A Case Of Need Part 5

"How do you know?"

"Because whenever I feel the symptoms coming on-the urge to work round the clock, to keep going until midnight, or to come in at five in the morning-I say to myself, it's just a game. I repeat that over and over. And it works: I settle down."

The cleaver finished the third rat.

"Ah," Peter said, "halfway there." He scratched his stomach reflectively. "But enough about me. What about you?"

"I'm just interested in Karen.""Ummm. And you wanted to know about an accident? There was none, that I recall.""Why were skull films taken last summer?""Oh that." that." He stroked the fourth victim soothingly and set it on the block. "That was typical Karen." He stroked the fourth victim soothingly and set it on the block. "That was typical Karen.""What do you mean?""She came into my office and said, 'I'm going blind.' She was very concerned, in her own breathless way. You know how sixteen-year-old girls can be: she was losing her vision, and her tennis game was suffering. She wanted me to do something. So I drew some blood and ordered a few tests. Drawing blood always impresses them. And I checked her blood pressure and listened to her and generally gave the impression I was being very thorough.'"And you ordered skull films.""Yes. That was part of the cure.""I don't follow you.""Karen's problems were purely psychosomatic,"he said. "She's like ninety percent of the women I see. Some little thing goes wrong-like your tennis game-and bang! you have a medical problem. You go to see your doctor. He can find nothing physically wrong with you. But does this satisfy you? No: on to another doctor, and still another, until you find one who will pat your hand and say, 'Yes, you're a very sick woman.'" He laughed."So you ordered all these tests as a diversion?"

"Largely," he said. "Not entirely. I believe in caution, and when one hears a complaint as serious as vision loss, one must investigate. I checked her fundi. Normal. I did a visual fields. Normal, but she said it came and went. So I took a blood sample and ordered tests of thyroid function and hormone levels. Normal. And the skull films. They were normal, too, or have you already seen them?"

"I saw them," I said. I lit a cigarette as the next rat died. "But I'm still not sure why-""Well, put it together. She's young, but it's still possible-vision and headache, slight weight gain, lethargy. That could be pan hypopituitarism with optic nerve involvement."'You mean a pituitary tumor?"

"It's possible, just possible. I figured the tests would show if she was pan hypopit. The skull films might show something if she was really badly off. But everything came back negative. It was all in her mind.'

"Are you sure?""Yes.""The labs might have made a mistake." "That's true. I would have run a second test, just to be sure.""Why didn't you?"

"Because she never came back," Peter said. "That's the key to it all. One day she comes in near hysteria because she's going blind. I say come back in a week, and my nurse makes the appointment. A week later, no show. She's out playing tennis, having a fine time. It was all in her mind." "Was she menstruating when you saw her?" "She said her periods were normal," he said. "Of course, if she were four months' pregnant at the time of her death, she would just have conceived when I saw her."

"But she never came back to you?" "No. She was rather scatterbrained, actually." He killed the last rat. All the girls were now busily working. Peter collected the carca.s.ses and put them into the paper bag, then dropped the bag into a wastebasket. "Ah," he said, "at last." He washed his hands vigorously."Well," I said, "thanks for your time." "Not at all." He dried his hands on a paper towel, then stopped. "I suppose I ought to make some sort of official statement," he said, "since I'm the uncle and so forth." I waited."J. D. would never speak to me again if he knew I'd had this conversation with you. Try to keep that in mind if you talk to anybody else.""O.K.," I said.

"I don't know what you're doing," Peter said, "and I don't want to know. You've always struck me as pretty level and sensible, and I a.s.sume you're not wasting your time."

I didn't know what to say. I couldn't see what he was leading up to, but I knew he was leading up to something.

"My brother, at this moment, is neither level nor sensible. He's paranoid; you can't get anything out of him. But I understand that you were present at the autopsy."

"That's right.""What's the dx1 there?" there?"

"It's uncertain on the basis of the gross," I said. "Nothing clear at all."

"And the slides?""I haven't seen them yet.""What was your impression at autopsy?"I hesitated, then made my decision. He had been honest with me; I'd be honest with him."Not pregnant," I said."Hmmm," he said. "Hmmmm."He scratched his stomach again, then held out his hand."That's very interesting," he said.We shook hands.1 See Appendix IV: Abbreviations.EIGHT WHEN I GOT HOME, a big squad car with a flas.h.i.+ng light was waiting at the curb. Captain Peterson, still crew-cut and tough-looking, leaned against the fender and stared at me as I pulled into my driveway.

I got out of my car and looked at the nearby houses. People had noticed the flasher and were staring out of their windows."I hope," I said, "that I didn't keep you waiting.""No," Peterson said with a little smile. "Just arrived. I knocked at the door and your wife said you weren't back yet, so I waited out here."I could see his bland, smug expression in the alternating flashes of red from the light. I knew he had kept the light on to irritate me."Something on your mind?"He s.h.i.+fted his position on the car. "Well, yes, actually. We've had a complaint about you, Dr. Berry.""Oh?""Yes.""From whom?""Dr. Randall."I said innocently, "What kind of complaint?""Apparently you have been hara.s.sing members ofhis family. His son, his wife, even his daughter's college friends.""Hara.s.sing?""That," said Peterson carefully, "was what he said.""And what did you say?""I said I'd see what could be done.""So here you are."He nodded and smiled slowly.The flasher was beginning to get on my nerves. Down the block, one or two kids were standing in the street, watching in silence.I said, "Have I broken any law?""That hasn't been determined yet.""If I have broken a law," I said, "then Dr. Randall may go to court about it. Or he may go to court if he feels he can show material damage as a result of my alleged actions. He knows that, and so do you." I smiled at him, giving him some of his own. "And so do I.""Maybe we should go down to the station and talk about it."I shook my head. "Haven't got time.""I can take you in for questioning, you know.""Yes," I said, "but it wouldn't be prudent.""It might be quite prudent."

"I doubt it," I said. "I am a private citizen acting within my rights as a private citizen. I did not force myself upon anyone, did not threaten anyone. Any person who did not wish to speak with me did not have to."

"You trespa.s.sed on private property. The Randall home."

"That was quite inadvertent. I was lost, and I wanted to ask directions. I pa.s.sed a large building, so large it never occurred to me it might be a private dwelling. I thought it was some kind of inst.i.tution."

"Inst.i.tution?""Yes. Like an orphanage, you know. Or a nursing home. So I drove in to ask questions. Imagine my surprise when I discovered that by purest chance-""Chance?""Can you prove otherwise?"Peterson gave a fair imitation of a good-natured chuckle. 'You're being very clever.""Not really," I said. "Now why don't you turn off that flasher and stop drawing attention? Because otherwise I will file a complaint of hara.s.sment by the police. And I'll file it with the Chief of Police, the District Attorney's office, and the Mayor's office."He reached indolently through the window and flicked a switch. The light stopped."Someday," he said, "all this may catch up with you."Yes," I said. "Me, or somebody else."He scratched the back of his hand, as he had done in his office. "There are times," he said, "when I think you're either an honest man or a complete fool.""Maybe both."He nodded slowly. "Maybe both." He opened the door and swung into the driver's seat.I went up to the front door and let myself in. As I closed the door, I heard him pull away from the curb.

NINE.

I DIDNT FEEL MUCH LIKE ATTENDING A c.o.c.kTAILparty, but Judith insisted. As we drove to Cambridge, she said, "What was it all about?""What?""The business with the police?""It was an attempt to call me off.""On what grounds?""Randall filed a complaint. Hara.s.sment.""Justified?""I think so."

I told her quickly about the people 1 had seen that day. When I was finished, she said, "It sounds complicated."

"I'm sure I've barely scratched the surface."

"Do you think Mrs. Randall was lying about the check for three hundred dollars?"

"She might have been," I admitted.Her question stopped me. I realized then that things had been happening so fast, I hadn't had time to consider everything I had learned, to sift it out and put it together. I knew there were inconsistencies and trouble spots-several of them-but I hadn't worked on them in any logical way.

"How's Betty?""Not good. There was an article in the paper today. . . .""Was there? I didn't see it.""Just a small article. Arrest of physician for abortion. Not many details, except his name. She's gotten a couple of crank calls.""Bad?""Pretty bad. I try to answer the phone, now.""Good girl.""She's trying to be very brave about it, trying to go on as if everything was normal. I don't know if that's worse or better. Because she can't. Things aren't normal, and that's all there is to it.""Going over there tomorrow?""Yes."I parked on a quiet residential block in Cambridge not far from the Cambridge City Hospital. It was a pleasant area of old frame houses and maple trees along the road. Brick-paved sidewalks; the whole Cambridge bit. As I parked Hammond pulled up on his motorcycle.Norton Francis Hammond III represents the hope of the medical profession. He doesn't know it, and it's just as well; if he did, he'd be insufferable. Hammond comes from San Francisco, from whathe calls "a long line of s.h.i.+pping." He looks like a walking advertis.e.m.e.nt for the California life-tall, blond, tanned, and handsome. He is an excellent doctor, a second-year resident in medicine at the Mem, where he is considered so good that the staff overlooks things like his hair, which reaches almost to his shoulders, and his moustache, which is long, curling and flamboyant.

What is important about Hammond, and the few other young doctors like him, is that they are breaking old patterns without rebelling against the Establishment. Hammond is not trying to antagonize anyone with his hair, his habits, or his motorcycle; he simply doesn't give a d.a.m.n what the other doctors think of him. Because he takes this att.i.tude, the other doctors cannot object-he does, after all, know his medicine. Though they find his appearance irritating, they have no ground for complaint.

So Hammond goes his way unmolested. And because he is a resident, he has a teaching function. He influences the younger men. And therein lies the hope of future medicine.

Since World War II, medicine has undergone great change, in two successive waves. The first was an outpouring of knowledge, techniques, and methods, beginning in the immediate postwar period. It was initiated by the introduction of antibiotics, continued with understanding of electrolyte balances, protein structure, and gene function. For the most part, these advances were scientific and technical, but they changed the face of medical practice drastically, until by 1965 three of the four most commonly prescribed drug cla.s.ses-antibiotics, hormones (mostly The Pill), and tranquilizers-were all postwar innovations.1The second wave was more recent and involved social, not technical, change. Social medicine, and socialized medicine, became real problems to be solved, like cancer and heart disease. Some of the older physicians regarded socialized medicine as a cancer in its own right, and some of the younger ones agreed. But it has become clear that, like it or not, doctors are going to have to produce better medical care for more people than they ever have before. before.It is natural to expect innovation from the young, but in medicine this has not been easy, for the old doctors train the young ones, and too often the students become carbon copies of their teachers. Then, too, there is a kind of antagonism between generations in medicine, particularly now. The young men are better prepared than the old guard; they know more science, ask deeper questions, demand more complex answers. They are also, like young men everywhere, hustling for the older men'sjobs.That was why Norton Hammond was so remark-1 The fourth cla.s.s, a.n.a.lgesics, was mostly that old standby, aspirin, synthesized in 1853. Aspirin is as much a wonder drug as any other. It is a painkiller, a swelling-reducer, a fever-breaker, and an antiallergic drug. None of its actions can be explained.

able. He was effecting a revolution without a rebellion.He parked his motorcycle, locked it, patted it fondly, and dusted off his whites.2 Then he saw us. Then he saw us."Hiya, kids." As nearly as I could tell, Hammond called everyone kid."How are you, Norton?""Hanging in." He grinned. "Against all obstacles." He punched my shoulder. "Hey, I hear you've gone to war, John.""Not exactly.""Any scars yet?""A few bruises," I said."Lucky," he said, "taking on old A. R."Judith said, "A. R.?""a.n.a.l Retentive: that's what the boys on the third floor call him.""Randall?""None other." He smiled at Judith. "The kid's bitten off quite a chunk.""I know.""They say A. R. prowls the third floor like a wounded vulture. Can't believe anybody'd oppose his majestic self.""I can imagine," I said."He's been in a terrible state," Hammond said. "He even chewed out Sam Carlson. You know Sam? He's a resident up there, working under A. R., rooting about in the nether regions of surgical politics.2 See Appendix V: Whites.

Sam is A.R.'s golden boy. A.R. loves him, and n.o.body can figure out why. Some say it's because he is stupid, Sam is, blindingly stupid. Crus.h.i.+ngly, awesomely stupid."

"Is he?" I said.

"Beyond description," Hammond said. "But Sam got chewed out yesterday. He was in the cafeteria, eating a chicken-salad sandwich-no doubt after asking the serving ladies what a chicken was- when Randall came in, and said, 'What are you doing here?' And Sam said, 'Eating a chicken-salad sandwich.' And A. R. said, "What the h.e.l.l for?' "

"What did Sam say?"

Hammond grinned broadly. "I have it on good authority, that Sam said, 'I don't know, sir.' And he put aside the sandwich and walked out of the cafeteria."

"Hungry," I said.

Hammond laughed. "Probably." He shook his head. "But you can't really blame A. R. He's lived in the Mem for a hundred years or so, and never had a problem. Now, with the headhunt, and then his daughter . . ."

"Headhunt?" Judith said.

"My, my, the grapevine is collapsing. The wives are usually the first to know. All h.e.l.l's broken out at the Mem over the Clinic pharmacy."

I said, "They lose something?""You bet.""What?""A gross of morphine ampoules. Hydromorphinehydrochloride. That's three to five times more powerful on a weight basis than morphine sulfate.""When?""Last week. The pharmacist nearly got the ax-he was off hustling a nurse when it happened. It was lunchtime.""They haven't found the stuff?""No. Turned the hospital upside down, but nothing.""Has this ever happened before?" I said."Apparently it has, a few years back. But only a couple of ampoules were taken then. This was a major haul."I said, "Paramedical?"

Hammond shrugged. "Could be anybody. Personally, I think it must have been a commercial move. They took too much. The risk was too great: can you imagine yourself waltzing into the Mem outpatient clinic and waltzing out with a box of morphine bottles under your arm?"

"Not really.""Guts.""But surely that's too much for one person," I said."Of course. That's why I think it was commercial. I think it was a robbery, carefully planned.""By somebody outside?""Ah," he said. "Now you get down to the question.""Well?"

"The thinking is that somebody did it from the inside."

"Any evidence?""No. Nothing."We walked up the stairs to the wooden frame house. I said, "That's very interesting, Norton.""You bet your a.s.s it's interesting.""Know anybody who's up?""On the staff? No. The word is that one of the girls in cardiac cath used to shoot speeds,3 but she kicked it a year ago. Anyhow, they went over her pretty hard. Stripped her down, checked for needle marks. She was clean." but she kicked it a year ago. Anyhow, they went over her pretty hard. Stripped her down, checked for needle marks. She was clean."I said, "How about-""Doctors?"I nodded. Doctors and drugs are a taboo subject. A reasonable number of doctors are addicts; that's no secret, any more than it's a secret that doctors have a high suicide rate.4 Less widely known is a cla.s.sic psychiatric syndrome involving a doctor and his son, in which the son becomes an addict and the doctor supplies his needs, to the mutual satisfaction of both. But n.o.body talks about these things. Less widely known is a cla.s.sic psychiatric syndrome involving a doctor and his son, in which the son becomes an addict and the doctor supplies his needs, to the mutual satisfaction of both. But n.o.body talks about these things."The doctors are clean," Hammond said, "as far as I know.""Anybody quit their job? Nurse, secretary, anybody?"3 Injected amphetamines, such as methedrene, intravenously.4 Psychiatrists have the highest suicide rate of all, more than ten times that of the GP.He smiled. "You're really hot on this, aren't you?"I shrugged."Why? Think it's related to the girl?""I don't know.""There's no reason to connect the two," Hammond said. "But it would be interesting.""Yes.""Purely speculative.""Of course.""I'll call you," Hammond said, "if anything turns up.""Do that," I said.We came to the door. Inside, we could hear party sounds: tinkling gla.s.ses, talk, laughter."Good luck with your war," Hammond said. "I hope to h.e.l.l you win.""So do I.""You will," Hammond said. "Just don't take any prisoners."I smiled. "That's against Geneva Conventions.""This," Hammond said, "is a very limited war."

THE PARTY WAS HELD BY GEORGE MORRIS, chief resident in medicine at the Lincoln. Morris was about to finish his residency and begin private practice, so it was a kind of coming-out party, given for himself. It was done very well, with an understated comfortability that must have cost him more than he could afford. I was reminded of those lavish parties given by manufacturers to launch a new product, or a new line. In a sense, that was what it was.

George Morris, twenty-eight, with a wife and two children, was deeply in debt: any doctor in his position would be. Now he was about to start burrowing out from under, and to do that he needed patients. Referrals. Consults. In short, he needed the good will and help of established physicians in the area, and that was why he had invited 200 of them to his home and filled them to the neck with the best booze he could buy and the best canapes the caterers could provide.

As a pathologist, I was flattered to have received an invitation. I couldn't do anything for Morris; pathologists deal with corpses and corpses don't need referrals. Morris had invited Judith and me because we were friends.

I think we were his only friends at the party that night.I looked around the room: the chiefs of service from most of the big hospitals were there. So were the residents, and so were the wives. The wives had cl.u.s.tered in a corner, talking babies; the doctors were cl.u.s.tered into smaller groups, by hospital or by specialty. It was a kind of occupational division, very striking to see.In one corner, Emery was arguing the therapeutic advantage of lower I131 doses in hyperthyroidism; in another, Johnston was talking about hepatic pressures in porto caval shunts; in still another, Lewiston could be heard muttering his usual line about the inhumanity of electroshock therapy for doses in hyperthyroidism; in another, Johnston was talking about hepatic pressures in porto caval shunts; in still another, Lewiston could be heard muttering his usual line about the inhumanity of electroshock therapy fordepressives. From the wives, occasional words like "IUD" and "chickenpox" drifted out.Judith stood next to me, looking sweet and rather young in a blue A-line. She was drinking her Scotch quickly-she's a gulper-and obviously preparing to plunge into the group of wives."I sometimes wish," she said, "that they'd talk about politics or something. Anything but medicine."I smiled, remembering Art's line about doctors being illpolitical. He meant it the way you used words like illiterate. Art always said doctors not only held no real political views, but also were incapable of them. "It's like the military," he had once said. "Political views are considered unprofessional." As usual, Art was exaggerating, but there was something to what he said.I think Art likes to overstate his case, to shock and irritate and goad people. It is a characteristic of his. But I think he is also fascinated by the thin line that separates truth from untruth, statement from overstatement. It is a characteristic of his to constantly throw out his comments and see who picks them up and how they react to them. He does this particularly when he is drunk.

Art is the only doctor I know who will get drunk. The others can apparently pour back fantastic quant.i.ties of alcohol without really showing it; they get talkative for a while, and then sleepy. Art gets drunk, and when he is drunk he is particularly angry and outrageous.

I have never understood this about him. For a while I thought he was a case of pathological intoxication,5 but later I decided it was a sort of personal indulgence, a willingness to let himself go when others kept themselves rigidly in control. Perhaps he needs this indulgence; perhaps he can't help it; perhaps he actively seeks it as an excuse to blow off steam. but later I decided it was a sort of personal indulgence, a willingness to let himself go when others kept themselves rigidly in control. Perhaps he needs this indulgence; perhaps he can't help it; perhaps he actively seeks it as an excuse to blow off steam.Certainly he is bitter toward his profession. Many doctors are, for various reasons: Jones because he is hooked on research and can't make as much money as he'd like; Andrews because urology cost him his wife and a happy family life; Telser because he is surrounded in dermatology by patients whom he considers neurotic, not sick. If you talk to any of these men, the resentment shows itself sooner or later. But they are not like Art. Art is resentful against the medical profession itself.I suppose in any profession you meet men who despise themselves and their colleagues. But Art is an extreme example. It is almost as if he went into medicine to spite himself, to make himself unhappy and angry and sad.In my blackest moments, I think he does abortions only to jar and irritate his colleagues. That is unfair, I think, but I can never be sure. When he is sober, he talks intellectually, unreeling arguments 5 Defined as a person who becomes more inebriated than his blood alcohol levels would explain. In the most extreme cases, a single drink may make a man a raving, destructive lunatic.

for abortion. When he is drunk, he talks emotions, att.i.tudes, stances, complacency.

I think he feels hostility toward medicine and gets drunk so that he can release his hostility with an excuse-he's drunk. Certainly he has gotten into bitter, almost vicious fights with other doctors when he was drunk; he once told Janis that he'd aborted his wife and Janis, who didn't know, looked as if he'd been kicked in the b.a.l.l.s. Janis is Catholic but his wife isn't. Art managed to end a perfectly happy dinner party right on the spot.I attended that party, and I was annoyed with Art afterward. He apologized to me a few days later, and I told him to apologize to Janis, which he did. For some strange reason, Janis and Art subsequently became close friends, and Janis became a convert to abortion. I don't know what Art said to him or how he convinced him, but whatever it was, it worked.Because I know Art better than most people, I attach a great importance to his being Chinese. I think his origin and his physical appearance have been a great influence on him. There are a lot of Chinese and j.a.panese men in medicine, and there are a lot of jokes about them-half-nervous jokes about their energy and their cleverness, their drive to success. It is precisely the kind of jokes one hears about Jews. I think Art, as a Chinese-American, has fought this tradition, and he has also fought his upbringing, which was essentially conservative. He swung the other way, became radical and leftist. One proof of this is his willingness to accept all things new. He has the most modern office equipment of any OB man in Boston. Whenever a new product comes out, he buys it. There are jokes about this, too-the gadget-oriented Orientals-but the motivation is different. Art is fighting tradition, routine, the accepted way.

When you talk to him, he seems bursting with ideas. He has a new method for doing the Papp smear.6 He wants to abandon the routine, digital pelvic exam as a waste of time. He thinks that basal temperature as an indicator of ovulation is more effective than reported. He thinks forceps should be eliminated from all deliveries, no matter how complicated. He thinks that general anesthesia in deliveries should be abandoned in favor of heavy doses of tranquilizers. He wants to abandon the routine, digital pelvic exam as a waste of time. He thinks that basal temperature as an indicator of ovulation is more effective than reported. He thinks forceps should be eliminated from all deliveries, no matter how complicated. He thinks that general anesthesia in deliveries should be abandoned in favor of heavy doses of tranquilizers.

When you first hear these ideas and theories, you are impressed. Only later do you realize that he is compulsively attacking tradition, finding fault whenever and wherever he can.

I suppose it is only natural that he should begin performing abortions. And I suppose that I should question his motives. But I don't usually, because I feel that a man's reasons for doing something are less important than the ultimate value of what he does. It is a historical truth that a man may do the wrong thing for the right reasons. In that case he loses. Or he may do the right thing for the wrong reasons. In that case, he is a hero.

6 The Papp smear is the most accurate diagnostic test in all of medicine.

Of all the people at the party, one might be able to help me. That was Fritz Werner, but I didn't see him; I kept looking.Instead I ran into Blake. Blake is a senior pathologist at the General, but he is princ.i.p.ally known for his head, which is enormous, round, and smooth. The features of his face are small and childlike, a tiny jaw and wide-set eyes, so that Blake looks like everybody's vision of future man. He is coldly, sometimes maddeningly intellectual man, and he is fond of games. He and I have played one game, off and on, for years.He greeted me with a wave of his martini gla.s.s and, "Ready?" "Sure.""Moans to Rocky," he said.

It sounded easy. I took out my notebook and pencil and tried it out. At the top of the page I wrote MOANS and at the bottom, ROCKY. Then I tried to fit things together.

MOANS.

LOANS.

LOINS.

LOONS.

BOONS.

BOOKS.

ROOKS.

ROCKS.

ROCKY.

It took only a few moments. "How many?" Blake said. "Nine."

He smiled. "I'm told it can be done in five. I have seven." He took the pad from me and wrote: MOANS.

LOANS.

LOONS.

LOOKS.

ROOKS.

ROCKS.

ROCKY.

I reached into my pocket and gave him a quarter. He had won the last three in a row, and over the years, he had beaten me consistently. But then Blake beat everybody."By the way," he said, "I heard another argument. Do you know the DNA template one?"7"Yes," I said.He shook his head. "Pity. I enjoy it. Springing it on people, I mean."I smiled at him, barely able to conceal my pleasure."You know the latest on Youth in Asia? The one about the right to refuse medication? You can fit it into the fluoride arguments, very neatly."87 See Appendix VI: Arguments on Abortion. 8 See Appendix VII: Medical Morals. See Appendix VII: Medical Morals.

I'd heard that one, too, and I told him so. This seemed to depress him. He wandered off to try his luck with someone else.Blake collects arguments on medical philosophy. He is never happier than when he is logically demonstrating to a surgeon that he has no right to operate, or to an internist that he is ethically bound to kill every patient he can. Blake likes words and tosses around ideas the way small children play softball in the street. It is easy for him, effortless and amusing. He and Art get along well together. Last year the two of them had a four-hour argument over whether an obstetrician was morally responsible for all children born under his direction, from the time they were born until they died.In retrospect, all of Blake's arguments seem no more useful or important than watching an athlete exercise in a gym, but at the time they can be fascinating. Blake has a keen sense of the arbitrary, and it stands him in good stead when working with members of the most arbitrary profession on earth.

Wandering around the party, I heard s.n.a.t.c.hes of jokes and conversations; it was, I thought, a typical medical party.

"Did you hear about the French biochemist who had twins. He baptized one and kept the other as a control.""They all get bacteremia sooner or later, anyway. ...""And he was walking around-walking around, mind you, with a blood pH of seven-point-six and a pota.s.sium of one. . . ."

"Well, what the h.e.l.l do you expect of a Hopkins man?""So he said, 'I gave up smoking, but I'll be d.a.m.ned if I'll give up drinking.'""Sure, you can correct the blood gases, but it doesn't help the vasculature. . . ."

"She was always a nice girl. Very well dressed. They must have spent a fortune on her clothes. . . ."

"...course he's p.i.s.sed. Anybody'd be p.i.s.sed. . . ."". . . oliguric my a.s.s. He was an anuric for five days, and he still survived. . . ."". . . in a seventy-four-year-old man, we just excised it locally and sent him home. It's slow growing, anyhow. . . ."". . . liver reached down to his knees, practically. But no hepatic failure. . . .""She said she'd sign herself out if we didn't operate, so naturally, we . . ."". . . but the students are always b.i.t.c.hing; it's a nonspecific response. . . .""Well, apparently this girl had bitten it off of him. . . .""Really? Harry, with that little nurse in Seven? The blonde?"". . . don't believe it. He publishes more journal articles than most people can read in a lifetime. . . ."". . . metastases to the heart . . ." heart . . .""Anyway, it goes like this: there's this desert prison, see, with an old prisoner, resigned to his life, and a young one just arrived. The young one talks constantly of escape, and, after a few months, he makes a break. He's gone a week, and then he's brought back by the guards. He's half dead, crazy with hunger and thirst. He describes how awful it was to the old prisoner. The endless stretches of sand, no oasis, no signs of life anywhere. The old prisoner listens for a while, then says, 'Yep. I know. I tried to escape myself, twenty years ago.' The young prisoner says, 'You did? Why didn't you tell me, all these months I was planning my escape? Why didn't you let me know it was impossible?' And the old prisoner shrugs, and says, 'So who publishes negative results?'"

AT EIGHT, I was beginning to get tired. I saw Fritz Werner come in, waving to everyone and talking gaily. I started over toward him, but Charlie Frank caught me on the way.

Charlie stood half hunched over, with a twisted, painful expression on his face as if he'd just been stabbed in the stomach. His eyes were wide and sad. Altogether, it was quite a dramatic effect, but Charlie always looked that way. He wore an air of impending crisis and imminent tragedy on his shoulders, and it burdened him, crus.h.i.+ng him to the floor. I had never seen him smile.In a tense, half whisper, he said, "How is he?""Who?""Art Lee."

"He's all right." I didn't want to talk about Lee with Charlie Frank.

"Is it true he's been arrested?""Yes.""Oh, my G.o.d." He gave a little gasp."I think it will turn out all right in the end," I said."Do you?""Yes," I said, "I do.""Oh, my G.o.d." He bit his lip. "Is there anything I can do?""I don't think so."He was still holding on to my arm. I looked across the room at Fritz, hoping Charlie'd notice and let go. He didn't."Say, John . . .""Yes?""What's this I heard about you, ah, getting involved?""Let's say I'm interested.""I ought to tell you," Charlie said, leaning close, "that there's talk in the hospitals. People are saying that you're concerned because you're mixed up in it yourself.""Talk is cheap.""John, you could make a lot of enemies."In my mind, I was thinking over Charlie Frank's friends. He was a pediatrician, and very successful: he worried over his young patients more than their mothers and that comforted them."Why do you say that?""It's just a feeling I get," he said with a sad look."What do you suggest I do?""Stay away from it, John. It's ugly. Really ugly.""I'll remember that.""A lot of people feel very strongly-""So do I.""-that this is something to be left to the courts.""Thanks for the advice."His grip on my arm hardened. "I'm saying this as a friend, John.""O.K., Charlie. I'll remember.""It's really ugly, John.""I'll remember.""These people won't stop at anything," he said."What people?"Quite abruptly, he let go of my arm. He gave an embarra.s.sed little shrug. "Well, you have to do what you think is best, in any case."And he turned away.

FRITZ WERNER WAS STANDING, as usual, by the bar. He was a tall, painfully thin, almost emaciated man. He kept his hair trimmed short, and this emphasized his large, dark, brooding eyes. He had a birdlike manner, a gawky walk, and a habit of craning his thin neck forward when he was addressed, as if he could not hear well. There was an intensity about him, which might have stemmed from his Austrian ancestry or from his artistic nature. Fritz painted and sketched as a hobby, and his office always had a cluttered, studiolike appearance. But he made his money as a psychiatrist, listening patiently to bored, middle-aged matrons who had decided at a late date that there was something wrong with their minds.

He smiled as we shook hands. "Well, well, if it isn't poison ivy.""I'm beginning to think so myself." ,He looked around the room. "How many lectures so far?""Just one. Charlie Frank.""Yes," Fritz said, "you can always count on him for bad advice.""And what about you?"He said, "Your wife is looking very charming tonight. Blue is her color.""I'll tell her.""Very charming. How is your family?""Good, thanks. Fritz-""And your work?""Listen, Fritz. I need help."He laughed softly. "You need more than help. You need rescue.""Fritz-""You've been seeing people," he said. "I imagine you've met them all by now. What did you think of Bubbles?""Bubbles?""Yes."I frowned. I had never heard of anyone named Bubbles. "You mean, Bubbles the stripper?""No. I mean Bubbles the roommate."

"Her roommate?" roommate?""Yes.""The one at Smith?""G.o.d, no. The one from last summer, on the Hill. Three of them shared an apartment. Karen, and Bubbles, and a third girl who had some kind of medical connections-nurse, or technician, or something. They made quite a group.""What's the real name of this girl Bubbles? What does she do?"Someone came up to the bar for another drink. Fritz looked out at the room and said in a professional voice, "This sounds quite serious. I suggest you send him to see me. As it happens, I have a free hour tomorrow at two-thirty.""I'll arrange it," I said."Good," he said. "Nice to see you again, John."We shook hands.

JUDITH WAS TALKING TO NORTON HAMMOND, who was leaning against the wall. As I walked up, I thought to myself that Fritz was right: she was looking good. And then I noticed that Hammond was smoking a cigarette. There was nothing wrong with that, of course, except that Hammond didn't smoke. was leaning against the wall. As I walked up, I thought to myself that Fritz was right: she was looking good. And then I noticed that Hammond was smoking a cigarette. There was nothing wrong with that, of course, except that Hammond didn't smoke.