A Case of Need

All heart surgeons are bastards, and Conway is no exception. [1]

A novel starting like this cannot be all bad and should probably be read by “all heart surgeons.” It depicts one week in a major Boston hospital in 1968 when, in cardiac surgery, death on the table “happened a lot: fifteen percent for most surgeons, eight percent for a man like Conway”—a perfect setting to obscure criminal deeds. The author knew the inside well: he went to Harvard Medical School and obtained an MD there in 1969. By that time he had become rather disillusioned by the circumstances, both in reputable teaching institutions as well as in the infamous Boston City Hospital. Fortunately, he had also gained experience as a writer under the pseudonyms John Lange and later Jeffery (sic!) Hudson, the latter apparently borrowed from Sir Jeffrey (sic!) Hudson, a dwarf at the court of England in the 17th-century, he himself being 6 ft 9 in, or 206 cm, tall. The only Hudson novel, featured here, had the title “A Case of Need” and earned its author an Edgar Award by the Mystery Writers of America in 1969. It also for the first time showed a characteristic that should make its creator world famous very soon: the detailed description of technologies and scientific (here: medical) practice as a crucial part of the plot.

His next work, “The Andromeda Strain,” became a bestseller and was finally published under his real name: Michael Crichton. From there, the success story never stopped, probably culminating in the Jurassic Park series in the 1990s. But the daily life of American doctors was not forgotten, leading to another evergreen: “ER” (Emergency Room), a medical drama TV series, eventually totaling 331 episodes over 15 seasons. Michael Crichton died from lymphoma in 2008, aged 66.

Let us have a closer look at what he had to say about cardiac surgery in 1968.

“In their gowns and masks, they all looked the same, impersonal, interchangeable. That was not true of course. One of those four men had responsibility for everything, for the contact of all sixteen workers present. And responsibility for the seventeenth person in that room: the man whose heart was stopped.” This brief characterization, still valid after five decades, neatly summarizes the emotional burden our profession has to bear on a daily basis. Crichton uses it to explain and at the same time to partly exculpate the personal oddities every so often displayed by its members—see the “bastard” above.

“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.”

Crichton was 26 when he wrote this book. It already exemplifies his gift of storytelling and plausibly explaining complicated facts and complex correlations. Still in training, he realized that education itself was part of the problem, if you want to call it a problem:

“It takes 13 years from the time you leave college to the time you become a cardiac surgeon. 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.”

Two statements most of us will be readily able to identify with. While undoubtedly true, they reflect the importance of motivating the young, starting with students and residents like Michael, before they become overwhelmed by an at times hostile, not-strictly-medical environment crushing their dreams.

Although cardiac surgery has dramatically evolved into a high-tech specialty, enabling surgeons to perform overly complex procedures at a comparatively low risk, the major undisputable indicator for success or failure has remained: death of the patient. This is a burden not many professions have to cope with so directly, and it is only logical that you have to possess and/or develop strategies to protect your own mental well-being. No matter how successful you may be at this, please consider one more quote from A Case of Need:

“In a sense that is a part of the training: surgeons are lonely men.”

Publication History

Article published online:
13 February 2025

• Reference

• 1 Hudson J. A Case of Need. Signet, a division of Penguin Books; United States: 1969