One issue ignored by medicine in my student days was the problem of abortion, which was then for the most part illegal in the United States. A million American women flew out of the country every year to have an elective abortion. Those who could not afford the plane fare often showed up, septic and bleeding, in hospital emergency rooms. There were abortionists in every city, back-room mills, and whispered addresses passed to frightened women in need of the tawdry, dangerous industry which the medical profession pretended did not exist.
I remember asking a senior physician why the profession did not address the inequities and health hazards of the present situation.
“Abortion is illegal,” he replied.
“I know,” I said. “It’s also medically dangerous and unfair.”
“But it’s illegal,” he said, as if that was all there was to say about it.
I felt there was more to say, and I devised a story that would talk about my concerns. I wrote A Case of Need in ten days during spring break. I sent it to my publisher, and received in reply the call I had been dreading for so long.
“We like it,” my editor said, “but we want some revisions.”
“Oh no,” I groaned.
“You don’t understand,” he said. “This is good news. We want to publish this book in hard cover. But we think it needs some revision first.”
“No,” I said. “Let’s just publish it in paperback, the way we always do.”
There was a puzzled silence. “Usually authors want their book published in hard cover,” he said.
“I don’t,” I said. “And I don’t want to revise it. I’m in school. I have no time.”
But in the end, he talked me into rewriting the novel during the summer, and A Case of Need was published the following year, in 1968.