Overall a very enjoyable read. For me it was a fantastic insight into the behaviours and attitudes of the time. The beginnings of black people emerging into a predominately white society, the role of women, views on coloured immigrants, the climate of the time, the attitudes towards abortion. A fantastic picture of the time was painted.

I was happy to note that even the protagonist was imperfect in his ways and it came through naturally, not as if it had been added for flavour. All characters were really brought to life, through their descriptions.

The beginning was a little difficult to get into with regards to the many footnotes (some I felt were helpful, but some broke my concentration as they provided added information that could have been explained in the story itself or done away with. However, the story really took off as any good mystery should.

I appreciate Michael Crichton's ability to portray characters for all they are, just as they are (comes through in Jurassic Park and The Lost World too) - very observant of the human condition and that resonates with me personally. One of the reasons I've enjoyed this and the other books of his I've read.

Came to this 1969 Edgar award winner curious about the source material for the adaptation that was made into a 1972 film I like, The Carey Treatment, starring James Coburn. I knew it would be a pre-Roe narrative with abortion at its center, but long ago this book lodged in consciousness because a colleague at one of the universities at which I taught used one of Michael Crichton's appendices to the novel, "Appendix VI: Arguments on Abortion" as an example of the use of existing views in argument.

Crichton had a nice little run in Hollywood starting with this book. It's an entertainment, with a contrarian's view of abortion. Crichton approaches abortions medically, from the p.o.v. of the pathologist-heroic narrator who watches a much-abused OBGYN colleague set up on a murder rap by folks within the hospital disturbed by the colleague's willingness to do abortions. Crichton's narrator is somewhat disparaging of the scapegoat's rationalization that abortion is a women's healthcare issue. The narrator, John Berry (Peter Carey in the movie), is a John Wayne-era loyalist endeavoring to uphold the values in a life -- one of which sees that abortion is a dirty little secret that ought to remain so. Meantime, the Harvard medical school student Crichton (a 25 yo writing as Jeffrey Hudson -- so keeping that secret himself) works his own second job as a novelist releasing concatenations of hospital lore into the charged atmosphere of the sexual revolution's backsliding into the drug culture. That's a hot "topic" for a novel that struggles to develop interesting characterizations -- and therein is what becomes the Crichton formula for Looker, Coma, Westworld et. al.

For highly specific reasons, I was snooping into the pre-Roe context of the abortion debate and will perhaps have fuel to return to the movie adaptation.

For a seemingly pro-abortion book written in pre-Roe v Wade America, it sure does paint a surprisingly unkind picture of all its female characters. While the book is an engaging read, my biggest quibble is its unwillingness to go past surface level conversations regarding the important issues it centres itself around.

"Michael Crichton sure is good at building suspense and making you wonder how it's going to come together, but too often in his books, it just... doesn't come together."

While entirely fictional, this short book by former medical-student-turned-novelist, Michael Crichton (under the pseudonym Jeffery Hudson), gives an interesting behind the scenes look at the medical profession. Not only do we catch a glimpse of the frantic and often heroic efforts of doctors and nurses to save lives, but we see that these "professionals" are humans with human frailties, drug addiction, adultery, egotism, etc. We also learn about the hidden business of abortion. Largely viewed from the "clinical" perspective of a pathologist (examining body tissue in hospital labs), we see the science of autopsies.

Although I enjoyed the eye opening discussion of the politics and processes of the hospital ecosystem, the book's storyline, written almost like a detective novel, was OK but nothing like many of Crichton's widely known masterpieces.

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A Case of Need, A Novel, by Michael Crichton.
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Anyone familiar with the huge stature of Jurassic Park, as not just a film but the concept behind, would be forgivable - should be forgiven - for being surprised over and over as one reads this book. This is so, even when one has read Jurassic Park, and been aware of how much the book is superior, despite the impressive film.

But knowing nothing about the author, one is surprised at the topic he writes about, the medical profession and world. One is surprised at - what one thinks is the author's tremendous research in the topic - just how much he informs a lay person.

And one is surprised, more than anything, at how well he writes. Not as the author of a thriller or a mystery, but far more. About people, and even more, about Boston.

One finishes the book, and the only thing one is slightly disappointed with, is the solution, however plausible or likely it all is; but one remains impressed with the author.

Then one reads about his having graduated from Harvard, having gotten medical degree, and writing this while he was yet to graduate medical school.

One is only wondering, why he left it behind.
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"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."

"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."

"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."

"“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."
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"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."
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"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."
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"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."
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"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."
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" ... MPs were the most unpopular people in the city in those days, during the last phases of the occupation. In our white helmets and uniforms, we represented the final reminders of a tiresome military authority to the Japanese. To the Americans on the Ginza, drunk with sake or whiskey if they could afford it, we represented all that was frustrating or constricting about rigid military life. We were therefore a challenge to anyone who saw us, and more than one of my friends ran into trouble. One was blinded by a knife in the eye. Another was killed."
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"ART WAS LOCKED IN A NICE CELL. It was tidy and didn’t smell much. Actually, Boston has some of the nicest cells in America. They have to: lots of famous people have spent time in those cells. Mayors, public officials, people like that. You can’t expect a man to run a decent campaign for reelection if he’s in a lousy cell, can you?"
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"The differential diagnosis of amenorrhea, particularly in young girls, must consider nervousness as a strong etiologic possibility. Women often delay or miss their menstrual periods for psychological reasons. “But four months?” “Well, not likely. And she’d also had a weight gain.” “How much?” “Fifteen pounds.” “Not diagnostic,” I said. “No,” he said, “but suggestive.”
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"Peterson said, “We have a witness who heard the girl implicate Dr. Lee.”

"“The girl arrived at the hospital in a state of shock, delirious and precomatose. Anything she said will constitute weak evidence.”

"“At the time she said it, she wasn’t in a state of shock. She said it much earlier.”

"“To whom?”

"“To her mother,” Peterson said, with a grin of satisfaction. “She told her mother that Lee did it. As they were leaving for the hospital. And her mother will swear to that.”"
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"“What can you hope to prove?”

"“That Lee didn’t do it.”

"Carr shook his head. “That’s not the point.”

"“It seems to me that’s precisely the point.”

"“No,” Carr said. “The point is that the daughter of J. D. Randall was killed by an abortionist, and somebody has to pay. Lee’s an abortionist—that won’t be hard to prove in court. In a Boston court, the jury is likely to be more than half Catholic. They’ll convict him on general principles.”

"“On general principles?”

"“You know what I mean,” Carr said, shifting in his chair.

"“You mean Lee’s the goat.” “That’s right. Lee’s the goat.”

"“Is that the official word?”

"“More or less,” Carr said.

"“And what are your feelings about it?” “A man who performs abortions puts himself in danger. He’s breaking the law. When he aborts the daughter of a famous Boston physician—”

"“Lee says he didn’t do it.” Carr gave a sad smile.

"“Does it matter?”"
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"It takes a certain kind of man to assume this burden, to set his sights on such a distant goal. By the time he is ready to begin surgery on his own, he has become another person, almost a new breed, estranged by his experience and his dedication from other men. In a sense, that is part of the training: surgeons are lonely men."
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"“You’re forgetting the way it works. J. D. is a big man. J. D. lost a daughter. There happens to be a convenient Chinaman in the neighborhood, who is known to do the nasty deed. A perfect situation.”

"“I’ve heard that theory before. I don’t buy it.”

"“Then you don’t know J. D. Randall.”"

"“As a surgeon,” he said, “he isn’t worth shit. He’s mediocre. He loses people he shouldn’t lose. Young people. Strong people.”"
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"NO ENGLISHMAN IN HIS RIGHT MIND would ever go to Boston, particularly in 1630. To embark on a long sea journey to a hostile wilderness took more than courage, more than fortitude—it required desperation and fanaticism. Above all it required a deep and irreconcilable break with English society.

"Fortunately, history judges men by their actions, not their motivations. It is for that reason that Bostonians can comfortably think of their ancestors as proponents of democracy and freedom, Revolutionary heroes, liberal artists and writers. It is the city of Adams and Revere, a city that still cherishes the Old North Church and Bunker Hill.

"But there is another face to Boston, a darker face, which lies hidden in the pillory, the stocks, the dunking stool, and the witch hunts. Hardly a man now alive can look at these devices of torture for what they are: evidences of obsession, neurosis, and perverse cruelty.'
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"“Is it second-degree murder or manslaughter?”

“Neither, technically. In terms of—”

“Then the charge is bailable?”

“Conceivably so. But in this case not, because the prosecution will attempt a murder charge under a common law act which says any death resulting from a felony is murder.”"
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"SMITH COLLEGE, Northampton, Massachusetts, 2,200 girls getting an exclusive education in the middle of nowhere. It was two hours on the turnpike to the Holyoke exit; another half-hour on small roads until I passed under the train tracks and came into the town. I’ve never liked Northampton. It has a peculiarly repressed atmosphere for a college town; you can almost smell irritation and frustration in the air, the heavy combined frustration of 2,200 pretty girls consigned to the wilderness for four years, and the combined irritation of the natives who are forced to put up with them for that time."
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August 03, 2021 - August 07, 2021.
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Good Story

I enjoyed this book however it was not one of my favorite novels by Michael Crichton. It seems to run on a bit in the beginning without really knowing where it was going.

However, the last quarter of the book was fast paced and exciting.

Recommend

Dr. John Berry, a pathologist, is interrupted at work by a call from his wife: Dr. Arthur Lee, an obstetrician friend of theirs, is in jail. John goes to see him and finds out what happened. Karen Randall, the daughter of a wealthy family, was brought into a hospital by her mother after an illegal abortion, bleeding profusely. She died, and Karen's mother claimed that Dr. Lee had done the abortion. Although he tells John that he did indeed speak to Karen, he hadn't performed the abortion - in fact, he'd turned her away, telling her that, at four months, she was too far along and he couldn't do it. She'd seemed to accept this and left, but clearly she'd gone to someone else instead.

Unfortunately, Dr. Lee makes a good scapegoat. He's half Chinese, so racism is a factor, and it won't take much work to uncover that he does, in fact, perform abortions (and people like John and other doctors helped him hide it). It won't matter to anyone but John and Dr. Lee's wife that he didn't perform this particular abortion. John figures that if he doesn't try to find out the truth, no one will.

This is one of the works on Rep. Matt Krause's list of books he wanted banned from Texas schools. It caught my eye for several reasons - the author, how old it was, and overall how odd it was to see it on the list. From what I can tell, it isn't YA fiction and was never marketed as such, although that's not to say it wouldn't appeal to teens. Still, if a school library has this in their collection, I'm guessing it's a pretty good indicator that they're sorely in need of funds for new books.

Anyway, it's pretty obvious that it ended up on the list because of its frank discussion of abortion. It even includes an appendix that lays out the arguments for and against abortion, at the time this book was written, and it's clear that Crichton considered the former to be stronger and more convincing than the latter. However, it's also clear that Rep. Krause didn't read all the books he included in his list, because one could argue that the text itself had anti-abortion aspects in the way Karen was written and John's surprising inability to explain the word "abortionist" to Dr. Lee's young son in a way that didn't make it sound like a terrible thing.

The story had a very noir feel to it. It was written in first person, from John's POV, and I often found myself thinking that he read like an old school detective who happened to know a lot of medical jargon. There was even a scene in which he followed a guy around for a bit, like some kind of private investigator. And a surprising number of people talked to him and told him everything he needed to know, even though literally no one was required to tell him anything.

The mystery was extremely convoluted and confusing - I kept forgetting who everyone was, since the primary identifying characteristic of most of them was that they were male doctors. While it kept my attention, it didn't come together in a satisfying way in the end. I was left with a bunch of questions about details that were never fully addressed. I'm still not sure if I missed something, or if Crichton really did just opt not to explain the various odd details that John kept coming across and puzzling over. I finished this feeling like I'd read maybe 95% of a book, as though the chapter that was supposed to tie everything together was left out.

This wasn't necessarily a horrible reading experience, but it did come across as extremely dated. The casual racism grated on my nerves, and it was amazing how few women had speaking roles considering this was a book dealing with an issue that primarily affects women. I did appreciate that it dealt with abortion almost entirely from a medical perspective, although the revelations about Karen possibly undermined that somewhat. Characters' opinions on abortion weren't always clear, but one thing the book never wavered on was the safety factor: abortions performed by trained doctors in medical facilities are safer than both amateur abortions and giving birth.

In case this wasn't already clear: This book is absolutely not for anyone who has phobias about going to the doctor, and not just because of the graphic descriptions of what happened to Karen. Pretty much all of the doctors were horrible in some way - arrogant, misogynistic, sleazy, etc. It's one thing to know intellectually that doctors are imperfect and human like everyone else, and another thing entirely to have all the ugliness on-page.

Extras:

Various footnotes throughout explaining some of the medical jargon. Also, six appendices: "Delicatessen Pathologists" (explains why some pathologists describe diseased organs as though they were food), "Cops and Doctors" (why doctors don't trust police), "Battlefields and Barberpoles" (the link between surgery and war), "Abbreviations," "Whites" (medical uniforms), "Arguments on Abortion," and "Medical Morals."

(Original review posted on A Library Girl's Familiar Diversions.)

Very odd to read this book--it was written in the late 1960s, and life was very different then. African-Americans were called "negroes," and one particular character noted the "curiosity" of an "educated negro." A doctor who was Chinese, was targeted for murder--and it was expected that he would be found guilty, regardless, because of his nationality. Oy. It was also in an era where politics was ruled by religion--in particular, the Roman Catholics. Many things also made me chuckle--no HIPAA rules (the main character calls the pharmacy for info on someone's prescription, and the details were kept in a ledger under the counter, shared freely with no question), no cell phones or internet, and everyone smoked and drank liberally. The women were all minor characters, at best, and were largely trophy wives and housekeepers.

Times have certainly changed, and reading this book through a 21st Century lens was almost more entertaining than the story itself.

A Case of Need
Jeffery Hudson (Michael Crichton)
1993 (1968)
“There are times, when I think you’re either an honest man or a complete fool.”


An intriguing book as it deals with medical, moral, and investigative issues. Interesting format as it uses footnotes to explain jargon and concepts. This makes the story feel more real and the narration more authoritarian.
When the mystery is solved it is a little sheepish but is that not always the way with a good mystery?
Also like the day by day short timeframe. Adds to the drama.
The interplay between the police and the doctors is also one that we do not usually see. An argument to restructure the police force?

Lino P Matteo, August 19, 2020

Notes:
39: I recognized his type: He was a successful cop, a guy who had learned when to take it and when to dish it out. A very diplomatic and polite cop, until he got the upper hand.
43: He could use the familiar line so famous among surgeons and internists that it was abbreviated DHJ: doing his job.
67: The last time anyone counted, there were 25,000 named diseases of man, and cures for 5,000 of them. Yet it remains the dream of every young doctor to discover a new disease. That is the fastest and surest way to gain prominence within the medical profession.
85: “A prick. Just a prick. The residents say he walks around with a hammer in his pocket and a half-dozen nails, just in case he sees the opportunity to crucify somebody.”
88: Footnote: A doctor cannot change his name after receiving his M.D. degree without invalidating that degree. This means that there is a great rush in the final weeks of med school among doctors flocking into court to change their names they receive their diplomas.
149: “Karen’s problems were purely psychosomatic,” he said. “She’s like ninety percent of the women I see. Some little thing goes wrong – like your tennis game – and bang! You have a medical problem. …until you find one who will pat your hand and say, ‘Yes, you’re a very sick woman.’” He laughed.
154: “There are times, when I think you’re either an honest man or a complete fool.”
156: …three of the four most commonly prescribed drug classes – antibiotics, hormones (mostly The Pill), and tranquilizers – were all postwar innovations.
Note: The fourth class, analgesics, was mostly that old standby, aspirin, synthesized in 1853. Aspirin is as much a wonder drug as any other. It is a painkiller, a swelling-reducer, a fever-breaker, and an antiallergic drug. None of its actions can be explained.
160: Psychiatrists have the highest suicide rate of all, more than ten times that of the GP.
167: “Did you hear about the French biochemist who had twins. He baptized one and kept the other as a control.”
217: The prosecution will attempt to discredit Dr. Lee as thoroughly as they know how. We, the defence, will attempt to discredit the deceased, Mrs. Randall, and Peter Randall. The prosecution will have, as an advantage, the innate hostility of a Boston jury to anyone accused of abortion. We will have as an advantage the desire of any random jury from Boston to witness the defilement of an old family.”
218: “And you believe in winning.”
298: There is no sense of time in a hospital. One day blends into the next; the routine – temperatures, meals, doctors’ rounds, more temperatures, more meals – was everything.
309: While it is possible that he missed the enlarged or ruptured spleen in his examination, it is highly unlikely considering the nature of the injury and extremely high calibre of the doctor. The conclusion of the hospital staff was that probably the man had received a good kick in the stomach by the police, after he had been examined.


~ A Case of Need, Jeffery Hudson (Michael Crichton)

There are two prominent creases in the spine of this book because for the most part, I read it in three long sittings. That seems to happen a lot with Crichton & me; two is a coincidence, three is a pattern, and this is his third work that I have read.

I'm still surprised it was one of the first things he ever wrote, and I had to keep reminding myself that this was written by a med student, and in 1968 to boot. Then he uses the word "Negro" consistently to describe one of the two black characters (neither of whom are very flatteringly portrayed, Dr. Crichton) and I would suddenly remember.

I have to say that I did not know that this was going to be about abortion when I picked it up. Then the title and date published both *clicked* when they started talking about the procedure and doctors who performed them safely. And then suddenly when the conflict enters: girl dies from botched D&C, I'm like "oh, duh." I guess I originally thought it was going to be an old person being euthanized during surgery or something, and it turned out to be at the patient's request in the end.

The Catch-22 is that there is no way the doc they arrested is guilty, but they can't prove that without admitting to the fact that he does safe, inexpensive abortions all the time. He wouldn't have done the procedure on someone four months along, he never charges more than the lab fees, etc. (And only performs them on a case-by-case basis for girls who would otherwise leave his office and wander down a back alley anyway. I actually really admired this doc.)

It was very interesting to read this, a 1968 novel by a male medical student at Harvard, as a fairly feminist college girl in 2014. I have never known a time without Roe v. Wade, but this was written five years before the case hit the Supreme Court. It comes off as "progressive for its time," instead of just "dated," and argues the same stats that have been around for the past forty years- keep it safe and rare. Much like a fox caught in a trap will consider chewing of its own leg, a girl in trouble will just find an alternate option (knitting needles are mentioned) and could very well die. The appendices were short, relevant, and very interesting. There is also a quick publisher's note that they removed the description of how LSD is synthesized (darn!).

I also really appreciated that it was written in first-person, and there was actual ~character development.~ It is striking that this is supposedly Crichton’s first published work (under a pseudonym) (I don't really count the John Lange novels, do you?) when I actually think it is written much better than Jurassic Park and The Lost World (1990 and 1995, respectively). As much as I adore dinosaurs, those last two would just name an adult male with a generic name (read: middle-aged and white!), and I kept picturing the same bland guy over and over again unless he had a last name like “Wu.” Or, if I happened to know that the guy was portrayed by Samuel L. Jackson in the film adaptation. Maybe the first-person narration in A Case of Need added to this- it was a person’s narration, not an omniscient perspective that selectively told us the other characters’ thoughts.

Stephen King is quoted on the back as "I love anything Michael Crichton writes, but his early medical thrillers have been favorites of mine." However, I couldn't dig up any other "medical" thrillers outside of Andromeda Strain, which I GUESS counts. More mysteries please! More medicine and bio, less technical shtuff! I'm reading Andromeda Strain soon, I think. Next, "Next."

This is a big step above everything else Crichton wrote in this era. He clearly took his time more with A Case of Need than the other books he wrote under a pen name. The premise is more realistic; the characters are more detailed. This novel is of its time, 1968, set in the debate about legalization of abortion. Crichton paints a fascinating picture of the Boston medical community--its people, places, and politics. This is a PI story posing as a medical thriller and takes a slower pace than much of his other work. But the characters, setting, and investigation are engaging enough to hold the reader's interest.

I really enjoyed A Case of Need and would give it five stars were it not for the inclusion of footnotes and eight appendices (?). It's a novel, not a textbook. It feels like Crichton just likes to show off that he knows a lot of shit.