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A Case of Need: A Novel

Name: A Case of Need: A Novel
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The death of a doctor’s daughter may be malpractice—or murder—in this novel by a #1 New York Times–bestselling author: “I loved it” (Stephen King).

In the tightly knit world of Boston medicine, the Randall family reigns supreme. When heart surgeon J. D. Randall’s teenage daughter dies during a botched abortion, the medical community threatens to explode. Was it malpractice? A violation of the Hippocratic Oath? Or was Karen Randall murdered in cold blood?

The natural suspect is Arthur Lee, a brilliant surgeon and known abortionist, who has been carrying out the illegal procedure with the help of pathologist John Berry. After Karen dies, Lee is thrown in jail on a murder charge, and only Berry can prove his friend wasn’t the one who wielded the scalpel. Behind this gruesome death, Berry will uncover a secret that would shock even the most hardened pathologist.

An Edgar Award–winning novel by the author of such blockbusters as The Andromeda Strain and Jurassic Park—and creator of the long-running NBC drama ER—A Case of Need is a “superb” medical-thriller mystery (Los Angeles Times).

This ebook features an illustrated biography of Michael Crichton including rare images from the author’s estate.

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Penerbit: Open Road MediaDirilis: Jul 23, 2013ISBN: 9781453299319Format: book

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A Case of Need - Michael Crichton

A Case of Need

A Novel

Michael Crichton

I will prescribe regimens for the good of my patients, according to my judgment and ability, and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may 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 …

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

There is no moral obligation to conserve DNA.

—GARRETT HARDIN

Monday, October 10

One

Two

Three

Four

Five

Six

Seven

Eight

Nine

Ten

Eleven

Twelve

Thirteen

Fourteen

Tuesday, October 11

One

Two

Three

Four

Five

Six

Seven

Eight

Nine

Ten

Wednesday, October 12

One

Two

Three

Four

Five

Six

Seven

Eight

Nine

Thursday, October 13

One

Two

Three

Four

Five

Six

Friday-Sunday, October 14-16

One

Postscript: Monday, October 17

Appendix I: Delicatessen Pathologists

Appendix II: Cops and Doctors

Appendix III: Battlefields and Barberpoles

Appendix IV: Abbreviations

Appendix V: Whites

Appendix VI: Arguments on Abortion

Appendix VII: Medical Morals

A Biography of Michael Crichton

Monday

October 10

One

ALL HEART SURGEONS ARE BASTARDS, 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.

Morons, Conway hissed, goddamned morons. 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.

Stupid clumsy bastard, Conway said. He kicked over a wastebasket. It rolled noisily across the floor.

Beat his brains in, his goddamned brains, Conway said, grimacing and staring up at the ceiling as if addressing God. God, like the rest of us, had heard it before. The same anger, the same clenched teeth and pounding and profanity. Conway always ran true to form, like the rerun of a movie.

Sometimes his anger was directed against the 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 through his teeth, I’ll never find a decent anes man. Never. They don’t exist. Stupid, shit-eating bastards, all of them.

We glanced at each other: this time it was Herbie. About four times a year the blame fell on Herbie. The rest of the time he and Conway were good friends. Conway would praise him to the sky, call him the finest anesthesiologist in the country, better than Sonderick at the Brigham, better than Lewis at the Mayo, better than anyone.

But four times a year, Herbert Landsman was responsible for a DOT, the surgical slang for a death on the table. In cardiac surgery, it happened a lot: fifteen percent for most surgeons, eight percent for a man like Conway.

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. Once he kicked over a path microscope and did a hundred dollars’ worth of damage. Nobody blinked, because Conway was an eight-percenter.

Of course, there was scuttlebutt in Boston about how he kept his percentage, known privately among surgeons as the kill rate, down. They said Conway avoided cases with complications. They said Conway avoided jerry cases.¹ 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.

The fact that he was also a miserable person was considered superfluous.

Stupid, stinking bastard, Conway said. He 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?

Yeah. Shit.

When?

Tonight.

It was a habit of Conway’s. He always did his autopsies on the dead cases in the evening, often 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 nobody really knew. Except Conway.

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

Yeah. Shit. He pounded the table. Mother of four, that’s what she was.

I’ll tell the desk to arrange everything.

"Arrested before we got into the ventricle. Cold. We massaged for thirty-five minutes, but nothing. Nothing."

What’s the name? I said. The desk would need the name.

McPherson, Conway said, Mrs. McPherson.

He turned to go and paused by the door. He seemed to falter, his body sagging, his shoulders slumping.

Jesus, he said, a mother of four. What the hell am I going to tell him?

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 had.

Jesus, Conway said. I should have been a dermatologist. Nobody ever dies on a dermatologist.

Then he kicked the door open and left the lab.

WHEN WE WERE ALONE, one of the first-year residents, looking very pale, said to me, Is he always like that?

Yes, I said. Always.

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 didn’t know that his act was purely for himself, a kind of ritual angry deceleration that he went through every 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.

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 the next specimen. We have a high-speed technique in the lab: the pathologists stand before waist-high benches and examine the biopsies. A microphone 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 week, and this specimen helped me: it was a white lump imbedded in a slice of lung. The pink tag attached gave the name of the patient; he was down in the OR now with his chest cut open. The surgeons were waiting for the path dx³ before proceeding 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.

I 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 mass, white in color, measuring"—

I measured the lump—approximately two centimeters in diameter. On cut surface, it appears whitish 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. There was only one way to be certain if the mass 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 your stuff into six or seven baths; it took at least six hours, sometimes days. The surgeons couldn’t wait.

When the tissue was frozen hard, I cranked out a 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 the lacy network of lung tissue formed into delicate alveolar sacs for exchange of gas between blood and air. The white mass was something else again.

I stepped on the floor button.

Micro examination, frozen section. The whitish mass 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 accumulation 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.

The telephone rang. I knew it would be Scanlon down in the OR, wetting his pants because we hadn’t gotten back to him in thirty seconds flat. 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 orderly has to bring it all the way from the surgical wing to the path labs before we can look at it. Scanlon also doesn’t figure that there are eleven other operating rooms in the hospital, all going like hell 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 bitch, like Conway. It gives them something to do. All surgeons have persecution complexes anyway. Ask the psychiatrists.

As I went to the phone, I stripped off one rubber glove. My hand was sweaty; I wiped it on the seat of my pants, then picked up the receiver. We are careful about the phone, but just to be safe it gets swabbed with alcohol and Formalin at the end of each day.

Berry speaking.

Berry, what’s going on up there?

After Conway, I felt like taking him on, but I didn’t. I just said, You’ve got a malignancy.

I thought so, Scanlon said as if the whole path 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.

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 intercom clicked.

Dr. Berry?

Yes?

The intercom has a high pickup. You can speak in a normal voice anywhere in the room, and the 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 how sensitive it is. That blasts the ears off the girl at the other end.

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 stitches 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.

Hello?

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

What is it?

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?

He called here asking for you. He’s in trouble.

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.

I don’t know, Judith said, but he’s in jail.

My first thought was that it was some kind of mistake. Are you sure?

Yes. He just called. John, is it something about—?

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 both in the vinyl-lined wastebasket. I’ll go see him now, I said. You sit tight and don’t worry. It’s probably a minor thing. Maybe he was drinking again.

All right, she said in a low voice.

Don’t worry, I repeated.

All right.

I’ll speak to you soon.

I hung up, untied my apron, and placed it on the peg by the door. Then I went down the hall to Sanderson’s office. Sanderson was chief of the path labs. He was very dignified looking; at forty-eight, his hair was just turning gray at the temples. He had a jowly, thoughtful face. He also had as much to fear as I did.

Art’s in jail, I said.

He was in the middle of reviewing an autopsy 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.

Call me, Sanderson said, peering over his half frames, when you know.

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 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.

Betty answered the phone in a state of stony shock. She told me they had Arthur downtown, on 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 should 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 DROVE MY VOLKSWAGEN out of the doctors’ parking lot, past all the shiny Cadillacs. The big cars are all owned by practicing physicians; pathologists are paid by the hospital and can’t afford all those glistening horses.

It was 8:45, right in the middle of rush-hour traffic, which in Boston means a life-and-death proposition. Boston has the highest accident rate in the 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 God 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 religion, he kept saying, doubled over in laughter. Blinded by religion.

The surgeon did plastic stuff, and he didn’t see the humor. I guess because he’d repaired too many punched-out eyesockets. But Art was convulsed.

Most people at the party were surprised by his laughter; they thought it was excessive and in 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.

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 nobody 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 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 illegal.

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 D & C’s that were positive. The D & C’s had been ordered for a variety of complaints—menstrual irregularity, pain, mid-period bleeding—but quite a few were showing evidence of pregnancy in the scrapings. 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 jokes. They sobered up quickly. Then I went to see Arthur. I found him in the hospital cafeteria.

Art, I said, something’s bothering me.

He was in a jovial mood, eating a doughnut and coffee. Not a gynecological problem, I hope. He laughed.

Not exactly. I overheard some of the residents say that you had a half-dozen pregnancy-positive scrapings in the last month. Have you been notified?

Immediately, the hearty manner was gone. Yes, he said, I have.

I just wanted you to know. There might be trouble in the tissue committee when these things come up, and—

He shook his head. No trouble.

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 looking directly at me. It gave me a strange feeling.

We’d better have a talk, he said. Are you free for a drink about six tonight?

I guess so.

Then meet me in the parking lot. And if you get some free time this afternoon, why don’t you have a look at a case of mine?

All right, I said, frowning.

The name is Suzanne Black. The number is AO—two-two-one-three-six-five.

I scribbled the number on a napkin, wondering why he should have remembered it. Doctors remember a lot about their patients, but rarely the hospital number.

Take a good look at this case, Art said, and 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 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.

Physical examination was essentially normal, except that she had a mild fever. Blood tests were normal, though hematocrit⁷ was somewhat low.

Dr. Lee ordered a D & C to correct her irregularity. This was in 1956, before the advent of estrogen therapy. The D & C was normal; no evidence of tumors or pregnancy. The girl seemed to respond well to this treatment. She was followed for the next three months and had normal periods.

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.

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 my autopsy.

I don’t know what made me think of the slide.

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 microscopic slides from a patient. They’re stored in long boxes arranged like card catalogs in a library. We had a whole room full of such boxes.

I went to the appropriate box and found slide 1365. The label gave the case number and Dr. Sanderson’s initials. It also said in large letters, D & C.

I took the slide back to the micro room, where we have ten microscopes in a long row. One was free; I slipped the slide onto the stage and had a look.

I saw it immediately.

The tissue was a uterine scraping, all right. It showed a rather normal endometrium in the proliferative phase, but the stain stopped me. This slide 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.

For routine work, the Hematoxylin-Eosin stain is used, producing pink and purple colors. Almost every 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.

But Dr. Sanderson had not mentioned that the 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 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 were made, one H & E, the other Zenker-Formalin, and only the Zenker was saved. Or that there had been some legitimate mixup.

None of these alternatives was particularly convincing. 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 someplace away from the hospital to talk. As he drove, he said, Read the case?

Yes, I said. Very interesting.

You checked the section?

Yes. Was it the original?

You mean, was it a scraping from Suzanne Black? No.

You should have been more careful. The stain was different. That kind of thing can get you into trouble. Where did the slide come from?

Art smiled thinly. A biological supply house. ‘Slide of normal endometrial scraping.’

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 scraping, 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?

Yes, Art said. He has been for several years.

Sanderson was a very wise, very kind, and very proper man.

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, but the reason was she was pregnant. She had been knocked up on a football weekend by a guy she said she loved and was going to marry, but she wanted to finish college first, and a baby would get in the way. Furthermore, she managed to get measles during the first trimester. She wasn’t a terribly bright girl,

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Go to lyndainoregon's profile

Early Crichton novel, from 1968, shows promise but is a tangle of too many characters, late surprise revelations that really don’t have anything to do with the main plot thread, and an up-in-the-air ending with the protagonist, after 400 pages of dogged investigation, seeming to just walk away from the final reveal.

Essentially, it’s the story of a doctor who is falsely accused of performing an illegal abortion that results in the death of a young woman from a prominent family. The protagonist, a friend of the accused, sets out to determine what really happened, and uncovers a coiling nest of prominent people with dirty secrets. It’s not a bad story, but it’s certainly the first novel I’ve ever read with footnotes. Somebody apparently thought it would be a good idea to footnote virtually every medical term used in the text – a disruptive and largely unnecessary step.

It’s a compelling read until the last quarter of the book, when the cast of characters reaches critical mass and the reader really has trouble remembering who was what and how they all tie together.

Go to dbsovereign's profile

Early Critchton that does not sizzle with the energy a few of his others do (_Rising Sun_ still top on my list of his work). Not one of Crichton's best novels - I consider him overrated most of the time.

Go to auntieknickers's profile

1968. I was in college near Boston. One of my housemates, a girl I didn't know well, was pregnant. Her roommate learned that the ex-boyfriend and father, a pre-med student, was planning to perform an amateur abortion. This was 5 years before Roe v. Wade. My housemates, all urban people, were galvanized into action, calling friends and even their mothers to locate a safe abortionist. I really had nothing to contribute except hand-wringing. The girl eventually decided to have the baby, and I think it was given up for adoption as I seem to recall she was back in school during my senior year.
The following year, in summer, I found a room in an off-campus house. One of my flatmates had taken some time off from school the previous year. It turned out she had had a legal abortion at one of the best hospitals in Boston. You could get one if a panel of three doctors agreed that it was necessary for your health, and mental health counted. Unfortunately something had gone wrong, and she would now be unable to bear children. Since the abortion took place in a hospital, she didn't die.

For these reasons and a few other stories from women I've known, I was interested immediately in A CASE OF NEED when, looking it up in the library catalog, I saw the tracing "Abortion - Fiction." (I was going to read it anyway as part of my Edgar-winners project.) I brought the book home and started reading it right away. I'm going to give it a rating four stars, because the story certainly pulled me along. But for my tired old eyes, I would have finished it in one sitting.

Why not five stars -- which was evidently the consensus of the Edgar committee? One reason is that there were some definite plot holes. I can't really describe them for fear of spoilers, but since the story centers around doctors and others performing illegal abortions, I will point out that the three-doctor panel option existed at the time of the book, and is not mentioned. There are several more, which I'm sure any of you who read the book will spot.

Another reason is Hudson/Crichton's annoying practice of using medical jargon and abbreviations and then FOOTNOTING them! Yes, footnotes in a mystery thriller! I realize that this book preceded /Chicago Hope/ and /ER/, which made us all so conversant with hospital talk, but after all, it did follow /Dr. Kildare /and /Ben Casey/! I haven't read any of Crichton's other books, so I trust this was just a matter of youthful inexperience. I've read many books set in milieus unfamiliar to me, and nearly all the authors have been able to explain unfamiliar terms without resorting to footnotes. Talk about taking the reader out of the story!

The third reason I have for withholding the fifth star is the evident misogyny of the narrator/protagonist and, I fear, of the author himself. Maybe it's just me, but the way the protagonist interacts with his wife, the nurses, and the other women who come into the story suggested to me that he really didn't believe women were people. Perhaps I'm being unduly harsh and perhaps my view is skewed by having read that Crichton has been married 5 times. I will accept correction if someone believes differently. The character of the narrator is problematic in some other ways as well, again, I can't really explain that without spoilers.

To be fair, I'm still impressed that Crichton wrote a book this good while studying at Harvard Medical School. In spite of some very dated attitudes, it's still worth reading.

Go to kakadoo202's profile

for sure one of his earlier books and not so action packed. interesting but the end leaves you wish for more substance.

Go to moonshineandrosefire's profile

When a young woman dies mysteriously on the operating table and her physician is charged with murder, his colleague is drawn into a world of sex and drugs in order to clear his name. I liked this story although the ending was a little hard to follow. I give it a B+!

Go to michaeldeavers's profile

A Stimulating Story that kept my interest. A Case of Need is a stimulating story that kept my interest and I found that it was hard to put down. It educated s on some of the arguments for both sides of the abortion issue while maintaining a very good story line and character set. The plot revolves around who performed an illegal abortion on a girl from an affluent family. As you read on you that the abortion killed the girl, so the person who performed the abortion is guilty of murder. For medical thriller fans I would highly recommend this book.

Go to andyray_1's profile

As with all Michael Crichton's works, you learn a lot of medical terminology as it surrounded the abortion issue. When this was written, abortion protests pro and con were leading to violent confrontations. The subject has been put onm the back burfner today, along with miscegnation and other social issues, doesn't cause such violence in most areas. The book is solid and could best be described as a quiet page-turner.

Go to glennbell_1's profile

Excellent story and author. I thoroughly enjoyed the book. Could not put it down. Like candy.

Go to loucypher_1's profile

A very good medical thriller. Caught me a little off guard I had not realized it was a reprint of a 1968 story Crichton had written under the name Jeffery Hudson I thought it was a little newer and some of the actions of people were definitely not 90's ish. It seems a little sad that in 1968 there were the same problems with abortion as we still have today 40 years later.

Go to ericnwest's profile

A very early Michael Crichton, written under the name of Jeffrey Hudson, while he was 26 years old. A weak plot, dragged down by his use of footnotes to explain medical terms. Written in '68 and very dated.

Go to kasualkafe's profile

Michael Crichton , a favorite author of mine`s , first book. I have read some favorable amazon reviews but must differ from them. I gave it a 3 rating so I liked it as the book kept my interest and I enjoyed the medical knowledge (or future knowledge when I look up a half-dozen items) it contained. But , the drama of his later books are clearly superior , and I think it is obvious that this is a weaker precursor of greater things to come. Some touted the plot twists , or the writing , or the conclusion as wonderful writing. I didn`t think the plots twisted enough , I thought too many threads were left dangling in the end , and the writing was just solid , not engrossing. That being said , it is still a worthy quick read , that does pose the moral questions of abortion and a glimpse of the social mind 40 yrs ago.

Go to lauriemk_1's profile

So this is apparently Michael Crichton's first book, written back in the late 1960s under a pen name. It wasn't the best written book, I think you could tell it was by a first-time author, but it wasn't too bad. It is basically about some doctors involved in doing abortions before Roe v. Wade, and was mostly interesting to me as a historical piece. It was crazy to see how much scandal and legal problems were caused by these doctors doing abortions in some cases, but also how much the medical community kind of accepted it as well. It was kind of like watching an old movie, in which it is hard to judge a lot of the characters as they live in a world so different from our own (all the doctors had wives who stayed home with the kids, and did whatever their husbands said. LOTS of smoking.) So it was interesting, but I don't say rush out and read it.

Go to omrythea_1's profile

Immersion into a compelling and interesting story.

Go to carlar_82074's profile

A good look at the writer that Crichton would grow up to be. Since I was born in 1973 I never knew what it was like before Roe v. Wade, but I am sure that at that time this book was pretty edgy, just as his books today are. I enjoyed this one.

Go to shrut_3's profile

Thought-provoking story, full of suspense...

Go to TerrenceStuart's profile

It kept me enthralled, especially towards the end. Surprising twist!

Go to bellabergen's profile

Second reading. Love it and all the others! Great author imagination.

Go to Tùng Nguyễn's profile

p hu tu ngo toa cb ty tr ể e
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Go to coloradogirl14's profile

This was one of the few Michael Crichton novels I hadn't read yet, so I figured that my month of reading suspense & thrillers would be the perfect time to dive in. It's also worth mentioning that I haven't read many medical thrillers either, so I killed two birds with one stone on this one.The story follows John Berry, a pathologist at a Boston hospital, who gets drawn into a medical and legal investigation when the daughter of a prominent Boston family dies in the emergency room after undergoing what appears to be an illegal abortion. (Note: the story was written before Roe v. Wade, when all abortions were still considered illegal and taboo.) Berry's colleague, Art Lee, has been accused of performing the abortion and is awaiting trial. While Berry knows that Lee occasionally performs abortions on the side, he doesn't believe Lee would have let a patient die while under the knife, and he begins his own investigation on the side. But because of the prominence of the victim's family, Berry encounters a lot of resistance to his investigation and quickly discovers that there was more to the story than meets the eye.While no one would argue that this is an accomplished work of literature, it still bears a strong resemblance to Crichton's later novels, particularly in terms of the scientific detail, the fast pace, and the incorporation of social issues to drive the plot, making this a very fast and entertaining read. A small thing I noticed: in this story, Crichton doesn't use many dialogue identifiers (eg. "he said," "she said"). This helped move the story along at a breakneck speed, but it also became a little difficult to follow the thread of the conversation, particularly if you read it as quickly as I did. Characters are hard to differentiate between, but then again, character development was never meant to be one of the story's strong points.Another note: While Crichton uses a lot of scientific terminology, don't let that deter you from trying this book. Crichton excels at making high-tech concepts accessible for the lay person.Recommended for: readers who like breakneck thrillers, medical thrillers, stories that incorporate major social issues into the plot.Readalikes: Anything else that Michael Crichton has written. Andromeda Strain was his first novel written under his actual name and also features much scientific & medical jargon as well as breakneck pacing, although The Andromeda Strain is usually classified more as science fiction as opposed to straight-up thriller. State of Fear is another good choice if you enjoyed the presence of social & political issues within the main story - in this case, global warming is the topic du jour.Robin Cook, a certified master of the medical thriller. Cook's prose is less scientific and straightforward than Crichton's, but he still offers an exciting glimpse into the dramatic and thrilling world of the medical community.Mark Alpert combines action with scientific theory & explanation, creating high-octane and fascinating thrillers that are still accessible for the average reader.

Go to slsmith101's profile

This book was first published in 1968 under the pen name of Jeffrey Hudson. It is a medical mystery written while Crichton was attending Harvard Medical School. I found it interesting to read one of his early novels. These novels were written under various pen names, and until recently, I had not known they existed. I could see the beginnings of his fast paced, very readable writing style. I could also see the beginnings of "ER", the television show he created which I watched faithfully. Crichton weaved many technical medical details into the storyline of this book, and I could see the beginnings of his techno thrillers. I enjoyed the medical references and didn't expect to learn so much from a novel written fifty years ago.The plot left a lot to be desired - especially in the last third of the book where it became very far fetched. Another thing that bothered me was his blatant sexism. For example, there were over a dozen doctors mentioned in the book and not one was a woman. Most of the women in the novel were referred to as "girls". Although the woman's movement was well under way by the time this novel was written, there were plenty of male chauvinists around and Crichton was clearly one of them. While this was not a great novel, I did enjoy it and would recommend it for Michael Crichton fans.

Go to Felipe Adan Lerma's profile

This is the fourth early Michael Crichton novel (penned as Jeffery Hudson) I've read since the first book I read of his, "State of Fear." I'm working my way through his other-name work to get a feel for how his writing developed. So far, each of the four first early books have a distinctive feel of being different somehow. Yes, there's meticulous scientific or historical research and details. And most of all, a sense of authority and calm power in the prose. Yet each story is its own.

"A Case of Need" is bit more of a ramble, but in a deliberate casual sort of way. I've been reading it off and on for months. Always interested, but like the story, not in any real hurry. When the physical action picks up dramatically about 3/4 through, it's like a bulldozer, and affects the main character the same way. So it works.

If one is looking for a genre standard suspense or mystery novel, this is probably not it. But if one has the time to be patient, the creative unraveling of the story might be worth it. It was for me, even if it did take me several months.

As to why 4 stars and not 5, the author's early books, in my mind, have the unfortunate predicament of being in contrast and comparison to some of the best thrillers written. So the 4 stars are how this book compares to his other work. If I'd written this, I give it five stars. But I could never write this. It's too far into medical and other details that only someone intimately in the field could relate. It was fascinating to read an inside look at a doctor's world. Especially this one.

Go to kimvadan's profile

Prey is a novel that talks about how nano-technology is used by a company to create tiny cameras for the military. On the outset this is harmless except that these cameras are programmed to learn from their past mistakes. This makes them dangerous and imperative to the scientists and programmers to finish them off as soon as possible. But there are more hassles than anyone bargained for.An excellent read for anyone who like science fiction and has dabbled in science sometime at school.

Go to aapjebaapje's profile

I had to struggle through this novel. It is an early oeuvre and it shows. In the introduction Crichton virtually apologises for the novel. He explains he “didn’t agonize over whether I was expressing myself; I didn’t worry about art’ I was writing under a pseudonym, at very high speed”. The subject matter was all there as usual, it was the characterisation that was missing. This is a 400 page book that should be 600 pages. I couldn’t empathise with the characters because they were just names. I couldn’t even remember who was who because they were that unmemorable! No really worth seeking out.

A Case of Need: A Novel

Ikhtisar

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Prey

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A Case of Need - Michael Crichton

Contents

October 10

One

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