A Case of Needing

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    A Case of Needing: Serious Revisions

    Michael Crichton has penned some of the most engaging, timely,

    and

    thoroughly accessible tales to be published in the last twenty-five

    years. What

    his novels lack in literary merit and distinctive style they make up

    for in

    crisp plotting and edge-of-your-seat suspense. From alien viruses to

    regenerated

    dinosaurs, from evil Japanese monoliths to the insidious maneuverings

    of the

    modern corporation, Crichton latches onto the scientific and political

    controversies of the day, and squeezes out of them every last ounce of

    shock

    value. At least, that's usually what he does.

    A Case Of Need could have used quite a bit more shock value. The

    problemis largely a matter of timing; when the book came out in 1969, the

    moral dilemma

    surrounding illegal abortions was still a hot enough topic to seem

    ripped from

    the headlines. Though abortion certainly remains a hot-button issue,

    the debate

    has shifted. For the time being, at least, the argument centers on

    whether or

    not the act should be legal, not on whether or not doctors are currently

    breaking the law by performing them.

    The antiquated plot line is not the story's main flaw. The

    biggest

    drawback here is a one-two punch of highly technical prose employed to

    relate a

    thoroughly dull story. Karen Randall, the daughter of an eminent

    physician, dies

    as the result of a botched abortion. Art Lee, a Chinese obstetrician,

    is accused

    of performing the D & C that has resulted in her death. Though Lee is

    known to

    be an abortionist, he vehemently denies any involvement in the case.

    Lee calls

    upon his friend, forensic pathologist John Berry, to clear his name.

    John Berry careens back and forth from one Boston hospital to

    another,

    trying to figure out who actually performed Randall's abortion, and why

    itkilled her. The investigation is complicated by the fact that Randall

    was not

    even pregnant. Slowly, a picture emerges of Randall as a freewheeling,

    loose

    woman with several abortions in her past, and connections to some

    shadowy

    underworld characters. Berry ultimately discovers that a drug-dealing

    musician

    was actually at fault for Randall's death.

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    Why did Michael Crichton write this book? The answer seems

    fairly

    obvious. Still fairly immersed in his medical school learnings,

    Crichton must

    have seen it as a chance to demonstrate just how much knowledge he had

    gained

    during his time at Harvard. Numerous medical procedures are described

    in detail,

    supplemented by footnotes and appendices for readers not in the know.

    All of this technical gobbledygook turns out to be almost

    totally

    superfluous. Berry clears Lee's name largely through old-fashioned

    detective

    work rather than through forensic pathology. That Randall was not

    actually

    pregnant turns out to be one of the very few salient clues that science

    reveals.

    Of course, without all that medical jargon, this book would have

    been

    almost entirely a study of law and American society, with science

    providinglittle more than a context in which the story can unfold. Crichton

    makes the

    terminology slightly more palatable by making Berry a fairly sarcastic

    and

    cynical practitioner of his craft. Still, one can only stomach so much

    detailed

    description of autopsies, biopsy examinations, and crit readings.

    It is surprising that Crichton devoted so much ink to these

    scientific

    proceedings, when the ethics that lie behind the novel's central act

    (or, at

    least, supposed central act) are so much more engaging. The notion that

    abortion

    represents one of the murkiest legal and moral issues in the medical

    community

    is mentioned, but not expounded upon in any great detail.

    Various statistics are quoted suggesting that abortion is a

    fairly safe

    procedure, and a doctor friend of Berry's makes a fairly eloquent speech

    regarding the positive aspects of getting rid of unwanted pregnancies,

    but there

    is no strong case ever made for either side.

    What would have been most engaging, in course, would have been

    strong

    arguments made for both sides. There is perhaps no issue as divisive as

    abortion,

    no modern medical procedure that elicits such strong passion fromadvocate both

    for and against. Granted, Crichton was writing a potboiler, and

    excessive

    philosophizing would have turned the book into an even greater dud than

    it

    already is. However, a little solid, even-handed consideration of the

    themes

    raised would have gone a very long way.

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    Another prominent ethical issue that courses throughout the book

    is

    Berry's methods of investigating the case. The story opens with an

    excerpt from

    the Hippocratic oath. Berry then proceeds to gain information through

    impersonation, deceit, threats, and other assorted trickeries. This is

    by no

    means, in and of itself, a misstep. Few doctors could claim to be

    choirboys.

    However, the ways in which Berry employs highly questionable

    fact-

    gaining techniques should not be rendered with so little self-

    consciousness.

    Berry is so driven by a desire to know the truth that he will sacrifice

    his

    honesty to achieve that end. Like the moral quagmire that is abortion,

    this

    dichotomy deserves far more attention than Crichton seems willing to

    give.

    Where does Crichton focus his attention? He spends most of his

    timedazzling the reader with his intricate knowledge of every medical

    procedure

    under the sun. Perhaps the editor is truly to blame for this mind-

    numbingly dull

    aspect of the book. At least there were footnotes. At least they tried.

    However,

    annotations can never replace clear, concise, everyday prose. While

    investigating whether or not Randall was pregnant or not, Berry learns

    this

    incredibly illuminating information from a colleague (p. 83):

    "'Only proteins can be denatured, and steroids are not

    proteins, right? This'll be easy. See, the normal rabbit

    test is chorionic gonadotrophin in urine. But in this lab

    we're geared to measure that, or progesterone, or any of a

    number of other eleven-beta hydroxylated compounds. In

    pregnancy, progesterone levels increase ten times. Estriol

    levels increase a thousand times. We can measure a jump

    like that, no sweat.'"

    A jump like what? All of this technical language does go a long

    way

    towards demonstrating that these are actual doctors talking to each

    other, but

    the "Dr." that comes before their names would have sufficed. All that

    is really

    being related here is that it can be determined whether or not Randallwas

    pregnant. The rest is quite literally commentary, and particularly

    intelligible

    commentary at that.

    This major flaw, however, also represents the novel's greatest

    triumph.

    If one learns nothing else from the story, one gains an appreciation

    from the

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    importance of method in forensic pathology. The painstaking details

    related

    about every step in the forensic process may be overly specific, but

    they

    succeed at conveying how delicate, how intricate, and how surprisingly

    exact a

    science it can be.

    Each twist and turn in the examination is detailed: the study of

    blood

    samples, the dissection of the corpse, the consideration of diet, age,

    even the

    psychological profile of the victim. Those these details range from

    gory to

    mundane, they manage to eloquently convey the process involved, even as

    they

    obscure the relevance of each step in the process.

    With all this emphasis placed on Berry's attention to detail, it

    is

    surprising how completely one important detail is overlooked: the role

    of the

    police in such an investigation. A burly cop named Peterson swaggers inand out

    of the story, but no serious mention is ever made of what the

    authorities are

    doing to figure out what happened.

    The case against Lee rests entirely on Randall's mother's claim

    that her

    daughter said that Lee performed the abortion. In reality, it is

    unlikely the

    police would rest on such scant evidence.

    Would they do it differently from Berry? If so, how? There seems

    to be

    some suggestion that Berry is a renegade, investigating the case by

    playing

    outside the rules, but this fails to become an engaging aspect of the

    plot,

    because there is no rule-abiding investigator with which to contrast

    him. One is

    led to believe that Berry's style is clever and unconventional, but his

    choices

    actually seem rather practical. An exploration of how such cases

    normally get

    handled would have made the tale far more engaging.

    While A Case Of Need does manage to ignore its own central

    themes, make

    the accessible complicated, and forego even the mildest attempt at

    illuminating

    character study, it still has a few things going for it. The roles ofracism,

    institutional power, and fear of professional embarrassment in the

    course of a

    medical examination are cleverly explored.

    Dr. Lee would not have found himself so easily railroaded had

    he only

    had the luck to have been born Dr. Smith. Lee's lawyer, George Wilson,

    is

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    himself not aided any by his African-American heritage. As a recent

    trial that

    need not even be named clearly demonstrated, in a criminal matter,

    science will

    always take a back seat to racial politics. Crichton was well aware of

    this

    twenty-five years before it became thunderingly clear to the rest of

    his fellow

    Americans.

    Justice can be obscured by much besides the color of the

    accused's skin.

    The power of the accuser is of great importance as well. Lee is dumped

    into such

    hot water not because he might have botched the abortion of some

    nameless young

    woman.

    Karen Randall is the daughter of an eminent, powerful doctor, a

    doctor

    willing to manipulate medical findings and force his colleagues to rush

    to

    judgment in order that someone might be punished for Karen's death.Without

    becoming preachy, Crichton reveals how corrupt and selfish big medicine

    can be.

    Another Randall is willing to play fast and loose with the facts

    as well.

    Karen's uncle, Peter Randall, also a doctor, performed two abortions on

    her in

    the past. Revealing this information might help to bring the truth

    about her

    death to light, but it also would soil Peter's pristine reputation.

    Peter will go so far as to torch an incriminating automobile

    rather than

    let the truth be known. From the evils of the all-powerful hospital to

    the

    darker recesses of one physician's heart, the cruelest and most self-

    serving

    side of the noblest science is placed out in the sun for all to see.

    It's interesting to consider what Crichton might do today if he

    were

    given a chance to revise this story. Aside from the twisters that would

    likely

    rip through Boston as computer-generated actors morphed into

    velociraptors,

    there would likely also be a more concerted effort to make the story

    not more

    three-dimensional, but less.

    The reduction of complex issues to easily grasp able argumentsis what

    makes Crichton so fantastically popular. You don't need a deeply

    considered

    position on the dangers of modern genetics to weigh in on Jurassic

    Park. You

    don't need any understanding of the world economy to hiss at the bad

    guys in

    Rising Sun. Those stories are focused, even though at may be at the

    expense of

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    telling the whole story. Here, the focus is hazy at best.

    Berry's investigative techniques, the importance of medical

    data, even

    the motives and actions of most of the minor characters, go largely

    unexplained.

    We are left with the trees, but little forest in which to view them.

    Crichton

    creates an intricate web of medical intrigue, but then leaves the map

    to guide

    the reader through it shoddy and half-finished.

    Of course, Crichton is a skilled craftsman, and this is why the

    book is

    not a total waste. By creating interesting (if somewhat stereotypical)

    stock

    characters, and placing them in somewhat contrived situations, Crichton

    does

    manage to explore some of the more complex issues surrounding a medical

    crime.

    However, through excessive detail and an unwillingness to weigh

    in

    sufficiently on some of the more important ethical dilemmas inherent tohis tale,

    Crichton ends up obscuring more than he reveals. A Case of Need is much

    like a

    botched autopsy: all the guts are ripped out into the open, but we are

    able to

    learn little from them.