A Case of Need

  “I see.”

  “They’re so wholesome, you know?”

  “What kind of stories did Karen tell you?”

  “I don’t know. They weren’t exactly stories. Just sort of implications. She liked people to believe that she was wild, and all her friends were wild. Actually, that was her favorite word: wild. And she knew how to make something sound real. She never just told you straight out, in a whole long thing. It was little comments here and there. About her abortions and all.”

  “Her abortions?”

  “She said she had had two before she ever got to college. Now that’s pretty incredible, don’t you think? Two abortions? She was only seventeen, after all. I told her I didn’t believe it, so she went into this explanation of how it was done, the complete explanation. Then I wasn’t so sure.”

  A girl from a medical family could easily acquire a knowledge of the mechanics of a D & C. That didn’t prove she’d had an abortion herself.

  “Did she tell you anything specific about them? Where they were done?”

  “No. She just said she’d had them. And she kept saying things like that. She wanted to shock me, I know that, but she could be pretty crude when she wanted. I remember the first—no, the second weekend we were here, she went out Saturday night, and she got back late. I went to a mixer. Karen came in all a mess, crawled into bed with the lights out, and said, ‘Jesus, I love black meat.’ Just like that. I didn’t know what to say, I mean, I didn’t know her well then, so I didn’t say anything. I just thought she was trying to shock me.”

  “What else did she say to you?”

  Ginnie shrugged. “I can’t remember. It was always little things. One night, as she’s getting ready to go out for the weekend, and she’s whistling in front of the mirror, she says to me, ‘I’m really going to get it this weekend.’ Or something like that, I don’t remember the exact words.”

  “And what did you say?”

  “I said, ‘Enjoy yourself.’ What can you say when you get out of the shower and somebody says that to you? So she said, ‘I will, I will.’ She was always coming up with shocking little comments.”

  “Did you ever believe her?”

  “After a couple of months, I was beginning to.”

  “Did you ever have reason to think she was pregnant?”

  “While she was here? At school? No.”

  “You’re sure?”

  “She never said anything. Besides, she was on the pill.”

  “Are you certain of that?”

  “Yeah, I think so. At least, she made this big ceremony of it every morning. The pills are right there.”

  “Where?”

  Ginnie pointed. “Right there on her desk. In that little bottle.”

  I got up and went to the desk, and picked up the plastic bottle. The label was from Beacon Pharmacy; there were no typed directions. I took out my notebook and wrote down the prescription number and the name of the doctor. Then I opened the bottle and shook out a pill. There were four left.

  “She took these every day?”

  “Every single day,” Ginnie said.

  I was no gynecologist and no pharmacologist, but I knew several things. First, that most birth-control pills were now sold in a dispenser to help a woman keep track of the days. Second, that the initial hormone dosage had been cut from ten milligrams a day to two milligrams. That meant the pills were small.

  These pills were huge in comparison. There were no surface markings of any kind; they were chalky white and rather crumbly to the touch. I slipped one into my pocket and replaced the others in the bottle. Even without checking, I had a pretty good idea what the pills were.

  “Did you ever meet any of Karen’s boyfriends?” I asked.

  Ginnie shook her head.

  “Did Karen ever talk about them? Talk about her dates?”

  “Not really. Not personally, if you know what I mean. She’d talk about how they’d been in bed, but it was usually just gross stuff. She was always trying to gross you out. You know, the earthy bit. Wait a minute.”

  She got up and went to Karen’s dresser. There was a mirror over the dresser; stuck into the frame were several pictures of boys. She plucked out two and handed them to me.

  “This guy was one she talked about, but I don’t think she was seeing him anymore. She used to date him over the summer or something. He goes to Harvard.”

  The picture was a standard publicity pose of a boy in a football uniform. He had the number 71, and was crouched down in a three-point stance, snarling into the camera.

  “What’s his name?”

  “I don’t know.”

  I picked up a Harvard-Columbia football program and looked up the roster. Number 71 was a right guard, Alan Zenner. I wrote the name in my notebook and gave the picture back to Ginnie.

  “This other one,” she said, handing me the second picture, “is a newer guy. I think she was seeing him. Some nights, she’d come back and kiss the picture before she went to bed. His name was Ralph, I think. Ralph or Roger.”

  The picture showed a young Negro standing in a tight, shiny suit with an electric guitar in one hand. He was smiling rather stiffly.

  “You think she was seeing him?”

  “Yes, I think so. He’s part of a group that plays in Boston.”

  “And you think his name is Ralph?”

  “Something like that.”

  “You know the name of the group?”

  Ginnie frowned. “She told me once. Probably more than once, but I don’t remember. Karen sort of liked to keep her boys a mystery. It wasn’t like some girl sitting down and telling you every little thing about her boyfriend. Karen never did that, it was always bits and snatches.”

  “You think she was meeting this fellow when she went away for weekends?”

  Ginnie nodded.

  “Where did she go on weekends? Boston?”

  “I imagine. Boston or New Haven.”

  I turned the picture over in my hands. On the back it said, “Photo by Curzin, Washington Street.”

  “Can I take this picture with me?”

  “Sure,” she said. “I don’t care.”

  I slipped it into my pocket, then sat down again.

  “Did you ever meet any of these people? Any of the boys?”

  “No. I never met any of her friends. Oh—wait a minute. I did, once. A girl.”

  “A girl?”

  “Yes. Karen told me one day that this good friend of hers was coming up for a day. She told me all about how cool this girl was, how wild. This big build-up. I was really waiting for something spectacular. Then when she showed up…”

  “Yes?”

  “Really strange,” Ginnie said. “Very tall, with real long legs, and all the time Karen kept saying how she wished she had long legs like that, and the girl just sort of sat there and didn’t say anything. She was pretty, I guess. But really strange. She acted like she was asleep. Maybe she was up on something; I don’t know. Finally she began to talk, after about an hour of just sitting there, and she said these weird things.”

  “Like what?”

  “I don’t know. Weird things. ‘The rain in Spain is mainly down the drain.’ And she made up poetry about people running in spaghetti fields. It was pretty dull, I mean, not what you’d call good.”

  “What was this girl’s name?”

  “I don’t remember. Angie, I think.”

  “Was she in college?”

  “No. She was young, but she wasn’t in college. She worked. I think Karen said she was a nurse.”

  “Try to remember her name,” I said.

  Ginnie frowned and stared at the floor, then shook her head. “I can’t,” she said. “I didn’t pay that much attention.”

  I didn’t want to let it go, but it was getting late. I said, “What else can you tell me about Karen? Was she nervous? Jittery?”

  “No. She was always very calm. Everybody else in the house was nervous, especially around hourly time, when we have our exams
, but she didn’t seem to care,”

  “Did she have a lot of energy? Was she bouncy and talkative?”

  “Karen? Are you kidding? Listen, she was always half dead, except for her dates, when she’d perk up, but otherwise she was always tired and always complaining about how tired she was.”

  “She slept a lot?”

  “Yes. She slept through most of her classes.”

  “Did she eat a lot?”

  “Not particularly. She slept through most of her meals, too.”

  “She must have lost weight, then.”

  “Actually, it went up,” Ginnie said. “Not too much, but enough. She couldn’t get into most of her dresses, after six weeks. She had to buy some more.”

  “Did you notice any other changes?”

  “Well, only one, but I’m not sure it really matters. I mean, it mattered to Karen, but nobody else cared.”

  “What was that?”

  “Well, she had the idea that she was getting hairy. You know, arms and legs and on her lip. She complained that she was shaving her legs all the time.”

  I looked at my watch and saw that it was nearly noon. “Well, I don’t want to keep you from your classes.”

  “Doesn’t matter,” Ginnie said. “This is interesting.”

  “How do you mean?”

  “Watching you work, and all.”

  “You must have talked with a doctor before.”

  She sighed. “You must think I’m stupid,” she said, in a petulant voice “I wasn’t born yesterday.”

  “I think you’re very intelligent,” I said.

  “Will you want me to testify?”

  “Testify? Why?”

  “In court, at the trial.”

  Looking at her, I had the feeling she was practicing before the mirror once again. Her face had a secretly wise expression, like a movie heroine.

  “I’m not sure I follow you.”

  “You can admit it to me,” she said. “I know you’re a lawyer.”

  “Oh.”

  “I figured it out ten minutes after you arrived. You want to know how?”

  “How?”

  “When you picked up those pills and looked at them. You did it very carefully, not like a doctor at all. Frankly, I think you’d make a terrible doctor.”

  “You’re probably right,” I said.

  “Good luck with your case,” she said as I was leaving.

  “Thanks.”

  Then she winked at me.

  TWO

  THE X-RAY ROOM on the second floor of the Mem had a fancy name: Radiological Diagnosis. It didn’t matter what they called it, it was the same inside as every other X-ray room anywhere. The walls were sheets of white frosted glass, and there were little jam-clips for the films. It was quite a large room, with sufficient space for a half-dozen radiologists to work at once.

  I came in with Hughes. He was a radiologist at the Mem that I’d known for a long time; he and his wife sometimes played bridge with Judith and me. They were good players, blood players, but I didn’t mind. Sometimes I get that way myself.

  I hadn’t called Lewis Carr because I knew he wouldn’t help me. Hughes was low on the General totem pole and didn’t give a damn whether I wanted to look at films from Karen Randall or the Aga Khan, who had come here for a kidney operation some years ago. He took me right up to the X-ray room.

  On the way I said, “How’s your sex life?”

  That’s a standard rib for a radiologist. It’s well known that radiologists have the shortest lifespan of any medical specialist. The exact reasons are unknown, but the natural assumption is that the X rays get to them. In the old days, radiologists used to stand in the same room as the patient when the films were taken. A few years of that, and they’d soak up enough gamma to finish them. Then, too, in the old days the film was less sensitive, and it took a whopping big dose to get a decent contrast exposure.

  But even now, with modern techniques and better knowledge, a ribald tradition remains, and radiologists are condemned to suffer through a lifetime of jokes about their lead-lined jockstraps and their shriveled gonads. The jokes, like the X rays, are an occupational hazard. Hughes took it well.

  “My sex life,” he said, “is a damn sight better than my bridge game.”

  As we came into the room, three or four radiologists were at work. They were each seated in front of an envelope full of films and a tape recorder; they took out films individually and read off the patient’s name and unit number, and the kind of film it was—AP or LAO, IVP, or thorax, and so forth— and then they slapped it up against the frosted glass and dictated their diagnosis.1

  One wall of the room was given over to the intensive care patients. These were seriously ill people, and their films were not stored in manila envelopes. Instead they were hung on revolving racks. You pressed a button and waited until the rack came around to the films of the patient you wanted to see. It meant you could get to a critically ill patient’s films rapidly.

  The film storeroom was adjacent to the X-ray room. Hughes went in and pulled Karen Randall’s films, and brought them back. We sat down in front of a sheet of glass, and Hughes clipped up the first picture.

  “Lateral skull film,” he said, peering at it. “Know why it was ordered?”

  “No,” I said.

  I, too, looked at the plate, but I could make little of it. Skull films—X rays of the head—are difficult to interpret. The cranium is a complex piece of bone, producing a confusing interlocking pattern of light and dark. Hughes examined it for some time, occasionally tracing lines with the cap of his fountain pen.

  “Seems normal,” he said at last. “No fractures, no abnormal calcification, no evidence of air or hematoma. Of course, it’d be nice to have an arteriogram or a PEG.”2

  “Let’s have a look at the other views,” he said. He pulled down the lateral view and put up the face-on, AP film. “This looks normal, too,” he said. “I wonder why they were taken—was she in an auto accident?”

  “Not that I know of.”

  He rummaged in the file. “No,” he said. “Obviously. They didn’t do face films. Only skull films.”

  Face films were a separate series of angles, utilized to check for fractures of the facial bones.

  Hughes continued to examine the AP film, then put the lateral back up. He still could find nothing abnormal.

  “Damned if I can figure it,” he said, tapping the plate. “Nothing. Not a goddamned thing there, for my money.”

  “All right,” I said, standing up. ‘Thanks for your help.”

  As I left I wondered whether the X rays had helped clear things up or just made everything worse.

  AP is anteroposterior, indicating that the X rays penetrated from front to back, where they struck the plate. LAO is left anterior oblique and IVP is contrast media in the genitourinary tract, a film showing kidneys, ureters, and bladder.

  These are ways of making skull films easier to interpret. An arteriogram is an X ray taken after the cerebral arteries have been filled with radio opaque liquid. A PEG, or pneumoencephalogram, consists of draining all the cerebrospinal fluid and pumping in air to increase contrast in the ventricles. It is a painful procedure which cannot be done under anesthesia. Both techniques are considered minor surgery, and are not done unless there is good evidence for their necessity.

  THREE

  I STEPPED INTO A PHONE BOOTH near the hospital lobby. I got out my notebook and found the pharmacy number and the prescription number. I also found the pill I had taken from Karen’s room.

  I chipped off a flake with my thumbnail and ground it into the palm of my hand. It crushed easily into a soft powder. I was pretty sure what it was, but to be certain I touched the tip of my tongue to the powder.

  There was no mistaking the taste. Crushed aspirin on your tongue tastes terrible.

  I dialed the pharmacy.

  “Beacon Pharmacy.”

  “This is Dr. Berry at the Lincoln. I’d like to know a drug as follows??
?”

  “Just a minute while I get a pencil.”

  A short pause.

  “Go ahead, Doctor.”

  “The name is Karen Randall. The number is one-four-seven-six-six-seven-three. Prescribing doctor Peter Randall.”

  “I’ll check that for you.”

  The phone was put down. I heard whistling and pages flipping, then: “Yes, here it is. Darvon, twenty capsules, 75 milligram. Orders—‘Once every four hours as needed for pain.’ It was refilled twice. Do you want the dates?”

  “No,” I said. “That’s fine.”

  “Is there anything else?”

  “No, thanks. You’ve been very helpful.”

  “Any time.”

  I replaced the receiver slowly. Things were getting more and more screwy. What kind of girl pretended to take birth-control pills but actually took aspirin, which she stored in an empty bottle that once contained pills for menstrual cramps?

  FOUR

  DEATH FROM ABORTION is a relatively rare event. This basic fact tends to be obscured in all the fanfare and statistics. The statistics, like the fanfare, are emotional and imprecise. Estimates vary widely, but most people agree that about a million illegal abortions are performed each year, and about 5,000 women die as a result of them. This means that the operative mortality is about 500/100,000.

  This is a very high figure, especially in the light of mortality in hospital abortions. Death in hospital abortions ranges from 0-18/100,000, which makes it, at worst, about as dangerous as a tonsillectomy (17/100,000).

  All this means is that illegal abortions are about twenty-five times as deadly as they have to be. Most people are horrified by this. But Art, who thought clearly and carefully about such things, was impressed by the statistic. And he said something very interesting: that one reason abortion remained illegal was because it was so safe.

  “You have to look at the volume of business,” he once said. “A million women is a meaningless number. What it comes down to is one illegal abortion every thirty seconds, day in, day out, year after year. That makes it a very common operation, and for better or worse, it’s safe.”