A Brain

by Robin Cook

  Reynolds saw Philips and walked over. In his hand he held a large autopsy knife like a butcher knife. Martin glanced around the room to keep from looking at the procedure in front of him. The area resembled an operating room. It was new and modern and completely tiled so that it could be easily cleaned. There were five stainless steel tables. On the rear wall were a series of square refrigerator doors.

  “Greetings, Martin,” said Reynolds, wiping his hands on his apron. “I’m sorry about that Marino case. I would have liked to have helped you.”

  “I understand. Thanks for trying. Since there wasn’t going to be a post, I tried to run a CAT scan on the corpse. It was surprising. Do you know what I found?”

  Reynolds shook his head.

  “There was no brain,” said Philips. “Somebody removed the brain and sewed her back up so you practically couldn’t tell.”

  “No!”

  “Yeah,” said Philips.

  “God. Can you imagine what kind of blowup that could cause if the press got a hold of it, much less the family? They were definite about no autopsy.”

  “That’s why I wanted to talk to you,” said Philips.

  There was a pause.

  “Wait a minute,” said Reynolds. “You don’t think Pathology was involved.”

  “I don’t know,” admitted Philips.

  Reynolds’ face reddened, and veins appeared on his forehead. “Well I can assure you. The body never came up here. It went directly to the morgue.”

  “What about Neurosurgery?” asked Philips.

  “Well, Mannerheim’s boys are crazy, but I don’t think that crazy.”

  Martin shrugged, then told Reynolds the real reason he’d stopped by was to inquire about a patient by the name of Ellen McCarthy who’d arrived dead at the ER about two months previously. Philips wanted to know if she’d been autopsied.

  Reynolds snapped off his gloves and pushed his way through the doors into the main portion of the department. Using Pathology’s terminal for the main computer, he typed in Ellen McCarthy’s name and unit number. Immediately her name appeared on the computer screen followed by the date and number of the autopsy as well as cause of death: head injury resulting in massive intracerebral hemorrhage and brain-stem herniation. Reynolds quickly located a copy of the autopsy report and handed it to Philips.

  “Did you do the brain?” asked Philips.

  “Of course we did the brain!” said Reynolds. He grabbed back the report. “You think we wouldn’t do the brain on a head-injury case?” His eyes rapidly scanned the paper.

  Philips watched him. Reynolds had gained nearly fifty pounds since they’d been lab partners in med school and a fold of skin on the back of his neck concealed the top of his collar. His cheeks bulged out and just beneath the skin there was a fine network of tiny red capillaries.

  “She might have had a seizure before the auto accident,” said Reynolds, still reading.

  “How could that be determined?”

  “Her tongue had been bitten multiple times. It’s not certain, just presumptive . . .”

  Philips was impressed. He knew that such fine points were usually only picked up by forensic pathologists.

  “Here’s the brain section,” said Reynolds. “Massive hemorrhage. There is something interesting though. A section of the cortex of the temporal lobe showed isolated nerve-cell death. Very little glial reaction. No diagnosis was advanced.”

  “How about the occipital area?” asked Philips. “I saw some subtle X-ray abnormalities there.”

  “One slide taken,” said Reynolds, “and that was normal.”

  “Just one. Damn, I wish there had been more.”

  “You might be in luck. It indicates here the brain was fixed. Just a minute.”

  Reynolds walked over to a card catalogue and pulled out the M drawer. Philips felt some mild encouragement.

  “Well, it was fixed and saved but we don’t have it. Neurosurgery wanted it so I guess it’s up in the neurosurgical lab.”

  After stopping to watch Denise flawlessly and efficiently perform a single-vessel angiogram, Philips headed over to surgery. Dodging patient traffic in the holding area, he walked up to the OR desk.

  “I’m looking for Mannerheim,” said Philips to the blond nurse. “Any idea when he’ll be out of surgery?”

  “We know exactly.”

  “And what time will that be?”

  “Twenty minutes ago.” The other two nurses laughed. Apparently things were going smoothly in the OR for them to be in such good moods. “His residents are closing. Mannerheim’s in the lounge.”

  Philips found Mannerheim holding court. The two visiting Japanese doctors were standing on either side of him smiling and bowing at irregular intervals. There were five other surgeons in the group, all drinking coffee. Mannerheim was holding a cigarette in the same hand as his cup. He’d given up smoking a year ago, which meant he didn’t buy any cigarettes, but borrowed them from everybody else.

  “So you know what I told this smart-ass lawyer?” said Mannerheim, gesturing dramatically with his free hand. “Of course I play God. Who do you think my patients want screwing around inside their brains, a garbage man?”

  The group roared with approval, and then began to disperse. Martin approached Mannerheim and looked down on him.

  “Well, well, our helpful radiologist.”

  “We try to please,” said Philips pleasantly.

  “Well, I can tell you I did not appreciate your little joke on the phone yesterday.”

  “It wasn’t meant to be a joke,” said Philips, “I’m sorry that my comment seemed out of place. I didn’t know Marino was dead and I’d noticed some very subtle abnormalities on her film.”

  “You’re supposed to look at the X rays before the patient dies,” said Mannerheim nastily.

  “Look, what I’m interested in discussing is that Marino’s brain was removed from her corpse.”

  Mannerheim’s eyes bulged and his full face turned a dull red. Taking Philips by the arm he led him away from the two Japanese doctors.

  “Let me tell you something,” he snarled, “I happen to know that you moved and X-rayed Marino’s body last night without authorization. And I can tell you this, I don’t like anybody fucking around with my patients. Especially my complications.”

  “Listen,” said Martin, shaking his arm free from Mannerheim’s grasp. “My only interest is some strange X-ray abnormalities that could result in a major research breakthrough. I have no interest in your complications.”

  “You’d better not. If there was something irregular done to Lisa Marino’s body, it would be on your head. You’re the only one known to have taken the body from the morgue. Keep that in mind.” Mannerheim waved a threatening finger in Philips’ face.

  A sudden fear of professional vulnerability made Martin hesitate. As much as he hated to admit it, Mannerheim had a point. If it became known that Marino’s brain had been removed, the burden would be on him to prove that he didn’t do it. Denise, with whom he was having an affair, was his only witness.

  “All right, let’s forget Marino,” he said. “I found another patient with the same X-ray picture. An Ellen McCarthy. Unfortunately she’d been killed in an auto accident. But she was posted here at the Med Center and the brain was fixed and turned over to Neurosurgery. I would like to get ahold of that brain.”

  “And I’d like you to stay out of my hair. I’m a busy man. I’m taking care of real patients, not sitting on my ass looking at pictures all day.”

  Mannerheim turned and started away.

  Philips felt a surge of fury. He wanted to shout, “You arrogant provincial bastard.” But he didn’t. That was what Mannerheim expected, maybe even wanted. Instead Martin went for the surgeon’s known Achilles’ heel. In a calm, understanding voice Martin said: “Dr. Mannerheim, you need a psychiatrist.”

  Mannerheim whirled, ready for combat, but Philips was already out the door. To Mannerheim, psychiatry represented the absolute antithesis
of everything he stood for. For him it was a morass of hyperconceptual nonessence, and to be told he needed one was the worst insult he could absorb. In a blind rage the surgeon crashed through the door into the dressing area, tore off his bloodstained OR shoes and threw them the length of the room. They crashed into a bank of lockers and skidded under the sinks.

  Then he snatched the wall phone and made two loud phone calls. First he called the Director of the hospital, Stanley Drake, then he called the Chief of Radiology, Dr. Harold Goldblatt, insisting to each that he wanted something done about Martin Philips. Both men listened in silence: Mannerheim was a powerful individual within the hospital community.

  Philips was not the kind of person who got angry very often, but by the time he reached his office, he was steaming.

  Helen looked up when he appeared. “Remember you’ve got the medical-student lecture in fifteen minutes.”

  Philips mumbled under his breath as he walked by her. To his surprise Denise was sitting in front of his alternator studying McCarthy’s and Collins’ charts. She looked up when he came in. “How about a bite of lunch, old man?”

  “I don’t have time for lunch,” snapped Philips, throwing himself into his chair.

  “You’re in a wonderful mood.”

  Leaning his elbows on the desk, he covered his face with his hands. There was a moment of silence. Denise put the charts down and stood up.

  “I’m sorry,” said Martin through his fingers. “It’s been a trying morning. This hospital is capable of erecting unbelievable barriers to any enlightened inquiry. I might have stumbled onto an important radiological find, but the hospital seems determined to discourage me from looking into it.”

  “Hegel wrote: ‘Nothing great in the world has been accomplished without passion,’ ” Denise said with a twinkle. Her undergraduate major had been philosophy and she’d discovered that Martin enjoyed her ability to quote some of the great thinkers.

  Philips finally took his hands from his face and smiled. “I could have used a little more passion last night.”

  “Leave it to you to interpret the word in that context. That’s hardly what Hegel meant. Anyway, I’m going to have some lunch. You sure you can’t join me?”

  “Not a chance. I’ve got a lecture with the medical students.”

  Denise started toward the door. “By the way, as I was going through those charts of Collins and McCarthy I noticed both had several atypical Pap smears.” Denise paused at the door.

  “I thought their GYN exams were normal,” said Philips.

  “Everything was normal except the Pap smears on both patients. They were atypical, meaning they weren’t frankly pathological, just not perfectly normal.”

  “Is that uncommon?”

  “No, but it’s supposed to be followed up until the test is normal. I didn’t see any normal reports. Well, it’s probably nothing. Just thought I’d mention it. Bye!”

  Philips waved but stayed at his desk, trying to recall Lisa Marino’s chart. It seemed to him that he remembered the Pap smear being mentioned there as well. Leaning out into the hall, Philips caught Helen’s attention: “Remind me to head down to Gynecology Clinic this afternoon.”

  At 1:05 P.M., armed with his carousel labeled “CAT Scanner Introductory Lecture,” Philips entered the Walowski Memorial Conference room. It was a far cry from the rest of the Department of Radiology, which was utilitarian and crammed into inadequate space. The conference room was inordinately plush, looking more like a Hollywood screening room than a hospital auditorium. The chairs were upholstered with a soft corduroy and arranged in tiers, giving each an unobstructed view of the screen. When Philips entered, the room was already filled.

  He put his carousel on the projector and mounted the podium. The students quickly settled into their chairs, giving him their attention. Philips dimmed the lights and flipped on the first slide.

  The lecture was polished. Philips had given it many times. It began with the origin of the concept of the CAT scanner by Mr. Godfrey Hornsfield of England, followed by a chronological recounting of its development. Philips very carefully emphasized that although an X-ray tube was used, the picture that resulted was really a mathematical reconstruction after a computer had analyzed the information. Once the students understood that basic concept, he felt the major point of the lecture had been accomplished.

  As he talked, Martin’s mind began to wander. He was so familiar with the material that it made no difference. His admiration of the people who had developed the CAT scanner included a touch of jealousy. But then he realized that if his own research proved out, he was going to be catapulted into the scientific limelight. His work might have even a more revolutionary impact on diagnostic radiology. It would certainly put him in contention for a Nobel prize.

  In the middle of a sentence describing the CAT scanner’s ability to pick up tumors, Philips’ beeper went off. Turning up the lights, he excused himself and ran to the phone. Philips knew Helen would not page him except in an emergency. But the operator told him it was an outside call, and before he could protest, he was connected to Dr. Donald Travis.

  “Donald,” said Martin, putting his hand around the receiver. “I’m in the middle of a lecture, can I call you back?”

  “Hell no!” yelled Travis. “I’ve wasted a good portion of my morning looking for your mythical middle-of-the-night transfer.”

  “You can’t find Lynn Anne Lucas?”

  “No. In fact, there hasn’t been any God-damn transfer from the Med Center for the last week.”

  “That’s strange. I was distinctly told New York Medical Center. Look, I’ll speak to Admitting, but please check once more, it’s important.”

  Philips hung up the phone, but let his hand remain on the receiver for a moment. Dealing with bureaucracy was almost as bad as dealing with the likes of Mannerheim. Heading back to the podium, he tried to pick up the pieces of the lecture, but his concentration was completely broken. For the first time since he began teaching, he claimed a false emergency and wound up the lecture.

  Back at his office, Helen apologized for the interruption, saying that Dr. Travis was insistent. Philips told her it was all right and she followed him into his office reeling off his messages. She said that the Director of the hospital, Stanley Drake, had called twice and wanted a call back as soon as possible. She said that Dr. Robert McNeally had called from Houston, asking if Dr. Philips would chair the Neuroradiology section at the annual radiology convention in New Orleans. She said he needed an answer within the week. She started to go on to the next topic, when Philips abruptly raised his hand.

  “That’s enough for now!” said Philips.

  “But there’s more.”

  “I know there’s more. There’s always more.”

  Helen was taken aback. “Are you going to call Mr. Drake?”

  “No. You call him and tell him I’m too busy to call him today and I’ll speak to him tomorrow.”

  Helen had the sense enough to know when to leave her boss alone.

  Standing on the threshold of his office, Philips looked around the room. The mess made by the stacks of skull films had been removed and in their place were the morning’s angiograms. At least his head technician, Kenneth Robbins, had things under control.

  Work was Philips’ stability. So he sat down, picked up the microphone, and began to dictate. He had come to the last angiogram when he realized someone had entered the office and was standing behind him. Expecting Denise, Philips was surprised to look up into the smiling face of Stanley Drake, the Director of the hospital.

  To Philips’ way of thinking, Drake resembled a smooth, styled politician. He was always very natty in his dark blue pinstriped three-piece suit and gold watch chain. He wore his silk ties with a stud so they stood out horizontally from his starched white shirt. He was the only person Philips knew who still wore large French cuff links. Somehow he always managed to look tan, even during a rainy April in New York.

  Philips turned b
ack to his angiogram and continued dictating. “In conclusion, the patient has a large arteriovenous malformation of the left basal ganglia area supplied by the left middle cerebral and left posterior cerebral choroidal artery. Period. End of Dictation. Thank you.”

  Putting down the microphone, Martin turned to face the Director. It irked him that there was so little sense of privacy in the hospital that Drake would think nothing of just walking right into his office.

  “Dr. Philips, good to see you,” said Drake, smiling. “How’s the wife?”

  Philips looked at him for a moment, not sure whether to laugh or be angry. Finally he said evenly, “I got divorced four years ago.” He played it down the middle.

  Drake swallowed, his smile faltering for a moment. He switched the subject to how pleased the Board of Directors of the hospital had been with the smooth functioning of the Department of Neuroradiology since Philips’ appointment. Then there was a pause. Philips just watched. He knew why Drake was here and he wasn’t going to make it any easier for him.

  “Well,” said the administrator, assuming a more serious tone. His small mouth pulled together. “I’m here to discuss this unfortunate Marino situation.”

  “What’s that?” said Philips.

  “The fact that the poor girl’s body was irreverently handled and X-rayed without authorization of a post-mortem examination.”

  “And the brain was removed,” said Philips. “X-raying a body and removing a brain are not in the same category!”

  “Yes, of course. Now, whether you were involved in actually taking the brain is immaterial at this point. The point is . . .”

  “Wait a minute!” Philips sat up in his chair. “I want this perfectly clear. I X-rayed the body, that’s true. I did not remove the brain.”

  “Dr. Philips. I’m not concerned who removed the brain. I’m concerned about the fact that the brain was removed. It’s my responsibility at this point to protect the hospital and its staff from bad publicity and financial burden.”