A Case of Need
by Michael Crichton
Summary
Karen Randall, seventeen, daughter of one of Boston medicine's dynastic families, bleeds to death after a botched abortion, and within hours the police have arrested Dr Art Lee, a Chinese American obstetrician who is, in fact, the city's discreet abortionist of choice, and who swears he turned Karen away. The year is 1968; abortion is a felony; and Lee's friend John Berry, a pathologist with no illusions about how Boston works, appoints himself investigator, because the system that is processing his friend has already decided what a Chinese abortionist is worth against a Randall.
The novel's authority is total immersion in the medical machine. Berry's investigation runs through autopsy suites, path labs, emergency rooms and hospital politics, footnoted, jargon glossed, procedure exact, the diagnosis of a crime conducted precisely like the diagnosis of a disease: the dead girl's tissue tells one story, her family tells another, and the gap between them widens through pharmacology reports and hostile interviews toward a solution running through the city's drug underworld and its desperate margins. Around the plot, delivered at thriller pace, stands the argument the book barely disguises: the abortion law as a machine for killing girls and selectively destroying doctors, prosecuted with the specific anger of someone watching it from inside the profession.
Around two hundred and forty pages including its appendices, which the author means you to read.
Best for readers who want the medical thriller at its moment of invention, and a procedural time capsule of American medicine five years before Roe.
Historical Context & Significance
A Case of Need won the Edgar for Best Novel in 1969, awarded to Jeffery Hudson, a pseudonym concealing a Harvard Medical School student named Michael Crichton, who was writing paperbacks to pay tuition and had reasons for cover: Crichton felt this more serious book needed a different name from his paperback thrillers. The name came from a seventeenth century court dwarf served to King Charles I in a pie.
Crichton graduated, never practised, and instead built the techno thriller: The Andromeda Strain the following year under his own name, then Westworld, Congo, Jurassic Park and the television series ER, all of it running on this book's formula of procedure rendered as suspense.
The 1972 film The Carey Treatment discarded most of the argument; the 1993 reissue under Crichton's name, against his loud objection, completed the pseudonym's unmasking.