“I wouldn’t exactly call it that, but control is tied to purse strings. I felt the same way at first, but I spent all of last year working in Balassi’s laboratory, innumerable hours here working with the PET scanner. I was never aware of any attempt on the part of PETronics to control the basic research that was taking place. Dr. Balassi says they’re the ideal silent partner.
“I know it’s hard to believe, but they built this building, donated this state-of-the-art PET scanner, and gave Dr. Balassi, the world pioneer in PET scan research, total freedom to run the program as he sees fit. No more mountains of paperwork, grant applications to the National Institutes of Health, or competition for scant research dollars in Washington. Life’s a tradeoff. So is medicine these days.”
“Maybe,” Karen said. But it just doesn’t feel right. The same way free black bags and stethoscopes from the drug companies didn’t feel right when I graduated medical school. I donated mine to the Nicaraguan Red Cross.”
The lighted “Do Not Enter” sign extinguished.
“So did I.” Geoff smiled. “Let’s go in.” Slowly he opened the oversized door and entered the imaging room, Karen following behind.
A waft of cool air swept over them as the heavy door clicked shut securely behind them, locking out the mustiness of the basement corridor. Their eyes adapted to the change in luminosity, the only light provided by the auxiliary controls on the PET scanner and two dimmed, overhead LED fixtures.
The room was about twenty-five by thirty feet, roughly the same size as the usual CT scan suite. There was nothing conspicuously unique about the place. It could have been, except for the size, any imaging room in any medical center in any city in America. But of course, it was anything but that.
The PET scanner was located at the far end of the room, a white metallic, box-like structure extending from the floor to just below the ceiling, with a central opening large enough to allow entry of any body part to be imaged, the patient being positioned on a retractable exam table. Massive cables surrounded by specially insulated ducting extended from the unit to the ceiling, all wires converging in the complex computer that choreographed the examination and processed the images.
The most unusual aspect of the suite was in what went unseen to the casual observer. Though the PET scanner was the most obvious and most talked-about piece of hardware, the adjacent room housed the cyclotron, a particle accelerator necessary to produce the radioactive compound used in each PET scan study, its close proximity dictated by the short half-life of the materials. A sixteen-ton, Rube Goldberg-like device composed of huge magnetic coils, stainless steel cylinders, vacuum chambers, hoses, and thousands of feet of tubing all surrounded by vast, retractable lead-shielded walls, the cyclotron provided the lifeblood of the PET scan. Like a mad scientist’s garage creation, it was an engineering marvel constructed for the essential function it performed, without regard to form or aesthetics.
The room was deserted, which surprised Geoff given the “Do Not Enter” sign had been turned off just moments ago. No patient, no tech, not even a sign that a scan had recently been performed. Where did everybody go?
Over the quiet hum of the nearby scanner’s cooling system, Geoff could make out the muted voice of a technician in the control room beyond the Plexiglas enclosure.
“Let’s go let the tech know we’re here,” Geoff said, feeling reassured.
Geoff rounded the corner of the Plexiglas partition and was surprised to discover two techs instead of one in the control room. Only one was not a tech. Seated behind the master imaging computer console, frenetically typing in commands, was Dr. Josef Balassi. The brightly colored images on the screen cast a peculiar vermillion hue across his full-bearded face, setting his normally intense, close-set, brown eyes afire. His collar-length, grey hair danced to the symphony of the flickering light of the CRT. Twenty Thousand Leagues Under the Sea, Captain Nemo at the keyboard. He was totally immersed in studying the three dimensional images of the brain appearing on the screen.
“Great images, Walter!” said Balassi in his thick Slavic accent. “The new C-11 isotope compound is labeling the brain just where I thought it would.” Balassi hit the table with his fist triumphantly, nodded his head in self-approval.
Intensely loyal to Balassi, whether out of admiration or fear Geoff didn’t know, Walter Krenholz, the archetypal worker bee smiled his mortician’s smile. “Looks like we have company,” he droned, acknowledging Geoff’s presence at the station.
Balassi hit the enter key, instantaneously storing the data and clearing the screen, then looked up, and recognizing the doctor standing at the console, offered a smile.
“Geoffrey, you’ve only been out of the lab one week, and already the monkeys and I miss you dearly!” He stood up and grabbed Geoff’s hand, shaking it firmly. Things going okay?”
“It’s been interesting. We’ve got a couple of tragic cases in the NSICU.”
“You mean that poor little girl injured at the zoo?” Balassi pursed his lips, nodded his head side to the side.
“She’s one of them. The other one’s the cop whose PET scan I thought you’d still be doing.” Geoff looked around for his patient, puzzled about where he was. It wasn’t that easy to move such a severely injured patient on and off the scanning table. “Where is he?”
“You just missed him. We completed his scan moments before you arrived, Geoff.” Balassi shot a glance at Walter. “He must be in the service elevator by now.”
Walter nodded affirmatively as he busied about the scanner getting it ready for the next study.
“Were there two residents with him?” Geoff felt uneasy, not knowing his patient’s status after the precarious trip from the NSICU and the physical stress of the scan.
“Two or three, I’m not really sure. One had a beard, though, if that helps. What happened to the poor man?” Balassi asked.
“Must be Phelps.”
“What?”
“Brian Phelps, the new resident. He was the one with the patient,” said Geoff.
“A new resident. I understand your concern. If it’s of any reassurance coming from a simple scientist, your patient seemed stable during his scan. I’m sure he’ll be all right. What happened to him?”
“A transit cop, attacked in the 168th Street subway station. Basal skull fracture on MRI. He’s in a bad way.”
“Packs of wolves roaming the subways. I stay out of them whenever I can, and so should everyone else.” Balassi shook his head, stroked his beard. “How’s the little girl doing?”
“Holding her own so far, coming out of her coma. I haven’t seen her admission PET scan yet, but I was told she graded two out of five on the endorphin-coma scale.”
“Actually, I haven’t had a chance to review it yet, either. I’ll have Walter dig it up before you leave,” Balassi said. “Let’s review the study on the last patient, Smithers. Looks like the computer just finished processing the images.” He entered a command on the keyboard, stared at the screen. Balassi looked up at Karen Choy, and as if suddenly aware of her presence, stood and seized her hand. “You must be one of the new residents, as well. A very beautiful one.”
“Dr. Balassi,” Karen said, blushing. “It’s an honor to meet you. I’m Karen Choy.”
Balassi smiled. Fifty-eight, divorced twice, now a sworn bachelor, he had an uncanny ability to engage any woman in his presence regardless of her station or marital status. “Beautiful hands, the hands of a fine surgeon, I’m sure, Dr. Choy.”
Karen awkwardly withdrew her hand. “Thank you.”
Balassi motioned towards the work station. “Come in, both of you. Sit down. Let’s look at the results.”
Balassi’s large right hand enveloped the mouse and began clicking a series of commands to the computer, dramatically altering the fuzzy, two-dimensional images that appeared on the scr
een. A Technicolor, three-dimensional reconstruction of the brain appeared, rotating slowly on its axis, all of its convolutions and fissures in full, finely detailed view.
More than an anatomical study, what was being displayed on the screen was a dynamic, physiological blueprint of the endorphin distribution in the brain, all of the inner workings of the mind potentially visualized on a computer screen, specific patterns and neural pathways mapped out in intricate detail like a genetic map of the human chromosome.
The rotation ceased at a view from above, looking down on the major lobes of the brain, frontal and parietal, separated by a central fissure. Click-click. A fine slice through the brain’s lower regions appeared, bringing the temporal lobes and limbic region—the deep-seated areas responsible for memory and emotion—onto the screen. Central areas of searing vermilion were enveloped by regions of yellow, emerald, and a deep, royal blue, a psychedelic map of the brain’s endorphin receptors.
Click-click. The brilliantly colored patterns dissolved, and a new image emerged, a large central blotch of orange-red, the brainstem, a more primitive area of the brain, responsible for controlling bodily functions, breathing and heart rate. Click-click-click. The central image magnified, honed in on the reticular formation, the gatekeeper of the brain’s conscious awareness, burning red on the CRT, its neuronal endings saturated with beta-endorphins.
“Well, that explains his coma,” said Geoff, pointing out the high concentration of endorphin receptors in the patient’s reticular formation. “Can you quantify it?”
Balassi answered the question with a click, positioning the cross hairs on the center of the hot spot on the screen by manipulating the mouse. Numbers appeared above the image corresponding to the color-hue scale at the top of the screen. Blue areas contained the smallest concentration of receptors, red the largest.
“Fifty picomoles per gram, about two-and-a-half times the normal density of endorphin receptors,” Balassi said matter-of-factly.
“That places him somewhere in the middle on the endorphin coma scale, about a three out of five, I’d say. Prognosis for coming out of his coma, fair,” Geoff said.
Balassi nodded affirmatively, manipulating the mouse and reducing the image magnification to review the slices higher in the brain at the level of the temporal lobe.
“What do those hot spots correspond to?” Karen asked, pointing to two faintly red, almond-shaped islands in a sea of chartreuse surrounding the central red of the brainstem.
“The amygdala, the area of the brain thought to be responsible for rage and fear. It probably contains the highest concentration of endorphins in the brain of a normal subject. But as you can see in our comatose patient, it seems faint relative to the sky high endorphin levels in his reticular formation, the endorphins suppressing his consciousness much the way a drug addict overdosed on morphine or heroine would be comatose. Morphine, heroine, and most narcotics bind to pretty much the same endorphin receptors, except, interestingly, PCP or angel dust, which binds to a class of newly discovered sigma endorphin receptors,” Geoff said.
“And the yellow-green area surrounding the amygdala? That indicates a moderate level of endorphin activity?”
“You’re catching on, Karen.” Geoff smiled. “That area is the limbic region, seat of our moods and emotions. The shrinks love to talk about this part of the brain. His limbic endorphin level appears normal. Good thing. The last thing you’d want out on the street is a schizophrenic cop.
“I’ll try and dig up a recent scan of one of the psych patients. The pattern’s completely different. The limbic area glows like a forest fire, and the reticular formation is blue as the ocean, just the opposite of what we see here. Looks kind of like a bright red horseshoe. Once you’ve seen the pattern, you won’t forget it,” Balassi said.
Geoff hadn’t been able to get that horseshoe out of his mind. He had to check for Romero’s scan before he left neuroimaging.
“Easy for you to say. Could just as well be psychedelic photos of the Beatles on the cover of Life to me. It all looks so foreign,” Karen said, shaking her head.
“Interesting scan, Geoff. Good case,” said Balassi. He turned to face Geoff. “Be sure to let me know how he does clinically so we can correlate the PET findings. Let’s be sure we keep within the project’s protocol.”
“Will do,” Geoff said. “You said you wanted to review the scan on the girl. There’s another scan I wanted to check for, also, a patient we scanned several months ago.”
Balassi raised his brow. “Oh?”
“His name is Jesus Romero. Ironically, he’s the crazy guy who held the girl hostage at the zoo. I tried to pull his scan up on the Neurad system from a terminal in the NSICU, but the system couldn’t find his record.”
“Why the interest in this Romero, Geoff?”
“Academic interest. That’s all.”
Balassi stroked his beard, hit the intercom button. “Walter, we need your assistance here.”
Seconds later, Walter Krenholz entered the control room. “Yes, Dr. Balassi,” he said, his face an expressionless mask.
“I need you to check the file room for two PET scans. One on Jessica Humphries, the other on a fellow named Romero, Jessie Romero.”
“Jesus is the first name,” said Geoff.
“Sorry. Jesus Romero.”
Bald as a cue ball, Walter’s deep-set, blue eyes appeared deeper still due to the dark circles below them. Sullen and seemingly devoid of personality, not many people at the NYTC, even those who worked directly with him day to day—as Geoff had for a year—knew much about Walter. Except of course, Balassi. The two had worked together for the last twenty years, Walter having accompanied him to the NYTC from the National Institutes of Health.
Walter nodded and left the control room.
“You know, Geoff, the Neurad system hasn’t crashed once yet. If it doesn’t show a scan on Romero, one was probably never done. You must be confusing him with someone else,” Balassi said. “But, if you like, I’ll try a search myself.”
Geoff shrugged his shoulders. “Sure.”
Balassi typed in a command to search for a scan on Jesus Romero. No image. No file. No such patient existed in the system. “Well, let’s see what Walter comes up with. If anyone can dig it up, he can.”
Their conversation was interrupted by Walter, who returned from the file room.
“I checked the files and the log books. There are no records of any scans on a Jesus Romero. The girl’s scan was signed out earlier today,” Walter said.
“Signed out?” Balassi asked. His face reddened, his gaze narrowed. “No one signs out a PET scan from here before I have a chance to review it! No one! Who signed that out?”
“Dr. Kapinsky,” said Walter.
“Who the hell does he think he is?” raged Balassi. His fist crashed down on the table, launching pencils into the air like aborted ballistic missiles. Walter scampered to pick them up and return them to their proper place.
“We have rules down here for a reason. If we let just anyone sign out an unread scan, they’d be all over this medical center! Besides, he doesn’t even know what he’s looking at.”
“Not that I’m defending his action, but we had a discussion about her scan on rounds this morning, and he probably wanted to review it himself. Maybe he’s becoming a believer,” said Geoff.
“Whatever the reason, his behavior is inexcusable. When you get up to the ICU, tell him I want that scan returned to me here—personally—or Pederson will hear about it!”
“I’ll take care of it,” Geoff said.
Balassi turned and headed out the door, leaving a gust of air in his wake. Walter Krenholz followed behind him.
Geoff was surprised by Balassi’s sudden outburst over the girl’s missing scan. It didn’t seem like a big deal to Geoff, but Balas
si was a perfectionist. After a year in Balassi’s lab, Geoff was used to that side of him and knew how to handle his sporadic outbursts.
Geoff was more puzzled by the lack of a record of any kind on Romero. He was sure Romero had had a scan just months ago. Damn the Neurad system. He’d check the medical record file room himself.
A shrill, beeping tone pierced the air. The alarm stopped, and a voice boomed from the overhead speaker. “Code 999, seven east, code 999 seven east!”
Geoff startled, sprang from the chair. He looked up at the speaker on the ceiling, waited for the “all clear” signal. Must be a drill. The alarm resumed, followed again by the urgent page. “Code 999, seven east, code 999.”
“Shit. Let’s go, Karen!” He grabbed her arm, pulled her up from the chair.
“What’s a code 999?”
“Disaster code. This is no drill.”
Chapter 11
Geoff dashed out of the elevator followed by Karen Choy and a cadre of residents and technicians. He raced down the hall toward the mob of people congregated at the nursing station on seven east, pushed his way through until he ran into a wall of security guards. A woman’s scream echoed from a distance, penetrated the babble of confusion at the nursing station, but Geoff could not make out her words.
Geoff turned to Gail Ross, the head nurse, who stood at the nursing station, anxiously biting her lower lip. “What the hell’s going on?”
“I can’t believe this is happening.” Gail nodded her head in denial.
Geoff grabbed her by the shoulders. “What’s happening, Gail? Tell me.”
“A patient flipped out and is holding one of the nurses hostage in his room. I was just in there half an hour ago to give him his meds. He seemed okay, just a little anxious. Nothing unusual, at least for a head trauma patient.”
The Endorphin Conspiracy Page 8