A Case of Need

  “You looked tired.”

  “I am tired. I’ve been tired all week.”

  “No. I mean you look drowsy.”

  “Don’t jump the gun,” I said. I glanced at my watch. Nearly two hours had passed since I had been beaten up. That was plenty of time. More than enough time.

  I began to wonder if something had gone wrong.

  At that moment, a police car came around the corner, tires squealing, siren going, blue light flashing. Immediately afterward an ambulance pulled up, followed by a third car. As the ambulance backed in, two men in business suits jumped out of the third car: reporters. You could tell by their eager little faces. One had a camera.

  “No pictures,” I said.

  The ambulance doors were opened and a body on a stretcher was brought out. The first thing I saw was the clothes—slashed and ripped across the trunk and upper limbs, as if the body had been caught in some kind of monstrous machine. Then, in the cold fluorescent light of the EW entrance, I saw the face: Roman Jones. His skull was caved in on the right side like a deflated football, and his lips were purple-black. The flashbulbs popped.

  Right there in the alleyway, Hammond went to work. He was quick: in a single movement, he picked up the wrist with his left hand, put his ear over the chest, and felt the carotids in the neck with his right hand. Then he straightened and without a word began to pound the chest. He did it with one hand flat and the heel of the other thumping against the flat hand in sharp, hard, rhythmic beats.

  “Call anesthesia,” he said, “and get the surgical resident. Get an arrest cart here. I want aramine, one-in-a-thousand solution. Oxygen by mask. Positive pressure. Let’s go.”

  We moved him inside the EW and down to one of the little treatment rooms. Hammond continued the cardiac massage all the time, not breaking his rhythm. When we got to the room the surgical resident was there. “Arrested?”

  “Yes,” Hammond said. “Apneic, no pulses anywhere.”

  The surgeon picked up a paper packet of size-eight gloves. He didn’t wait for the nurse to open them for him; he took them out of the paper himself and yanked them over his fingers. He never took his eyes off the motionless figure of Roman Jones.

  “We’ll open him up,” the surgeon said, flexing his fingers in the gloves.

  Hammond nodded, continuing his pounding of the chest. It didn’t seem to be doing much good: Roman’s lips and tongue were blacker. His skin, especially in the face and ears, was blotchy and dark.

  An oxygen mask was slapped on.

  “How much, sir?” said the nurse.

  “Seven liters,” said the surgeon. He was given a scalpel. Roman’s already shredded clothes were torn away from his chest; nobody bothered to strip him down completely. The surgeon stepped forward, his face blank, the scalpel held tightly in his right hand with his index finger over the blade.

  “All right,” he said and made the incision, sloping, across the ribs on the left side. It was a deep incision and there was bleeding, which he ignored. He exposed the whitish glistening ribs, cut between them, and then applied retractors. The retractors were pulled wide and there was a crunching, snapping sound as the ribs snapped. Through the gaping incision, we could see Roman’s lungs, collapsed and wrinkled-looking, and his heart, large, bluish, not beating, but wriggling like a bag of worms.

  The surgeon reached into the chest and began to massage. He did it smoothly, contracting his little finger first, then all the others in his hand up to the index finger, expelling blood from the heart. He squeezed very hard and grunted rhythmically.

  Someone had slapped on a blood-pressure cuff and Hammond pumped it up to take a reading. He watched the needle for a moment, then said, “Nothing.”

  “He’s fibrillating,” the resident said, holding the heart. “No epinephrine. Let’s wait.”

  The massage continued for one minute, then two. Roman’s color turned darker still.

  “Getting weaker. Give me five cc’s in one to a thousand.”

  A syringe was prepared. The surgeon injected it directly into the heart, then continued squeezing. Several more minutes passed. I watched the squeezing heart, and the rhythmic inflation of the lungs from the respirator. But the patient was declining. Finally, they stopped.

  “That’s it,” the surgeon said. He removed his hand from the chest, looked at Roman Jones, and stripped off his gloves. He examined the lacerations across the chest and arms and the dent in the skull. “Probably primary respiratory arrest,” he said. “He was hit pretty hard over the head.” To Hammond: “You going to do the death certificate?”

  “Yeah,” Hammond said, “I’ll do it.”

  At that moment, a nurse burst into the room. “Dr. Hammond,” she said, “Dr. Jorgensen needs you. They’ve got a girl in hemorrhagic shock.”

  OUT IN THE HALL, the first one I saw was Peterson. He was standing there in a suit, looking both confused and annoyed. When he saw me he did a double take and plucked at my sleeve.

  “Say, Berry—”

  “Later,” I said.

  I was following Hammond and the nurse down to another treatment room. A girl was there, lying flat, very pale. Her wrists were bandaged. She was conscious, but just barely—her head rolled back and forth, and she made moaning sounds.

  Jorgensen, the intern, was bent over her. “Got a suicide here,” he said to Hammond. “Slashed wrists. We’ve stopped the bleeding and we’re getting whole blood in.”

  He was finding a vein for the IV feeder. Working on the leg.

  “She’s cross-matched,” he said, slipping the needle in. “We’re getting more blood from the bank. She’ll take at least two units. Hematocrit’s O.K., but that doesn’t mean anything.”

  “Why the legs?” Hammond said, nodding to the IV.

  “Had to bandage her wrists. Don’t want to fool with upper extremities.”

  I stepped forward. The girl was Angela Harding. She did not look so pretty now; her face was the color of chalk, with a grayish tinge around the mouth.

  “What do you think?” Hammond said to Jorgensen.

  “We’ll keep her,” he said. “Unless something goes wrong.”

  Hammond examined the wrists, which were bandaged.

  “Is this the lesion?”

  “Yes. Both sides. We’ve sutured it.”

  He looked at the hands. The fingers were stained dark brown. He looked at me. “Is this the girl you were talking about?”

  “Yes,” I said, “Angela Harding.”

  “Heavy smoker,” Hammond said.

  “Try again.”

  Hammond picked up one hand and smelled the stained fingers.

  “These aren’t tobacco,” he said.

  “That’s right.”

  “Then…”

  I nodded. “That’s right.”

  “…she’s a nurse.”

  “Yes.”

  The stains were from tincture of iodine, used as a disinfectant. It was a brownish-yellowish liquid, and it stained tissues it came in contact with. It was employed for scrubbing a surgical incision before cutting, and for such other practices as introduction of an IV feeder.

  “I don’t get it,” Hammond said.

  I held up her hands. The balls of the thumb and the backs of the hands were covered with minute slashes which were not deep enough to draw blood.

  “What do you make of this?”

  “Testing.” A classic finding in suicides by wrist-slashing is one or more preliminary cuts on the hand as if the suicide victim wishes to test the sharpness of the blade or the intensity of the pain that would result.

  “No,” I said.

  “Then what?”

  “Ever seen a fellow who’s been in a knife fight?”

  Hammond shook his head. Undoubtedly, he never had. It was the kind of experience one had only as a pathologist: small cuts on the hands were the hallmark of a knife fight. The victim held up his hands to ward off the knife; he ended up with small cuts.

  “Is this the pattern?”
/>
  “Yes.”

  “You mean she was in a knife fight?”

  “Yes.”

  “But why?”

  “Tell you later,” I said.

  I went back to Roman Jones. He was still in the same room, along with Peterson and another man in a suit, examining the eyes of the body.

  “Berry,” Peterson said, “you show up at the damnedest times.”

  “So do you.”

  “Yeah,” Peterson said, “but it’s my job.”

  He nodded toward the other man in the room.

  “Since you were so worried the last time, I brought a doctor along. A police doctor. This is a coroner’s case now, you know.”

  “I know.”

  “Fellow by the name of Roman Jones. We got that from the wallet.”

  “Where’d you find him?”

  “Lying on the street. A nice quiet street in Beacon Hill. With his skull bashed in. Must have fallen on his head. There was a broken window two floors up, in an apartment owned by a girl named Angela Harding. She’s here, too.”

  “I know.”

  “You know a lot tonight, don’t you?”

  I ignored him. My headache was worse; it was throbbing badly, and I felt terribly tired. I was ready to lie down and go to sleep for a long, long time. But I wasn’t relaxed; my stomach was churning.

  I bent over the body of Roman Jones. Someone had stripped off the clothing to expose multiple, deep lacerations of the trunk and upper arms. The legs were untouched. That, I thought, was characteristic.

  The doctor straightened and looked at Peterson. “Hard to tell now what the cause of death was,” he said. He nodded to the gaping chest wound. “They’ve messed it up pretty bad. But I’d say crush injury to the cranium. You said he fell from a window?”

  “That’s the way we figure it,” Peterson said, glancing at me.

  “I’ll handle the forms,” the doctor said. “Give me the wallet.”

  Peterson gave him Roman Jones’ wallet. The doctor began to write on a clipboard at one side of the room. I continued to look at the body. I was particularly interested in the skull. I touched the indentation, and Peterson said, “What’re you doing?”

  “Examining the body.”

  “On whose authority?”

  I sighed. “Whose authority do I need?”

  He looked confused then.

  I said, “I’d like your permission to conduct a superficial examination of the body.”

  As I said it, I glanced over at the doctor. He was making notes from the wallet, but I was sure he was listening.

  “There’ll be an autopsy,” Peterson said.

  “I’d like your permission,” I said.

  “You can’t have it.”

  At that point, the doctor said, “Oh, for shit’s sake, Jack.”

  Peterson looked from the police doctor, to me, and back again. Finally he said, “Okay, Berry. Examine. But don’t disturb anything.”

  I looked at the skull lesion. It was a cup-shaped indentation roughly the size of a man’s fist, but it hadn’t been made by any fist. It had been made by the end of a stick, or a pipe, swung with considerable force. I looked more closely and saw small brown slivers of wood sticking to the bloody scalp. I didn’t touch them.

  “You say this skull fracture was caused by a fall?”

  “Yes,” Peterson said. “Why?”

  “Just asking.”

  “Why?”

  “What about the lacerations of the body?” I said.

  “We figure he got those in the apartment. Apparently he had a fight with this girl, Angela Harding. There was a bloody kitchen knife in the apartment. She must have gone after him. Anyway, he fell out of the window or was pushed out. And he got this fracture, which killed him.”

  He paused and looked at me.

  “Go on,” I said.

  “That’s all there is to tell,” he said.

  I nodded, left the room, and returned with a needle and syringe. I bent over the body and jabbed the needle into the neck, hoping for the jugular vein. There was no point in fooling with arm veins, not now.

  “What’re you doing?”

  “Drawing blood,” I said, pulling back the syringe and drawing out several milliliters of bluish blood.

  “What for?”

  “I want to know whether he was poisoned,” I said. It was the first thought, the first answer, that came into my head.

  “Poisoned?”

  “Yes.”

  “Why do you think he was poisoned?”

  “Just a hunch,” I said.

  I dropped the syringe into my pocket and started to leave. Peterson watched me, then said, “Just wait a minute.”

  I paused.

  “I have one or two questions for you.”

  “Oh?”

  “The way we figure it,” Peterson said, “this fellow and Angela Harding had a fight. Then Jones fell, and the girl attempted suicide.”

  “You already told me that.”

  “There’s only one problem,” Peterson said. “Jones is a big fellow. He must have gone one-ninety, two hundred. You think a little girl like Angela Harding could have shoved him out?”

  “Maybe he fell.”

  “Maybe she had help.”

  “Maybe she did.”

  He looked at my face, at the bandage covering my cut. “Have some trouble tonight?”

  “Yes.”

  “What happened?”

  “I fell on the wet streets.”

  “Then you have an abrasion?”

  “No. I fell against one of the city’s excellent parking meters. I have a laceration.”

  “A jagged laceration.”

  “No, quite fine.”

  “Like Roman Jones’?”

  “I don’t know.”

  “Ever met Jones before?”

  “Yes.”

  “Oh? When?”

  “Tonight. About three hours ago.”

  “That’s interesting,” Peterson said.

  “Do your best with it,” I said. “I wish you luck.”

  “I could take you in for questioning.”

  “Sure you could,” I said. “But on what charge?”

  He shrugged. “Accessory. Anything.”

  “And I’d have a lawsuit on you so fast your head would swim. I’d have two million dollars out of your hide before you knew what hit you.”

  “Just for questioning?”

  “That’s right,” I said. “Compromising a doctor’s reputation. A doctor’s reputation is his life, you know. Anything, even the slightest shadow of suspicion, is potentially damaging—financially damaging. I could very easily prove damages in court.”

  “Art Lee doesn’t take that attitude.”

  I smiled. “Want to bet?”

  I continued on. Peterson said, “How much do you weigh, Doctor?”

  “One hundred and eighty-five pounds,” I said. “The same as I weighed eight years ago.”

  “Eight years ago?”

  “Yes,” I said, “when I was a cop.”

  MY HEAD FELT AS IF IT WERE IN A VISE. The pain was throbbing, aching, agonizing. On my way down the corridor, I felt sudden and severe nausea. I stopped in the men’s room and vomited up the sandwich and coffee I had eaten. I felt weak, with cold sweat afterward, but that passed and I was better. I went back and returned to Hammond.

  “How do you feel?”

  “You’re getting monotonous,” I said.

  “You look like hell,” he said. “Like you’re about to be sick.”

  “I’m not,” I said.

  I took the syringe with Jones’ blood from my pocket and set it on the bedside table. I picked up a fresh syringe and went.

  “Can you find me a mouse?” I said.

  “A mouse?”

  “Yes.”

  He frowned. “There are some rats in Cochran’s lab; it may be open now.”

  “I need mice.”

  “I can try,” he said.

  We headed for th
e basement. On the way, a nurse stopped Hammond to say that Angela Harding’s parents had been called. Hammond said to let him know when they arrived or when the girl recovered consciousness.

  We went down to the basement and moved through a maze of corridors, crouching beneath pipes. Eventually we came to the animal-storage area. Like most large hospitals connected with a university, the Mem had a research wing, and many animals were used in experiments. We heard barking dogs and the soft flutter of birds’ wings as we passed room after room. Finally we came to one which said MINOR SUBJECTS. Hammond pushed it open.

  It was lined, floor to ceiling, with row after row of rats and mice. The smell was strong and distinctive. Every young doctor knew that smell, and it was just as well, because it had clinical significance. The breath of patients in hepatic failure from liver disease had a peculiar odor known as fetor hepaticus; it was very similar to the smell of a room full of mice.

  We found one mouse and Hammond plucked it from the cage in the accepted manner, by the tail. The mouse squirmed and tried to bite Hammond’s hand, but had no success. Hammond set it down on the table and held the animal by a fold of loose flesh just behind the head.

  “Now what?”

  I picked up the syringe and injected some of the blood from Roman Jones’ body. Then Hammond dropped the mouse in a glass jar.

  For a long time, the mouse did nothing but run around the jar in circles.

  “Well?” Hammond said.

  “It’s your failing,” I said. “You aren’t a pathologist. Have you ever heard of the mouse test?”

  “No.”

  “It’s an old test. It used to be the only bioassay available.”

  “Bioassay? For what?”

  “Morphine,” I said.

  The mouse continued to run in circles. Then it seemed to slow, its muscles becoming tense, and the tail stuck straight up in the air.

  “Positive,” I said.

  “For morphine?”

  “Right.”

  There were better tests now, such as nalorphine, but for a dead person, the mouse test remained as good as any.

  “He’s an addict?” Hammond said. Yes.

  “And the girl?”

  “We’re about to find out,” I said.

  She was conscious when we returned, tired and sad-eyed after taking three units2 of blood. But she was no more tired than I was. I felt a deep, overpowering fatigue, a kind of general weakness, a great desire to sleep.