A Case of Need

  Peterson nodded. “A reliable witness,” he said. “A mature woman, stable, careful in her judgments. 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 interest 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 decided 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 escape: 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 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 Jackson did at the conference of the American Society of Surgeons a few years back. I knew she’d be upset 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 beginning 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 visibly 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 almost 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 Vermont, 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. Bradford 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 professor of medicine at the Boston Memorial Hospital. 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. Obviously 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.

  This happens a lot in medicine. For example, a patient presents with fever, leukocytosis—increased numbers of white cells—and pain in the right-lower quadrant of the abdomen. The obvious diagnosis is appendicitis. The surgeon may perform an appendectomy only to find that the appendix 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.

  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 monument 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 Prudential 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 apocryphal, 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 happened 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 married.” 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 offices just off the Commons. He was very fashionable, very exclusive, and supposedly quite good, though I had no way of knowing.

  J. D. had a son, Karen’s brother, who was in medical school at Harvard. A year ago there was a rumor 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 academic 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 officership1 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 Columbus avenues. At night it teems with whores, pimps, addicts, and pushers; it got its name because 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 establishment, the City is known as the Boston Shitty because 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 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 required 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.
br />   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 hospital, is given over to the medical examiner’s offices. In routine cases, most of the autopsies are performed 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 epidemic was expected this winter?