A Case of Need

  There was a nurse in the room who said, “Her pressure’s up to one hundred over sixty-five.”

  “Good,” I said. I fought back the fatigue and went up to her, patted her hand. “How are you feeling, Angela?”

  Her voice was flat. “Like hell.”

  “You’re going to be all right.”

  “I failed,” she said in a dull monotone.

  “How do you mean?”

  A tear ran down her cheek. “I failed, that’s all. I tried it and I failed.”

  “You’re all right now.”

  “Yes,” she said. “I failed.”

  “We’d like to talk to you,” I said.

  She turned her head away. “Leave me alone.”

  “Angela, this is very important.”

  “Damn all doctors,” she said. “Why couldn’t you leave me alone? I wanted to be left alone. That’s why I did it, to be left alone.”

  “The police found you.”

  She gave a choking laugh. “Doctors and cops.”

  “Angela, we need your help.”

  “No.” She raised her bandaged wrists and looked at them. “No. Never.”

  “I’m sorry, then.” I turned to Hammond and said, “Get me some nalorphine.”

  I was certain the girl had heard me, but she did not react.

  “How much?”

  “Ten milligrams,” I said. “A good dose.”

  Angela gave a slight shiver, but said nothing.

  “Is that all right with you, Angela?”

  She looked up at me and her eyes were filled with anger and something else, almost hope. She knew what it meant, all right.

  “What did you say?” she asked.

  “I said, is it all right if we give you ten milligrams of nalorphine.”

  “Sure,” she said. “Anything. I don’t care.”

  Nalorphine was an antagonist of morphine.3 If this girl was an addict, it would bring her down with brutal swiftness—possibly fatal swiftness, if we used enough.

  A nurse came in. She blinked when she did not recognize me, but recovered quickly. “Doctor, Mrs. Harding is here. The police called her.”

  “All right. I’ll see her.”

  I went out into the corridor. A woman and man were standing there nervously. The man was tall, wearing clothes he had obviously put on hurriedly—his socks didn’t match. The woman was handsome and concerned. Looking at her face, I had the strange feeling I had met her before, though I was certain I had not. There was something very, almost hauntingly, familiar about her features.

  “I’m Dr. Berry.”

  “Tom Harding.” The man held out his hand and shook mine quickly, as if he were wringing it. “And Mrs. Harding.”

  “How do you do.”

  I looked at them both. They seemed like nice fifty-year-old people, very surprised to find themselves in a hospital EW at four in the morning with a daughter who’d just slashed her wrists.

  Mr. Harding cleared his throat and said, “The, uh, nurse told us what happened. To Angela.”

  “She’s going to be all right,” I said.

  “Can we see her?” Mrs. Harding said.

  “Not right now. We’re still conducting some tests.”

  “Then it isn’t—”

  “No,” I said, “these are routine tests.”

  Tom Harding nodded. “I told my wife it’d be all right. Angela’s a nurse in this hospital, and I told her they’d take good care of her.”

  “Yes,” I said. “We’re doing our best.”

  “Is she really all right?” Mrs. Harding said.

  “Yes, she’s going to be fine.”

  Mrs. Harding said to Tom, “Better call Leland and tell him he doesn’t have to come over.”

  “He’s probably already on his way.”

  “Well, try,” Mrs. Harding said.

  “There’s a phone at the admitting desk,” I said.

  Tom Harding left to call. I said to Mrs. Harding, “Are you calling your family doctor?”

  “No,” she said, “my brother. He’s a doctor, and he was always very fond of Angela, ever since she was a little girl. He—”

  “Leland Weston,” I said, recognizing her face.

  “Yes,” she said. “Do you know him?”

  “He’s an old friend.”

  Before she could answer, Hammond returned with the nalorphine and syringe. He said, “Do you really think we should—”

  “Dr. Hammond, this is Mrs. Harding,” I said quickly. “This is Dr. Hammond, the chief medical resident.”

  “Doctor.” Mrs. Harding nodded slightly, but her eyes were suddenly watchful.

  “Your daughter’s going to be fine,” Hammond said.

  “I’m glad to hear that,” she said. But her tone was cool.

  We excused ourselves and went back to Angela.

  * * *

  “I HOPE TO HELL you know what you’re doing,” Hammond said as we walked down the hall.

  “I do.” I paused at a water fountain and filled a cup with water. I drank it down, then filled it again. My headache was now very bad, and my sleepiness was terrible. I wanted to lie down, to forget everything, to sleep.…

  But I didn’t say anything. I knew what Hammond would do if he found out.

  “I know what I’m doing,” I said.

  “I hope so,” he said, “because if anything goes wrong, I’m responsible. I’m the resident in charge.”

  “I know. Don’t worry.”

  “Worry, hell. Ten milligrams of this stuff will shove her into cold turkey so fast—”

  “Don’t worry.”

  “It could kill her. We ought to be doing graded doses. Start with two, and if there’s no effect in twenty minutes, go to five, and so on.”

  “Yes,” I said. “But graded doses won’t kill her.”

  Hammond looked at me and said, “John, are you out of your mind?”

  “No,” I said.

  We entered Angela’s room. She was turned away from us, rolled over on her side. I took the ampoule of nalorphine from Hammond and set it with the syringe on the table just alongside her bed; I wanted to be sure she read the label.

  Then I walked around to the other side of the bed, so her back was to me.

  I reached across her and picked up the ampoule and syringe. Then I quickly filled the syringe with water from the cup.

  “Would you turn around, Angela, please?”

  She rolled onto her back and held out her arm. Hammond was too astonished to move; I put the tourniquet on her arm and rubbed the veins in the crook of her elbow until they stood out. Then I slipped the needle in and squeezed out the contents. She watched me in silence.

  When it was done, I stood back and said, “There now.”

  She looked at me, then at Hammond, then back to me.

  “It won’t be long,” I said.

  “How much did you give me?”

  “Enough.”

  “Was it ten? Did you give me ten?”

  She was becoming agitated. I patted her arm reassuringly. “There’s nothing to worry about.”

  “Was it twenty?”

  “Well, no,” I said. “It was only two. Two milligrams.”

  “Two!”

  “It won’t kill you,” I said mildly.

  She groaned and rolled away from us.

  “Disappointed?” I said.

  “What are you trying to prove?” she said.

  “You know the answer to that, Angela.”

  “But two milligrams. That’s—”

  “Just enough to give you symptoms. Just the cold sweats and the cramps and the pain. Just the beginnings of withdrawal.”

  “Jesus.”

  “It won’t kill you,” I said again. “And you know it.”

  “You bastards. I didn’t ask to come here, I didn’t ask to be—”

  “But you are here, Angela. And you have nalorphine in your veins. Not much, but enough.”

  She began to break out into a sweat. “Stop it,” she
said.

  “We can use morphine.”

  “Stop it. Please. I don’t want it.”

  “Tell us,” I said. “About Karen.”

  “First stop it.”

  “No.”

  Hammond was bothered by all this. He started forward toward the bed. I pushed him back.

  “Tell us, Angela.”

  “I don’t know anything.”

  “Then we’ll wait until the symptoms start. And you’ll have to tell us while you scream from the pain.”

  Her pillow was soaked with sweat. “I don’t know, I don’t know.”

  “Tell us.”

  “I don’t know anything.”

  She began to shiver, slightly at first, and then more uncontrollably, until her whole body shook.

  “It’s starting, Angela.”

  She gritted her teeth. “I don’t care.”

  “It will get worse, Angela.”

  “No…no…no….”

  I produced an ampoule of morphine and set it on the table in front of her.

  “Tell us.”

  Her shivering got worse, until her whole body was wracked with spasms. The bed shook violently. I would have felt pity if I had not known that she was causing the reaction herself, that I had not injected any nalorphine at all.

  “Angela.”

  “All right,” she said, gasping. “I did it. I had to.”

  “Why?”

  “Because of the heat. The heat. The clinic and the heat.”

  “You’d been stealing from the surgery?”

  “Yes…not much, just a little…but enough…”

  “How long?”

  “Three years…maybe four…”

  “And what happened?”

  “Roman robbed the clinic…Roman Jones.”

  “When?”

  “Last week.”

  “And?”

  “The heat was on. They were checking everybody…”

  “So you had to stop stealing?”

  “Yes…”

  “What did you do?”

  “I tried to buy from Roman.”

  “And?”

  “He wanted money. A lot.”

  “Who suggested the abortion?”

  “Roman.”

  “To get money?”

  “Yes.”

  “How much did he want?”

  I already knew the answer. She said, “Three hundred dollars.”

  “So you did the abortion?”

  “Yes…yes…yes….”

  “And who acted as anesthetist?”

  “Roman. It was easy. Thiopental.”

  “And Karen died?”

  “She was all right when she left…. We did it on my bed…the whole thing.… It was all right, everything…on my bed….”

  “But later she died.”

  “Yes…Oh God, give me some stuff….”

  “We will,” I said.

  I filled a syringe with more water, squeezed out the air until a fine stream shot into the air, and injected it intravenously. Immediately she calmed. Her breathing became slower, more relaxed.

  “Angela,” I said, “did you perform the abortion?”

  “Yes.”

  “And it resulted in Karen’s death?”

  A dull voice. “Yes.”

  “All right.” I patted her arm. “Just relax now.”

  * * *

  WE WALKED DOWN THE CORRIDOR. Tom Harding was waiting there with his wife, smoking a cigarette and pacing up and down.

  “Is she all right, Doctor? Did the tests—”

  “Fine,” I said. “She’ll recover beautifully.”

  “That’s a relief,” he said, his shoulders sagging.

  “Yes,” I said.

  Norton Hammond gave me a quick glance, and I avoided his eyes. I felt like hell; my headache was much worse and I was beginning to have moments when my vision blurred. It seemed much worse in my right eye than my left.

  But someone had to tell them. I said, “Mr. Harding, I am afraid your daughter has been implicated in business that involves the police.”

  He looked at me, stunned, disbelieving. Then I saw his face melt into a peculiar acceptance. Almost as if he had known it all along. “Drugs,” he said, in a low voice.

  “Yes,” I said and felt worse than ever.

  “We didn’t know,” he said quickly. “I mean, if we had…”

  “But we suspected,” Mrs. Harding said. “We never could control Angela. She was a headstrong girl, very independent. Very self-reliant and sure of herself. Even as a child, she was sure of herself.”

  HAMMOND wiped the sweat from his face with his sleeve. “Well,” he said, “that’s that.”

  “Yes.”

  Even though he was close to me, he seemed far away. His voice was suddenly faint and insignificant. Everything around me was insignificant. The people seemed small and faded. My headache now came in bursts of severe pain. Once, I had to stop for a moment and rest.

  “What’s the matter?”

  “Nothing. Just tired.”

  He nodded. “Well,” he said, “it’s all over. You should be pleased.”

  “Are you?”

  We went into the doctors’ conference room, a small cubbyhole with two chairs and a table. There were charts on the walls, detailing procedure for acute emergencies: hemorrhagic shock, pulmonary edema, MI, burns, crush injuries. We sat down and I lit a cigarette. My left hand felt weak as I flicked the lighter.

  Hammond stared at the charts for a while; neither of us said anything. Finally, Hammond said, “Want a drink?”

  “Yes,” I said. I was feeling sick to my stomach, disgusted, and annoyed. A drink would do me good, snap me out of it. Or else it would make me sicker.

  He opened a locker and reached into the back, producing a flask. “Vodka,” he said. “No smell. For acute medical emergencies.” He opened it and took a swallow, then passed it to me.

  As I drank, he said, “Jesus. Tune in, turn on, drop dead. Jesus.”

  “Something like that.”

  I gave the flask back to him.

  “She was a nice girl, too.”

  “Yes.”

  “And that placebo effect. You got her into withdrawal on water, and you snapped her out of it with water.”

  “You know why,” I said.

  “Yeah,” he said, “she believed you.”

  “That’s right,” I said. “She believed me.”

  I looked up at a chart illustrating the pathological lesion and emergency steps for diagnosis and treatment of ectopic pregnancy. I got down to the place where they talked about menstrual irregularity and cramping right-lower-quadrant pain when the words began to blur.

  “John?”

  It took me a long time to answer. It seemed as if it took me a long time to hear the words. I was sleepy, slow-thinking, slow-acting.

  “John?”

  “Yes,” I said. My voice was hollow, a voice in a tomb. It echoed.

  “You O.K.?”

  “Yes, fine.”

  I kept hearing the words repeated in a kind of dream: fine, fine, fine….

  “You look terrible.”

  “I’m fine….” Fine, fine, fine…

  “John, don’t get mad—”

  “I’m not mad,” I said and shut my eyes. The lids were hard to keep open. They stuck down, were heavy, sticking to the lower lids. “I’m happy.”

  “Happy?”

  “What?”

  “Are you happy?”

  “No,” I said. He was talking nonsense. It meant nothing. His voice was squeaky and high like a baby, a chattering, childish voice. “No,” I said, “I’m not mad at all.”

  “John—”

  “Stop calling me John.”

  “That’s your name,” Norton said. He stood up, slowly, moving in dreamy slowness, and I felt very tired as I watched him move. He reached into his pocket and produced his light and shined it into my face. I looked away; the light was bright and hurt my eyes. Especially my right e
ye.

  “Look at me.”

  The voice was loud and commanding. Drill sergeant’s voice. Snappish and irritable.

  “Fuck off,” I said.

  Strong fingers on my head, holding me, and the light shining into my eyes.

  “Cut it out, Norton.”

  “John, hold still.”

  “Cut it out.” I closed my eyes. I was tired. Very tired. I wanted to sleep for a million years. Sleep was beautiful, like the ocean washing the sand, lapping up with a slow, beautiful, hissing sound, cleaning everything.

  “I’m O.K., Norton. I’m just mad.”

  “John, hold still.”

  John, hold still.

  John, hold still.

  John, hold still.

  “Norton, for Christ’s sake—”

  “Shut up,” he said.

  Shut up, shut up.

  He had his little rubber hammer out. He was tapping my legs. Making my legs bounce up and down. It tingled and irritated me. I wanted to sleep. I wanted to go fast, fast asleep.

  “Norton, you son of a bitch.”

  “Shut up. You’re as bad as any of them.”

  As any of them, as any of them. The words echoed in my head. As any of what? I wondered. Then the sleep, creeping up on me, fingers stretching out, plastic, rubbery fingers, closing over my eyes, holding them shut….

  “I’m tired.”

  “I know you are. I can see.”

  “I can’t. I can’t see anything.”

  Anything.

  Can’t see.

  I tried to open my eyes. “Coffee. Need coffee.”

  “No,” he said.

  “Give me a fetus,” I said and wondered why I said it. It made no sense. Did it? Didn’t it? So confusing. Everything was confused. My right eye hurt. The headache was right behind my right eye. Like a little man with a hammer, pounding the back of my eyeball.

  “A little man,” I said.

  “What?”

  “A little man,” I explained. It was obvious. He was stupid not to understand. It was perfectly obvious, a reasonable statement from a reasonable man. Norton was just playing games, pretending he didn’t understand.

  “John,” he said, “I want you to count backward from one hundred. Subtract seven from one hundred. Can you do that?”

  I paused. It wasn’t easy. In my mind, I saw a piece of paper, a shining white piece of paper, with pencil on it. One hundred minus seven. And a line, for the subtraction.

  “Ninety-three.”