthyroidism; in another, Johnston was talking about hepatic pressures in porto caval shunts; in still another, Lewiston could be heard muttering his usual line about the inhumanity of electroshock therapy for depressives. From the wives, occasional words like “IUD” and “chickenpox” drifted out.

Judith stood next to me, looking sweet and rather young in a blue A-line. She was drinking her Scotch quickly—she’s a gulper—and obviously preparing to plunge into the group of wives.

“I sometimes wish,” she said, “that they’d talk about politics or something. Anything but medicine.”

I smiled, remembering Art’s line about doctors being illpolitical. He meant it the way you used words like illiterate. Art always said doctors not only held no real political views, but also were incapable of them. “It’s like the military,” he had once said. “Political views are considered unprofessional.” As usual, Art was exaggerating, but there was something to what he said.

I think Art likes to overstate his case, to shock and irritate and goad people. It is a characteristic of his. But I think he is also fascinated by the thin line that separates truth from untruth, statement from overstatement. It is a characteristic of his to constantly throw out his comments and see who picks them up and how they react to them. He does this particularly when he is drunk.

Art is the only doctor I know who will get drunk. The others can apparently pour back fantastic quantities of alcohol without really showing it; they get talkative for a while, and then sleepy. Art gets drunk, and when he is drunk he is particularly angry and outrageous.

I have never understood this about him. For a while I thought he was a case of pathological intoxication,
⁵
but later I decided it was a sort of personal indulgence, a willingness to let himself go when others kept themselves rigidly in control. Perhaps he needs this indulgence; perhaps he can’t help it; perhaps he actively seeks it as an excuse to blow off steam.

Certainly he is bitter toward his profession. Many doctors are, for various reasons: Jones because he is hooked on research and can’t make as much money as he’d like; Andrews because urology cost him his wife and a happy family life; Telser because he is surrounded in dermatology by patients whom he considers neurotic, not sick. If you talk to any of these men, the resentment shows itself sooner or later. But they are not like Art. Art is resentful against the medical profession itself.

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.

In my blackest moments, I think he does abortions only to jar and irritate his colleagues. That is unfair, I think, but I can never be sure. When he is sober, he talks intellectually, unreeling arguments for abortion. When he is drunk, he talks emotions, attitudes, stances, complacency.

I think he feels hostility toward medicine and gets drunk so that he can release his hostility with an excuse—he’s drunk. Certainly he has gotten into bitter, almost vicious fights with other doctors when he was drunk; he once told Janis that he’d aborted his wife and Janis, who didn’t know, looked as if he’d been kicked in the balls. Janis is Catholic but his wife isn’t. Art managed to end a perfectly happy dinner party right on the spot.

I attended that party, and I was annoyed with Art afterward. He apologized to me a few days later, and I told him to apologize to Janis, which he did. For some strange reason, Janis and Art subsequently became close friends, and Janis became a convert to abortion. I don’t know what Art said to him or how he convinced him, but whatever it was, it worked.

Because I know Art better than most people, I attach a great importance to his being Chinese. I think his origin and his physical appearance have been a great influence on him. There are a lot of Chinese and Japanese men in medicine, and there are a lot of jokes about them—half-nervous jokes about their energy and their cleverness, their drive to success. It is precisely the kind of jokes one hears about Jews. I think Art, as a Chinese-American, has fought this tradition, and he has also fought his upbringing, which was essentially conservative. He swung the other way, became radical and leftist. One proof of this is his willingness to accept all things new. He has the most modern office equipment of any OB man in Boston. Whenever a new product comes out, he buys it. There are jokes about this, too—the gadget-oriented Orientals—but the motivation is different. Art is fighting tradition, routine, the accepted way.

When you talk to him, he seems bursting with ideas. He has a new method for doing the Papp smear.
⁶
He wants to abandon the routine, digital pelvic exam as a waste of time. He thinks that basal temperature as an indicator of ovulation is more effective than reported. He thinks forceps should be eliminated from all deliveries, no matter how complicated. He thinks that general anesthesia in deliveries should be abandoned in favor of heavy doses of tranquilizers.

When you first hear these ideas and theories, you are impressed. Only later do you realize that he is compulsively attacking tradition, finding fault whenever and wherever he can.

I suppose it is only natural that he should begin performing abortions. And I suppose that I should question his motives. But I don’t usually, because 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.

Of all the people at the party, one might be able to help me. That was Fritz Werner, but I didn’t see him; I kept looking.

Instead I ran into Blake. Blake is a senior pathologist at the General, but he is principally known for his head, which is enormous, round, and smooth. The features of his face are small and childlike, a tiny jaw and wide-set eyes, so that Blake looks like everybody’s vision of future man. He is coldly, sometimes maddeningly intellectual man, and he is fond of games. He and I have played one game, off and on, for years.

He greeted me with a wave of his martini glass and, “Ready?”

Sure.

“Moans to Rocky,” he said.

It sounded easy. I took out my notebook and pencil and tried it out. At the top of the page I wrote MOANS and at the bottom, ROCKY. Then I tried to fit things together.

MOANS

LOANS

LOINS

LOONS

BOONS

BOOKS

ROOKS

ROCKS

ROCKY

It took only a few moments.

“How many?” Blake said.

“Nine.”

He smiled. “I’m told it can be done in five. I have seven.” He took the pad from me and wrote:

MOANS

LOANS

LOONS

LOOKS

ROOKS

ROCKS

ROCKY

I reached into my pocket and gave him a quarter. He had won the last three in a row, and over the years, he had beaten me consistently. But then Blake beat everybody.

“By the way,” he said, “I heard another argument. Do you know the DNA template one?”
⁷

“Yes,” I said.

He shook his head. “Pity. I enjoy it. Springing it on people, I mean.”

I smiled at him, barely able to conceal my pleasure.

“You know the latest on Youth in Asia? The one about the right to refuse medication? You can fit it into the fluoride arguments, very neatly.”
⁸

I’d heard that one, too, and I told him so. This seemed to depress him. He wandered off to try his luck with someone else.

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. It is easy for him, effortless and amusing. He and Art get along well together. Last year the two of them had a four-hour argument over whether an obstetrician was morally responsible for all children born under his direction, from the time they were born until they died.

In retrospect, all of Blake’s arguments seem no more useful or important than watching an athlete exercise in a gym, but at the time they can be fascinating. Blake has a keen sense of the arbitrary, and it stands him in good stead when working with members of the most arbitrary profession on earth.

Wandering around the party, I heard snatches of jokes and conversations; it was, I thought, a typical medical party.

“Did you hear about the French biochemist who had twins. He baptized one and kept the other as a control.”

“They all get bacteremia sooner or later, anyway …”

“And he was walking around—
walking around,
mind you, with a blood pH of seven-point-six and a potassium of one …”

“Well, what the hell do you expect of a Hopkins man?”

“So he said, ‘I gave up smoking, but I’ll be damned if I’ll give up drinking.’”

“Sure, you can correct the blood gases, but it doesn’t help the vasculature …”

“She was always a nice girl. Very well dressed. They must have spent a fortune on her clothes …”

“… course he’s pissed. Anybody’d be pissed …”

“… oliguric my ass. He was
an
uric for five days, and he still survived …”

“… in a seventy-four-year-old man, we just excised it locally and sent him home. It’s slow growing, anyhow …”

“… liver reached down to his knees, practically. But no hepatic failure …”

“She said she’d sign herself out if we didn’t operate, so naturally, we …”

“… but the students are always bitching; it’s a nonspecific response …”

“Well, apparently this girl had bitten it off of him …”

“Really? Harry, with that little nurse in Seven? The blonde?”

“… don’t believe it. He publishes more journal articles than most people can read in a life-time …”

“… metastases to the
heart …
”

“Anyway, it goes like this: there’s this desert prison, see, with an old prisoner, resigned to his life, and a young one just arrived. The young one talks constantly of escape, and, after a few months, he makes a break. He’s gone a week, and then he’s brought back by the guards. He’s half dead, crazy with hunger and thirst. He describes how awful it was to the old prisoner. The endless stretches of sand, no oasis, no signs of life anywhere. The old prisoner listens for a while, then says, ‘Yep. I know. I tried to escape myself, twenty years ago.’ The young prisoner says, ‘You did? Why didn’t you tell me, all these months I was planning my escape? Why didn’t you let me know it was impossible?’ And the old prisoner shrugs, and says, ‘So who publishes negative results?’”

AT EIGHT
, I was beginning to get tired. I saw Fritz Werner come in, waving to everyone and talking gaily. I started over toward him, but Charlie Frank caught me on the way.

Charlie stood half hunched over, with a twisted, painful expression on his face as if he’d just been stabbed in the stomach. His eyes were wide and sad. Altogether, it was quite a dramatic effect, but Charlie always looked that way. He wore an air of impending crisis and imminent tragedy on his shoulders, and it burdened him, crushing him to the floor. I had never seen him smile.

In a tense, half whisper, he said, “How is he?”

“Who?”

“Art Lee.”

“He’s all right.” I didn’t want to talk about Lee with Charlie Frank.

“Is it true he’s been arrested?”

“Yes.”

“Oh, my God.” He gave a little gasp.

“I think it will turn out all right in the end,” I said.

“Do you?”

“Yes,” I said, “I do.”

“Oh, my God.” He bit his lip. “Is there anything I can do?”

“I don’t think so.”

He was still holding onto my arm. I looked across the room at Fritz, hoping Charlie’d notice and let go. He didn’t.

“Say, John …”

“Yes?”

“What’s this I heard about you, ah, getting involved?”

“Let’s say I’m interested.”

“I ought to tell you,” Charlie said, leaning close, “that there’s talk in the hospitals. People are saying that you’re concerned because you’re mixed up in it yourself.”