A Case of Need: A Novel (2 page)

And they don’t. They just want to bitch, like Conway. It gives them something to do. All surgeons have persecution complexes anyway. Ask the psychiatrists.

As I went to the phone, I stripped off one rubber glove. My hand was sweaty; I wiped it on the seat of my pants, then picked up the receiver. We are careful about the phone, but just to be safe it gets swabbed with alcohol and Formalin at the end of each day.

“Berry speaking.”

“Berry, what’s going on up there?”

After Conway, I felt like taking him on, but I didn’t. I just said, “You’ve got a malignancy.”

“I thought so,” Scanlon said as if the whole path work-up had been a waste of time.

“Yeah,” I said and hung up.

I wanted a cigarette badly. I’d only had one at breakfast, and I usually have two.

Returning to my table, I saw three specimens were waiting: a kidney, a gallbladder, and an appendix. I started to pull my glove back on when the intercom clicked.

“Dr. Berry?”

“Yes?”

The intercom has a high pickup. You can speak in a normal voice anywhere in the room, and the girl will hear you. They mount the microphone high up, near the ceiling, because the new residents usually rush over and shout into it, not knowing how sensitive it is. That blasts the ears off the girl at the other end.

“Dr. Berry, your wife is on the telephone.”

I paused. Judith and I have an understanding: no calls in the morning. I’m always busy from seven to eleven, six days a week, sometimes seven if one of the staff gets sick. She’s usually very good about it. She didn’t even call when Johnny drove his tricycle into the back of a truck and had to have fifteen stitches in his forehead.

“All right,” I said, “I’ll take it.” I looked down at my hand. The glove was half on. I stripped it off and went back to the phone.

“Hello?”

“John?” Her voice was trembling. I hadn’t heard her sound that way in years. Not since her father died.

“What is it?”

“John, Arthur Lee just called.”

Art Lee was an obstetrician friend of ours; he had been best man at our wedding.

“What’s the problem?”

“He called here asking for you. He’s in trouble.”

“What kind of trouble?” As I spoke, I waved to a resident to take my place at the table. We had to keep those surgical specimens moving.

“I don’t know,” Judith said, “but he’s in jail.”

My first thought was that it was some kind of mistake. “Are you sure?”

“Yes. He just called. John, is it something about—?”

“I don’t know,” I said. “I don’t know any more than you do.” I cradled the phone in my shoulder and stripped away my other glove. I threw them both in the vinyl-lined wastebasket. “I’ll go see him now,” I said. “You sit tight and don’t worry. It’s probably a minor thing. Maybe he was drinking again.”

“All right,” she said in a low voice.

“Don’t worry,” I repeated.

“All right.”

“I’ll speak to you soon.”

I hung up, untied my apron, and placed it on the peg by the door. Then I went down the hall to Sanderson’s office. Sanderson was chief of the path labs. He was very dignified looking; at forty-eight, his hair was just turning gray at the temples. He had a jowly, thoughtful face. He also had as much to fear as I did.

“Art’s in jail,” I said.

He was in the middle of reviewing an autopsy case. He shut the file. “Why?”

“I don’t know. I’m going to see him.”

“Do you want me to come with you?”

“No,” I said. “It’s better if I go alone.”

“Call me,” Sanderson said, peering over his half frames, “when you know.”

“I will.”

He nodded. When I left him, he had opened the file again, and was reading the case. If he had been upset by the news, he wasn’t showing it. But then Sanderson never did.

In the hospital lobby I reached into my pocket for my car keys, then realized I didn’t know where they were holding Art, so I went to the information desk to call Judith and ask her. The girl at the desk was Sally Planck, a good-natured blonde whose name was the subject of endless jokes among the residents. I phoned Judith and asked where Art was; she didn’t know. It hadn’t occurred to her to ask. So I called Arthur’s wife, Betty, a beautiful and efficient girl with a Ph.D. in biochem from Stanford. Until a few years ago, Betty had done research at Harvard, but she stopped when she had her third child. She was usually very calm. The only time I had seen her upset was when George Kovacs had gotten drunk and urinated all over her patio.

Betty answered the phone in a state of stony shock. She told me they had Arthur downtown, on Charles Street. He had been arrested in his home that morning, just as he was leaving for the office. The kids were very upset, and she had kept them home from school that day, and now what should she do with them? What was she supposed to tell them, for Pete’s sake?

I told her to say it was all a mistake and hung up.

I
DROVE MY VOLKSWAGEN
out of the doctors’ parking lot, past all the shiny Cadillacs. The big cars are all owned by practicing physicians; pathologists are paid by the hospital and can’t afford all those glistening horses.

It was 8:45, right in the middle of rush-hour traffic, which in Boston means a life-and-death proposition. Boston has the highest accident rate in the U.S., even higher than Los Angeles, as any EW
⁵
intern can tell you. Or pathologists: we see a lot of automobile trauma at autopsy. They drive like maniacs; like sitting in the EW as the bodies come in, you think there’s a war going on. Judith says it’s because they’re repressed. Art has always said it was because they’re Catholic and think God will look after them as they wander across the double stripe, but Art is a cynic. Once, at a medical party, a surgeon explained how many eye injuries occur from plastic dashboard figurines. People get into accidents, pitch forward, and have their eyes put out by the six-inch Madonna. It happens a lot; Art thought it was the funniest thing he had ever heard.

He laughed until he was crying. “Blinded by religion,” he kept saying, doubled over in laughter. “Blinded by religion.”

The surgeon did plastic stuff, and he didn’t see the humor. I guess because he’d repaired too many punched-out eyesockets. But Art was convulsed.

Most people at the party were surprised by his laughter; they thought it was excessive and in rather poor taste. I suppose of all the people there I was the only one who understood the significance of this joke to Art. I was also the only one who knew the great strains under which he worked.

Art is my friend, and he has been ever since we went to medical school together. He’s a bright guy and a skilled doctor, and he believes in what he’s doing. 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.

I don’t know exactly when he started. I guess it was right after he finished his gynecology residency. It’s not a particularly difficult operation—a well-trained nurse can do it with no problem. There’s only one small catch.

It’s illegal.

I remember very well when I first found out about it. There was some talk among some of the path residents about Lee; they were getting a lot of D & C’s that were positive. The D
&
C’s had been ordered for a variety of complaints—menstrual irregularity, pain, mid-period bleeding—but quite a few were showing evidence of pregnancy in the scrapings. I got concerned because the residents were young and loose-mouthed. I told them right there in the lab that it wasn’t funny, that they could seriously damage a doctor’s reputation by such jokes. They sobered up quickly. Then I went to see Arthur. I found him in the hospital cafeteria.

“Art,” I said, “something’s bothering me.”

He was in a jovial mood, eating a doughnut and coffee. “Not a gynecological problem, I hope.” He laughed.

“Not exactly. I overheard some of the residents say that you had a half-dozen pregnancy-positive scrapings in the last month. Have you been notified?”

Immediately, the hearty manner was gone. “Yes,” he said, “I have.”

“I just wanted you to know. There might be trouble in the tissue committee when these things come up, and—”

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.”

“Then meet me in the parking lot. And if you get some free time this afternoon, why don’t you have a look at a case of mine?”

“All right,” I said, frowning.

“The name is Suzanne Black. The number is AO—two-two-one-three-six-five.”

I scribbled the number on a napkin, wondering why he should have remembered it. Doctors remember a lot about their patients, but rarely the hospital number.

“Take a good look at this case,” Art said, “and don’t mention it to anyone until you talk to me.”

Puzzled, I went back to work in the lab. I was up for an autopsy that day, so I wasn’t free until four in the afternoon. Then I went to the record room and pulled the chart for Suzanne Black. I read it right there—it wasn’t very long. She was Dr. Lee’s patient, first admitted at age twenty. She was a junior at a local Boston college. Her CC
⁶
was menstrual irregularity. Upon questioning, it was revealed that she had recently suffered a bout of German measles, had been very tired afterward, and had been examined by her college doctor for possible mononucleosis. She reported irregular spotting approximately every seven to ten days, but no normal flow. This had been going on for the last two months. She was still tired and lethargic.

Physical examination was essentially normal, except that she had a mild fever. Blood tests were normal, though hematocrit
⁷
was somewhat low.

Dr. Lee ordered a D & C to correct her irregularity. This was in 1956, before the advent of estrogen therapy. The D & C was normal; no evidence of tumors or pregnancy. The girl seemed to respond well to this treatment. She was followed for the next three months and had normal periods.

It looked like a straightforward case. Illness or emotional stress can disrupt a woman’s biological clock, and throw off her menses; the D & C reset that clock. I couldn’t understand why Art had wanted me to look at it. I checked the path report on the tissue. It had been done by Dr. Sanderson. The write-up was brief and simple: gross appearance normal, micro examination normal.

I returned the chart and went back to the lab. When I got there, I still couldn’t imagine what the point of the case was. I wandered around, doing odds and ends, and finally began the work-up on my autopsy.

I don’t know what made me think of the slide.

Like most hospitals, the Lincoln keeps path slides on file. We save them all; it is possible to go back twenty or thirty years and reexamine the microscopic slides from a patient. They’re stored in long boxes arranged like card catalogs in a library. We had a whole room full of such boxes.

I went to the appropriate box and found slide 1365. The label gave the case number and Dr. Sanderson’s initials. It also said in large letters, “D & C.”

I took the slide back to the micro room, where we have ten microscopes in a long row. One was free; I slipped the slide onto the stage and had a look.

I saw it immediately.

The tissue was a uterine scraping, all right. It showed a rather normal endometrium in the proliferative phase, but the stain stopped me. This slide had been stained with Zenker-Formalin stain, giving everything a brilliant blue or green color. It was a rather unusual stain, employed for special diagnostic problems.

For routine work, the Hematoxylin-Eosin stain is used, producing pink and purple colors. Almost every tissue slice is stained with H & E, and if this is not the case, the reasons for the unusual stain are noted in the pathological summary.

But Dr. Sanderson had not mentioned that the slide was Zenker-Formalin.

The obvious conclusion was that the slides had been switched. I looked at the handwriting on the label. It was Sanderson’s, no doubt about it. What had happened?

Almost immediately, other possibilities came to mind. Sanderson had forgotten to note in his report that an unusual stain was used. Or two sections were made, one H & E, the other Zenker-Formalin, and only the Zenker was saved. Or that there had been some legitimate mixup.

None of these alternatives was particularly convincing. I thought about it and waited impatiently until six that evening, when I met Art in the parking lot and got into his car. He wanted to go someplace away from the hospital to talk. As he drove, he said, “Read the case?”

“Yes,” I said. “Very interesting.”

“You checked the section?”

“Yes. Was it the original?”

“You mean, was it a scraping from Suzanne Black? No.”

“You should have been more careful. The stain was different. That kind of thing can get you into trouble. Where did the slide come from?”

Art smiled thinly. “A biological supply house. ‘Slide of normal endometrial scraping.’”

“And who made the switch?”

“Sanderson. We were new to the game, in those days. It was his idea to put in a phony slide and write it up as normal. Now, of course, we’re much more refined. Every time Sanderson gets a normal scraping, he makes up a few extra slides and keeps them around.”

“I don’t understand,” I said. “You mean Sanderson is in this with you?”

“Yes,” Art said. “He has been for several years.”

Sanderson was a very wise, very kind, and very proper man.

“You see,” Art said, “that whole chart is a lie. The girl was twenty, all right. And she had German measles. And she had menstrual irregularity, too, but the reason was she was pregnant. She had been knocked up on a football weekend by a guy she said she loved and was going to marry, but she wanted to finish college first, and a baby would get in the way. Furthermore, she managed to get measles during the first trimester. She wasn’t a terribly bright girl, but she was bright enough to know what it meant when you got measles. She was very worried when she came to see me. She hemmed and hawed for a while, and then blurted it all out and asked for an abortion.