“Have you reported it to the police?”
“Yes.” He shrugged. “For whatever it’s worth.”
Brigit hung up and returned to her seat. Peter sighed, picked up the cleaver, and said, “Well, better get on with it.”
He held the rat by the tail. The rat tried to pull away, spread-eagling its body on the block. In a swift motion, Peter lifted the cleaver over his head and brought it down. There was a loud thump! as the blade struck the block. The girls stared away. I looked back and saw Peter holding the wriggling decapitated body over the sink. The blood drained out for a few moments. Then he carried it over to Brigit and placed it on the cork pad.
“Number one,” he said briskly. He returned to the block, pushed the head into the paper bag, and selected a second rat.
I watched Brigit work. With swift, practiced moves she pinned the body on its back to the cork. Then she cut into the legs, clearing away the flesh and muscle around the bones. Next she clipped the bones free of the body and dropped them into the ice bath.
“A minor triumph,” Peter said, preparing the next rat on the block. “In this lab, we perfected the first in vitro bone cultures. We are able to keep isolated bone tissue alive for as long as three days. The real problem is getting the bone out of the animal and into the bath before the cells die. We’ve got it down to a fine art now.”
“What exactly is your field?”
“Calcium metabolism, particularly as it relates to parathyroid hormone and thyrocalcitonin. I want to know how those hormones work to release calcium from bone.”
Parathyroid hormone was a little-understood substance secreted by four small glands attached to the thyroid. Nobody knew much about it, except that the parathyroids seemed to control calcium levels in the blood, and that these levels were strictly regulated—much more so than, say, blood sugar or free fatty acid. Blood calcium was necessary for normal nerve transmission and normal muscle contraction, and it was theorized that calcium was shunted to and from the bone, as occasion demanded. If you had too much calcium in your blood, you deposited it in bone. If you had too little, you drew it out of bone. But nobody knew quite how this was accomplished.
“The time course is crucial,” Peter continued. “I once performed an interesting experiment. I took a dog and put in an arterial bypass. I was able to take his blood, treat it with chemicals to remove all calcium, and put it back again. I ran this thing for hours, taking out literally pounds of calcium. Yet the blood levels remained normal, readjusting instantly. That dog was draining large quantities of calcium out of his bone and into his blood at a very rapid rate.”
The cleaver swung down again with a heavy sound. The rat wriggled and was still. It was given to the second girl.
“I got interested in all this,” Peter said. “The whole problem of calcium storage and release. It’s fine to say you can put your calcium into bone, or take it out; but bone is a crystal, it’s hard and rigidly structured. We can apparently build it up or tear it down in fractions of a second. I wanted to know how.”
He reached into a cage and produced another rat with a purple tail.
“So I decided to set up an in vitro system to study bone. Nobody thought I could do it. Bone metabolism was too slow, they said. Impossible to measure. But I succeeded, several hundred rats later.” He sighed. “If the rats ever take over the world, I’ll be tried for my war crimes.”
He positioned the rat on the block.
“You know, I’ve always wanted to find a girl to do this work for me. I kept looking for a cold-blooded German girl, or a sadist of some sort. Never found one. All of those”—he nodded to the three at the table—“came to work only after I agreed that they would never have to kill the animals.”
“How long have you been doing this work?”
“Seven years now. I started very slowly, half a day a week. Then it got to be every Tuesday. Pretty soon it was Tuesdays and Thursdays. Then it was all weekend as well. I’ve cut down my practice as much as I can. This work is really addicting.”
“You like it?”
“I adore it. It’s a game, a big wonderful game. A puzzle where nobody knows the answer. If you’re not careful, though, you can become obsessed with the answer. Some people in the biochem department work longer hours than any practicing doctor. They drive themselves. But I won’t let that happen to me.”
“How do you know?”
“Because whenever I feel the symptoms coming on—the urge to work round the clock, to keep going until midnight, or to come in at five in the morning—I say to myself, it’s just a game. I repeat that over and over. And it works: I settle down.”
The cleaver finished the third rat.
“Ah,” Peter said, “halfway there.” He scratched his stomach reflectively. “But enough about me. What about you?”
“I’m just interested in Karen.”
“Ummm. And you wanted to know about an accident? There was none, that I recall.”
“Why were skull films taken last summer?”
“Oh that.” He stroked the fourth victim soothingly and set it on the block. “That was typical Karen.”
“What do you mean?”
“She came into my office and said, ‘I’m going blind.’ She was very concerned, in her own breathless way. You know how sixteen-year-old girls can be: she was losing her vision, and her tennis game was suffering. She wanted me to do something. So I drew some blood and ordered a few tests. Drawing blood always impresses them. And I checked her blood pressure and listened to her and generally gave the impression I was being very thorough.”
“And you ordered skull films.”
“Yes. That was part of the cure.”
“I don’t follow you.”
“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. You go to see your doctor. He can find nothing physically wrong with you. But does this satisfy you? No: on to another doctor, and still another, until you find one who will pat your hand and say, ‘Yes, you’re a very sick woman.’” He laughed.
“So you ordered all these tests as a diversion?”
“Largely,” he said. “Not entirely. I believe in caution, and when one hears a complaint as serious as vision loss, one must investigate. I checked her fundi. Normal. I did a visual fields. Normal, but she said it came and went. So I took a blood sample and ordered tests of thyroid function and hormone levels. Normal. And the skull films. They were normal, too, or have you already seen them?”
“I saw them,” I said. I lit a cigarette as the next rat died. “But I’m still not sure why—”
“Well, put it together. She’s young, but it’s still possible—vision and headache, slight weight gain, lethargy. That could be pan hypopituitarism with optic nerve involvement.”
“You mean a pituitary tumor?”
“It’s possible, just possible. I figured the tests would show if she was pan hypopit. The skull films might show something if she was really badly off. But everything came back negative. It was all in her mind.”
“Are you sure?”
“Yes.”
“The labs might have made a mistake.”
“That’s true. I would have run a second test, just to be sure.”
“Why didn’t you?”
“Because she never came back,” Peter said. “That’s the key to it all. One day she comes in near hysteria because she’s going blind. I say come back in a week, and my nurse makes the appointment. A week later, no show. She’s out playing tennis, having a fine time. It was all in her mind.”
“Was she menstruating when you saw her?”
“She said her periods were normal,” he said. “Of course, if she were four months’ pregnant at the time of her death, she would just have conceived when I saw her.”
“But she never came back to you?”
“No. She was rather scatterbrained, actually.” He
killed the last rat. All the girls were now busily working. Peter collected the carcasses and put them into the paper bag, then dropped the bag into a wastebasket. “Ah,” he said, “at last.” He washed his hands vigorously.
“Well,” I said, “thanks for your time.”
“Not at all.” He dried his hands on a paper towel, then stopped. “I suppose I ought to make some sort of official statement,” he said, “since I’m the uncle and so forth.” I waited.
“J. D. would never speak to me again if he knew I’d had this conversation with you. Try to keep that in mind if you talk to anybody else.”
“O.K.,” I said.
“I don’t know what you’re doing,” Peter said, “and I don’t want to know. You’ve always struck me as pretty level and sensible, and I assume you’re not wasting your time.”
I didn’t know what to say. I couldn’t see what he was leading up to, but I knew he was leading up to something.
“My brother, at this moment, is neither level nor sensible. He’s paranoid; you can’t get anything out of him. But I understand that you were present at the autopsy.”
“That’s right.”
“What’s the dx1 there?”
“It’s uncertain on the basis of the gross,” I said. “Nothing clear at all.”
“And the slides?”
“I haven’t seen them yet.”
“What was your impression at autopsy?”
I hesitated, then made my decision. He had been honest with me; I’d be honest with him.
“Not pregnant,” I said.
“Hmmm,” he said. “Hmmmm.”
He scratched his stomach again, then held out his hand.
“That’s very interesting,” he said.
We shook hands.
See Appendix IV: Abbreviations.
EIGHT
WHEN I GOT HOME, a big squad car with a flashing light was waiting at the curb. Captain Peterson, still crew-cut and tough-looking, leaned against the fender and stared at me as I pulled into my driveway.
I got out of my car and looked at the nearby houses. People had noticed the flasher and were staring out of their windows.
“I hope,” I said, “that I didn’t keep you waiting.”
“No,” Peterson said with a little smile. “Just arrived. I knocked at the door and your wife said you weren’t back yet, so I waited out here.”
I could see his bland, smug expression in the alternating flashes of red from the light. I knew he had kept the light on to irritate me.
“Something on your mind?”
He shifted his position on the car. “Well, yes, actually. We’ve had a complaint about you, Dr. Berry.”
“Oh?”
“Yes.”
“From whom?”
“Dr. Randall.”
I said innocently, “What kind of complaint?”
“Apparently you have been harassing members of his family. His son, his wife, even his daughter’s college friends.”
“Harassing?”
“That,” said Peterson carefully, “was what he said.”
“And what did you say?”
“I said I’d see what could be done.”
“So here you are.”
He nodded and smiled slowly.
The flasher was beginning to get on my nerves. Down the block, one or two kids were standing in the street, watching in silence.
I said, “Have I broken any law?”
“That hasn’t been determined yet.”
“If I have broken a law,” I said, “then Dr. Randall may go to court about it. Or he may go to court if he feels he can show material damage as a result of my alleged actions. He knows that, and so do you.” I smiled at him, giving him some of his own. “And so do I.”
“Maybe we should go down to the station and talk about it.”
I shook my head. “Haven’t got time.”
“I can take you in for questioning, you know.”
“Yes,” I said, “but it wouldn’t be prudent.”
“It might be quite prudent.”
“I doubt it,” I said. “I am a private citizen acting within my rights as a private citizen. I did not force myself upon anyone, did not threaten anyone. Any person who did not wish to speak with me did not have to.”
“You trespassed on private property. The Randall home.”
“That was quite inadvertent. I was lost, and I wanted to ask directions. I passed a large building, so large it never occurred to me it might be a private dwelling. I thought it was some kind of institution.”
“Institution?”
“Yes. Like an orphanage, you know. Or a nursing home. So I drove in to ask questions. Imagine my surprise when I discovered that by purest chance—”
“Chance?”
“Can you prove otherwise?”
Peterson gave a fair imitation of a good-natured chuckle. ‘You’re being very clever.”
“Not really,” I said. “Now why don’t you turn off that flasher and stop drawing attention? Because otherwise I will file a complaint of harassment by the police. And I’ll file it with the Chief of Police, the District Attorney’s office, and the Mayor’s office.”
He reached indolently through the window and flicked a switch. The light stopped.
“Someday,” he said, “all this may catch up with you.”
“Yes,” I said. “Me, or somebody else.”
He scratched the back of his hand, as he had done in his office. “There are times,” he said, “when I think you’re either an honest man or a complete fool.”
“Maybe both.”
He nodded slowly. “Maybe both.” He opened the door and swung into the driver’s seat.
I went up to the front door and let myself in. As I closed the door, I heard him pull away from the curb.
NINE
I DIDNT FEEL MUCH LIKE ATTENDING A COCKTAIL party, but Judith insisted. As we drove to Cambridge, she said, “What was it all about?”
“What?”
“The business with the police?”
“It was an attempt to call me off.”
“On what grounds?”
“Randall filed a complaint. Harassment.”
“Justified?”
“I think so.”
I told her quickly about the people I had seen that day. When I was finished, she said, “It sounds complicated.”
“I’m sure I’ve barely scratched the surface.”
“Do you think Mrs. Randall was lying about the check for three hundred dollars?”
“She might have been,” I admitted.
Her question stopped me. I realized then that things had been happening so fast, I hadn’t had time to consider everything I had learned, to sift it out and put it together. I knew there were inconsistencies and trouble spots—several of them—but I hadn’t worked on them in any logical way.
“How’s Betty?”
“Not good. There was an article in the paper today….”
“Was there? I didn’t see it.”
“Just a small article. Arrest of physician for abortion. Not many details, except his name. She’s gotten a couple of crank calls.”
“Bad?”
“Pretty bad. I try to answer the phone, now.”
“Good girl.”
“She’s trying to be very brave about it, trying to go on as if everything was normal. I don’t know if that’s worse or better. Because she can’t. Things aren’t normal, and that’s all there is to it.”
“Going over there tomorrow?”
“Yes.”
I parked on a quiet residential block in Cambridge not far from the Cambridge City Hospital. It was a pleasant area of old frame houses and maple trees along the road. Brick-paved sidewalks; the | whole Cambridge bit. As I parked Hammond pulled up on his motorcycle.
Norton Francis Hammond III represents the hope of the medical profession. He doesn’t know it, and it’s just as well; if he did, he’d be insufferable. Hammond comes from San Francisco, from
what he calls “a long line of shipping.” He looks like a walking advertisement for the California life—tall, blond, tanned, and handsome. He is an excellent doctor, a second-year resident in medicine at the Mem, where he is considered so good that the staff overlooks things like his hair, which reaches almost to his shoulders, and his moustache, which is long, curling and flamboyant.
What is important about Hammond, and the few other young doctors like him, is that they are breaking old patterns without rebelling against the Establishment. Hammond is not trying to antagonize anyone with his hair, his habits, or his motorcycle; he simply doesn’t give a damn what the other doctors think of him. Because he takes this attitude, the other doctors cannot object—he does, after all, know his medicine. Though they find his appearance irritating, they have no ground for complaint.
So Hammond goes his way unmolested. And because he is a resident, he has a teaching function. He influences the younger men. And therein lies the hope of future medicine.
Since World War II, medicine has undergone great change, in two successive waves. The first was an outpouring of knowledge, techniques, and methods, beginning in the immediate postwar period. It was initiated by the introduction of antibiotics, continued with understanding of electrolyte balances, protein structure, and gene function. For the most part, these advances were scientific and technical, but they changed the face of medical practice drastically, until by 1965 three of the four most commonly prescribed drug classes—antibiotics, hormones (mostly The Pill), and tranquilizers—were all postwar innovations.1
The second wave was more recent and involved social, not technical, change. Social medicine, and socialized medicine, became real problems to be solved, like cancer and heart disease. Some of the older physicians regarded socialized medicine as a cancer in its own right, and some of the younger ones agreed. But it has become clear that, like it or not, doctors are going to have to produce better medical care for more people than they ever have before.
It is natural to expect innovation from the young, but in medicine this has not been easy, for the old doctors train the young ones, and too often the students become carbon copies of their teachers. Then, too, there is a kind of antagonism between generations in medicine, particularly now. The young men are better prepared than the old guard; they know more science, ask deeper questions, demand more complex answers. They are also, like young men everywhere, hustling for the older men’s jobs.