A Case of Need: A Novel (8 page)

One of the technicians took up the challenge. “I used to be accurate,” she said, “before I got frostbite on my fingers.”

“Excuses, excuses,” Murphy grinned. He turned back to me and picked up the tube of blood. “This’ll be easy. We’ll just pop it onto the old fractionating column and let it perk through,” he said. “Maybe we’ll do two independent aliquots, just in case one gets fouled up. Who’s it from?”

“What?”

He waved the test tube in front of me impatiently. “Whose blood?”

“Oh. Just a case,” I said, shrugging.

“A four-month pregnancy and you can’t be sure? John boy, not leveling with your old buddy, your old bridge opponent.”

“It might be better,” I said, “if I told you afterward.”

“O.K., O.K. Far from me to pry. Your own way, but you
will
tell me?”

“Promise.”

“A pathologist’s promise,” he said, standing up, “rings of the eternal.”

¹
Boston Lying-In Hospital.

²
Stillbirths, abortuses, and placentas are in hot demand at the BLI for the dozen or so groups doing hormone research. Sometimes rather bitter arguments break out over who needs the next dead baby most for their studies.

T
HE 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. Practically speaking, it is much better to discover a new disease than to find a cure for an old one; your cure will be tested, disputed, and argued over for years, while a new disease is readily and rapidly accepted.

Lewis Carr, while still an intern, hit the jackpot: he found a new disease. It was pretty rare—a hereditary dysgammaglobulinemia affecting the beta-fraction which he found in a family of four—but that was not important. The important thing was that Lewis discovered it, described it, and published his results in the
New England Journal of Medicine.

Six years later he was made clinical professor at the Mem. There was never any question he would be; simply a matter of waiting until somebody on the staff retired and vacated an office.

Carr had a good office in terms of status at the Mem; it was perfect for a young hotshot internist. For one thing, it was cramped and made even worse by the stacks of journals, texts, and research papers scattered all around. For another, it was dirty and old, tucked away in an obscure corner of the Calder Building, near the kidney research unit. And for the finishing touch, amid the squalor and mess sat a beautiful secretary, looking sexy, efficient, and wholly unapproachable: a nonfunctional beauty to contrast with the functional ugliness of the office.

“Dr. Carr is making rounds,” she said without smiling. “He asked for you to wait inside.”

I went in and took a seat, after removing a stack of back issues of the
American Journal of Experimental Biology
from the chair. 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.

Unkind souls said Carr was more than political, that he shamelessly sucked up to the senior staff men. But many people resented his swift success and his confident manner. Carr had a round and childlike face; his cheeks were smooth and ruddy. He had an engaging boyish grin that went over very well with the female patients. He gave me that grin now.

“Hi, John.” He shut the door to his outer office and sat down behind his desk. I could barely see him over the stacked journals. He removed the stethoscope from his neck, folded it, and slipped it into his pocket. Then he looked at me.

I guess it’s inevitable. Any practicing doctor who faces you from behind a desk gets a certain manner, a thoughtful-probing-inquisitive air which is unsettling if there’s nothing wrong with you. Lewis Carr got that way now.

“You want to know about Karen Randall,” he said, as if reporting a serious finding.

“Right.”

“For personal reasons.”

“Right.”

“And anything I tell you goes no further?”

“Right.”

“O.K.,” he said. “I’ll tell you. I wasn’t present, but I have followed things closely.”

I knew that he would have. Lewis Carr followed everything at the Mem closely; he knew more local gossip than any of the nurses. He gathered his knowledge reflexively, the way some other people breathed air.

“The girl presented in the outpatient ward at four this morning. She was moribund on arrival; when they sent a stretcher out to the car she was delirious. Her trouble was frank vaginal hemorrhage. She had a temperature of 102, dry skin with decreased turgor, shortness of breath, a racing pulse, and low blood pressure. She complained of thirst.”
¹

Carr took a deep breath. “The intern looked at her and ordered a cross match so they could start a transfusion. He drew a syringe for a count and crit
²
and rapidly injected a liter of D 5.
³
He also attempted to locate the source of the hemorrhage but he could not, so he gave her oxytocin to clamp down the uterus and slow bleeding, and packed the vagina as a temporary measure. Then he found out who the girl was from the mother and shit in his pants. He panicked. He called in a resident. He started the blood. And he gave her a good dose of prophylactic penicillin. Unfortunately, he did this without consulting her chart or asking the mother about allergic reactions.”

“She was hypersensitive.”
⁴

“Severely,” Carr said. “Ten minutes after giving the penicillin i.m.
⁵
the girl went into choking spasms and appeared unable to breathe despite a patent airway. By now the chart was down from the record room, and the intern realized what he had done. So he administered a milligram of epinephrine i.m. When there was no response, he went to a slow IV, benadryl, cortisone, and aminophylline. They put her on positive pressure oxygen. But she became cyanotic,
⁶
convulsive, and died within twenty minutes.”

I lit a cigarette and thought to myself that I wouldn’t like to be that intern now.

“Probably,” Carr said, “the girl would have died anyway. We don’t know that for sure, but there’s every reason to think that at admission her blood loss already approached fifty percent. That seems to be the cut-off, as you know—the shock is usually irreversible. So we probably couldn’t have kept her. Of course, that doesn’t change anything.”

I said, “Why’d the intern give penicillin in the first place?”

“That’s a peculiarity of hospital procedure,” Carr said. “It’s a kind of routine around here for certain presenting symptoms. Normally when we get a girl with evidence of a vaginal bleed and a high fever—possible infection—we give the girl a D & C, put her to bed, and stick her a shot of antibiotic. Send her home the next day, usually. And it goes down on the charts as miscarriage.”

“Is that the final diagnosis on Karen Randall’s record? Miscarriage?”

Carr nodded. “Spontaneous. We always put it down that way, because if we do that, we don’t have to fool with the police. We see quite a few self-induced or illegally induced abortions here. Sometimes the girls come in with so much vaginal soap they foam like overloaded dishwashers. Other times, it’s bleeding. In every case, the girl is hysterical and full of wild lies. We just take care of it quietly and send her on her way.”

“And never report it to the police?”
⁷

“We’re doctors, not law-enforcement officers. We see about a hundred girls a year this way. If we reported every one, we’d all spend our time in court testifying and not practicing medicine.”

“But doesn’t the law require—”

“Of course,” Carr said quickly. “The law requires that we report it. The law also requires that we report assaults, but if we reported every drunk who got into a bar brawl, we’d never hear the end of it. No emergency ward reports everything it should. You just can’t operate on that basis.”

“But if there’s been an abortion—”

“Look at it logically,” Carr said. “A significant number of these cases are spontaneous miscarriages. A significant number aren’t, but it doesn’t make sense for us to treat it any other way. Suppose you know that the butcher of Barcelona worked on a girl; suppose you call in the police. They show up the next day and the girl tells them it was spontaneous. Or she tells them she tried it on herself. But either way she won’t talk, so the police are annoyed. Mostly, with you, because you called them in.

“Does this happen?”

“Yes,” Carr said, “I’ve seen it happen twice myself. Both times, the girl showed up crazy with fear, convinced she was going to die. She wanted to nail the abortionist, so she demanded the police be called in. But by morning, she was feeling fine, she’d had a nice hospital D & C, and she realized her problems were over. She didn’t want to fool with the police; she didn’t want to get involved. So when the cops came, she pretended it was all a big mistake.”

“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.”

I wasn’t going to argue with him; I knew it wouldn’t do any good. So I changed the subject.

“What about the charges against Lee? What happened there?”

“When the girl died,” Carr said, “Mrs. Randall became hysterical. She started to scream, so they gave her a tranquilizer and sedative. After that, she settled down, but she continued to claim that her daughter had named Lee as the abortionist. So she called the police.”

“Mrs. Randall did?”

“That’s right.”

“What about the hospital diagnosis?”

“It remains miscarriage. This is a legitimate medical interpretation. The change to illegal abortion is made on nonclinical grounds, so far as we are concerned. The autopsy will show whether an abortion was performed.”

“The autopsy showed it,” I said. “Quite a good abortion, too, except for a single laceration of the endometrium. It was done by someone with skill—but not quite enough skill.”

“Have you talked with Lee?”

“This morning,” I said. “He claims he didn’t do it. On the basis of that autopsy, I believe him.”

“A mistake—”

“I don’t think so. Art’s too good, too capable.”

Carr removed the stethoscope from his pocket and played with it, looked uncomfortable. “This is a very messy thing,” he said. “Very messy.”

“It has to be cleared up,” I said. “We can’t hide our heads in the sand and let Lee go to hell.”

“No, of course not,” Carr said. “But J. D. was very upset.”

“I imagine so.”

“He practically killed that poor intern when he saw what treatment had been given. I was there, and I thought he was going to strangle the kid with his bare hands.”

“Who was the intern?”

“Kid named Roger Whiting. Nice kid, even though he went to P & S.”

“Where is he now?”

“At home, probably. He went off at eight this morning.” Carr frowned and fiddled once more with his stethoscope. “John,” he said, “are you sure you want to get involved in this?”

“I don’t want anything to do with it,” I said. “If I had my choice, I’d be back in my lab now. But I don’t see any choice.”

“The trouble is,” Carr said slowly, “that this thing has gotten out of control. J. D. is very upset.”

“You said that before.”

“I’m just trying to help you understand how things are.” Carr rearranged things on his desk and did not look at me. Finally he said, “The case is in the proper hands. And I understand Lee has a good lawyer.”

“There are a lot of dangling questions. I want to be sure they’re all cleaned up.”

“It’s in the proper hands,” Carr said again.

“Whose hands? The Randalls? The goons I saw down at the police station?”

“We have an excellent police force in Boston,” Carr said.

“Bullshit.”

He sighed patiently and said, “What can you hope to prove?”

“That Lee didn’t do it.”

Carr shook his head. “That’s not the point.”

“It seems to me that’s precisely the point.”

“No,” Carr said. “The point is that the daughter of J. D. Randall was killed by an abortionist, and somebody has to pay. Lee’s an abortionist—that won’t be hard to prove in court. In a Boston court, the jury is likely to be more than half Catholic. They’ll convict him on general principles.”

“On general principles?”

“You know what I mean,” Carr said, shifting in his chair.

“You mean Lee’s the goat.”

“That’s right. Lee’s the goat.”

“Is that the official word?”

“More or less,” Carr said.

“And what are your feelings about it?”

“A man who performs abortions puts himself in danger. He’s breaking the law. When he aborts the daughter of a famous Boston physician—”

“Lee says he didn’t do it.”

Carr gave a sad smile. “Does it matter?”

¹
Thirst is an important symptom in shock. For unknown reasons, it appears only in severe shock due to fluid loss, and is regarded as an ominous sign.

²
White count and hematocrit.

³
Five percent dextrose in water, used to replace lost fluid volume.

⁴
Penicillin reactions occur in 9-10 percent of normal patients.

⁵
Intramuscularly.

⁶
Blue.

⁷
See
Appendix II: Cops and Doctors
.

I
T TAKES THIRTEEN YEARS
from the time you leave college to the time you become a cardiac surgeon. You have four years of medical school, a year of internship, three of general surgery, two of thoracic surgery, two of cardiac surgery. Somewhere along the line, you spend two years working for Uncle Sam.
¹