by Robin Cook
Then Stevens started the lab work. He drew blood for routine chemistries, and Victor had several tubes iced and put aside for him to take back to Chimera. Afterward, VJ was subjected to both PET and NMR scanning.
The PET scanning involved injecting harmless radioactive substances which emitted positrons into VJ’s arm while his head was positioned inside a large doughnut-shaped apparatus. The positrons collided with electrons in VJ’s brain, releasing a burst of energy with each collision in the form of two gamma rays. Crystals in the PET scanner recorded the gamma rays, and a computer tracked the course of the radiation, creating an image.
For the second test, the NMR scanning, VJ was placed inside a six-foot-long cylinder surrounded by huge magnets supercooled with liquid helium. The resultant magnetic field, which was sixty thousand times greater than the earth’s magnetic field, aligned the nuclei of the hydrogen atoms in the water molecules of VJ’s body. When a radio wave of a specific frequency knocked these nuclei out of alignment, they sprang back, emitting a faint radio signal of their own which was picked up in radio sensors in the scanner and transformed by computer into an image.
When all the tests were done, Dr. Ruddock summoned Victor and Marsha back to his office. VJ was left outside in the waiting room. Victor was plainly nervous, crossing and uncrossing his legs and running his hand through his hair. Throughout the testing neither Dr. Stevens nor the technician made any comment. By the end, Victor was almost paralyzed with tension.
“Well,” Dr. Ruddock began, fingering some of the print-outs and images from the tests, “not all the results are back, specifically the blood work, but we do have several positive findings here.”
Marsha’s heart sank.
“Both the PET and the NMR scans are abnormal,” Dr. Ruddock explained. He held up one of the multicolored PET scan images with his left hand. In his right hand he held a Mont Blanc pen. Carefully pointing to different areas, he said, “There is a markedly elevated but diffuse uptake of glucose in the cerebral hemispheres.” He dropped the paper and picked up another colored image. “In this NMR scan we can see the ventricles quite clearly.”
With her heart pounding, Marsha leaned forward to get a better look.
“It’s quite obvious,” Dr. Ruddock continued, “that these ventricles are significantly smaller than normal.”
“What does this mean?” Marsha asked hesitantly.
Dr. Ruddock shrugged. “Probably nothing. The child’s neurological exam is entirely normal according to Dr. Stevens. And these findings, although interesting, most likely have no effect on function. The only thing I can think of is that if his brain is using that much glucose, maybe you should feed him candy whenever he’s doing much thinking.” Dr. Ruddock laughed heartily at his own attempt at humor.
For a moment both Victor and Marsha sat there numbly, trying to make the transition from the bad news they’d expected to the good news they’d received. Victor was the first to recover. “We’ll certainly take your advice,” he said with a chuckle. “Any candy in particular?”
Dr. Ruddock laughed anew, enjoying that his humor was so well received. “Peter Paul Mounds is the therapy I recommend!”
Marsha thanked the doctor and ran out the door. Catching VJ unaware, she had him in a bear hug before he could move away. “Everything is fine,” she whispered in his ear. “You’re okay.”
VJ extracted himself from her grasp. “I knew I was fine before we came. Can we go now?”
Victor tapped Marsha on the shoulder. “I’ve got some other business here and then I’ll go directly to work. I’ll see you at home, okay?” Victor said.
“We’ll have a special dinner,” Marsha said, turning back to VJ. “We can leave but you, young man, are not finished. We are going to my office. I have a few more tests for you.”
“Oh, Mom!” whined VJ.
Marsha smiled. He sounded just like any other ten-year-old.
“Humor your mother,” Victor said. “I’ll see you both later.” He gave Marsha a peck on the cheek and tousled VJ’s hair.
Victor crossed from the professional building to the hospital proper and took the elevator to Pathology. He found Dr. Burghofen’s office. The man’s secretary was nowhere to be seen so Victor looked inside. Burghofen was typing with his two index fingers. Victor knocked on the doorjamb.
“Come in, come in!” Burghofen said with a wave. He continued to peck at the typewriter for a few moments, then gave up. “I don’t know why I’m doing this except my secretary calls in sick every other day, and I’m constrained from firing her. Administering this department is going to be the death of me.”
Victor smiled, reminding himself to remember that academia had its own limitations the next time he got fed up with office problems at Chimera.
“I was wondering if you had finished the autopsies on the two children who died of cerebral edema,” Victor said.
Dr. Burghofen scanned the surface of his cluttered desk. “Where’s that clipboard?” he asked rhetorically. He spun around in his chair, finding what he was searching for on the shelf directly behind him. “Let’s see,” he said, flipping over the pages. “Here we are: Maurice Hobbs and Mark Murray. Are those the ones?”
“Yup,” Victor said.
“They were assigned to Dr. Shryack. He’s probably doing them now.”
“All right if I go look?” asked Victor.
“Suit yourself,” he said, checking the clipboard. “It’s amphitheater three.” Then as Victor was about to leave, he asked, “You did say you were a medical doctor, didn’t you?”
Victor nodded.
“Enjoy yourself,” Dr. Burghofen said, returning to the typewriter.
The pathology department, like the rest of the hospital, was new, with state-of-the-art equipment. Everything was steel, glass or Formica.
The four autopsy rooms looked like operating rooms. Only one was in use and Victor went directly inside. The autopsy table was shining stainless steel, as were the other implements in sight. Two men standing on either side of the table looked up as Victor entered. In front of them was a young child whose body was splayed open like a gutted fish. Behind them on a gurney was the small, covered body of another.
Victor shuddered. It had been a long time since he’d seen an autopsy and he’d forgotten the impact. Particularly when viewing a child.
“Can we help you?” the doctor on the right asked. He was masked like a surgeon, but instead of a gown, he wore a rubberized apron.
“I’m Dr. Frank,” Victor said, struggling to suppress nausea. Besides the visual assault, there was the fetid odor that even the room’s modern air conditioning could not handle. “I’m interested in the Hobbs baby and the Murray baby. Dr. Burghofen sent me down.”
“You can watch over here if you like,” the pathologist said, motioning Victor over with his scalpel.
Tentatively, Victor advanced into the room. He tried not to look at the tiny eviscerated body.
“Are you Dr. Shryack?” asked Victor.
“That’s me.” The pathologist had a pleasant, youthful voice and bright eyes. “And this is Samuel Harkinson,” he said, introducing his assistant. “These children your patients?”
“Not really,” Victor said. “But I’m terribly interested in the cause of their deaths.”
“Join the group,” Dr. Shryack said. “Strange story! Come over here and look at this brain.”
Victor swallowed. The child’s scalp had been cut and pulled down over the face. Then the skull had been sawed around the circumference of the head, and the crown lifted off. Victor found himself looking at the child’s brain, which had risen out of its confinement, giving the child the appearance of some sort of alien being. Most of the gyri of the cerebral cortices had been flattened where they had pressed against the inside of the skull.
“This has to be the worst case of cerebral edema I’ve ever seen,” Dr. Shryack said. “It makes getting the brain out a chore and a half. Took me half an hour with the other one.” He pointe
d toward the shrouded body.
“Till you figured out how to do it,” Harkinson said with a faint Cockney accent.
“Right you are, Samuel.”
With Harkinson holding the head and pushing the swollen brain to the side, Dr. Shryack was able to get his knife between the brain and the base of the skull to cut the upper part of the spinal cord.
Then, with a dull, ripping sound, the brain pulled free. Harkinson cut the cranial nerves, and Dr. Shryack quickly hoisted the brain and placed it in the pan of the overhead scale. The pointer swung wildly back and forth, then settled on 3.2.
“It’s a full pound more than normal,” Dr. Shryack said, scooping the brain back up with his gloved hands and carrying it over to a sink that had continuous running water. He rinsed the clotted blood and other debris from the brain, then put it on a wooden chopping block.
With experienced hands, Dr. Shryack carefully examined the brain for gross pathology. “Other than its size, it looks normal.”
He selected a carving knife from a group in a drawer, and began slicing off half-inch sections. “No hemorrhage, no tumors, no infection. The NMR scanner was right again.”
“I was wondering if I could ask a favor,” Victor said. “Would it be at all possible for me to take a sample back to my own lab to have it processed?”
Dr. Shryack shrugged. “I suppose, but I wouldn’t want it to become common knowledge. It would be a great thing to get into the Boston Globe that we’re giving out brain tissue. I wonder what that would do to our autopsy percentage?”
“I won’t tell a soul.”
“You want this case, which I think is the Hobbs kid, or do you want the other one?” Dr. Shryack asked.
“Both, if you wouldn’t mind.”
“I suppose giving you two specimens is no different than giving you one,” said Dr. Shryack.
“Have you done the gross on the internal organs yet?” asked Victor.
“Not yet,” Shryack said. “That’s next on the agenda. Want to watch?”
Victor shrugged. “Why not. I’m here.”
VJ was even less communicative on the ride back to Lawrence than he’d been on the ride into Boston that morning. He was obviously mad about the whole situation, and Marsha wondered if he would be cooperative enough to make psychological testing worthwhile.
She parked across from her office. They waited for the elevator even though they were going up only one floor because the stairwell door was locked from the inside. “I know you’re angry,” Marsha said. “But I do want you to take some psychological tests, yet it’s not worth your time or Jean’s unless you cooperate. Do I make myself clear?”
“Perfectly,” VJ said crisply, fixing Marsha with his dazzlingly blue eyes.
“Well, will you cooperate?” she asked as the elevator doors opened.
VJ nodded coldly.
Jean was overjoyed to see them. She’d had a terrible time juggling Marsha’s patients, but she’d managed in her usual efficient way.
As for VJ, she was really happy to see him, even though he greeted her without much enthusiasm, then excused himself to use the bathroom.
“He’s a bit out of sorts,” Marsha explained. She went on to tell Jean about the neuro work-up and her desire to have him take their basic battery of psychological tests.
“It will be hard for me to do it today,” Jean said. “With you out all morning the phone has been ringing off the hook.”
“Let the service handle the phone,” Marsha advised. “It’s important I get VJ tested.”
Jean nodded and immediately began getting out the forms and preparing their computer to grade and correlate the results.
When VJ returned from the bathroom, Jean had him sit right down at the keyboard. Since he was familiar with some of the tests, she asked him which kind he wanted to take first.
“Let’s start with the intelligence tests,” VJ said agreeably.
For the next hour and a half, Jean administered the WAIS-R intelligence test, which included six verbal and five performance subtests. From her experience she knew that VJ was doing well, but nowhere near what he’d done seven years previously. She also noted that VJ tended to hesitate before he answered a question or performed a task. It was like he wanted to be doubly sure of his choice.
“Very good!” Jean said when they’d reached the completion. “Now how about the personality test?”
“Is that the MMPI?” VJ asked. “Or the MCMI?”
“I’m impressed,” Jean said. “Sounds like you have been doing a little reading.”
“It’s easy when one of your parents is a psychiatrist,” VJ said.
“We use both, but let’s start with the MMPI,” Jean said. “You don’t need me for this. It’s all multiple choice. If you have any problems, just yell.”
Jean left VJ in the testing room, and went back to the reception desk. She called the service and got the pile of messages that had accumulated. She attended to the ones that she could and when Marsha’s patient left, gave her the messages she had to handle herself.
“How’s VJ doing?” Marsha asked.
“Couldn’t be better,” Jean reported.
“He’s being cooperative?” Marsha asked.
“Like a lamb,” Jean said. “In fact, he seems to be enjoying himself.”
Marsha shook her head in amazement. “Must be you. He was in an awful mood with me.”
Jean took it as a compliment. “He’s had a WAIS-R and he’s in the middle of an MMPI. What other tests do you want? A Rorschach and a Thematic Apperception Test or what?”
Marsha chewed on her thumbnail for a moment, thinking. “Why don’t we do that TAT and let the Rorschach go for now. We can always do it later.”
“I’ll be happy to do both,” Jean said.
“Let’s just do the TAT,” Marsha said as she picked up the next chart. “VJ’s in a good mood but why push it? Besides, it might be interesting to cross check the TAT and the Rorschach if they are taken on different days.” She called the patient whose chart she was holding and disappeared for another session.
After Jean finished as much paperwork as she could, she returned to the testing room. VJ was absorbed in the personality test.
“Any problems?” Jean asked.
“Some of these questions are too much,” VJ said with a laugh. “A couple of them have no appropriate answers.”
“The idea is to select the best one possible,” Jean said.
“I know,” VJ said. “That’s what I’m doing.”
At noon, they broke for lunch and walked to the hospital. They ate in the coffee shop. Marsha and Jean had tuna salad sandwiches while VJ had a hamburger and a shake. Marsha noted with contentment that VJ’s attitude had indeed changed. She began to think she had worried for nothing; the tests he was taking would probably result in a healthy psychological portrait. She was dying to ask Jean about the results so far, but she knew she couldn’t in front of VJ. Within thirty minutes they were all back at their respective tasks.
An hour later, Jean put the phone back on service and returned to the testing room. Just as she closed the door behind her, VJ spoke up: “There,” he said, clicking the last question. “All done.”
“Very good,” Jean said, impressed. VJ had gone through the five hundred and fifty questions in half the usual time. “Would you like to rest before the next test?” she asked.
“Let’s get it over with,” VJ said.
For ninety minutes, Jean showed the TAT cards to VJ. Each contained a black and white picture of people in circumstances that elicited responses having psychological overtones. VJ was asked to describe what he thought was going on in each picture and how the people felt. The idea was for VJ to project his fantasies, feelings, patterns of relationships, needs, and conflicts.
With some patients the TAT was no easy test to administer. But with VJ, Jean found herself enjoying the process. The boy had no trouble coming up with interesting explanations and his responses were both logical and normal
. By the end of the test Jean felt that VJ was emotionally stable, well adjusted, and mature for his age.
When Marsha was finished with her last patient, Jean went into the office and gave her the computer print-outs. The MMPI would be sent off to be evaluated by a program with a larger data base, but their PC gave them an initial report.
Marsha glanced through the papers, as Jean gave her own positive clinical impression. “I think he is a model child. I truly can’t see how you can be concerned about him.”
“That’s reassuring,” Marsha said, studying the IQ test results. The overall score was 128. That was only a two-point variation from the last time that Marsha had had VJ tested several years previously. So VJ’s IQ had not changed, and it was a good, solid, healthy score, certainly well above average. But there was one discrepancy that bothered Marsha: a fifteen-point difference between the verbal and the performance IQ, with the verbal lower than the performance, which suggested a cognitive problem relating to language disabilities. Given VJ’s facility in French, it didn’t seem to make sense.
“I noticed that,” Jean said when Marsha queried it, “but since the overall score was so good I didn’t give it much significance. Do you?”
“I don’t know,” Marsha said. “I don’t think I’ve ever seen a result like this before. Oh well, let’s go on to the MMPI.”
Marsha put the personality inventory results in front of her. The first part was called the validity scales. Again something immediately aroused her attention. The F and K scales were mildly elevated and at the upper limit of what would be considered normal. Marsha pointed that out to Jean as well.
“But they are in the normal range,” Jean insisted.
“True,” Marsha said, “but you have to remember that all this is relative. Why would VJ’s validity scales be nearly abnormal?”
“He did the test quickly,” Jean said. “Maybe he got a little careless.”
“VJ is never careless,” Marsha said. “Well, I can’t explain this, but let’s go on.”