Brain

by Robin Cook

  Somewhat mollified, she said, “I’ll just run and shower. I’ll be back in thirty minutes.”

  Philips watched Denise leave, then spun to his viewing screen. In the process his eyes swept over his desk and noted something new in the chaos. Walking over he found two hospital charts and a note from Randy. The note merely told him that the rest of the X rays would be pulled the following evening. The charts were those of Katherine Collins and Ellen McCarthy.

  Philips carried them over to the chair in front of the viewer, opening Collins’ first. It took only a few minutes to glean the essential information, namely: Katherine Collins was a twenty-one-year-old white female with diffuse neurological symptoms, extensively worked up by neurology without a confirmed diagnosis. In the differential diagnosis, multiple sclerosis was being considered.

  Philips carefully read through the whole chart. As he got to the end he noticed that Collins’ visits and laboratory tests abruptly stopped about one month ago. Up until that time there had been increasingly frequent entries and some of the latter notes indicated that she was due back for follow-up. Apparently she never showed up.

  Taking the other chart, which was considerably smaller, Philips read about Ellen McCarthy. She was a twenty-two-year-old female whose neurological history involved two seizures. She was in the process of being worked-up when her entries abruptly stopped. That was two months ago. Philips even found a note saying that the patient had been scheduled for another EEG with a sleep sequence the following week. It had never been done. Her work-up had not been completed and no differential diagnosis was listed in the chart.

  Helen arrived and came in with her usual handful of problems, but before she said anything she presented Martin with a fresh cup of coffee and a doughnut she’d brought from Chock Full O’ Nuts. Then she got down to business. Ferguson had called again and said that the supplies had to be out of the room in question by noon or they were going to be out on the street. Helen paused for a response.

  Martin had no idea what to do with all the equipment. The department was already crammed into a space half the size they needed. Just to be rid of the problem, even temporarily, he told Helen to bring everything into his office and stack it against the wall. He said he’d think of something by the end of the week.

  Satisfied, she went on to the problem with the technicians who wanted to get married. Philips told her to let Robbins handle it. Helen patiently explained that Robbins was the one who had presented the problem to her in order to have Philips handle it.

  “Damn,” said Martin. There was really no solution. It was too late to train new technicians before they left. If he fired them, they’d get new jobs easily while Philips would have trouble finding replacements. “Find out exactly how long they plan to be away,” he said trying to stifle his exasperation. He hadn’t taken a vacation himself in two years.

  Turning to the next page of her notes, Helen told Philips that Cornelia Rogers from Typing had called in sick again making it the ninth day absent this month. She’d managed to be ill for at least seven days each month for the five months she’d been working for neuroradiology. Helen asked what Philips wanted to do about it.

  Philips wanted to have the girl beat up, quartered, and thrown into the East River. “What would you like to do?” he asked, controlling himself.

  “I think she should be given notice.”

  “Fine, you handle it.”

  Helen had one last comment before heading for the door: Philips had to give a 1 P.M. lecture on the CAT scanner to the current group of medical students. She was about to leave when Philips stopped her. “Listen, do me a favor. There’s an in-patient named Lynn Anne Lucas. See that she gets scheduled this morning for a CAT scan and polytomography. If there’s any trouble, just say it’s a special request of mine. And tell the technicians to give me a call just before they do the procedures.”

  Helen wrote down the message and left. Martin went back to the two charts. It was encouraging that both young women had neurological symptoms, especially since multiple sclerosis was specifically listed as a possibility in Katherine Collins’ case. In the case of Ellen McCarthy, Philips checked to see how often seizures were a part of the clinical picture of multiple sclerosis. Less than ten percent, yet they did occur. But why had both girls been suddenly lost to follow-up? Martin couldn’t help worrying that he was going to have difficulty getting them in for X rays if they had transferred their care someplace else, maybe even to another city.

  Just then Helen buzzed him to say that the resident was ready for him in the cerebral angiography room. Philips put on his lead apron with the faded Superman logo, picked up Collins’ and McCarthy’s charts and walked out of his office. Stopping at Helen’s desk, he asked her to track the two patients down and encourage them to come in for some free diagnostic X rays. He wanted Helen not to frighten the young women, but to make sure they understood it was important.

  Downstairs he found Denise waiting for him. She had showered, washed her hair, and changed her clothes; it had been a miraculous thirty-minute transformation. She no longer looked tired and her light brown eyes sparkled above her surgical mask. Philips would have loved to have touched her, but instead let his eyes linger for an extra second on hers.

  She had already done enough angiograms so that he just acted as her assistant. There was no conversation as she deftly handled the catheter, threading it up inside the patient’s artery. Philips watched carefully, ready to make suggestions if he thought they were needed. They weren’t. The patient was Harold Schiller, who’d been CAT scanned the day before. As Philips had guessed, Mannerheim had ordered a cerebral angiogram probably in preparation to operate, although clearly the case was inoperable.

  An hour later the case was all but done.

  “I tell you,” whispered Martin, “you’re getting better than I and you’ve only been doing it a few weeks.” Denise blushed but Martin knew she was pleased. Leaving her to finish, he told her to buzz when the next case was ready to go. He wanted to finish scanning the skull films on his alternator, then begin to set up running the old films through Michaels’ computer. He reasoned that if he could run a hundred a day he could go through the whole master list in a month and a half. He also thought that he could give Michaels the discrepancies as they surfaced so that perhaps by the time he finished, Michaels would have the bugs out of the program. If that were the case, they’d have something to present to the unsuspecting medical world by July.

  But as Philips rounded the corner outside his office, Helen ambushed him with disappointing news. She’d had no luck with any of his requests. Lynn Anne Lucas could not be CAT scanned or X-rayed because she’d been transferred during the night to New York Medical Center. As far as Katherine Collins and Ellen McCarthy were concerned, she’d traced both of them to the university. They were both listed as undergraduates. However, Collins could not be reached because she’d allegedly run away a month ago and was considered a missing person. Ellen McCarthy, on the other hand, was dead. She’d had a fatal auto accident on the West Side Highway two months ago.

  “Jesus Christ!” said Philips. “Tell me you’re joking.”

  “I’m sorry,” said Helen. “That’s the best I could do.”

  Philips shook his head in disbelief. He’d been so sure that he’d get at least one case out of the three to examine. He stepped into his office and stared blankly at the far wall. His compulsive personality wasn’t accustomed to dealing with such reversals.

  He pounded his fist against his open hand so that the sound echoed in the room. Then he paced, trying to think. Collins was out. If the police couldn’t find her, how could he. McCarthy? If she’d been killed she must have been taken to a hospital. But which? And Lucas . . . at least she’d been taken to New York Medical Center where he had a good friend, instead of Bellevue. If it had been Bellevue, he would have had to give up.

  Philips told Helen to see if she could find out why Lynn Anne had been transferred and then asked her to put a call t
hrough to Dr. Donald Travis at New York Medical Center. He also asked her to see if the police knew where Ellen McCarthy had been taken after her accident.

  Still distracted, Philips forced himself to concentrate on the skull films in front of him. They were all normal in respect to their texture. When he went out to Helen’s desk, she had little good news. Dr. Travis was tied up and would have to call back. She hadn’t been able to find out much about Lucas because the nurse on duty at the time went home at 7 A.M. and could not be reached. The only positive information she had was that Ellen McCarthy had been taken back to the Med Center after her accident.

  Before Philips could ask her to track down that lead, a maintenance man appeared with an enormous trolley piled with boxes, paper, and other debris. Without a word, he pushed it into Philips’ office and began unloading the material.

  “What the hell?” asked Philips.

  “That’s the supplies from the storeroom you said to have put in here,” explained Helen.

  “Shit,” said Philips as the man stacked the supplies along the wall. Philips had the uncomfortable feeling that events were slipping out of his control.

  Sitting down amidst the chaos, Philips dialed Admitting. He felt his mood deteriorating further as the phone rang interminably on the other end of the line.

  “Have a moment?” called William Michaels. He’d leaned in through Philips’ open door, his cheerful grin in direct contrast to Martin’s scowl. Then his eyes swept around the room in total disbelief.

  “Don’t ask,” said Philips, anticipating some smart comment.

  “My God,” said Michaels. “When you work, you don’t mess around.”

  At that point someone finally answered the phone in Admitting, but it was a temporary receptionist who transferred Martin to someone else. That person only handled admissions, not discharges or transfers, so Philips was switched again. Only then did he learn that the person he had to speak to was on a coffee break, so he hung up, frustrated with bureaucracy, saying, “Why didn’t I become a plumber?”

  Michaels laughed, then asked how Philips was doing with their project. Philips told him that he’d had most of the X rays pulled, indicating the pile with his hand. He told Michaels that he thought he could run them all in a month and a half.

  “Perfect,” said Michaels. “The sooner the better, because the new memory storage and association system we’ve been working on is proving better than we’d dreamed. By the time you finish we’ll have a new central processor to handle the debugged program. You have no idea how good it’s going to be.”

  “Quite the contrary,” said Philips, getting up from the desk. “I have a pretty good idea. Let me show you what the program picked up.”

  Martin cleared a viewing screen and put up Marino’s, Lucas’, Collins’, and McCarthy’s X rays. With his index finger, then the piece of paper with the hole in it, Philips tried to show the abnormal densities on each.

  “They look all the same to me,” admitted Michaels.

  “That’s just the point,” said Philips. “That’s how good this system is.” Just talking with Michaels rekindled Martin’s excitement.

  Just then the phone rang and Philips picked it up. It was Dr. Donald Travis from New York Medical Center. Martin explained his problem about Lynn Anne Lucas but purposefully left out the radiologic abnormality. Then he asked Travis if he would arrange to have a CAT scan and some special X rays done on the patient. Travis agreed and hung up. Immediately the phone buzzed and Helen told Philips that Denise was ready for the next angiogram.

  “I got to be going anyway,” said Michaels. “Good luck with the films. Remember, it’s up to you now. We need this information as soon as you can give it to us.”

  Philips lifted his apron off its hook and followed Michaels out of the office.

  9

  One of the large fluorescent light fixtures directly over Kristin Lindquist was malfunctioning so that it flickered at a rapid frequency and emitted a constant buzzing sound. She tried to ignore it, but it was difficult. She hadn’t felt right ever since she’d awakened that morning with a slight headache and the quivering light intensified her discomfort. It was a steady dull pain and Kristin noticed that physical exertion did not make it worse as was the case with her usual headaches.

  She looked at the naked male model on the platform in the center of the room, then down at her work. Her drawing looked flat, two-dimensional and without feeling. Normally she liked her life drawing class. But this morning she was not enjoying herself and her work reflected it.

  If only the light would stop flickering. It was driving her crazy. With her left hand she shielded her eyes. That made it better. Using a fresh piece of charcoal, she began to draw a base for her figure to rest on. She started with a perpendicular line, pulling the fresh charcoal straight down the paper. When she lifted the marker she was surprised no line had resulted. Looking at the end of the charcoal she could see a flattened area where it had rubbed against the paper. Thinking it was a defective piece, Kristin turned her head slightly to make a mark with the charcoal in the corner of the paper. As she did so she noticed that the perpendicular line she had just drawn appeared in the periphery of her vision. She looked back and the line disappeared. Rotating her head slightly caused the line to appear. Kristin did it several times to make sure she wasn’t hallucinating. Her eye couldn’t perceive the perpendicular line when her head was perfectly aligned with it. If she rotated her head in either direction the line appeared. Weird!

  Kristin had heard of migraine headaches, and although she’d never had a migraine, she guessed she was experiencing one. After putting down her charcoal and stacking her materials in her locker, Kristin explained to the instructor that she was not feeling well and left for her apartment.

  Walking across the campus, Kristin experienced the same dizziness that she’d noticed on her way to class. It seemed that the world would abruptly rotate just a fraction of a degree to make Kristin’s step feel slightly off-balance. It was accompanied by an unpleasant although vaguely familiar odor and a slight ringing in her ears.

  One block from campus, Kristin’s apartment was a third-floor walk-up, which she shared with her roommate, Carol Danforth. As Kristin climbed the stairs she felt a heaviness in her legs which made her wonder if she were getting the flu.

  The apartment was empty. Carol was undoubtedly at class. In one way that was good because Kristin guessed she needed some undisturbed rest, but she would have appreciated Carol’s sympathy. She took two aspirins, slipped out of her clothes, climbed into bed, and put a cold cloth over her head. Almost immediately she felt better. It was such a sudden reversal that she just lay there, concerned that if she moved the strange symptoms would recur.

  When the phone by her bed rang she was pleased because she wanted to talk to someone. But it wasn’t one of her friends. It was the GYN clinic calling to tell her that her Pap smear was abnormal.

  Kristin listened, trying to keep herself calm. They told her not to be concerned because abnormal Pap smears were not that uncommon, especially when associated with the slight erosion she had on her cervix, but to be on the safe side they wanted her to return to the clinic that afternoon to repeat it.

  Kristin tried to protest, mentioning her migraine headache. But GYN was insistent, saying the sooner the better. They had an opening that afternoon and Kristin could be in and out in no time.

  Reluctantly Kristin agreed to come. Maybe something really was wrong with her and if that were the case she had to be responsible. But she dreaded going alone. She tried calling her boyfriend, Thomas, but of course he wasn’t in. Kristin knew it was irrational, but she couldn’t help feeling there was something evil about the Med Center.

  Martin took a deep breath before entering Pathology. When Philips had been a medical student, that service had been his bête noire. His first autopsy had been an ordeal that he had not been prepared for. He had assumed it was going to be like first-year anatomy, where the cadaver bore as little re
semblance to a human being as a wooden statue. The odor had been unpleasant but at least it had been chemical. Besides, anatomy lab had been characterized by pranks and jokes, relieving any tension. Not so with pathology. The autopsy had been on a ten-year-old boy who had died from leukemia. His body was pale, but supple and all too life-like. When the corpse had been rudely opened, then gutted like a fish, Martin’s legs had turned to rubber and his lunch came up in his mouth. He’d avoided vomiting by turning his head, but his esophagus burned from the acid of his own digestive juices. The professor had droned on, but Philips had heard nothing. He had stayed but he had suffered, and his heart had gone out to that lifeless boy.

  Now Philips pushed open the doors to Pathology. The environment was a far cry from what he’d experienced as a medical student. The department had been moved to the new medical-school building and housed in an ultramodern setting. Instead of small and somber spaces with high ceilings and marble floors where footsteps echoed unnaturally, the new pathology area was open and clean. The predominant materials were white Formica and stainless steel. Individual rooms had been replaced by areas demarcated by shoulder-height dividers. The walls were covered with colorful prints of Impressionist paintings, particularly Monet.

  The receptionist directed Martin to the autopsy theater where Dr. Jeffrey Reynolds was helping the residents. Martin had hoped to catch Reynolds in his office, but the receptionist insisted that Philips could go into the theater because Dr. Reynolds did not mind interruptions. Philips wasn’t worrying about Reynolds, he was concerned about himself. Nonetheless, he followed the receptionist’s pointing finger.

  He should have known better. In front of him on a stainless steel table, like a side of beef, was a corpse. The autopsy had just begun with a Y-shaped incision across the chest and down to the pubis. The skin and underlying tissues had been flopped back revealing the rib cage and the abdominal organs. At the moment of Philips’ entry, one of the residents was loudly clipping through the ribs.