A Case of Need: A Novel (22 page)

I must have looked puzzled, because she made jabbing motions at her elbow with her finger, imitating intravenous injection.

“Nobody else shoots it,” Bubbles said. “But Karen went all out.”

I said, “Her trips …”

“Acid. Once, DMT.”

“How did she feel afterward?”

“Like hell. She was really turned off. Wired out. Down, you know, they were really down-trips.”

“Did she stay turned off?”

“Yeah. The rest of the summer. Never made it once with a guy for the rest of the summer. Like she was afraid.”

“Are you sure about that?”

“Yeah,” she said. “Sure.”

I looked around the apartment. “Where is Angela?”

“Out.”

“Where did she go? I’d like to talk to her.”

“She really needs to talk to you, right now.”

I said, “Is she in some kind of trouble?”

“No.”

“I’d like to talk to her.”

Bubbles shrugged. “If you can find her, talk to her.”

“Where did she go?”

“I told you. Out.”

“I understand she’s a nurse,” I said.

“That’s right,” Bubbles said. “You got the—”

At this point, the door opened and a tall girl burst into the room. She said, “That bastard isn’t anywhere, he’s hiding, the rotten—”

She stopped when she saw me.

“’Lo, Ang,” Bubbles said. She nodded to me. “You got an oldie but goodie here to see you.”

Angela Harding swept into the room and slumped on the couch, and lit a cigarette. She wore a very short black dress, black-net stockings, and patent-leather black boots. She had long dark hair and a hard, classically beautiful face with bones that looked chiseled; the face of a model. I had trouble picturing her as a nurse.

“You’re the one who wants to know about Karen?”

I nodded.

“Sit down,” she said. “Take a load off.”

Bubbles said, “Ang, I didn’t tell him—”

“Get me a Coke, would you, Bubbles?” Angela said. Bubbles nodded quietly and went into the kitchen. “You want a Coke?”

“No, thanks.”

She shrugged. “Suit yourself.” She sucked on the cigarette and stubbed it out. Her movements were quick but she kept her composure, a calm in her face. She lowered her voice. “I didn’t want to talk about Karen in front of Bubbles. She’s pretty upset about it.”

“Karen?”

“Yes. They were close.”

“And you?”

“Not so close.”

“How’s that?”

“She came on strong, in the beginning. Nice girl, a little wild, but fun. Very strong in the beginning. So we decided to share a room, the three of us. Then later Bubbles moves in with Superhead, and I’m stuck with Karen. It wasn’t so easy.”

“Why?”

“She was a crazy kid. She was nuts.”

Bubbles came back with the Coke. “She wasn’t.”

“Not around you. She had an act for you.”

“You’re just mad because of—”

“Yeah. Right. Sure.” Angela tossed her head and shifted her long legs. She turned to me and said, “She’s talking about Jimmy. Jimmy was a resident I knew, in OB.”

“That was the service you were on?”

“Yes,” she said. “Jimmy and I had a thing, and I thought it was good. It
was
good. Then Karen stepped in.”

Angela lit another cigarette and avoided my eyes. I could not really tell whether she was talking to me or to Bubbles. Obviously the two girls did not agree.

“I never thought she’d do it,” Angela said. “Not your own roommate. I mean, there are rules …”

“She liked him,” Bubbles said.

“She
liked
him. Yeah, I suppose so. For a quick seventy-two hours.”

Angela stood up and paced up and down the room. Her dress barely reached to mid thigh. She was a strikingly beautiful girl, much more beautiful than Karen.

“You’re not fair,” Bubbles said.

“I don’t
feel
fair.”

“You know what you’re saying is a lie. You know that Jimmy—”

“I don’t know anything,” Angela said. “All I know is that Jimmy’s in Chicago now finishing his residency, and I am not with him. Maybe if I was—” She stopped.

“Maybe,” Bubbles said.

“Maybe what?” I said.

“Skip it,” Angela said.

I said, “When did you last see Karen?”

“I don’t know. It must have been August sometime. Before she started school.”

“You didn’t see her last Sunday?”

“No,” she said, still pacing. She didn’t even break step. “No.”

“That’s funny. Alan Zenner saw her last Sunday.”

“Who?”

“Alan Zenner. He was a friend of hers.”

“Uh-huh.”

“He saw her, and she told him she was coming over here.”

Angela and Bubbles exchanged looks. Bubbles said, “The dirty little—”

“It’s not true?” I asked.

“No,” Angela said tightly. “We didn’t see her.”

“But he was positive—”

“She must have changed her mind. She usually did, you know. Karen changed her mind so often you wondered if she had one.”

Bubbles said, “Ang, listen …”

“Get me another Coke, will you?”

There was no mistaking the command in the voice. Bubbles got up meekly for another Coke.

“Bubbles is nice,” Angela said, “but a little naïve. She likes everything to be sweet and nice in the end. That’s why what happened to Karen bothers her so much.”

“I see.”

She stopped pacing and stood in front of me. Her body took on a rigidity that melted slowly into an icy calm. “Was there anything in particular you wanted to ask me?”

“Just if you’d seen Karen.”

“No. The answer is no.”

I stood. “Well then, thank you for your time.”

Angela nodded. I went to the door. As I left I heard Bubbles say, “Is he leaving?”

And Angela said, “Shut up.”

S
HORTLY BEFORE NOON
I called Bradford’s office and was told that one of the staff was taking Dr. Lee’s case. The man was named George Wilson. My call was put through to him. Over the phone he sounded smooth and self-confident; he agreed to meet me for drinks at five, but not at the Trafalgar Club. We would meet at Crusher Thompson’s, a bar downtown.

After that, I had lunch in a drive-in and read the morning papers. The story about Art’s arrest had finally broken, big, hitting all the front pages, though there was still no link to Karen Randall’s death. Along with the story was a picture of Art. There were dark, sadistic circles under his eyes. His mouth drooped in a sinister way and his hair was disheveled. He could have been any cheap hood.

The stories didn’t say much, just a bare outline of the facts of his arrest. They didn’t have to say much: the picture said it all. In a way it was clever. You couldn’t move for a prejudicial pretrial publicity on the basis of an unflattering picture.

After lunch I smoked a cigarette and tried to put it all together. I didn’t have much success. The descriptions I had heard of Karen were too conflicting, too uncertain. I had no clear picture of her, or what she might have done. Particularly what she might have done if she arrived in Boston for a weekend, pregnant, and needing an abortion.

At one I called Murphy’s lab again. Murph answered the phone.

“Hormones Unlimited.”

“Hello, Murph. What’s the word?”

“On Karen Randall?”

“Murph, you’ve been doing homework.”

“Not exactly,” he said. “The City just called. Weston was on the phone. Wanted to know if you’d brought in a blood sample.”

“And what did you say?”

“Yes.”

“And what did he say?”

“Wanted to know the results. I told him.”

“What are the results?”

“All the hormone and excretion metabolite levels are flat low. She wasn’t pregnant. Absolutely impossible.”

“O.K.,” I said. “Thanks.”

Murph had just put some life back into my theory. Not much, but some.

“You going to explain all this, John?”

“Not now,” I said.

“You promised.”

“I know,” I said. “But not now.”

“I knew you’d do this to me,” Murph said. “Sarah will hate me.” Sarah was his wife. She thrived on gossip.

“Sorry, but I just can’t.”

“Hell of a thing to do to an old friend.”

“Sorry.”

“If she divorces me,” Murph said, “I’m naming you as co-defendant.”

I
ARRIVED AT THE MALLORY PATH LABS AT THREE
. The first man I ran into was Weston, who was looking tired. He gave me a lopsided smile of greeting.

“What did you find out?” I said.

The findings are negative,” he said, “for pregnancy.”

“Oh?”

“Yes.” He picked up the folder containing the path protocol and thumbed through it. “No question.”

“I called here earlier and was told the report was three months’ pregnancy.”

Weston said carefully, “Whom did you talk with?”

“A secretary.”

“There must have been some kind of mistake.”

“I guess,” I said.

He handed me the folder. “Want to see the slides, too?”

“Yes. I’d like to.”

We walked to the pathologists’ reading room, a long room divided into individual cubicles, where the pathologists kept their microscopes and slides, and wrote up their autopsies.

We stopped at one booth.

“There it is,” Weston said, pointing to a box of slides. “I’ll be curious to have your opinion on them when you’re through.”

He left me, and I sat down in front of the scope, switched on the light, and began work. There were thirty slides in the box, made from all the major organs. Six had been made from different parts of the uterus: I began with them.

It was immediately clear that the girl was not pregnant. The endometrium was not hyperplastic. If anything, it appeared dormant and atrophic, with a thin proliferative layer, few glands, and decreased vascularity. I checked several other slides to be sure. They were all the same. Some contained thromboses from the scraping, but that was the only difference.

As I looked at the slides I considered their meaning. The girl had not been pregnant, yet she had been convinced she was. Therefore her periods must have stopped. That could account for the dormant appearance of the endometrium. But what had caused the periods to stop? I ran through the differential in my mind.

In a girl of this age, neurogenic factors came immediately to mind. The pressures and excitement of beginning school and moving to a new environment might have temporarily suppressed menstruation—but not for three months, and not with the associated signs: obesity, change in hair distribution, and so on.

Then there were hormonal disorders. Adrenal virilizing syndromes, Stein-Leventhal, irradiation. All of them seemed unlikely for one reason or another, but there was one quick way to find out.

I put the adrenal slide under the stage. There was good evidence of cortical atrophy, particularly in the cells of the zona fascicularis. The zona glomerulosa appeared normal.

Rule out virilizing syndromes and adrenal tumor.

Next I looked at the ovaries. Here the changes were striking. The follicles were small, immature, withered-looking. The whole organ, like the uterine endometrium, had a dormant appearance.

Rule out Stein-Levanthal and ovarian tumor.

Finally, I put the thyroid slide under the stage. Even under the lowest power, the atrophy of the gland was apparent. The follicles were shrunken and the lining cells were low. Clear hypothyroidism.

That meant that the thyroid, adrenals, and ovaries were all atrophic. The diagnosis was clear, though the etiology was not. I opened the folder and read through the official report. Weston had done it; the style was brisk and direct. I came to the micro write-ups. He had noted the endometrium was low and aberrant-looking, but he had considered the other glands to be “of normal appearance, question mark early atrophic changes.”

I shut the folder and went to see him.

His office was large, lined with books, and very neat. He sat behind an old, heavy desk smoking a briar pipe, looking scholarly and venerable.

“Something wrong?” he asked.

I hesitated. I had been wondering whether he had covered up, whether he had joined the others who were out to frame Art. But that was ridiculous; Weston couldn’t be bought, not at his age, not with his reputation. Nor was he particularly close to the Randall family. He would have no reason to falsify the report.

“Yes,” I said. “I wondered about your micro diagnosis.”

He puffed the pipe calmly. “Oh?”

“Yes. I’ve just reviewed the slides, and they seem pretty atrophic to me. I thought perhaps—”

“Well, John,” Weston said, chuckling, “I know what you’re going to say. You thought perhaps I’d want to review them.” He smiled at me. “I
have
reviewed them. Twice. This is an important postmortem and I did it as carefully as I know how. The first time I examined the slides, I felt as you did, that they seemed to show pan hypopituitarism affecting all three target organs—thyroid, adrenals, gonads. I felt that very strongly, so I went back to the gross organs. As you yourself say, the gross organs were not strikingly abnormal.”

“It might have been recently acquired,” I said.

“Yes,” he said, “it might. That’s what makes it so difficult. Then, too, we’d like a look at the brain, to check for evidence of neoplasm or infarction. But that’s not possible; the body was cremated this morning.”

“I see.”

He smiled up at me. “Sit down, John. It makes me nervous to have you standing like that.” When I was sitting, he said, “Anyway I looked at the gross, and then went back to the slides. This time I was less certain. I wasn’t fully convinced. So I checked some old cases of pan hypopit, reviewed the old slides, and finally looked at the Randall slides a third time. By then I felt I could not be certain of a diagnosis of pituitary dysfunction. The more I looked, the less certain I felt. I wanted some land of corroboratory evidence—brain pathology, or X rays, or blood hormones. That was why I called Jim Murphy.”

“Oh?”

“Yes.” His pipe went out; he relit it again. “I suspected you’d taken the blood sample to do estradiol tests, and that you’d get Murphy to do it. I wanted to know if you’d also decided to have other hormone levels checked—TSH, ACTH, T
₄
, anything that might help.”