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 problem is 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 it killed 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. 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 providing little 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 from advocate 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. 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 time dazzling 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 Randall was 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 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 in and 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 of racism, 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 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 arguments is 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 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 to his 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.