A Case Of Need Part 1

A case of need.

by Michael Crichton.

I will prescribe regimen for the good of my pa tients, according to my judgment and ability, and tients, according to my judgment and ability, and never do harm to anyone. To please no one will I never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may prescribe a deadly drug, nor give advice which may cause his death. Nor will I give a woman a pessary 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. . . . to procure abortion. But I will preserve the purity of my life and my art. . . .

-FROM THE HIPPOCRATIC OATH -FROM THE HIPPOCRATIC OATH DEMANDED OF THE YOUNG PHYSICIAN DEMANDED OF THE YOUNG PHYSICIAN ABOUT TO ENTER UPON THE PRACTICE ABOUT TO ENTER UPON THE PRACTICE OF HIS PROFESSION. OF HIS PROFESSION.

There is no moral obligation to conserve DNA.

-GARRETT HARDIN

MONDAY MONDAY OCTOBER 10

ONE

ALL HEART SURGEONS ARE b.a.s.t.a.r.dS, 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. 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, "G.o.dd.a.m.ned morons." "Morons," Conway hissed, "G.o.dd.a.m.ned morons." He pounded the wall with his fist; bottles in the cabinets rattled. 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. 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 b.a.s.t.a.r.d," Conway said. He kicked over a wastebasket. It rolled noisily across the floor. over a wastebasket. It rolled noisily across the floor.

"Beat his brains in, his G.o.dd.a.m.ned brains," Conway said, grimacing and staring up at the ceil Conway said, grimacing and staring up at the ceil ing as if addressing G.o.d. G.o.d, like the rest of us, ing as if addressing G.o.d. G.o.d, like the rest of us, had heard it before. The same anger, the same had heard it before. The same anger, the same clenched teeth and pounding and profanity. clenched teeth and pounding and profanity. Conway always ran true to form, like the rerun of Conway always ran true to form, like the rerun of a movie. a movie. Sometimes his anger was directed against the Sometimes his anger was directed against the thoracic man, sometimes against the nurses, sometimes against the pump technicians. But oddly enough, never against Conway. 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 "If I live to be a hundred," Conway hissed through his teeth, "I'll never find a decent anes through his teeth, "I'll never find a decent anes man. Never. They don't exist. Stupid, s.h.i.+t-eating b.a.s.t.a.r.ds, all of them." man. Never. They don't exist. Stupid, s.h.i.+t-eating b.a.s.t.a.r.ds, all of them." We glanced at each other: this time it was We glanced at each other: this time it was Herbie. About four times a year the blame fell on Herbie. About four times a year the blame fell on Herbie. The rest of the time he and Conway were Herbie. The rest of the time he and Conway were good friends. Conway would praise him to the sky, good friends. Conway would praise him to the sky, call him the finest anesthesiologist in the country, call him the finest anesthesiologist in the country, better than Sonderick at the Brigham, better than better than Sonderick at the Brigham, better than Lewis at the Mayo, better than anyone. Lewis at the Mayo, better than anyone. But four times a year, Herbert Landsman was re But four times a year, Herbert Landsman was re sponsible for a DOT, the surgical slang for a death sponsible for a DOT, the surgical slang for a death on the table. In cardiac surgery, it happened a lot: on the table. In cardiac surgery, it happened a lot: fifteen percent for most surgeons, eight percent for a man like Conway. fifteen percent for most surgeons, eight percent for a man like Conway. Because Frank Conway was good, because he 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 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 . Once he kicked over a path microscope and did a hundred dollars' worth of damage. No- and did a hundred dollars' worth of damage. No- body blinked, because Conway was an eight- body blinked, because Conway was an eight- percenter. percenter. Of course, there was scuttleb.u.t.t in Boston about Of course, there was scuttleb.u.t.t in Boston about how he kept his percentage, known privately among how he kept his percentage, known privately among surgeons as the "Kill rate," down. They said surgeons as the "Kill rate," down. They said Conway avoided cases with complications. They Conway avoided cases with complications. They said Conway avoided jerry cases. said Conway avoided jerry cases.1 They said 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. 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 The fact that he was also a miserable person was considered superfluous. considered superfluous. "Stupid, stinking b.a.s.t.a.r.d," Conway said. He "Stupid, stinking b.a.s.t.a.r.d," Conway said. He looked angrily about the room. "Who's on today?" 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?" "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. s.h.i.+t." "Yeah. s.h.i.+t." "When?" "When?" "Tonight." "Tonight."

It was a habit of Conway's. He always did his autopsies on the dead cases in the evening, often autopsies on the dead cases in the evening, often going long into the night. It was as if he wanted to 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 n.o.body really knew. Except Conway. 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 n.o.body really knew. Except Conway.

' Geriatrics. ' Geriatrics.

"I'll tell the desk," I said. "They'll hold a locker for you." for you."

"Yeah. s.h.i.+t." He pounded the table. "Mother of "Yeah. s.h.i.+t." He pounded the table. "Mother of four, that's what she was." four, that's what she was." "I'll tell the desk to arrange everything." "Arrested before we got into the ventricle. Cold. We ma.s.saged for thirty-five minutes, but nothing. "I'll tell the desk to arrange everything." "Arrested before we got into the ventricle. Cold. We ma.s.saged for thirty-five minutes, but nothing. Nothing." Nothing." "What's the name?" I said. The desk would need "What's the name?" I said. The desk would need the name. the name. "McPherson," Conway said, "Mrs. McPherson." "McPherson," Conway said, "Mrs. McPherson." He turned to go and paused by the door. He He turned to go and paused by the door. He seemed to falter, his body sagging, his shoulders seemed to falter, his body sagging, his shoulders slumping. slumping. "Jesus," he said, "a mother of four. What the h.e.l.l "Jesus," he said, "a mother of four. What the h.e.l.l am I going to tell him?" am I going to tell him?" He held his hands up, surgeon-style, palms facing him, and stared at his fingers accusingly, as if 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 they had betrayed him. I suppose in a sense they had. had. "Jesus," Conway said. "I should have been a dermatologist. n.o.body ever dies on a dermatologist." Then he kicked the door open and left the lab. "Jesus," Conway said. "I should have been a dermatologist. n.o.body ever dies on a dermatologist." Then he kicked the door open and left the lab. WHEN WE WERE ALONE, WHEN WE WERE ALONE, one of the first-year resi one of the first-year resi dents, looking very pale, said to me, "Is he always like that?" dents, looking very pale, said to me, "Is he always like that?" "Yes," I said. "Always." "Yes," I said. "Always." I turned away, looking out at the rush-hour traffic moving slowly through the October drizzle. It would 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 have been easier to feel sympathy for Conway if I didn't know that his act was purely for himself, a kind didn't know that his act was purely for himself, a kind of ritual angry deceleration that he went through ev of ritual angry deceleration that he went through ev ery time he lost a patient. I guess he needed it, but 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. 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. 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 I turned my back to the window and picked up the next specimen. We have a high-speed tech the next specimen. We have a high-speed tech nique in the lab: the pathologists stand before nique in the lab: the pathologists stand before waist-high benches and examine the biopsies. A mi 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. 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 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 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 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 dx geons were waiting for the path dx3 before proceed- before proceed- 2 The files containing the history of treatment of patients in the hospital. 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. 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 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. 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. 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 ma.s.s, white in color, measuring"- 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 ma.s.s, white in color, measuring"- I measured the lump-"approximately two centimeters in diameter. On cut surface, it appears whit 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." 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. I cut a slice of the white lump and quick-froze it. There was only one way to be certain if the ma.s.s There was only one way to be certain if the ma.s.s was benign or malignant, and that was to check it 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 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 4 Crepitant means it is crackly and filled with air. This is normal. Crepitant means it is crackly and filled with air. This is normal. your stuff into six or seven baths; it took at least six your stuff into six or seven baths; it took at least six hours, sometimes days. The surgeons couldn't wait. hours, sometimes days. The surgeons couldn't wait. When the tissue was frozen hard, I cranked out a When the tissue was frozen hard, I cranked out a section with the microtome, stained the slice, and 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 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 the lacy network of lung tissue formed into delicate alveolar sacs for exchange of gas between blood and alveolar sacs for exchange of gas between blood and air. The white ma.s.s was something else again. I stepped on the floor b.u.t.ton. "Micro examination, frozen section. The whitish ma.s.s 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." air. The white ma.s.s was something else again. I stepped on the floor b.u.t.ton. "Micro examination, frozen section. The whitish ma.s.s 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 acc.u.mulation of carbon particles Anthracosis is acc.u.mulation 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. 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 down in the OR, wetting his pants because we hadn't gotten back to him in thirty seconds flat. hadn't gotten back to him in thirty seconds flat. Scanlon is like all surgeons. If he's not cutting, he's 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- 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 derly has to bring it all the way from the surgical wing to the path labs before we can look at it. wing to the path labs before we can look at it. Scanlon also doesn't figure that there are eleven Scanlon also doesn't figure that there are eleven other operating rooms in the hospital, all going like h.e.l.l 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. other operating rooms in the hospital, all going like h.e.l.l 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 b.i.t.c.h, like And they don't. They just want to b.i.t.c.h, like Conway. It gives them something to do. All sur Conway. It gives them something to do. All sur geons have persecution complexes anyway. Ask the geons have persecution complexes anyway. Ask the psychiatrists. psychiatrists. As I went to the phone, I stripped off one rubber As I went to the phone, I stripped off one rubber glove. My hand was sweaty; I wiped it on the seat of glove. My hand was sweaty; I wiped it on the seat of my pants, then picked up the receiver. We are careful my pants, then picked up the receiver. We are careful about the phone, but just to be safe it gets swabbed about the phone, but just to be safe it gets swabbed with alcohol and Formalin at the end of each day. "Berry speaking." with alcohol and Formalin at the end of each day. "Berry speaking." "Berry, what's going on up there"?" "Berry, what's going on up there"?" After Conway, 1 felt like taking him on, but I After Conway, 1 felt like taking him on, but I didn't. I just said, "You've got a malignancy." didn't. I just said, "You've got a malignancy." "I thought so," Scanlon said as if the whole path "I thought so," Scanlon said as if the whole path work-up had been a waste of time. 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. "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 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 were waiting: a kidney, a gallbladder, and an appendix. I started to pull my glove back on when the in tercom clicked. tercom clicked. "Dr. Berry?" "Dr. Berry?" "Yes?" "Yes?" The intercom has a high pickup. You can speak The intercom has a high pickup. You can speak in a normal voice anywhere in the room, and the in a normal voice anywhere in the room, and the girl will hear you. They mount the microphone high 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 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 how sensitive it is. That blasts the ears off the girl at the other end. at the other end. "Dr. Berry, your wife is on the telephone." "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 st.i.tches in his forehead. 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 st.i.tches 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. "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. "h.e.l.lo?" "h.e.l.lo?"

"John?" Her voice was trembling. I hadn't heard her sound that way in years. Not since her father her sound that way in years. Not since her father died. died.

"What is it?" "What is it?" "John, Arthur Lee just called." "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?" "What's the problem?" "He called here asking for you. He's in trouble." "He called here asking for you. He's in trouble." "What kind of trouble?" As I spoke, I waved to a "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. keep those surgical specimens moving. "I don't know," Judith said, "but he's in jail." "I don't know," Judith said, "but he's in jail." My first thought was that it was some kind of My first thought was that it was some kind of mistake. "Are you sure?" mistake. "Are you sure?" "Yes. He just called. John, is it something "Yes. He just called. John, is it something about about ----- ?" ----- ?" "I don't know," I said. "I don't know any more than you do." I cradled the phone in my shoulder "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 and stripped away my other glove. I threw them both in the vinyl-lined wastebasket. "I'll go see him both in the vinyl-lined wastebasket. "I'll go see him now," I said. "You sit tight and don't worry. It's prob now," I said. "You sit tight and don't worry. It's prob ably a minor thing. Maybe he was drinking again." ably a minor thing. Maybe he was drinking again." "All right," she said in a low voice. "All right," she said in a low voice. "Don't worry," I repeated. "Don't worry," I repeated. "All right." "All right." "I'll speak to you soon." "I'll speak to you soon." I hung up, untied my ap.r.o.n, and placed it on the I hung up, untied my ap.r.o.n, and placed it on the peg by the door. Then I went down the hall to peg by the door. Then I went down the hall to Sanderson's office. Sanderson was chief of the path Sanderson's office. Sanderson was chief of the path labs. He was very dignified looking; at forty-eight, labs. He was very dignified looking; at forty-eight, his hair was just turning gray at the temples. He his hair was just turning gray at the temples. He had a jowly, thoughtful face. He also had as much had a jowly, thoughtful face. He also had as much to fear as I did. to fear as I did. "Art's in jail," I said. "Art's in jail," I said. He was in the middle of reviewing an autopsy He was in the middle of reviewing an autopsy case. He shut the file. "Why?" 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." "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." frames, "when you know."

"I will." "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 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. 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. 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 Betty answered the phone in a state of stony shock. She told me they had Arthur downtown, on shock. She told me they had Arthur downtown, on Charles Street. He had been arrested in his home 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? 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 told her to say it was all a mistake and hung up.

I DROVE MY VOLKSWAGEN out of the doctors' parking out of the doctors' parking lot, past all the s.h.i.+ny Cadillacs. The big cars are lot, past all the s.h.i.+ny Cadillacs. The big cars are all owned by practicing physicians; pathologists all owned by practicing physicians; pathologists are paid by the hospital and can't afford all those are paid by the hospital and can't afford all those glistening horses. glistening horses. It was 8:45, right in the middle of rush-hour traffic, which in Boston means a life-and-death propo 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 sition. Boston has the highest accident rate in the U.S., even higher than Los Angeles, as any EW 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 G.o.d 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. 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 G.o.d 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 He laughed until he was crying. "Blinded by reli gion," he kept saying, doubled over in laughter. "Blinded by religion." gion," he kept saying, doubled over in laughter. "Blinded by religion." The surgeon did plastic stuff, and he didn't see The surgeon did plastic stuff, and he didn't see the humor. 1 guess because he'd repaired too many the humor. 1 guess because he'd repaired too many punched-out eyesockets. But Art was convulsed. punched-out eyesockets. But Art was convulsed. 5 5 Emergency ward. Emergency ward.

Most people at the party were surprised by his laughter; they thought it was excessive and in laughter; they thought it was excessive and in rather poor taste. I suppose of all the people there 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. 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 n.o.body 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 I don't know exactly when he started. I guess it was right after he finished his gynecology residency. 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 not a particularly difficult operation-a well-trained nurse can do it with no problem. There's only one small catch. It's illegal. It's illegal. I remember very well when I first found out 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 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 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 regularity, pain, mid-period bleeding-but quite a few were showing evidence of pregnancy in the sc.r.a.pings. I got concerned because the residents were young and loose-mouthed. I told them right few were showing evidence of pregnancy in the sc.r.a.pings. 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 seriously damage a doctor's reputation by such jokes. They sobered up quickly. Then I went to see jokes. They sobered up quickly. Then I went to see Arthur. I found him in the hospital cafeteria. Arthur. I found him in the hospital cafeteria. "Art," I said, "something's bothering me." "Art," I said, "something's bothering me." He was in a jovial mood, eating a doughnut and He was in a jovial mood, eating a doughnut and coffee. "Not a gynecological problem, I hope." He coffee. "Not a gynecological problem, I hope." He laughed. laughed. "Not exactly. I overheard some of the residents "Not exactly. I overheard some of the residents say that you had a half-dozen pregnancy-positive say that you had a half-dozen pregnancy-positive sc.r.a.pings in the last month. Have you been noti sc.r.a.pings in the last month. Have you been noti fied?" fied?" Immediately, the hearty manner was gone. "Yes," Immediately, the hearty manner was gone. "Yes," he said, "I have." he said, "I have." "I just wanted you to know. There might be trou "I just wanted you to know. There might be trou ble in the tissue committee when these things ble in the tissue committee when these things come up, and come up, and -" -" He shook his head. "No trouble." He shook his head. "No trouble." "Well, you know how it looks." "Yes," he said. "It looks like I'm performing abortions." "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 His voice was low, almost dead calm. He was looking directly at me. It gave me a strange feeling. looking directly at me. It gave me a strange feeling. "We'd better have a talk," he said. "Are you free "We'd better have a talk," he said. "Are you free for a drink about six tonight?" for a drink about six tonight?" "I guess so." "I guess so." "Then meet me in the parking lot. And if you get "Then meet me in the parking lot. And if you get some free time this afternoon, why don't you have some free time this afternoon, why don't you have a look at a case of mine?" a look at a case of mine?" "All right," I said, frowning. "All right," I said, frowning. "The name is Suzanne Black. The number is "The name is Suzanne Black. The number is AO-two-two-one-three-six-five." AO-two-two-one-three-six-five." I scribbled the number on a napkin, wondering I scribbled the number on a napkin, wondering why he should have remembered it. Doctors re why he should have remembered it. Doctors re member a lot about their patients, but rarely the member a lot about their patients, but rarely the hospital number. hospital number. "Take a good look at this case," Art said, "and "Take a good look at this case," Art said, "and don't mention it to anyone until you talk to me." 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 CC 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. 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 Physical examination was essentially normal, ex cept that she had a mild fever. Blood tests were cept that she had a mild fever. Blood tests were normal, though hematocrit normal, though hematocrit7 was somewhat low. was somewhat low. Dr. Lee ordered a D & C to correct her irregularity. This was in 1956, before the advent of estrogen Dr. Lee ordered a D & C to correct her irregularity. This was in 1956, before the advent of estrogen 6Chief complaint, the term for the medical disorder that brings the pa Chief complaint, the term for the medical disorder that brings the pa tient to seek treatment.

7A test of the amount of hemoglobin, or red cells, in the blood. A test of the amount of hemoglobin, or red cells, in the blood.

therapy. The D & C was normal; no evidence of tu therapy. The D & C was normal; no evidence of tu mors or pregnancy. The girl seemed to respond well mors or pregnancy. The girl seemed to respond well to this treatment. She was followed for the next three months and had normal periods. to this treatment. She was followed for the next three months and had normal periods. It looked like a straightforward case. Illness or 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. 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. 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 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. my autopsy. I don't know what made me think of the slide. I don't know what made me think of the slide. Like most hospitals, the Lincoln keeps path 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 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 croscopic slides from a patient. They're stored in long boxes arranged like card catalogs in a library. long boxes arranged like card catalogs in a library. We had a whole room full of such boxes. We had a whole room full of such boxes. I went to the appropriate box and found slide I went to the appropriate box and found slide 1365. The label gave the case number and Dr. 1365. The label gave the case number and Dr. Sanderson's initials. It also said in large letters, Sanderson's initials. It also said in large letters, "D & C." "D & C." I took the slide back to the micro room, where I took the slide back to the micro room, where we have ten microscopes in a long row. One was we have ten microscopes in a long row. One was free; I slipped the slide onto the stage and had a free; I slipped the slide onto the stage and had a look. look. I saw it immediately. I saw it immediately. The tissue was a uterine sc.r.a.ping, all right. It The tissue was a uterine sc.r.a.ping, all right. It showed a rather normal endometrium in the proliferative showed a rather normal endometrium in the proliferative phase, but the stain stopped me. This slide phase, but the stain stopped me. This slide had been stained with Zenker-Formalin stain, giving 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. 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 For routine work, the Hematoxylin-Eosin stain is used, producing pink and purple colors. Almost ev 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 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. noted in the pathological summary. But Dr. Sanderson had not mentioned that the But Dr. Sanderson had not mentioned that the slide was Zenker-Formalin. 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 label. It was Sanderson's, no doubt about it. What had happened? 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 that an unusual stain was used. Or two sections were made, one H & E, the other Zenker-Formalin, were made, one H & E, the other Zenker-Formalin, and only the Zenker was saved. Or that there had been some legitimate mixup. 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 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- 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?" place away from the hospital to talk. As he drove, he said, "Read the case?" "Yes," I said. "Very interesting." "Yes," I said. "Very interesting." "You checked the section?" "You checked the section?" "Yes. Was it the original?" "Yes. Was it the original?" "You mean, was it a sc.r.a.ping from Suzanne "You mean, was it a sc.r.a.ping from Suzanne Black? No." Black? No." "You should have been more careful. The stain "You should have been more careful. The stain was different. That kind of thing can get you into was different. That kind of thing can get you into trouble. Where did the slide come from?" trouble. Where did the slide come from?" Art smiled thinly. "A biological supply house. Art smiled thinly. "A biological supply house. 'Slide of normal endometrial sc.r.a.ping.' " 'Slide of normal endometrial sc.r.a.ping.' " "And who made the switch?" "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 sc.r.a.ping, he makes up a few extra slides and keeps them around." "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 sc.r.a.ping, he makes up a few extra slides and keeps them around." "I don't understand," I said. "You mean Sanderson is in this with you?" "I don't understand," I said. "You mean Sanderson is in this with you?" "Yes," Art said. "He has been for several years." "Yes," Art said. "He has been for several years." Sanderson was a very wise, very kind, and very Sanderson was a very wise, very kind, and very proper man. proper man. "You see," Art said, "that whole chart is a lie. The "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, 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 but the reason was she was pregnant. She had been knocked up on a football weekend by a guy she said knocked up on a football weekend by a guy she said she loved and was going to marry, but she wanted she loved and was going to marry, but she wanted to finish college first, and a baby would get in the to finish college first, and a baby would get in the way. Furthermore, she managed to get measles dur way. Furthermore, she managed to get measles dur ing the first trimester. She wasn't a terribly bright ing the first trimester. She wasn't a terribly bright girl, but she was bright enough to know what it girl, but she was bright enough to know what it meant when you got measles. She was very worried 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. 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 "I was pretty horrified. I was fresh from my res idency, and I still had a little starry idealism in me. 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. 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. 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." 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. He sighed and shook his head as he drove.

"I went home that night feeling like h.e.l.l. 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 sleep; I kept thinking all night. I had a vision of her going to a smelly back room somewhere and going to a smelly back room somewhere and meeting a leering little guy who would letch her meeting a leering little guy who would letch her and maybe even manage to kill her. I thought about 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." 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. I smoked a cigarette and said nothing. "So I got up in the middle of the night and "So I got up in the middle of the night and fought it out with six cups of coffee, staring at the fought it out with six cups of coffee, staring at the kitchen wall. By morning I had decided that the kitchen wall. By morning I had decided that the law was unfair. I had decided that a doctor could law was unfair. I had decided that a doctor could play G.o.d in a lot of c.r.a.ppy ways, but this was a play G.o.d in a lot of c.r.a.ppy ways, but this was a good way. I had seen a patient in trouble and I had good way. I had seen a patient in trouble and I had refused to help her when it was within my power. refused to help her when it was within my power. That was what bothered me-I had denied her That was what bothered me-I had denied her treatment. It was just as bad as denying penicillin treatment. It was just as bad as denying penicillin to a sick man, just as cruel and just as foolish. The 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 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 the whole situation and told him I wanted to do a D & C. He said he would arrange to do the path D & C. He said he would arrange to do the path examination himself, and he did. That was how it examination himself, and he did. That was how it all started." all started." "And you've been doing abortions ever since?" "And you've been doing abortions ever since?"

"Yes," Art said. "When I've felt that they were warranted." "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. 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 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?" 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 a.n.a.logy," I said, "but I don't buy it." "I see your a.n.a.logy," I said, "but I don't buy it." "Listen," he said. "Morality must keep up with "Listen," he said. "Morality must keep up with technology, because if a person is faced with the technology, because if a person is faced with the choice of being moral and dead or immoral and choice of being moral and dead or immoral and alive, they'll choose life every time. People today alive, they'll choose life every time. People today know that abortions are safe and easy. They know it know that abortions are safe and easy. They know it isn't a long, tedious, dangerous operation. They isn't a long, tedious, dangerous operation. They know it's simple and they want the personal happi know it's simple and they want the personal happi ness it can give them. They demand it. And one ness it can give them. They demand it. And one way or another they get it. If they're rich, they go to j.a.pan or Puerto Rico; if they're poor, they go to the Marine orderly. But one way or another, they get Marine orderly. But one way or another, they get that abortion." that abortion."

"Art," I said. "It's illegal." "Art," I said. "It's illegal." He smiled. "I never thought you had so much re He smiled. "I never thought you had so much re spect for the law." spect for the law." That was a reference to my career. After college, That was a reference to my career. After college, I entered law school and stuck it out for a year and I entered law school and stuck it out for a year and a half. Then I decided I hated it and quit to try a half. Then I decided I hated it and quit to try medicine. In between, I did some army time. 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 "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." cense. You know that." "I'm doing what I have to do." "Don't be an a.s.s." "I'm doing what I have to do." "Don't be an a.s.s." "I believe," he said, "that what I'm doing is right." "I believe," he said, "that what I'm doing is right." Looking at his face, I saw he meant it. And as Looking at his face, I saw he meant it. And as time went on, I personally encountered several time went on, I personally encountered several cases where an abortion was the obvious, humane cases where an abortion was the obvious, humane answer. Art handled them. I joined Dr. Sanderson answer. Art handled them. I joined Dr. Sanderson in covering up in the path department. We fixed in covering up in the path department. We fixed things so that the tissue committee never knew. That was necessary because the tissue committee 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 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 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 most agreed with him, because he exercised careful judgment in deciding his cases. Most would have judgment in deciding his cases. Most would have performed abortions too, if they had dared. performed abortions too, if they had dared. A few didn't agree with Art and would have been A few didn't agree with Art and would have been tempted to turn him in if they'd had the guts. a.n.a.l retentives like Whipple and Gluck, men whose re tempted to turn him in if they'd had the guts. a.n.a.l retentives like Whipple and Gluck, men whose re ligion precluded compa.s.sion and common sense. ligion precluded compa.s.sion and common sense. For a long time, I worried about the Whipples For a long time, I worried about the Whipples and the Glucks. Later on I ignored them, turning and the Glucks. Later on I ignored them, turning away from their nasty knowing glances and away from their nasty knowing glances and pinched, disapproving faces. Perhaps that was a pinched, disapproving faces. Perhaps that was a mistake. mistake. Because now Art was down, and if his head Because now Art was down, and if his head rolled, so would Sanderson's. And so would mine. rolled, so would Sanderson's. And so would mine. THERE WAS NO PLACE TO PARK THERE WAS NO PLACE TO PARK near the police station. Finally I came to a lot four blocks away and near the police station. Finally I came to a lot four blocks away and walked quickly back to find out why Arthur Lee walked quickly back to find out why Arthur Lee was in jail. was in jail.

TWO.

WHEN I WAS IN THE ARMY a few years back, I served WAS IN THE ARMY a few years back, I served as an MP in Tokyo, and the experience taught me as an MP in Tokyo, and the experience taught me a lot. MP's were the most unpopular people in the a lot. MP's were the most unpopular people in the city in those days, during the last phases of the oc city in those days, during the last phases of the oc cupation. In our white helmets and uniforms, we cupation. In our white helmets and uniforms, we represented the final reminders of a tiresome mili represented the final reminders of a tiresome mili tary authority to the j.a.panese. To the Americans on the Ginza, drunk with sake or whiskey if they could tary authority to the j.a.panese. To the Americans on the Ginza, drunk with sake or whiskey if they could afford it, we represented all that was frustrating or 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." 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 In effect we were ordered to bluff our way through everything. We learned to do it. All cops through everything. We learned to do it. All cops learn to do it. learn to do it. I remembered this as I faced the surly police ser 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. geant in the Charles Street Station. He looked up at me as if he'd enjoy breaking my skull. "Yeah? What is it?" "Yeah? What is it?" "I'm here to see Dr. Lee," I said. "I'm here to see Dr. Lee," I said. He smiled. "The little c.h.i.n.k's uptight, is he? Too He smiled. "The little c.h.i.n.k's uptight, is he? Too bad." bad." "I'm here to see him," I repeated. "I'm here to see him," I repeated. "Can't." "Can't." He looked back at his desk and shuffled the papers on it in a busy, irritable dismissal. He looked back at his desk and shuffled the papers on it in a busy, irritable dismissal. "Would you care to explain that?" "Would you care to explain that?" "No," he said. "I wouldn't 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 "What are you, a funny guy? Beat it. You can't see him." see him." "You are required by law to give your badge "You are required by law to give your badge number upon request." number upon request." "That's nice." "That's nice." I looked at his s.h.i.+rt and pretended to write down the number. Then I started for the door. I looked at his s.h.i.+rt and pretended to write down the number. Then I started for the door. He said casually, "Going somewhere?" He said casually, "Going somewhere?" "There's a phone booth right outside." "There's a phone booth right outside." So? So? "It's a shame. I'll bet your wife spent hours sew "It's a shame. I'll bet your wife spent hours sew ing those stripes on your shoulder. It takes them ing those stripes on your shoulder. It takes them ten seconds to get them off. They use a razor blade: ten seconds to get them off. They use a razor blade: doesn't even damage the uniform." doesn't even damage the uniform." He stood up heavily behind the desk. "What's He stood up heavily behind the desk. "What's your business here?" your business here?" "I've come to see Dr. Lee." "I've come to see Dr. Lee." He looked at me evenly. He didn't know if I He looked at me evenly. He didn't know if I could have him busted, but he knew it could be could have him busted, but he knew it could be done. done. "You his lawyer?" "You his lawyer?" "That's right." "That's right." "Well, for Christ's sake, you should have said so "Well, for Christ's sake, you should have said so before." He took a set of keys from his desk drawer. before." He took a set of keys from his desk drawer. "Come on." He smiled at me, but his eyes were still "Come on." He smiled at me, but his eyes were still hostile. hostile. I followed him back through the station. He said I followed him back through the station. He said nothing, but grunted a couple of times. Finally he nothing, but grunted a couple of times. Finally he said over his shoulder, "You can't blame me for be said over his shoulder, "You can't blame me for be ing careful. Murder is murder, you know." ing careful. Murder is murder, you know." "Yes," I said. "Yes," I said. ART WAS LOCKED IN A NICE CELL. 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. 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 b.u.t.ts and ash. He looked up as we came down the hallway. Art was sitting on his bed, staring at a cigarette between his fingers. The stone floor was littered with b.u.t.ts and ash. He looked up as we came down the hallway. "John!" "John!" "You have him for ten minutes," the sergeant "You have him for ten minutes," the sergeant said. said. I entered the cell. The sergeant locked the door I entered the cell. The sergeant locked the door behind me and stood there, leaning again