A Case of Need

Set in the insular world of Boston's medical establishment in the 1960s, the novel follows Dr. John Berry, a hospital pathologist, as he races to prove his friend's innocence after a young woman's death from a botched illegal abortion.

Berry narrates from Lincoln Hospital, where his routine morning is interrupted by a call from his wife, Judith: Their close friend Dr. Art Lee, an obstetrician who served as best man at their wedding, has been arrested for murder. Karen Randall, the 18-year-old daughter of J. D. Randall, a powerful heart surgeon, was brought to Boston Memorial Hospital (commonly called "the Mem") early that morning, bleeding from an apparent abortion, and died. Art insists he is innocent: Karen visited his office the previous week seeking an abortion, but he refused because she was too far along. He kept no records and has no alibi for the night in question.

The personal stakes are high. For years, Berry and his supervisor, Dr. Sanderson, have helped conceal Art's abortion practice by switching tissue slides and falsifying pathology records. If Art is convicted, they face exposure too. Captain Peterson of the homicide division reveals the prosecution's key evidence: Karen's stepmother, Mrs. Randall, will testify that Karen said "Lee did it" as they drove to the hospital.

Berry attends Karen's autopsy, where Dr. Leland Weston, the chief pathologist of City Hospital, takes charge. The uterus does not appear large enough for a four-month pregnancy, and no corpus luteum, the hormonal structure signaling recent ovulation, is found. The scraping was performed by someone with basic skill but not full professional competence. Berry secretly collects a blood sample and takes it to Dr. Jim Murphy, a biochemist, for a definitive pregnancy hormone assay. Berry also learns that the intern on duty at the Mem injected penicillin without checking for allergies; Karen was severely hypersensitive and died of anaphylactic shock compounded by hemorrhagic shock. Dr. Lewis Carr, a clinical professor, tells Berry that J. D. Randall is determined to see someone punished, and the hospital consensus is that Art is "the goat."

Berry spends Monday gathering information. J. D. Randall first tries to bribe Berry with a prestigious job offer, then threatens his career. Art's lawyer, George Bradford, declines the case, believing Art is guilty. On Tuesday, Berry drives to Smith College and questions Karen's roommate, Ginnie, who reveals a very different Karen: rebellious, drug-using, and throwing darts at her father's photograph nightly. Ginnie says Karen claimed two prior abortions and took daily pills she called birth control, which Berry identifies as aspirin. She provides a photograph of a young Black musician Karen was dating and mentions a friend named "Angie" who may be a nurse.

Berry visits the Randall estate, where Evelyn Randall, J. D.'s strikingly young second wife, shows him her yellow Porsche, its interior still soaked with Karen's blood. She claims Karen said "Lee did it" three times during the drive to the hospital and that she found a check for $300 made out to cash in Karen's purse. Berry notes that Art's fee was always only $25. Berry also tracks down Alan Zenner, Karen's ex-boyfriend, who saw Karen the previous Sunday; she told him she was going to have an abortion and seemed scared. Zenner mentions a friend of Karen's named Angela Hardy or Harley who appeared high on drugs. Berry visits Peter Randall, J. D.'s brother and Karen's personal physician, who mentions his Mercedes was recently stolen. When Berry shares his impression that Karen may not have been pregnant, Peter responds thoughtfully.

On Wednesday, Murphy's assays confirm Karen was definitively not pregnant. Berry locates Angela Harding and her roommate, Bubbles, on Beacon Hill. Bubbles reveals Karen used heavy drugs, including injected methamphetamine, and had an abortion the previous summer that caused severe psychological disturbance. Berry meets George Wilson, Art's new defense attorney, a young, ambitious Black lawyer given a case his firm considered hopeless. Wilson outlines a ruthless strategy: either pressure the Randalls into dropping charges by threatening to expose family secrets, or destroy Mrs. Randall's credibility in court while implicating Peter as the likely abortionist.

That evening, Berry arrives at the Lee house to find a smoldering cross on the lawn, every window smashed, and Art's children cut by flying glass. He pressures police into posting a guard. Berry and Wilson drive to the Randall estate, where they discover Peter's supposedly stolen Mercedes. They watch as J. D. and Peter pour gasoline inside the car, set it on fire, and push it off a cliff into the ocean on Cape Cod. Wilson photographs the sequence. They confront the Randalls, but J. D. refuses to drop charges.

On Thursday, Peter invites Berry to lunch and reveals his alibi: Evelyn Randall, with whom he has been having a long affair. Peter confirms he aborted Karen three times previously but refused a fourth, doubting she was truly pregnant. Evelyn admits she lied about Karen naming Art. Karen actually said "That bastard" repeatedly, never identifying anyone, and spoke about "the needle." Evelyn had panicked and named Art, the only other abortionist she knew, because Art had performed an abortion on Evelyn herself the previous year. Peter asks Berry to find the real abortionist.

That night, Berry confronts Roman Jones, the musician from Karen's photograph, at a bar called the Electric Grape. Roman becomes hostile when Berry mentions Karen and Angela. Berry follows Roman through dark streets but is attacked, struck on the head with a razor, and left bleeding. A cab driver brings him to the Mem emergency ward. Shortly afterward, Roman is brought in dead, his skull caved in. Angela Harding arrives simultaneously with slashed wrists. Berry notices her fingers are stained with iodine, a surgical disinfectant, and her hands bear cuts consistent with a knife fight rather than a suicide attempt.

Berry tricks Angela into confessing by pretending to inject her with nalorphine, a drug that induces agonizing withdrawal in a morphine addict, when he actually injects water. Angela breaks down: She performed the abortion on Karen. Roman, who had stolen morphine from the Mem's outpatient clinic, supplied thiopental as an anesthetic. When the investigation cut off Angela's access to hospital drugs, she had to buy from Roman, who demanded $300. Berry then begins losing consciousness. Dr. Norton Hammond, a young Mem resident Berry spoke with earlier in the week, recognizes the symptoms of an epidural hematoma, a life-threatening accumulation of blood inside the skull. Hammond rushes Berry into emergency surgery.

Berry recovers over the weekend. Art visits to say goodbye; the publicity has destroyed his career, and he is moving to Los Angeles. After discharge, Berry visits Angela's apartment, where police note that a kitchen chair and the outside doorknob were wiped clean of fingerprints while nothing else was cleaned. On Monday, Berry confronts Weston, who admits he was at his niece Angela's apartment Thursday night and found Roman chasing her with a razor. When Roman turned on Weston, Weston struck him with the chair, killing him. Angela told Weston to leave to protect him; she apparently pushed Roman's body out the window. Berry tells Weston he might get off on self-defense. Weston responds slowly, "I might." Berry leaves. Outside, an ambulance passes with its siren off. Berry feels a compulsion to follow it but instead walks to his car and drives home.