Free A Case of Need: A Novel by Michael Crichton, Jeffery Hudson

manner. Carr had a round and childlike face; his cheeks were smooth and ruddy. He had an engaging boyish grin that went over very well with the female patients. He gave me that grin now.
    “Hi, John.” He shut the door to his outer office and sat down behind his desk. I could barely see him over the stacked journals. He removed the stethoscope from his neck, folded it, and slipped it into his pocket. Then he looked at me.
    I guess it’s inevitable. Any practicing doctor who faces you from behind a desk gets a certain manner, a thoughtful-probing-inquisitive air which is unsettling if there’s nothing wrong with you. Lewis Carr got that way now.
    “You want to know about Karen Randall,” he said, as if reporting a serious finding.
    “Right.”
    “For personal reasons.”
    “Right.”
    “And anything I tell you goes no further?”
    “Right.”
    “O.K.,” he said. “I’ll tell you. I wasn’t present, but I have followed things closely.”
    I knew that he would have. Lewis Carr followed everything at the Mem closely; he knew more local gossip than any of the nurses. He gathered his knowledge reflexively, the way some other people breathed air.
    “The girl presented in the outpatient ward at four this morning. She was moribund on arrival; when they sent a stretcher out to the car she was delirious. Her trouble was frank vaginal hemorrhage. She had a temperature of 102, dry skin with decreased turgor, shortness of breath, a racing pulse, and low blood pressure. She complained of thirst.” 1
    Carr took a deep breath. “The intern looked at her and ordered a cross match so they could start a transfusion. He drew a syringe for a count and crit 2 and rapidly injected a liter of D 5. 3 He also attempted to locate the source of the hemorrhage but he could not, so he gave her oxytocin to clamp down the uterus and slow bleeding, and packed the vagina as a temporary measure. Then he found out who the girl was from the mother and shit in his pants. He panicked. He called in a resident. He started the blood. And he gave her a good dose of prophylactic penicillin. Unfortunately, he did this without consulting her chart or asking the mother about allergic reactions.”
    “She was hypersensitive.” 4
    “Severely,” Carr said. “Ten minutes after giving the penicillin i.m. 5 the girl went into choking spasms and appeared unable to breathe despite a patent airway. By now the chart was down from the record room, and the intern realized what he had done. So he administered a milligram of epinephrine i.m. When there was no response, he went to a slow IV, benadryl, cortisone, and aminophylline. They put her on positive pressure oxygen. But she became cyanotic, 6 convulsive, and died within twenty minutes.”
    I lit a cigarette and thought to myself that I wouldn’t like to be that intern now.
    “Probably,” Carr said, “the girl would have died anyway. We don’t know that for sure, but there’s every reason to think that at admission her blood loss already approached fifty percent. That seems to be the cut-off, as you know—the shock is usually irreversible. So we probably couldn’t have kept her. Of course, that doesn’t change anything.”
    I said, “Why’d the intern give penicillin in the first place?”
    “That’s a peculiarity of hospital procedure,” Carr said. “It’s a kind of routine around here for certain presenting symptoms. Normally when we get a girl with evidence of a vaginal bleed and a high fever—possible infection—we give the girl a D & C, put her to bed, and stick her a shot of antibiotic. Send her home the next day, usually. And it goes down on the charts as miscarriage.”
    “Is that the final diagnosis on Karen Randall’s record? Miscarriage?”
    Carr nodded. “Spontaneous. We always put it down that way, because if we do that, we don’t have to fool with the police. We see quite a few self-induced or illegally induced abortions here. Sometimes the girls come in with so much vaginal