I will prescribe regimen for the good of my pa tients, according to my judgment and ability, and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. . . .
-FROM THE HIPPOCRATIC OATH DEMANDED OF THE YOUNG PHYSICIAN ABOUT TO ENTER UPON THE PRACTICE OF HIS PROFESSION.
There is no moral obligation to conserve DNA.
—Garrett Hardin
MONDAY
OCTOBER 10
ONE
ALL HEART SURGEONS ARE BASTARDS, and Conway is
no exception. He came storming into the path lab at 8:30 in the morning, still wearing his green surgical gown and cap, and he was furious. When Conway is mad he clenches his teeth and speaks through them in a flat monotone. His face turns red, with purple blotches at the temples.
“Morons,” Conway hissed, “goddamned morons.” He pounded the wall with his fist; bottles in the cabinets rattled.
We all knew what was happening. Conway does two open-heart procedures a day, beginning the first at 6:30. When he shows up in the path lab two hours later, there’s only one reason.
“Stupid clumsy bastard,” Conway said. He kicked over a wastebasket. It rolled noisily across the floor.
“Beat his brains in, his goddamned brains,” Conway said, grimacing and staring up at the ceil ing as if addressing God. God, like the rest of us,
had heard it before. The same anger, the same clenched teeth and pounding and profanity. Conway always ran true to form, like the rerun of
a movie.
Sometimes his anger was directed against the thoracic man, sometimes against the nurses, sometimes against the pump technicians. But oddly enough, never against Conway.
“If I live to be a hundred,” Conway hissed through his teeth, “I’ll never find a decent anes man. Never. They don’t exist. Stupid, shit-eating bastards, all of them.”
We glanced at each other:this timeit was Herbie. About four times a year the blame fell on Herbie. The rest of the time he and Conway were good friends. Conway would praise him to the sky, call him the finest anesthesiologist in the country, better than Sonderick at the Brigham, better than Lewis at the Mayo, better than anyone.
But four times a year, Herbert Landsman was re sponsible for a DOT, the surgical slang for a death on the table. In cardiac surgery, it happened a lot: fifteen percent for most surgeons, eight percent for a man like Conway.
Because Frank Conway was good, because he was an eight-percenter, a man with lucky hands, a man with the touch, everyone put up with his temper tantrums, his moments of anger and destructiveness . Once he kicked over a path microscope and did a hundred dollars’ worth of damage. No-
body blinked, because Conway was an eight- percenter.
Of course, there was scuttlebutt in Boston about how he kept his percentage, known privately among surgeons as the “Kill rate,” down. They said Conway avoided cases with complications. They said Conway avoided jerry cases.1 They said Conway never innovated, never tried a new and dangerous procedure. The arguments were, of course, wholly untrue. Conway kept his kill rate low because he was a superb surgeon. It was as simple as that.
The fact that he was also a miserable person was considered superfluous.
“Stupid, stinking bastard,” Conway said. He looked angrily about the room. “Who’s on today?”
“I am,” I said. I was the senior pathology staff member in charge for the day. Everything had to be cleared through me. “You want a table?”
“Yeah. Shit.”
“When?”
“Tonight.”
It was a habit of Conway’s. He always did his autopsies on the dead cases in the evening, often going long into the night. It was as if he wanted to punish himself. He never allowed anyone, not even his residents, to be present. Some said he cried while he did them. Others said he giggled. The fact was that nobody really knew. Except Conway.
‘ Geriatrics.
“I’ll tell the desk,” I said. “They’ll hold a locker for you.”
“Yeah. Shit.” He pounded the table. “Mother of four, that’s what she was.”
“I’ll tell the desk to arrange everything.” “Arrested before we got into the ventricle. Cold. We massaged for thirty-five minutes, but nothing. Nothing.”
“What’s the name?” I said. The desk would need the name.
“McPherson,” Conway said, “Mrs. McPherson.” He turned to go and paused by the door. He seemed to falter, his body sagging, his shoulders slumping.
“Jesus,” he said, “a mother of four. What the hell am I going to tell him?”
He held his hands up, surgeon-style, palms facing him, and stared at his fingers accusingly, as if they had betrayed him. I suppose in a sense they had.
“Jesus,” Conway said. “I should have been a dermatologist. Nobody ever dies on a dermatologist.” Then he kicked the door open and left the lab.
when we were alone, one of the first-year resi dents, looking very pale, said to me, “Is he always like that?”
“Yes,” I said. “Always.”
I turned away, looking out at the rush-hour traffic moving slowly through the October drizzle. It would have been easier to feel sympathy for Conway if I
didn’t know that his act was purely for himself, a kind of ritual angry deceleration that he went through ev ery time he lost a patient. I guess he needed it, but still most of us in the lab wished he could be like Delong in Dallas, who did crossword puzzles in French, or Archer in Chicago, who went out and had a haircut whenever he lost someone.
Not only did Conway disrupt the lab, he put us behind. In the mornings, that was particularly bad, because we had to do the surgical specimens and we were usually behind schedule anyway.
I turned my back to the window and picked up the next specimen. We have a high-speed tech nique in the lab: the pathologists stand before waist-high benches and examine the biopsies. A mi crophone hangs from the ceiling before each of us, and it’s controlled by a foot pedal. This leaves your hands free; whenever you have something to say, you step on the pedal and speak into the mike, recording your comments on tape. The secretaries type it up later for the charts.2
I’ve been trying to stop smoking for the past week, and this specimen helped me: it was a white lump imbedded in a slice of lung. The pink tag at tached gave the name of the patient; he was down in the OR now with his chest cut open. The sur geons were waiting for the path dx3 before proceed-
2
The files containing the history of treatment of patients in the hospital.
Called a “chart” because the bulk of the file consists of daily charts of tem
perature, blood pressure, pulse and respiration, the so-called “vital signs.”
3
Diagnosis.
ing further with the operation. If this was a benign tumor, they’d simply remove one lobe of his lung. If it was malignant, they’d take the whole lung and all his lymph nodes.
1 stepped on the floor pedal. “Patient AO—four-five-two-three-three-six. Joseph Magnuson, The specimen is a section of right lung, upper lobe, measuring”—I took my foot off the pedal and measured it—”five centimeters by seven point five centimeters. The lung tissue is pale pink in color and crepitant.4 The pleural surface is smooth and glistening, with no evidence of fibrous material or adhesions. There is some hemorrhage. Within the parenchyma is an irregular mass, white in color, measuring”—
I measured the lump—”approximately two centimeters in diameter. On cut surface, it appears whit ish and hard. There is no apparent fibrous capsule, and there is some distortion of surrounding tissue structure. Gross impression . . . cancer of the lung, suggestive of malignancy, question mark metastatic. Period, signed, John Berry.”
I cut a slice of the white lump and quick-froze it. There was only one way to be certain if the mass was benign or malignant, and that was to check it under the microscope. Quick-freezing the tissue allowed a thin section to be rapidly prepared. Normally, to make a microscope slide, you had to dunk
4
Crepitant means it is crackly and filled with air. This is normal.
your stuff into six or seven baths; it took at least six hours, sometimes days. The surgeons couldn’t wait. When the tissue was frozen hard, I cranked out a section with the microtome, stained the slice, and took it to the microscope. I didn’t even need to go to high dry: under the low-power objective, I could see the lacy network of lung tissue formed into delicate alveolar sacs for exchange of gas between blood and air. The white mass was something else again. I stepped on the floor button. “Micro examination, frozen section. The whitish mass appears composed of undifferentiated parenchyma cells which have invaded the normal surrounding tissue. The cells show many irregular, hyperchromatic nuclei and large numbers of mitoses. There are some multinucleate giant cells. There is no clearly defined capsule. Impression is primary malignant cancer of the lung. Note marked degree of anthracosis in surrounding tissue.”
Anthracosis is accumulation of carbon particles in the lung. Once you gulp carbon down, either as cigarette smoke or city dirt, your body never gets rid of it. It just stays in your lungs.
The telephone rang. I knew it would be Scanlon down in the OR, wetting his pants because we hadn’t gotten back to him in thirty seconds flat. Scanlon is like all surgeons. If he’s not cutting, he’s not happy. He hates to stand around and look at the big hole he’s chopped in the guy while he waits for the report. He never stops to think that after he takes a biopsy and drops it into a steel dish, an or-
derly has to bring it all the way from the surgical wing to the path labs before we can look at it. Scanlon also doesn’t figure that there are eleven other operating rooms in the hospital, all going like hell between seven and eleven in the morning. We have four residents and pathologists at work during those hours, but biopsies get backed up. There’s nothing we can do about it—unless they want to risk a misdiagnosis by us.
And they don’t. They just want to bitch, like Conway. It gives them something to do. All sur geons 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, 1 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 in tercom 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 justcalled.John,isitsomething
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 prob ably 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 did 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 propo sition. Boston has the highest accident rate in the U.S., even higher than Los Angeles, as any EW5 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 reli gion,” he kept saying, doubled over in laughter. “Blinded by religion.”
The surgeon did plastic stuff, and he didn’t see the humor. 1 guess because he’d repaired too many punched-out eyesockets. But Art was convulsed.
5
Emergency ward.
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 ir regularity, 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 noti fied?”
Immediately, the hearty manner was gone. “Yes,”
he said, “I have.”
“I just wanted you to know. There might be trou ble 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 re member 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 CC6 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, ex cept that she had a mild fever. Blood tests were normal, though hematocrit7 was somewhat low.
Dr. Lee ordered a D & C to correct her irregularity. This was in 1956, before the advent of estrogen
6
Chief complaint, the term for the medical disorder that brings the pa tient to seek treatment.
7
A test of the amount of hemoglobin, or red cells, in the blood.
therapy. The D & C was normal; no evidence of tu mors 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 mi croscopic 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 ev ery 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 con vincing. 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 some-
place 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.”
“Idon’tunderstand,”Isaid.“Youmean 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 dur ing 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.
“I was pretty horrified. I was fresh from my res idency, and I still had a little starry idealism in me. She was in a terrible fix; she was a wreck and acted as if the world had collapsed around her. I guess in a way it had. All she could see was her problem as a college dropout, the unwed mother of a possibly deformed child. She was a nice enough girl, and I felt sorry for her, but I said no. I sympathized with her, feeling rotten inside, but I explained that my hands were tied.
“So then she asked me if it was a dangerous op eration, to have an abortion. At first I thought she was planning to try it on herself, so I said it was. Then she said she knew of a man in the North End who would do it for two hundred dollars. He had been a medical orderly in the Marines, or something. And she said that if I wouldn’t do it for her, she’d go to this man. And she walked out of my office.”
He sighed and shook his head as he drove.
“I went home that night feeling like hell. I hated her: I hated her for intruding on my new practice, for intruding on my neatly planned life. I hated her for the pressure she was putting on me. I couldn’t
sleep; I kept thinking all night. I had a vision of her going toasmelly back roomsomewhereand meeting a leering little guy who would letch her and maybe even manage to kill her. I thought about my own wife and our year-old baby, and how happy it could all be. I thought about the amateur abortions I’d seen as an intern, when the girls came in bleeding and foaming at three in the morning. And let’s face it, I thought about the sweats I’d had in college. Once with Betty, we sat around for six weeks waiting for her period. I knew perfectly well that anybody can get pregnant by accident. It’s not hard, and it shouldn’t be a crime.”
I smoked a cigarette and said nothing. “So I got up in the middle of the night and fought it out with six cups of coffee, staring at the kitchen wall. By morning I had decided that the law was unfair. I had decided that a doctor could play God in a lot of crappy ways, but this was a good way. I had seen a patient in trouble and I had refused to help her when it was within my power. That was what bothered me—I had denied her treatment. It was just as bad as denying penicillin to a sick man, just as cruel and just as foolish. The next morning, I went to see Sanderson. I knew he had liberal ideas about a lot of things. I explained the whole situation and told him I wanted to do a D & C. He said he would arrange to do the path examination himself, and he did. That was how it
all started.”
“And you’ve been doing abortions ever since?”
“Yes,” Art said. “When I’ve felt that they were warranted.”
After that, we went to a bar in the North End, a simple place, filled with Italian and German laborers. Art was in a talkative, almost confessional mood.
“I often wonder,” he said, “about what medicine would be like if the predominant religious feeling in this country were Christian Scientist. For most of history, of course, it wouldn’t have mattered; medicine was pretty primitive and ineffective. But supposing Christian Science was strong in the age of penicillin and antibiotics. Suppose there were pressure groups militating against the administration of these drugs. Suppose there were sick people in such a society who knew perfectly well that they didn’t have to die from their illness, that a simple drug existed which would cure them. Wouldn’t there be a roaring black market in these drugs? Wouldn’t people die from home administration of overdoses, from impure, smuggled drugs? Wouldn’t everything be an unholy mess?”
“I see your analogy,” I said, “but I don’t buy it.”
“Listen,” he said. “Morality must keep up with technology, because if a person is faced with the choice of being moral and dead or immoral and alive, they’ll choose life every time. People today know that abortions are safe and easy. They know it isn’t a long, tedious, dangerous operation. They know it’s simple and they want the personal happi ness it can give them. They demand it. And one
way or another they get it. If they’re rich, they go to Japan or Puerto Rico; if they’re poor, they go to the Marine orderly. But one way or another, they get that abortion.”
“Art,” I said. “It’s illegal.”
He smiled. “I never thought you had so much re spect for the law.”
That was a reference to my career. After college, I entered law school and stuck it out for a year and a half. Then I decided I hated it and quit to try medicine. In between, I did some army time.
“But this is different,” I said. “If they catch you, they’ll toss you in the clink and take away your li cense. You know that.”
“I’m doing what I have to do.” “Don’t be an ass.”
“I believe,” he said, “that what I’m doing is right.” Looking at his face, I saw he meant it. And as time went on, I personally encountered several cases where an abortion was the obvious, humane answer. Art handled them. I joined Dr. Sanderson in covering up in the path department. We fixed things so that the tissue committee never knew. That was necessary because the tissue committee of the Lincoln was composed of all the chiefs of service, as well as a rotating group of six doctors. The average age of the men on the tissue committee was sixty-one, and, at any given time, at least a third were Catholic.
Of course it was not a well-kept secret. Many of the younger doctors knew what Art was doing, and
most agreed with him, because he exercised careful judgment in deciding his cases. Most would have performed abortions too, if they had dared.
A few didn’t agree with Art and would have been tempted to turn him in if they’d had the guts. Anal retentives like Whipple and Gluck, men whose re ligion precluded compassion and common sense.
For a long time, I worried about the Whipples and the Glucks. Later on I ignored them, turning away from their nasty knowing glances and pinched, disapproving faces. Perhaps that was a mistake.
Because now Art was down, and if his head rolled, so would Sanderson’s. And so would mine.
there was no place to park near the police station. Finally I came to a lot four blocks away and walked quickly back to find out why Arthur Lee was in jail.
TWO
when I was in the army a few years back, I served as an MP in Tokyo, and the experience taught me a lot. MP’s were the most unpopular people in the city in those days, during the last phases of the oc cupation. In our white helmets and uniforms, we
represented the final reminders of a tiresome mili tary authority to the Japanese. To the Americans on the Ginza, drunk with sake or whiskey if they could afford it, we represented all that was frustrating or constricting about rigid military life. We were therefore a challenge to anyone who saw us, and more than one of my friends ran into trouble. One was blinded by a knife in the eye. Another was killed. Of course, we were armed. I remember when we were first issued our guns, a hard-nosed captain said to us: “You have your weapons, now take my advice: never use the gun. You shoot a rowdy drunk, even in self-defense, and you’ll find out later his uncle is a congressman or a general. Keep the gun in sight, but keep it in your holster. Period.”
In effect we were ordered to bluff our way through everything. We learned to do it. All cops
learn to do it.
I remembered this as I faced the surly police ser geant in the Charles Street Station. He looked up at me as if he’d enjoy breaking my skull.
“Yeah? What is it?”
“I’m here to see Dr. Lee,” I said.
He smiled. “The little chink’s uptight, is he? Too
bad.”
“I’m here to see him,” I repeated.
“Can’t.”
He looked back at his desk and shuffled the papers on it in a busy, irritable dismissal. “Would you care to explain that?” “No,” he said. “I wouldn’t care to explain that.”
I took out my pen and notebook. “I’d like your badge number, please.”
“What are you, a funny guy? Beat it. You can’t see him.”
“You are required by law to give your badge number upon request.”
“That’s nice.”
I looked at his shirt and pretended to write down the number. Then I started for the door.
He said casually, “Going somewhere?”
“There’s a phone booth right outside.” So?
“It’s a shame. I’ll bet your wife spent hours sew ing those stripes on your shoulder. It takes them ten seconds to get them off. They use a razor blade: doesn’t even damage the uniform.”
He stood up heavily behind the desk. “What’s your business here?”
“I’ve come to see Dr. Lee.”
He looked at me evenly. He didn’t know if I could have him busted, but he knew it could be done.
“You his lawyer?”
“That’s right.”
“Well, for Christ’s sake, you should have said so before.” He took a set of keys from his desk drawer. “Come on.” He smiled at me, but his eyes were still hostile.
I followed him back through the station. He said nothing, but grunted a couple of times. Finally he
said over his shoulder, “You can’t blame me for be ing careful. Murder is murder, you know.” “Yes,” I said.
art was locked in a nice cell. It was tidy and didn’t smell much. Actually, Boston has some of the nicest cells in America. They have to: lots of famous people have spent time in those cells. Mayors, public officials, people like that. You can’t expect a man to run a decent campaign for reelection if he’s in a lousy cell, can you? It just wouldn’t look right.
Art was sitting on his bed, staring at a cigarette between his fingers. The stone floor was littered with butts and ash. He looked up as we came down the hallway.
“John!”
“You have him for ten minutes,” the sergeant
said.
I entered the cell. The sergeant locked the door behind me and stood there, leaning against the
bars.
“Thank you,” I said. “You can go now.” He gave me a mean look and sauntered off, rat tling the keys.
When we were alone, I said to Art, “You all
right?”
“I think so.”
Art is a small, precise man, a fastidious dresser. Originally he’s from San Francisco from a large family of doctorsand lawyers.Apparently his
nese. His skin is more olive than yellow, his eyes lack epicanthic folds, and his hair is light brown. He is very nervous, constantly moving his hands in fluttering movements, and the total effect is more Latin than anything else.
He was pale now and tense. When he got up to pace the cell, his movements were quick and ab rupt.
“It was good of you to come.”
“In case there’s any question, I’m the representative of your lawyer. That’s how I got in here.” I took out my notebook. “Have you called your lawyer?”
“No, not yet.”
“Why not?”
“I don’t know.” He rubbed his forehead and mas saged his eyes with his fingers. “I’m not thinking straight. Nothing seems to make sense. . . .”
“Tell me your lawyer’s name.”
He told me, and I wrote it in the notebook. Art had a good lawyer. I guess he figured he’d need one, sometime.
“Okay,” I said. “I’ll call him when I leave. Now what’s going on?”
“I’ve been arrested,” Art said. “For murder.”
“So I gathered. Why did you call me?”
“Because you know about these things.”
“About murder? I don’t know anything.”
“You went to law school.”
“For a year,” I said. “That was ten years ago. I al-
most flunked out, and I don’t remember a thing I learned.”
“John,” he said, “this is a medical problem and a legal problem. Both. I need your help.”
“You’d better start from the beginning.”
“John, I didn’t do it. I swear I didn’t. I never touched that girl.”
He was pacing faster and faster. I gripped his arm and stopped him. “Sit down,” I said, “and start from the beginning. Very slowly.”
He shook his head and stubbed out his cigarette. Immediately he lit another, then said, “They picked me up at home this morning, about seven. Brought me in and started questioning me. At first they said it was routine, whatever that means. Then they turned nasty.”
“How many were there?”
“Two. Sometimes three.”
“Did they get rough? Slap you around? Bright lights?”
“No, nothing like that.”
“Did they say you could call a lawyer?”
“Yes. But that was later. When they advised me of my constitutional rights.” He smiled that sad, cynical smile of his. “At first, you see, it was just for routine questioning, so it never occurred to me to call one. I had done nothing wrong. They talked to me for an hour before they even mentioned the girl.”
“What girl?”
“Karen Randall.”
“You don’t mean the Karen—”
He nodded. “J. D. Randall’s daughter.”
“Jesus.”
“They began by asking me what 1 knew about her, and whether I’d ever seen her as a patient. Things like that. I said yes, that she had come to me a week ago for consultation. Chief complaint of amenorrhea.”
“What duration?”
“Four months.”
“Did you tell them the duration?”
“No, they didn’t ask me.”
“Good,” I said.
“They wanted to know other details about her visit. They wanted to know if that was her only problem, they wanted to know how she had acted. I wouldn’t tell them. I said that the patient had spoken in confidence. So then they switched tacks: they wanted to know where I was last night. I told them I had made evening rounds at the Lincoln and then taken a walk in the park. They asked me if I had gone back to my office. I said no. They asked me if anyone had seen me in the park that night. I said I couldn’t remember anyone, certainly nobody I knew.”
Art sucked deeply on his cigarette. His hands were trembling. “Then they started to hammer at me. Was 1 sure I hadn’t returned to my office? What had I done after making rounds? Was I sure I hadn’t seen Karen since last week? I didn’t under stand the point of the questions.”
“And what was the point?”
“Karen Randall was brought to the Mem EW at four this morning by her mother. She was bleeding profusely—exsanguinating actually—and was in a state of hemorrhagic shock when she arrived. I don’t know what treatment they gave her, but any way she died. The police think I aborted her last night.”
I frowned. It just didn’t make sense. “How can they be so sure?”
“They wouldn’t say. I kept asking. Maybe the kid was delirious and mentioned my name at the Mem. I don’t know.”
I shook my head. “Art, cops fear false arrest like they fear the plague. If they arrest you and can’t make it stick, a lot of people are going to lose their jobs. You’re a respected member of the professional community, not some drunken bum without a penny or a friend in the world. You have recourse to good legal advice, and they know you’ll get it. They wouldn’t dare charge you unless they had a strong case.”
Art waved his hand irritably. “Maybe they’re just stupid.”
“Of course they’re stupid, but not that stupid.”
“Well,” he said, “I don’t know what they’ve got on me.”
“You must know.”
“I don’t,” he said, resuming his pacing. “I can’t even begin to guess.”
I watched him for a moment, wondering when to
ask the question, knowing that I would have to, sooner or later. He noticed I was staring.
“No,” he said.
“No what?”
“No, I didn’t do it. And stop looking at me that way.” He sat down again and drummed his fingers on the bunk. “Christ, I wish I had a drink.”
“You’d better forget that,” I said.
“Oh, for Christ’s sake—”
“You only drink socially,” I said, “and in modera tion.”
“Am I on trial for my character and personal hab its, or for—”
“You’re not on trial at all,” I said, “and you don’t want to be.”
He snorted.
“Tell me about Karen’s visit,” I said.
“There’s nothing much to tell. She came asking for an abortion, but I wouldn’t do it because she was four months’ pregnant. I explained to her why I couldn’t do it, that she was too far along, and that an abortion would now require abdominal section.”
“And she accepted that?”
“She seemed to.”
“What did you put in your records?”
“Nothing. I didn’t open a file on her.”
I sighed. “That,” I said, “could be bad. Why didn’t you?”
“Because she wasn’t coming to me for treatment, she wasn’t becoming my patient. I knew I’d never see her again, so I didn’t open a file.”
“How are you going to explain that to the police?”
”Look,” he said, “if I’d known that she was going to get me arrested, I might have done lots of things differently.”
I lit a cigarette and leaned back, feeling the cold stone against my neck. I could already see that it was a messy situation. And the small details, innocent in another context, could now assume great weight and importance.
“Who referred her to you?”
“Karen? I assumed Peter.”
“Peter Randall?”
“Yes. He was her personal physician.”
“You didn’t ask her who referred her?” Art was usually careful about that.
“No. She arrived late in the day, and I was tired. Besides, she came right to the point; she was a very direct young lady, no foolishness about her. When I heard the story, I assumed Peter had sent her to me to explain the situation, since it was obviously too late to arrange an abortion.”
“Why did you assume that?”
He shrugged. “I just did.”
It wasn’t making sense. I was sure he wasn’t telling me everything. “Have other members of the Randall family been referred to you?”
“What do you mean?”
“Just what I said.”
“I don’t think it’s relevant,” he said.
“It might be.”
“I assure you,” he said, “it’s not.”
I sighed and smoked the cigarette. I knew Art could be stubborn when he wanted to. “O.K.,” I said. “Then tell me more about the girl.”
“What do you want to know?”
“Had you ever seen her before?”
“No.”‘
“Ever met her socially?”
“No.”
“Ever helped any of her friends?”
“No.”
“How can you be sure?”
“Oh, hell,” he said, “I can’t be sure, but I doubt it very much. She was only eighteen.”
“O.K.,” I said. Art was probably right. I knew he usually aborted only married women, in their late twenties and thirties. He had often said he didn’t want to get involved with the younger ones, though he did on occasion. Older women and married women were much safer, more closemouthed and realistic. But I also knew that he had recently been doing more young girls, calling them “teeny-bopper scrapes,” because he said to do only married women was discrimination. He meant that partly as a joke, and partly not.
“How was she,” I said, “when she came to your office? How would you describe her?”
“She seemed like a nice girl,” Art said. “She’s pretty and intelligent and well poised. Very direct, as I said before. She came into my office, sat down, folded her hands in her lap, and reeled it all off. She used medical terms too, like amenorrhea. I
suppose that comes from being in a family of doc tors.”
“Was she nervous?”
“Yes,” he said, “but they all are. That’s why the differential is so hard.”
The differential diagnosis of amenorrhea, partic ularly in young girls, must consider nervousness as a strong etiologic possibility. Women often delay or miss their menstrual periods for psychological rea sons.
“But four months?”
“Well, not likely. And she’d also had a weight gain.”
“How much?”
“Fifteen pounds.”
“Not diagnostic,” I said.
“No,” he said, “but suggestive.”
“Did you examine her?”
“No. I offered to, but she refused. She had come to me for an abortion, and when I said no, she left.”
“Did she say what her plans were?”
“Yes,” Art said. “She gave a little shrug and said, ‘Well, I guess I’ll just have to tell them and have the kid.'”
“So you thought she would not seek an abortion elsewhere?”
“Exactly. She seemed very intelligent and percep tive, and she seemed to follow my explanation of the situation. That’s what I try to do in these cases—explain to a woman why it is impossible for
her to have a safe abortion, and why she must rec oncile herself to having the child.”
“Obviously she changed her mind.”
“Obviously.”
“I wonder why.”
He laughed. “Ever meet her parents?”
“No,” I said, and then seeing my chance, “have you?”
But Art was quick. He gave me a slow, apprecia tive grin, a kind of subtle salute, and said, “No. Never. But I’ve heard about them.”
“What have you heard?”
At that moment, the sergeant came back and be gan clanking the key into the lock.
“Time’s up,’ he said.
“Five more minutes,” I said, limes up.
Art said, “Have you spoken to Betty?”
“Yes,” I said. “She’s fine. I’ll call her when I leave here and tell her you’re all right.”
“She’s going to be worried,” Art said.
“Judith will stay with her. It’ll be O.K.”
Art grinned ruefully. “Sorry to cause all this trou ble.”
“No trouble.” I glanced at the sergeant, standing with the door open, waiting. “The police can’t hold you. You’ll be out by the afternoon.”
The sergeant spit on the floor.
I shook hands with Art. “By the way,” I said, “where’s the body now?”
“Perhaps at the Mem. But it’s probably gone to the City by now.”
“I’ll check,” I said. “Don’t worry about a thing.” I stepped out of the cell and the sergeant locked up behind me. He said nothing as he led me out, but when we reached the lobby, he said, “Captain wants to see you.”
“All right.”
“Captain’s very interested in having a little talk.”
“Just lead the way,” I said.
THREE
THE SIGN ON THE FLAKING GREEN DOOR SAID HOMI CIDE, and underneath, on a hand-printed name card, “Captain Peterson.” He turned out to be a stiff, burly man with close-cropped gray hair and a terse manner. He came around the desk to shake hands with me, and I noticed he had a limp in his right leg. He made no effort to hide it; if anything, he exaggerated it, allowing his toe to scrape loudly over the floor. Cops, like soldiers, can be proud of their infirmities. You knew Peterson hadn’t received his in an auto accident.
I was trying to determine the cause of Peterson’s injury and had decided that it was probably a bullet wound—rarely does anyone get cut with a knife in
the calf—when he stuck out his hand and said, “I’m Captain Peterson.”
“John Berry.”
His handshake was hearty, but his eyes were cold and inquiring. He waved me to a chair.
“The sergeant said he hadn’t seen you around before and I thought I ought to meet you. We know most of the criminal lawyers in Boston.”
“Don’t you mean trial lawyers?”
“Of course,” he said easily. “Trial lawyers.” He looked at me expectantly.
I said nothing at all. A short silence passed, then Peterson said, “Which firm do you represent?”
“Firm?”
“Yes.”
“I’m not a lawyer,” I said, “and I don’t know what makes you think I am.”
He pretended to be surprised. “That’s not the im pression you gave the sergeant.”
“No?”
“No. You told him you were a lawyer.”
“I did?”
“Yes,” Peterson said, placing his hands flat on his desk.
“Who says so?”
He says so.
“Then he’s wrong.”
Peterson leaned back in his chair and smiled at me, a very pleasant, let’s-not-get-all-excited smile.
“If we had known you weren’t a lawyer, you’d never have been allowed to see Lee.”
“That’s possible. On the other hand, I was not asked for my name or my occupation. Nor was I asked to sign in as a visitor.”
“The sergeant was probably confused.”
“That’s logical,” I said, “considering the sergeant.”
Peterson smiled blankly. I recognized his type: he was a successful cop, a guy who had learned when to take it and when to dish it out. A very diplomatic and polite cop, until he got the upper hand.
“Well?” he said at last.
“I’m a colleague of Dr. Lee.”
If he was surprised, he didn’t show it. “A doctor?”
“That’s right.”
“You doctors certainly stick together,” he said, still smiling. He had probably smiled more in the last two minutes than he had in the last two years.
“Not really,” I said.
The smile began to fall, probably from fatigue and unused muscles. “If you are a doctor,” Peterson said, “my advice to you is to stay the hell away from Lee. The publicity could kill your practice.”
“What publicity?”
“The publicity from the trial.”
“There’s going to be a trial?”
“Yes,” Peterson said. “And the publicity could kill your practice.”
“I don’t have a practice,” I said.
“You’re in research?”
“No,” I said. “I’m a pathologist.”
He reacted to that. He started to sit forward,
caught himself, and leaned back again. “A patholo gist,” he repeated.
“That’s right. I work in hospitals, doing autopsies and things.”
Peterson was silent for some time. He frowned, scratched the back of his hand, and looked at his desk. Finally he said, “I don’t know what you’re try ing to prove, Doctor. But we don’t need your help, and Lee is too far gone to —”
“That remains to be seen.”
Peterson shook his head. “You know better than that.”
“I’m not sure I do.”
“Do you know,” Peterson said, “what a doctor could claim in a false-arrest suit?”
“A million dollars,” I said.
“Well, let’s say five hundred thousand. It doesn’t matter much. The point is essentially the same.”
“You think you have a case.”
“We have a case.” Peterson smiled again. “Oh, Dr. Lee can call you as a witness. We know that. And you can talk up a storm using the big words, trying to fool the jury, to impress them with your weighty scientific evidence. But you can’t get past the central fact. You just can’t get past it.”
“And what fact is that?”
“A young girl bled to death in the Boston Memo rial Hospital this morning, from an illegal abortion. That fact, straight and simple.”
“And you allege Dr. Lee did it?”
“There is some evidence,” Peterson said mildly.
“It had better be good,” I said, “because Dr. Lee is an established and respected —”
“Listen,” Peterson said, showing impatience for the first time, “what do you think this girl was, a ten-dollar doxy? This was a nice girl, a hell of a nice girl, from a good family. She was young and pretty and sweet, and she got butchered. But she didn’t go to some Roxbury midwife or some North End quack. She had too much sense and too much money for that.”
“What makes you think Dr. Lee did it?”
“That’s none of your business.”
I shrugged. “Dr. Lee’s lawyer will ask the same question, and then it will be his business. And if you don’t have an answer —”
“We have an answer.”
I waited. In a sense, I was curious to see just how good, just how diplomatic Peterson was. He didn’t have to tell me anything; he didn’t have to say another word. If he did say more, it would be a mistake.
Peterson said, “We have a witness who heard the girl implicate Dr. Lee.”
“The girl arrived at the hospital in a state of shock, delirious and precomatose. Anything she said will constitute weak evidence.”
“At the time she said it, she wasn’t in a state of shock. She said it much earlier.”
“To whom?”
“To her mother,” Peterson said, with a grin of sat isfaction. “She told her mother that Lee did it. As
they were leaving for the hospital. And her mother will swear to that.”
FOUR
I tried to play it Peterson’s way. I tried to keep my face blank. Fortunately you have a lot of practice at that in medicine; you are trained to show no sur prise if a patient tells you they make love ten times a night, or have dreams of stabbing their children, or drink a gallon of vodka daily. It is part of the mystique of the doctor that nothing surprises him. “I see,” I said.
Peterson nodded. “‘A reliable witness,” he said. “A mature woman, stable, careful in her judg ments. And very attractive. She will make an excellent impression on the jury.” “Perhaps.”
“And now that I have been so frank,” Peterson said, “perhaps you would tell me your special inter est in Dr. Lee.”
“I have no special interest. He is my friend.” “He called you before he called his lawyer.” “He is allowed two telephone calls.” “Yes,” Peterson said, “but most people use them to call their lawyer and their wife.” “He wanted to talk to me.”
“Yes,” he said. “But the question is why.”
“I have had some legal training,” I said, “as well as my medical experience.”
“You have an L.L.B.?”
“No,” I said.
Peterson ran his fingers across the edge of his desk. “I don’t think I understand.”
“I’m not convinced,” I said, “that it is important that you do.”
“Could it be you are involved in this business in some way?”
“Anything is possible,” I said.
“Does that mean yes?”
“That means anything is possible.”
He regarded me for a moment. “You take a very tough line, Dr. Berry.”
“Skeptical.”
“If you are so skeptical, why are you convinced Dr. Lee didn’t do it?”
“I’m not the defense attorney.”
“You know,” Peterson said, “anyone can make a mistake. Even a doctor.”
when I got outside into the October drizzle, I de cided this was a hell of a time to quit smoking. Peterson had unnerved me; I smoked two cigarettes as I walked to the drugstore to buy another pack. I had expected him to be stupid and pointlessly tough. He was neither of those things. If what he had said was true, then he had a case. It might not work, but it was strong enough to protect his job.
Peterson was caught in a quandary. On the one hand, it was dangerous to arrest Dr. Lee; on the other, it was dangerous not to arrest him, if the case seemed strong enough. Peterson was forced into a decision, and he had made it. Now he would stick by it as long as he could. And he had an es cape: if things began to go bad, he could blame it all on Mrs. Randall. He could use the familiar line so famous among surgeons and internists that it was abbreviated DHJ: doing his job. That meant that if the evidence was strong enough, you acted and did not care whether you were right or not; you were justified in acting on the evidence.1 In that sense, Peterson’s position was strengthened. He was taking no gambles: if Art was convicted, Peterson would receive no accolades. But if Art was acquitted, Peterson was covered. Because he was doing his job.
I went into the drugstore, bought two packs of cigarettes, and made some phone calls from a pay phone. First I called my lab and told them I’d be gone the rest of the day. Then I called Judith and asked her to go over to the Lees’ house and stay with Betty. She wanted to know if I’d seen Art, and I said I had. She asked if he was all right, and I said
This happens a lot in medicine. For example, a patient presents with fe ver, leukocytosis—increased numbers of white cells—and pain in the right-lower quadrant of the abdomen. The obvious diagnosis is appendici tis. The surgeon may perform an appendectomy only to find that the ap pendix is normal. But he is vindicated, so long as he is not overhasty, because the evidence is consistent with appendicitis, and delay may be fatal.
everything was fine, that he’d be out in an hour or so.
I don’t usually keep things from my wife. Just one or two small things, like what Cameron Jack son did at the conference of the American Society of Surgeons a few years back. I knew she’d be up set for Cameron’s wife, as she was when they got divorced last spring. The divorce was what is known locally as an MD, a medical divorce, and it had nothing to do with conventions. Cameron is a busy and dedicated orthopedist, and he began missing meals at home, spending his life in the hospital. His wife couldn’t take it after a while. She began by resenting orthopedics and ended by resenting Cameron. She got the two kids and three hundred dollars a week, but she’s not happy. What she really wants is Cameron—without medicine.
Cameron’s not very happy, either. I saw him last week and he spoke vaguely of marrying a nurse he’d met. He knew people would talk if he did, but you could see he was thinking, “At least this one will understand—”
I often think of Cameron Jackson and the dozen people I know like him. Usually, I think of him late at night, when I’ve been held up at the lab or when I’ve been so busy I haven’t had time to call home and say I’ll be late.
Art Lee and I once talked about it, and he had the last word, in his own cynical way.“I’m begin ning to understand,” he said, “why priests don’t marry.”
Art’s own marriage has an almost stifling sort of stability. I suppose it comes from his being Chinese, though that can’t be the whole answer. Both Art and his wife are highly educated, and not visi bly tied to tradition, but I think they have both found it difficult to shake off. Art is always guilt ridden about the little time he spends with his family, and lavishes gifts on his three children; they are all spoiled silly. He adores them, and it’s often hard to stop him once he begins talking about them. His attitude toward his wife is more complex and ambiguous. At times he seems to expect her to revolve around him like a trusting dog, and at times she seems to want this as much as he does. At other times she is more independent.
Betty Lee is one of the most beautiful women I’ve ever seen. She is soft-spoken, gracious, and slender; next to her Judith seems big, loud, and al most masculine.
Judith and I have been married eight years. We met while I was in medical school and she was a senior at Smith. Judith was raised on a farm in Ver mont, and is hardheaded, as pretty girls go.
I said, “Take care of Betty.”
“I will.”
“Keep her calm.”
“All right.”
“And keep the reporters away.”
“Will there be reporters?”
“I don’t know. But if there are, keep them away.”
She said she would and hung up.
I then called George Bradford, Art’s lawyer. Brad ford was a solid lawyer and a man with the proper connections; he was senior partner of Bradford, Stone and Whitlaw. He wasn’t in the office when I called, so I left a message.
Finally I called Lewis Carr, who was clinical pro fessor of medicine at the Boston Memorial Hospi tal. It took a while for the switchboard to page him, and as usual he came on briskly.
“Carr speaking.”
“Lew, this is John Berry.”
“Hi, John. What’s on your mind?”
That was typical of Carr. Most doctors, when they receive calls from other doctors, follow a kind of ritual pattern: first they ask how you are, then how your work is, then how your family is. But Carr had broken this pattern, as he had broken other patterns.
I said, “I’m calling about Karen Randall.”
“What about her?” His voice turned cautious. Ob viously it was a hot potato at the Mem these days.
“Anything you can tell me. Anything you’ve heard.”
“Listen, John,” he said, “her father is a big man in this hospital. I’ve heard everything and I’ve heard nothing. Who wants to know?”
“I do.”
“Personally?”
“That’s right.”
“Why?”
“I’m a friend of Art Lee.”
“They got him on this? I heard that, but I didn’t believe it. I always thought Lee was too smart—”
“Lew, what happened last night?”
Carr sighed. “Christ, it’s a mess. A real stinking hell of a mess. They blew it in outpatient.”
“What do you mean?”
“I can’t talk about this now,” Carr said. “You’d better come over and see me.”
“All right,” I said. “Where is the body now? Do your people have it?”
“No, it’s gone to the City.”
“Have they performed the post yet?”
“I haven’t any idea.”
“O.K.,” I said. “I’ll stop by in a few hours. Any chance of getting her chart?”
“I doubt it,” Carr said. “The old man has it now.”
“Can’t spring it free?”
“I doubt it,” he said.
“O.K.,” I said, “I’ll see you later.”
I hung up, put in another dime, and called the morgue at the City. The secretary confirmed that they had received the body. The secretary, Alice, was a hypothyroid; she had a voice as if she had swallowed a bass fiddle.
“Done the post yet?” I said.
“They’re just starting.”
“Will they hold it? I’d like to be there.”
“I don’t think it’s possible,” Alice said, in her rumbling voice. “We have an eager beaver from the Mem.”
She advised me to hurry down. I said I would.
FIVE
IT IS widely believed in boston that the best medical care in the world is found here. It is so universally acknowledged among the citizens of the city that there is hardly any debate.
The best hospital in Boston is, however, a question subject to hot and passionate debate. There are three major contenders: the General, the Brigham, and the Mem. Defenders of the Mem will tell you that the General is too large and the Brigham too small; and the General is too coldly clinical and the Brigham too coldly scientific; that the General neglects surgery at the expense of medicine and the Brigham the reverse. And finally, you will be told solemnly that the house staffs of the General and the Brigham are simply inferior in training and intelligence to those of the Mem.
But on anybody’s list of hospitals, the Boston City comes near the bottom. I drove toward it, passing the Prudential Center, the proudest monu ment to what the politicians call the New Boston. It is a vast complex of skyscrapers, hotels, shops, and plazas, with lots of fountains and wasted space, giving it a modern look. It stands within a few minutes’ lustful walk of the red-light district,
which is neither modern nor new, but like the Pru dential Center, functional in its way.
The red-light district lies on the outskirts of the Negro slums of Roxbury, as does the Boston City. I bounced along from one pothole to another and thought that I was far from Randall territory.
It was natural that the Randalls would practice at the Mem. In Boston the Randalls were known as an old family, which meant that they could claim at least one seasick Pilgrim, straight off the Mayflower, contributing to the gene pool. They had been a family of doctors for hundreds of years: in 1776, Wilson Randall had died on Bunker Hill.
In more recent history, they had produced a long line of eminent physicians. Joshua Randall had been a famous brain surgeon early in the century, a man who had done as much as anyone, even Gushing, to advance neurosurgery in America. He was a stern, dogmatic man; a famous, though apoc ryphal, story had passed into medical tradition.
Joshua Randall, like many surgeons of his period, had a rule that no resident working under him could marry. One resident sneaked off and did; a few months later, Randall discovered what had hap pened and called a meeting of all his residents. He lined them up in a row and said, “Dr. Jones, please take one step forward.”
The guilty doctor did, trembling slightly.
Randall said, “I understand you have gotten mar ried.” He made it sound like a disease.
“Yes, sir.”
“Before I discharge you from the staff, do you have anything to say in your defense?”
The young doctor thought for a moment, then said, “Yes, sir. I promise I’ll never do it again.”
Randall, according to the story, was so amused by this reply that he kept the resident after all.
After Joshua Randall came Winthrop Randall, the thoracic surgeon. J. D. Randall, Karen’s father, was a heart surgeon, specializing in valvular replacements. I had never met him, but I’d seen him once or twice—a fierce, patriarchal man, with thick white hair and a commanding manner. He was the terror of the surgical residents, who flocked to him for training, but hated him.
His brother, Peter, was an internist with his of fices just off the Commons. He was very fashion able, very exclusive, and supposedly quite good, though I had no way of knowing.
J. D. had a son, Karen’s brother, who was in med ical school at Harvard. A year ago there was a ru mor that the kid was practically flunking out, but nothing recently.
In another town, at another time, it might seem odd that a young boy with such a distinguished medical tradition would choose to try and live it down. But not Boston: in Boston the wealthy old families had long felt only two professions were worthy of one’s attention. One was medicine and the other was law; exceptions were made for the ac ademic life, which was honorable enough so long as one became a professor at Harvard.
But the Randalls were not an academic family, or a legal family. They were a medical family, and any Randall who could, contrived to get himself through medical school and into a house officer-ship1 at the Mem. Both the medical school and the Mem had, in the past, made allowances for poor grades when it came to the Randalls, but over the years, the family had more than repaid the trust. In medicine, a Randall was a good gamble.
And that was about all I knew about the family, except that they were very wealthy, firmly Episcopal, determinedly public spirited, widely respected, and very powerful.
I would have to find out more.
THREE BLOCKS FROM THE HOSPITAL, I passed through
the Combat Zone at the corner of Mass and Co lumbus avenues. At night it teems with whores, pimps, addicts, and pushers; it got its name be cause doctors at the City see so many stabbings and shootings from this area they regard it as the location of a limited war.2
The Boston City itself is an immense complex of buildings sprawling over three city blocks. It has more than 1,350 beds, mostly filled with alcoholics and derelicts. Within the Boston medical establish-
1
Position as an intern or resident, where one is an M.D. but not licensed
to practice, and still completing education.
2
Formerly the most violent area in Boston was Scollay Square, but it was
demolished five years ago to make way for government buildings. Some
consider that an improvement; some a step backward.
ment, the City is known as the Boston Shitty be cause of its clientele. But it is considered a good teaching hospital for residents and interns, because one sees there many medical problems one would never see in a more affluent hospital. A good example is scurvy. Few people in modern America contract scurvy. To do so requires general malnutrition and a complete abstinence from fruit for five months. This is so rare that most hospitals see a case every three years; at the Boston City there are a half-dozen each year, usually in the spring months, the “scurvy season.”
There are other examples: severe tuberculosis, tertiary syphilis, gunshot wounds, stabbings, accidents, self-abuse, and personal misfortune. Whatever the category, the City sees more of it, in a more advanced state, than any other hospital in Boston.3
THE INTERIOR OF THE CITY HOSPITAL is a maze built by a madman. Endless corridors, above ground and below, connect the dozen separate buildings of the hospital. At every corner, there are large green signs
3
The frequently bizarre cases mean that every doctor and surgeon has a backlog of strange stories. One surgeon is fond of telling how he was on the Accident Floor—the City’s EW—when two victims of an auto acci dent were brought in. One man had lost his leg at the knee. The other had massive crush injury to the chest, so bad that the degree of damage could not at first be ascertained from the heavy bleeding. On an X ray of the chest, however, it was seen that one man’s foot and lower leg had been rammed into the second man’s chest, where it was lodged at the time of admission.
pointing directions, but they don’t help much; it is still hopelessly confusing.
As I cut through the corridors and buildings, I remembered my rotation through the hospital as a resident. Small details came back. The soap: a strange, cheap, peculiar-smelling soap that was used everywhere. The paper bags hung by each sink, one for paper towels, the other for rectal gloves. As an economy, the hospital saved used gloves, cleaned them, and used them again. The little plastic name tags edged in black, blue, and red depending on your service. I had spent a year in this hospital, and during that time I had done several autopsies for the medical examiner.
THERE ARE FOUR MEDICAL SITUATIONS in which the coroner claims jurisdiction and an autopsy is re quired by law. Every pathology resident knows the list cold:
If the patient dies under violent or unusual circumstances.
If the patient is DOA.4
If he dies within twenty-four hours of admission.
If a patient dies outside the hospital while not under a doctor’s care.
Under any of these circumstances, an autopsy is performed at the City. Like many cities, Boston has no separate police morgue. The second floor of the Mallory Building, the pathology section of the hos-
4
Dead on arrival at hospital.
pital, is given over to the medical examiner’s offices. In routine cases, most of the autopsies are per formed by first-year residents from the hospital in which the patient died. For the residents, new to the game and still nervous, a coroner’s autopsy can be a tense business.
You don’t know what poisoning or electrocution looks like, for instance, and you’re worried about missing something important. The solution, passed down from resident to resident, is to do a meticulous PM, to take lots of pictures and notes as you go, and to “save everything,” meaning to keep pieces of tissue from all the gross organs in case there is a court action that requires reexamination of the autopsy findings. Saving everything is, of course, an expensive business. It requires extra jars, extra preservative, and more storage space in the freezers. But it is done without question in police cases.
Yet even with the precautions, you worry. As you do the post, there is always that fear, that dreadful thought at the back of your mind that the prosecution or the defense will demand some piece of information, some crucial bit of evidence either positive or negative, that you cannot supply because you did not consider all the possibilities, all the variables, all the differentials.for some long-forgotten reason, there are two small stone sphinxes just inside the doors of Mallory. Each time I see them, they bother me;
somehow sphinxes in a pathology building smack of Egyptian embalming chambers. Or something.
I went up to the second floor to talk to Alice. She was grumpy; the post hadn’t been started be cause of some delay; everything was going to hell in a wheelbarrow these days; did I know that a flu ep idemic was expected this winter?
I said 1 did, and then asked, “Who’s doing the post on Karen Randall?”
Alice gave a disapproving frown. “They sent someone over from the Mem. His name, I believe, is Hendricks.”
I was surprised. I had expected someone big to do this case.
“He inside?” I asked, nodding toward the end of the hall.
“Umm,” Alice said.
I walked down toward the two swinging doors, past the freezers on the right which stored the bodies, and past the neatly labeled sign: authorized
PERSONNELONLYBEYONDTHISPOINT.Thedoors
were wood, without windows, marked in and out. I pushed through into the autopsy room. Two men were talking in a far corner.
The room was large, painted a dull, institutional green. The ceiling was low, the floor was concrete, and the pipes overhead were exposed; they don’t spend much on interior decoration here. In a neat row were five stainless-steel tables, each six feet long. They were tilted slightly and made with a lip. Water flowed constantly down the table in a thin
sheet and emptied into a sink at the lower end. The water was kept running all during the autopsy, to carry away blood and bits of organic matter. The huge exhaust fan, three feet across and built into one frosted-glass window, was also kept on. So was the small chemical unit that blew scented ersatz air-freshener into the room, giving it a phony pine- woods odor.
Off to one side was a changing room where pathologists could remove their street clothes and put on surgical greens and an apron. There were four large sinks in a row, the farthest with a sign that said this sink for washing hands only. The others were used to clean instruments and specimens. Along one wall was a row of simple cabinets containing gloves, bottles for specimens, preservatives, reagents, and a camera. Unusual specimens were often photographed in place before removal.
As I entered the room, the two men looked over at me. They had been discussing a case, a body on the far table. I recognized one of the men, a resi dent named Gaffen. I knew him slightly. He was very clever and rather mean. The other man I did not know at all; I assumed he was Hendricks.
“Hello, John,” Gaffen said. “What brings you here?”
“Post on Karen Randall.”
“They’ll start in a minute. Want to change?”
“No, thanks,” I said. “I’ll just watch.”
Actually I would have liked to change, but it seemed like a bad idea. The only way I could be
certain of preserving my observer’s role would be to remain in street clothes. The last thing I wanted to do was to be considered an active participant in the autopsy, and therefore possibly influencing the find ings.
I said to Hendricks, “I don’t think we’ve met. I’m John Berry.”
“Jack Hendricks.” He smiled, but did not offer to shake hands. He was wearing gloves, and had been touching the autopsy body before them.
“I’ve just been showing Hendricks a few physical findings,” Gaffen said, nodding to the body. He stepped back so I could see. It was a young Negro girl. She had been an attractive girl before somebody put three round holes in her chest and stom ach.
“Hendricks here has been spending all his time at the Mem,” Gaffen said. “He hasn’t seen much of this sort of thing. For instance, we were just discussing what these little marks might represent.”
Gaffen pointed to several flesh tears on the body. They were on the arms and lower legs.
Hendricks said, “I thought perhaps they were scratches from barbed wire.”
Gaffen smiled sadly. “Barbed wire,” he repeated.
I said nothing. I knew what they were, but I also knew that an inexperienced man would never be able to guess.
“When was she brought in?” I said.
Gaffen glanced at Hendricks, then said, “Five a.m. But the time of death seems to be around midnight.” To Hendricks he said, “Does that suggest anything?”
Hendricks shook his head and bit his lip. Gaffen was giving him the business. I would have objected but this was standard procedure. Browbeating often passes for teaching in medicine. Hendricks knew it. I knew it. Gaffen knew it.
“Where,” Gaffen said, “do you suppose she was for those five hours after death?”
“I don’t know,” Hendricks said miserably.
“Guess.”
“Lying in bed.”
“Impossible. Look at the lividity.5 She wasn’t ly ing flat anywhere. She was half seated, half rolled over on her side.”
Hendricks looked at the body again, then shook his head again.
“They found her in the gutter,” Gaffen said. “On Charleston Street, two blocks from the Combat Zone. In the gutter.”
“Oh.”
“So,” Gaffen said, “what would you call those marks now?”
Hendricks shook his head. I knew this could go on forever; Gaffen could play it for all it was worth. I cleared my throat and said, “Actually, Hendricks, they’re rat bites. Very characteristic: an initial puncture, and then a wedge-shaped tear.”
5
The seeping of blood to the lowest portions of the body after death. It of ten helps establish the position of the body.
“Rat bites,” he said in a low voice.
“Live and learn,” Gaffen said. He checked his watch. “I have a CPC now. Good to see you again, John.” He stripped off his gloves and washed his hands, then came back to Hendricks.
Hendricks was still looking at the bullet holes and the bites.
“She was in the gutter for five hours?”
“Yes.”
“Didn’t the police find her?”
“Yes, eventually.”
“Who did it to her?”
Gaffen snorted. “You tell me. She has a history of a primary luetic oral lesion, treated at this hospital, and five episodes of hot tubes, treated at this hospital.”
“Hot tubes?”
“P.I.D.”6
“When they found her,” Gaffen said, “she had forty dollars in cash in her bra.”
