A Case of Need: A Novel (23 page)

“Why didn’t you just call me?”

“I did, but your lab didn’t know where you were.”

I nodded. Everything he had said made perfect sense. I felt my body slowly relaxing.

“By the way,” Weston said, “I understand some skull films of Karen Randall were taken a while back. Any idea what they showed?”

“Nothing,” I said. “They were negative.”

Weston sighed. “Pity.”

“I’ll tell you something interesting though,” I said.

“What’s that?”

“They were ordered because she complained of blurring vision.”

Weston sighed. “John, do you know the most common cause of blurring vision?”

“No.”

“Lack of sleep,” Weston said. He pushed the pipe to the side of his mouth and held it in his teeth. “What would you do if you were in my position? Make a diagnosis on the basis of a complaint which led to negative X rays?”

“The slides
are
suggestive,” I reminded him.

“But only suggestive.” He shook his head slowly. This is already a confused case, John. I’m not going to make it more confused by throwing in a diagnosis I’m not sure about. After all, I may be called into court to defend it. I’d rather not stick my neck out. If the prosecution or the defense wants to find a pathologist to review the material and stick
his
neck out, that’s fine. The material is here for anyone to see. But I’m not going to do it. My years in the courtroom have taught me one thing, at least.”

“What’s that?”

“Never take a position unless you are certain it can be defended against any onslaught. That may sound like good advice to a general,” he said, smiling, “but then, a courtroom is nothing more than a very civilized war.”

I
HAD TO SEE SANDERSON
. I had promised to see him, and now I needed his advice badly. But as I entered the lobby of the Lincoln Hospital, the first person I saw was Harry Fallon.

He was slinking down a corridor, wearing a raincoat and hat pulled down over his forehead. Harry is an internist with a large suburban practice in Newton; he is also a former actor and something of a clown. I greeted him and he raised the brim of his hat slowly. His eyes were bloodshot and his face sallow.

“I hab a code,” Harry said.

“Who are you seeing?”

“Gordon. The cheeb residend.” He took out a Kleenex and blew his nose loudly. “Aboud my bat code.”

I laughed. “You sound like you’ve swallowed cotton.

“Thang you bery mugh.” He sniffled. “This is no labbing madder.”

He was right, of course. All practicing doctors feared getting sick. Even small colds were considered bad for your image, for what is loosely called “patient rapport,” and any serious illness became a matter for the utmost secrecy. When old Henley finally developed chronic glomerulonephritis, he went to elaborate lengths to be sure his patients never found out; he would visit his doctor in the middle of the night, sneaking about like a thief.

“It doesn’t sound like a bad cold,” I told Harry.

“Hah. You thingh so? Listen to me.” He blew his nose again, a long, honking sound, somewhere between a foghorn and the death rattle of a hippopotamus.

“How long have you had it?”

“Du days. Du miberable, miberable days. My padends are nodicing.”

“What are you taking for it?”

“Hod toddies,” he said. “Besd thing for a virus. Bud the world is againsd me, John. Today, on tob ov my code, I got a tickud.”

“A thickud?”

“Yes. For double-barking.”

I laughed, but at the back of my mind, something was bothering me, something I knew I should be remembering and thinking about, something I had forgotten and ignored.

It was a strange and irritating feeling.

I
MET SANDERSON IN THE PATH LIBRARY
. It’s a square room with lots of chairs, the folding kind, and a projector and screen. Path conferences are held here, in which autopsies are reviewed, and they are so frequent you can practically never get in to use the library books.

On the shelves, in boxes, were autopsy reports for every person done in the Lincoln since 1923, the year we began to keep good records. Prior to that time, nobody had a very good idea of how many people were dying from what diseases, but as knowledge of medicine and the human body increased that information became vitally important. One proof of increased interest was the number of autopsies performed in 1923: all the reports filled one slim box—but by 1965 it required half a shelf for all the records. At present, more than seventy percent of all patients who died in the hospital were autopsied, and there was talk of microfilming the reports for the library.

In one corner of the room was a portable electric coffeepot, a bowl of sugar, a stack of paper cups, and a sign that said, “5 cents a cup. Scout’s honor.” Sanderson was fussing with the pot, trying to get it to work. The pot represented an ancient challenge: it was said nobody was permitted to finish his path residency at the Lincoln until he had mastered its workings.

“Someday,” Sanderson muttered, “I’m going to electrocute myself on this damned thing.” He plugged it in; crackling sounds were heard. “Me, or some other poor bastard. Cream and sugar?”

“Please,” I said.

Sanderson filled two cups, holding the pot at arm’s length. Sanderson was notoriously bad with anything mechanical. He had a superb, almost instinctive understanding of the human body and its functions of flesh and bone, but mechanical, steel, and electrical objects were beyond him. He lived in constant fear that his car, or his TV, or his stereo would break down; he regarded them all as potential traitors and deserters.

He was a tall, powerfully built man who had once rowed stroke for the Harvard heavyweights. His forearms and wrists were as thick as most men’s calves. He had a solemn, thoughtful face: he might have been a judge, or an excellent poker player.

“Did Weston say anything else?” he asked.

“No.”

“You sound unhappy.”

“Let’s say I’m worried.”

Sanderson shook his head. “I think you’re barking up the wrong tree here,” he said. “Weston wouldn’t fake a report for anybody. If he says he was unsure, then he was.”

“Maybe you should examine the slides yourself.”

“I’d like to,” Sanderson said, “but you know that’s impossible.”

He was right. If he showed up at Mallory and asked to see the slides, it would be taken as a personal insult by Weston. That kind of thing just wasn’t done.

I said, “Maybe if he asked you …”

“Why should he?”

“I don’t know.”

“Weston has made his diagnosis and signed his name to it. The matter closes there, unless it comes up again during the trial.”

I felt a sinking feeling. Over the past days, I had come to believe very strongly that there must not be a trial. Any trial, even an acquittal, would seriously damage Art’s reputation, his standing, and his practice. A trial had to be prevented.

“But you think she was hypopit,” Sanderson said.

“Yes.”

“Etiology?”

“Neoplasm, I think.”

“Adenoma?”
¹

“I imagine. Maybe craniopharyngioma.”

“How long?”

“It couldn’t be very long,” I said. “X rays four months ago were normal. No enlargement or erosion of the sella turcica. But she did complain of vision trouble.”

“What about pseudotumor?”

Pseudotumor cerebri is a disorder of women and young children. Patients get all the symptoms of a tumor, but don’t actually have one. It is related to withdrawal of steroid therapy; women sometimes get it when taking birth-control pills. But as far as I knew, Karen wasn’t taking pills. I told Sanderson.

“Too bad we don’t have slides of the brain,” he said.

I nodded.

“On the other hand,” Sanderson said, “an abortion was performed. We can’t forget that.”

“I know,” I said. “But it’s just another indicator that Art didn’t do it. He wouldn’t have aborted her without doing a bunny test first, and such a test would have been negative.”

“That’s only circumstantial evidence, at best.”

“I know,” I said, “but it’s something. A start.”

“There is another possibility,” Sanderson said. “Supposing the abortionist was willing to take Karen’s word that she was pregnant.”

I frowned. “I don’t understand. Art didn’t know the girl; he had never seen her before. He would never—”

“I’m not thinking of Art,” Sanderson said. He was staring at his feet, as if he had something embarrassing on his mind.

“What do you mean?”

“Well, this is all highly speculative …”

I waited for him.

“A lot of muck has been thrown already. I hate to add to it,” he said.

I said nothing.

“I never knew it before,” Sanderson continued. “I thought I was pretty well informed about these things, but I never knew it until today. As you can imagine, the whole medical community is buzzing. J. D. Randall’s girl dies from an abortion—you can’t keep other doctors from talking about
that.”
He sighed. “Anyway, it was something one of the wives told my wife. I don’t even know if it’s true.”

I wasn’t going to push Sanderson. He could take his time in telling me; I lit a cigarette and waited patiently.

“Oh hell,” Sanderson said, “it’s probably just a rumor. I can’t imagine I’d never heard of it before.”

“What?” I said finally.

“Peter Randall. Peter does abortions. Very quiet and exclusive, but he does them.”

“Jesus,” I said, sitting down in a chair.

“It’s hard to believe,” Sanderson said.

I smoked a cigarette and thought it over. If Peter did abortions, did J. D. know? Did he think Peter had done it, and was covering up for him? Was that what he meant by “a family matter”? If so, why had Art been dragged into this?

And why would Peter abort the girl in the first place? Peter had evidence that there might be something wrong with the girl. He was a good enough doctor to think of a pit tumor. If the girl came to him saying she was pregnant, he’d certainly think back to her vision trouble. And he’d run tests.

“Peter didn’t do it,” I said.

“Maybe she put pressure on him. Maybe she was in a hurry. She only had one weekend.”

“No. He wouldn’t respond to pressure from her.”

“She was family.”

“She was a young and hysterical girl,” I said, remembering Peter’s description.

Sanderson said, “Can you be sure Peter didn’t do it?”

“No,” I admitted.

“Let’s suppose he did. And let’s suppose Mrs. Randall knew about the abortion. Or that the girl told her, as she was bleeding to death, that Peter had done it. What would Mrs. Randall do? Turn in her brother-in-law?”

I could see where he was leading me. It certainly provided an explanation for one of the puzzles of the case—why Mrs. Randall had called in the police. But I didn’t like it, and I told Sanderson so.

“The reason you don’t like it is you’re fond of Peter.”

“That may be.”

“You can’t afford to exclude him or anyone else. Do you know where Peter was last Sunday night?”

“No.”

“Neither do I,” Wes Sanderson said, “but I think it’s worth checking.”

“No,” I said, “it’s not. Peter wouldn’t do it. And even if he did, he wouldn’t have botched it so badly. No professional would have.”

“You’re prejudging the case,” Sanderson said.

“Look, if Peter could have done it—without tests, without anything—then so could Art.”

“Yes,” Sanderson said mildly. “That has occurred to me.”

¹
A chromophobe adenoma is the most common tumor of the pituitary. It is slow-growing and relatively benign, but it presses on the optic nerve, causing visual symptoms, and it may create endocrine dysfunction.

I
WAS FEELING IRRITABLE
when I left Sanderson. I couldn’t decide exactly why. Perhaps he was right; perhaps I was unreasonably and illogically searching for fixed points, for things and people to believe in.

But there was something else. In any court action, there was always the chance that Sanderson and I could be implicated, and our role in fooling the tissue committee brought out. Both Sanderson and I had a large stake in this business, a stake as large as Art’s. We hadn’t talked about that, but it was there in the back of my mind, and I was sure in the back of his as well. And that put a different interpretation on things.

Sanderson was perfectly correct: we could put the squeeze on Peter Randall. But if we did, we’d never know why we did. We could always say it was because we believed Peter was guilty. Or because it was expedient, to save a falsely accused man.

But we would always wonder whether we did it simply to protect ourselves.

Before I did anything, I would have to get more information. Sanderson’s argument made no distinction between Mrs. Randall knowing that Peter had done the abortion and merely suspecting that he had.

And there was another question. If Mrs. Randall suspected that Peter had done the abortion and wished to keep him from being arrested, why had she named Art? What did she know about Art?

Art Lee was a circumspect and cautious man. He was hardly a household word among the pregnant women of Boston. He was known to a few physicians and a relatively small number of patients. His clientele was carefully chosen.

How had Mrs. Randall known he performed abortions? There was one man who might know the answer: Fritz Werner.

FRITZ WERNER
lived in a town house on Beacon Street. The ground floor was given over to his office—an anteroom and a large, comfortable room with desk, chair, and couch—and to his library. The upper two floors comprised his living quarters. I went directly to the second floor and entered the living room to find it the same as always: a large desk by the window, covered with pens, brushes, sketchbooks, pastels; drawings by Picasso and Miró on the walls; a photograph of T. S. Eliot glowering into the camera; an informal, signed portrait of Marianne Moore talking with her friend Floyd Patterson.

Fritz was sitting in a heavy armchair, wearing slacks and an enormous bulky sweater. He had stereophonic earphones on his head, was smoking a thick cigar, and crying. The tears rolled down his flat, pale cheeks. He wiped his eyes when he saw me, and took off the earphones.