A CASE OF NEED by Michael Crichton

Michael Crichton was a writer who knew how to write, and what he chose to write seemingly meant something to him.  His later novels tended to deal with science, technology and ethics, and his early works—particularly the novels written “as by”—dealt with both youth and culture in a strikingly simple and meaningful manner.  His 1968 novel A Case of Need written as by Jeffery Hudson is not only the best of his early works, but it is also arguably his best novel.

John Berry is a pathologist at a Boston hospital and the novel opens with a heart surgeon ranting about losing a patient on the table.  Berry doesn’t pay much attention because this is how the surgeon deals with the stress and anger of a lost patient.  The rant, like everything in the novel, has the subtle feel of reality and prepares the scene for the main crux of the novel: an abortion gone wrong.  A procedure that was illegal when the novel was published and no less controversial than it is today.

Dr. Art Lee is an OBGYN and an abortionist.  He is also one of John Berry’s best friends.  When a young woman dies in an ER hemorrhaging from a botched abortion, Dr. Lee is the primary suspect.  This sets the novel in motion—John Berry is certain his friend didn’t perform the procedure and he wants to clear Dr. Lee’s name, but his motives become less clear as the novel unravels.

A Case of Need is a crossroads novel between Mr Crichton’s early pulp adventure novels and his larger, more complex modern novels.  It is something like a DMZ between the John Lange thrillers and The Andromeda Strain.  It features many of the hallmarks of his later works, particularly cultural and medical ethics, but it is wrapped in a damn terrific mystery.  It won an Edgar in 1969 for best novel and it represents Crichton’s talent at its highest.

What truly separates A Case of Need from the herd is its setting, theme and dialogue.  The setting is the world of medicine.  It clearly focuses the reader’s attention on not only what it is like, or was like, to be a work-a-day physician, but it also thematically explores the ethical decisions that lurk in the industry.  It gives a murky representation of abortion and its relation to both physicians who perform the procedure and those who do not. And the dialogue is vintage Crichton; it moves the story forward in quick and linear fashion.

There really isn’t anything about the novel that is weak or underdeveloped.  The prose is strong and vivid—

“All heart surgeons are bastards, and Conway is no exception. He came storming into the path lab at 8:30 in the morning, still wearing his green surgical gown and cap, and he was furious.”

The mystery is plotted perfectly and the suspense is built as well as any novel I have read.  It begins with what appears to be a moment of subterfuge—the angry heart surgeon—but ties the seemingly out-of-place opening scene perfectly into the theme of the story; the imperfect surgeon struggling with his own limitations and balancing the imperfections of society with the needs and demands of his patients.

A Case of Need is a terrific novel that is as relevant and entertaining today as it was forty years ago.  In a sense it is very much a novel of its time, but it also has a timeless quality in that the questions it never quite answers will continue to debated generations from now.  And it very well may be the evidence we need to prove Michael Crichton was from another world.  He really was that good, and this novel proves it.