Brain

Chapter 7

Waiting in a long line to check in, Lynn Anne Lucas wondered if it had been a good idea to come to the emergency room. Earlier she had called student health, hoping to be seen on campus, but the doctor had left at three, and the only place she could get immediate care was the emergency room at the hospital. Lynn Anne had debated with herself about waiting until the following day. But all she had to do was pick up a book and try to read to convince herself to go at once. She was scared.

The emergency room was so busy in the late afternoon that the queue just to check in moved at a snail's pace. It seemed as if all of New York were there. The man behind Lynn Anne was drunk, dressed in rags, and reeking of old urine and wine. Each time the line would move forward, he would stumble into Lynn Anne, grabbing at her to keep from falling. In front of Lynn Anne was a huge woman, carrying a child completely swathed in a dirty blanket. The woman and child were silent, waiting their turn.

Large doors sprang open to Lynn Anne's left, and the check-in line had to give way to a swarm of gurneys carrying the results of an auto accident that had occurred just minutes earlier. The injured and dead were whisked past the waiting area and taken directly into the emergency room proper. Those waiting to be seen knew it was going to take that much longer to be called. In one corner a Puerto Rican family was sitting around a Kentucky Fried Chicken bucket having dinner. They seemed unconcerned with what was happening in the emergency room and hadn't even noticed the arrival of the auto-accident victims.

Finally only the huge woman with the baby was ahead of Lynn Anne. Hearing the woman speak it was apparent she was foreign. She told the clerk that "the baby she no cry no more." The clerk told her that usually the complaint was the opposite, which the woman didn't understand. The clerk asked to see the baby. The woman pulled back the edges of the blanket, revealing a baby the color of the sky before a summer storm, a dark blue-gray. The baby had been dead so long it was stiff like a board.

Lynn Anne was so shocked that when it was her turn she couldn't speak. The clerk sympathized with her and told her that they have to be prepared to see anything and everything. Pushing her auburn hair from her forehead, Lynn Anne found her voice and gave her name, student I.D. number, and her complaint. The clerk told her to have a seat and that it would be a wait. He assured her they'd see her as soon as possible.

After waiting nearly two more hours, Lynn Anne Lucas was led down a busy hall and placed in a cubicle separated from a larger room by stained nylon curtains. An efficient LPN took an oral temperature and her blood pressure, then left. Lynn Anne sat on the edge of an old examining table and listened to the multitude of sounds around her. Her hands were wet from anxiety. She was twenty, and a Junior, and had been entertaining the idea of going to medical school by taking the required courses. But now when she looked around, she wondered. It was not what she'd expected.

She was a healthy young woman, and her only other experience with hospital emergency rooms had been a roller-skating mishap at age eleven. Strangely enough she'd been brought to the very same emergency room, since she and her family had lived nearby before moving to Florida. But Lynn Anne had not had a bad memory of the event. She guessed that the Med Center had changed as much as its neighborhood since she'd been there as a child.

The intern who appeared a half-hour later was youthful Dr. Huggens. Being from West Palm Beach he seemed to enjoy the fact that Lynn Anne was from Coral Gables, and he made small talk about Florida while he looked at her chart. It was also obvious that he was pleased Lynn Anne was a pretty ail-American girl, something he hadn't seen in his last one thousand patients. Later he even asked for her phone number.

"What brings you to the ER?" he said, beginning his workup.

"It's hard to describe," said Lynn Anne. "I get episodes of not seeing right. It started about a week ago while I was reading. All at once I began to have trouble with certain words. I could see them but I couldn't be sure of their meaning. At the same time I would get a terrible headache. Here." Lynn Anne put her hand on the back of her head and ran it around the side of her head to a point above her ear. "It's a dull pain that comes and goes."

Dr. Huggens nodded.

"And I can smell something," said Lynn Anne.

"What was that?"

Lynn Anne acted a little embarrassed. "I don't know," she said. "It is a bad smell, and although I don't know what it is, it seems familiar."

Dr. Huggens nodded, but it was apparent that Lynn Anne's symptoms were not falling into any simple category. "Anything else?"

"Some dizziness, and my legs feel heavy, and it's happening mere often now, almost every time I try to read."

Dr. Huggens put down the chart and examined Lynn Anne. He looked into her eyes and ears; he looked into her mouth and listened to her heart and lungs. He tested her reflexes, had her touch things, walk in a straight line, and remember sequences of numbers.

"You seem pretty normal to me," said Dr. Huggens. "I think maybe you should take two doctors and come back and see us in the aspirin." He laughed at his own joke. Lynn Anne didn't laugh. She had decided she wasn't going to be brushed off that easily, especially after waiting so long. Dr. Huggens noticed she wasn't responding to his humor. "Seriously. I think you should take some aspirin for symptomatic relief and come back to Neurology tomorrow. Maybe they'll be able to find something."

"I want to see Neurology now," said Lynn Anne.

"This is an emergency room, not a clinic," said Dr. Huggens firmly.

"I don't care," said Lynn Anne. She shielded her emotions with defiance.

"Okay, Okay!" said Dr. Huggens. "I'll get Neurology. In fact I'll get Ophthalmology too, but it might be a wait."

Lynn Anne nodded. She was afraid to talk for the moment lest her defense dissolve to tears.

And a wait it was. It was after six when the curtain was pulled aside again. Lynn Anne looked up into the bearded face of Dr. Wayne Thomas. Dr. Thomas, a black from Baltimore, surprised Lynn Anne, who had never been treated by a black doctor. But she quickly forgot her initial reaction and responded to his exacting questions.

Dr. Thomas was able to uncover several more facts he felt were significant. About three days previously Lynn Anne had had one of her "episodes" as she called them, and had immediately jumped up from her bed where she had been reading. The next thing she remembered was that she "came to" on the floor, having fainted. Apparently she had hit her head, because she had suffered a large lump on the right side of her scalp. Dr. Thomas also learned that Lynn Anne had had two atypical Pap smear tests and was currently scheduled to return to GYN clinic in a week. She also had had a recent urinary-tract infection successfully treated with sulfur.

After finishing the history, Dr. Thomas called in an LPN and did the most complete physical examination Lynn Anne had ever had. He did everything Dr. Huggens did and more. Most of the tests were a total mystery to Lynn Anne, but his thoroughness encouraged her. The only test she disliked was the lumbar puncture. Curled up on her side with her knees to her chin, she felt a needle pierce the skin of her lower back, but it only hurt for a moment.

When he finished, Dr. Thomas told Lynn Anne that he wanted to take some X rays to make sure she had not fractured her skull when she had fallen. Just before he left her he told her that all he found during the examination was that certain areas of her body seemed to have lost sensation. He admitted that he didn't know if it was significant or not. Lynn Anne waited again.

"Can you believe it?" asked Philips while he shoved more turkey tetrazzini into his mouth. He chewed quickly and swallowed. "Mannerheim's first OR death and it has to be a patient I wanted more film on."

"She was only twenty-one, wasn't she?" said Denise.

"That's right." Martin put more salt and pepper on his food to give it some taste. "Tragedy, actually a double tragedy since I can't get those films."

They had taken their hospital cafeteria trays to the farthest corner from the steam table, trying to isolate themselves as much as possible from the institutional environment. It was difficult. The walls were painted a dirty mustard; the floor was covered with gray linoleum; and the molded plastic chairs were an awful yellow-green. In the background the hospital paging system maintained a steady monotone of doctors' names and the extension number they were to call.

"Why was she having the surgery?" asked Denise, picking at her chef's salad.

"Seizure disorder. But the interesting thing was that she might have had multiple sclerosis. After you left this afternoon, it occurred to me that the density changes we saw on her X ray might represent some sort of widespread neurological disease. I checked her chart. Multiple sclerosis was being considered."

"Have you pulled any films of patients with known multiple sclerosis?" asked Denise.

"That starts tonight," said Philips. "In order to check Michaels' program I've got to run as many skull films as possible. It will be very interesting if I can find any other cases with the same radiologic picture."

"It sounds as if your research project has really taken off."

"I hope so." Martin took one bite of his asparagus and decided against taking any more. "I'm trying not to let myself get too excited this early, but, my God, it looks good. That's why I got so excited about this Marino case. It promised something immediately tangible. Actually there's still a chance. She's being autopsied tonight, so I'll try to correlate the radiological picture with the Path findings. If it is multiple sclerosis, we're back in the ball game. But I tell you, I've got to find something to get me away from this clinical rat race, even if it's only a couple of days a week."

Denise put down her fork and looked into Martin's reitless blue eyes. "Get away from clinical? You can't do that. You're one of the best neuroradiologists there is. Think of all the patients that benefit from your skills. If you leave clinical radiology, that will be a real tragedy."

Martin put down his fork, and grasped her left hand. For the first time he didn't care who in the hospital might be watching. "Denise," he said softly. "At the present time in my life there are only two things I really care about: you and my research. And if there were some way I could make a living out of being with you, I might even forget the research."

Denise looked at Martin uncertain whether to be flattered or wary. She'd become more and more confident of his affection but she had no idea that he had even the potential for commitment. From the beginning she'd been awed by his reputation and seemingly encyclopedic knowledge of radiology. He had been both a lover and professional idol and she hadn't allowed herself the thought that maybe their relationship had a future. She wasn't sure she was ready for it.

"Listen," Martin continued. "This is neither the time nor the place for this kind of conversation." He pushed his asparagus out of the way as if to make a point. "But it's important that you know where I'm coming from. You're at an early stage in your clinical training, which is very fulfilling. You spend all your time learning and dealing with patients. Unfortunately I spend the smallest part of my time doing that. The major part is spent trying to handle administrative headaches and bureaucratic bullshit. I've had it up to here."

Denise raised her left hand, which was still firmly grasped in his, and lightly brushed his knuckles with her lips. She did it quickly, then looked at him from under her dark eyebrows. She was being purposefully coquettish, knowing that it would defuse his sudden anger. It worked as it usually did and Martin laughed. He squeezed her hand before letting go, then glanced around to see if anyone had seen.

His beeper shocked them both as it went off. He got up immediately and strode over to the hospital phones. Denise watched him. She had been attracted to him since they met, but she found herself increasingly drawn by his humor and surprising sensitivity, and now his new admission of dissatisfaction and vulnerability seemed to heighten her feelings.

But was it true vulnerability? Was Philips' excuse about administrative burdens only a rationalization to explain a dissatisfaction with having to grow older, and having to admit that, professionally speaking, his life had become predictable? Denise didn't know. As long as she had known Martin, he'd always approached his work with such compulsion that she'd never considered the possibility of dissatisfaction, but she was moved that he would share his feelings with her. It must mean he believed their relationship was more important than she thought he had.

Watching Martin at the phone, she admitted one other point about their affair. He had given her the strength to finally end another relationship, which had been totally destructive. While Denise was still a medical student she had met and had been dazzled by a neurology resident who had skillfully manipulated her feelings. Because of the impersonal isolation of school, Denise was susceptible to the idea of commitment. There had never been any doubt in her mind that she would be able to mix a home and a career with someone who was intimately aware of the demands of medicine. Richard Druker, her lover, was astute enough to recognize her feelings and to convince her that he felt the same way. But he didn't. He led her on for years, avoiding any real commitment, but cleverly fostering her dependency. The result was that she could not break away from him, even after she recognized what he was and suffered the humiliation of several of his affairs. She kept returning like an old dog for more abuse, vainly hoping that he'd mend his ways and become the person he said he was. Hope became desperation as she began to question her own femininity rather than his immaturity. She had not been able to let go until she met Martin Philips.

Now as Martin walked back to their table, Denise felt a rush of affection, and gratitude. At the same time she recognized he was a man, and she was afraid of assuming a commitment he did not feel.

"This is not my day," said Martin, sitting down across from her. "That was Dr. Reynolds. Marino is not being autopsied."

"I thought she'd have to be," said Denise, surprised and trying to switch her mind back to medicine.

"True. It was a medical examiner's case, but in deference to Mannerheim, the examiner released the body to our Path department. The Path department approached the family for permission, and the family refused. Apparently they were pretty hysterical."

"That's understandable," said Sanger.

"I suppose," said Philips, dejectedly. "Damn… Damn!"

"Why not pull some X rays of patients with known multiple sclerosis and see if you can find similar changes."

"Yeah," said Philips with a sigh.

"You could think a little about the patient rather than your own disappointment."

Martin stared at Denise for several minutes, making her feel that she had overstepped an unspoken boundary. She hadn't meant to be moralizing. Then his face changed and he smiled broadly.

"You're right!" he said. "In fact you just gave me a fabulous idea."

Directly across from the emergency room desk was a gray door with a sign that read EMERGENCY ROOM STAFF. It was the lounge for the interns and residents, although it was rarely used for relaxation. In the back was a lavatory with showers for the men: the women doctors had to go upstairs to the Nurses' lounge. Along the side there were three small rooms with two cots each, but they weren't used much except for short naps. There was never time.

Dr. Wayne Thomas had taken the one comfortable chair in the lounge: an old leather monster with some of its stuffing extruding through an open seam like a dehisced wound.

"I think Lynn Anne Lucas is sick," he was saying with conviction.

Around him, either leaning against the desk or seated in one of the wooden chairs, were Dr. Huggens, Dr. Carolo Langone, Resident in Internal Medicine; Dr. Ralph Lowry, Resident in Neurosurgery; Dr. David Harper, Resident in Gynecology; and Dr. Scan Farnsworth, Resident in Ophthalmology. Separated from the group were two other doctors reading EKG's at a counter.

"I think you must be horny," said Dr. Lowry with a cynical smile. "She's the best-looking chick we've seen all day and you're trying to find some excuse to admit her on your service."

Everyone laughed but Dr. Thomas. He didn't move except for his eyes, which turned to Dr. Langone.

"Ralph has a point," admitted Langone. "She's afebrile, normal vital signs, normal blood work, normal urine, and normal cerebral spinal fluid."

"And normal skull X ray," added Dr. Lowry.

"Well," said Dr. Harper, getting up from his chair. "Whatever it is, it ain't GYN. She's had a couple of abnormal Pap smears, but that's being followed in the clinic. So I'm going to leave you to solve this problem without me. To tell you the truth, I think she's being hysterical."

"I agree," said Dr. Farnsworth. "She claims to have trouble seeing but her ophthalmology exam is normal and with this near vision card she can read the small row of numbers with ease."

"What about her visual fields?" asked Dr. Thomas.

Farnsworth got to his feet, preparing to leave. "Seem normal to me. Tomorrow we can have a Goldmann field done, but we don't do them on an emergency basis."

"And her retinas?" asked Dr. Thomas.

"Normal," said Farnsworth. "Thanks for the consult. It's been swell." Picking up his suitcase of instruments, the ophthalmologist left the room.

"Swell! Shit," said Dr. Lowry. "If I have one more Goddamn prissy eyeball resident tell me they don't do Goldmann fields at night, I think I'll punch him out."

"Shut up, Ralph," said Dr. Thomas. "You're starting to sound like a surgeon."

Dr. Langone stood up and stretched. "I got to be going too. Tell me Thomas, why do you think this girl is sick: just because of her decreased sensation? I mean, that's pretty subjective."

"It's a feeling I have. She's scared, but I'm sure she's not hysterical. Besides, her sensory abnormalities are very reproducible. She's not faking. There's something screwy going on in her brain."

Dr. Lowry laughed. "The only thing screwy about this case is what you'd like to be doing if you met her under more social circumstances. Come on, Thomas. If she were a dog, you woulda' just told her to come back to clinic in the A.M."

The whole lounge laughed. Dr. Thomas waved them away as he pulled himself from the easy chair. "I give up with you clowns. I'll handle this case myself."

"Be sure to get her phone number," said Dr. Lowry as Thomas left. Dr. Huggens laughed, he'd already thought it wasn't a bad idea.

Back in the ER Thomas looked around. From seven to nine there was a relative respite, as if people took time out from misery, pain, and illness while they ate. By ten, the drunks, the auto accidents, and the victims of thieves and psychos would begin to arrive; by eleven it would be the crimes of passion. So Thomas had a little time to think about Lynn Anne Lucas. Something was nagging him about the case; he felt as if he were missing some important clue.

Stopping at the main desk, he asked one of the ER clerks if Lynn Anne Lucas's hospital chart had arrived from the record room. The clerk checked, said no, but then reassured him that he'd call again. Dr. Thomas nodded absently, wondering if Lynn Anne had taken any exotic drugs. Turning down the main corridor, he headed back to the examination room, where the girl was waiting.

Denise had no inkling what Martin's "fabulous idea" was. He had asked her to come back to his office around 9 P.M. It was about a quarter past when she had a break from reading trauma films in the emergency room. Using the stairs across from the closed hospitality shop, she reached the Radiology floor. The corridor seemed a different place from the commotion and chaos of the day. At the very end of the hall one of the janitors was using a power polisher on the vinyl floor.

The door to Philips' office was open, and Denise could hear his dictating monotone. When she entered, she found him finishing up the day's cerebral angiograms. In front of him on his alternator was a series of angiographic studies. Within each X ray of the skull the thousands of blood vessels showed up as white threads which appeared like an upside-down root system to a tree. While he spoke he pointed with his ringer at the pathology for Denise's benefit. She looked and nodded, although it was incomprehensible how he knew the names and the normal size and position of each vessel.

"Conclusion: " said Philips, "Cerebral angiography shows a large arteriovenous malformation of the right basal ganglia in this nineteen-year-old male. Period. This circulatory malformation is supplied by the right middle cerebral artery via the lenticulostriate branches as well as from the right posterior cerebral artery via the thalamoperforate and the thalamogeniculate branches. Period." End of dictation. Please send a copy of this report to doctors Mannerheim, Prince, and Clauson. Thank you."

With a click, the recorder stopped, and Martin swung around in his chair. He was wearing a mischievous smile and he rubbed his hands together like a Shakespearean rogue.

"Perfect timing," he said.

"What's gotten into you?" she asked, pretending to be scared.

"Come," said Philips, leading her outside. Against the wall was a loaded gurney complete with IV bottles, linen, and a pillow. Smiling at her surprise, Martin began pushing the gurney down the hall. Denise caught up to him at the patient elevator.

"I gave you this fabulous idea?" she asked, helping guide the gurney into the car.

"That's right," said Philips. He hit the button for the sub-basement and the doors closed.

They emerged in the bowels of the hospital. A tangle of pipes, like blood vessels, ran off in both directions, twisting and turning on one another as if in agony. Everything was painted gray or black, eliminating all sense of color. The light, which was sparse, came from wire-mesh encased fluorescent bulbs placed at distant intervals, causing contrasting patches of white glare to be separated by long stretches of heavy shadow. Across from the elevator was a sign: MORGUE: FOLLOW RED LINE.

Like a trail of blood, the line ran along the middle of the corridor. It traced a complicated route through the dark passages, winding sharply when the corridor branched. Ultimately it ran down a sloping incline, which nearly pulled the gurney from Martin's hands.

"What in God's name are we doing down here?" asked Denise, her voice echoing with their footsteps in the lifeless spaces.

"You'll see," said Philips. His smile had waned and his voice sounded tense. His original playfulness had given way to a nervous concern about the prudence of what he was doing.

The corridor abruptly opened up into a huge underground cavern. The lighting here was equally as meager as in the corridor, and the two-story-high ceiling was lost in shadow. On the left wall was the closed door to the incinerator, and the hiss of hungry flames could be heard.

Ahead were the double swinging doors leading into the morgue. In front of them the red line on the floor ended with abrupt finality. Philips left the gurney and advanced toward the entrance. Pushing open the door on the right he looked inside. "We're in luck," he said, returning to the gurney. "We have the place to ourselves."

Denise followed reluctantly.

The morgue was a large neglected room, which had been allowed to decay to the point that it resembled one of those unearthed porticoes of Pompeii. A multitude of hooded lights hung on bare wires from the ceiling, but only a few had bulbs. The floor was constructed of stained terrazzo, while walls were surfaced with cracked and chipped ceramic tile. In the center of the room was a partially sunken pit containing an old marble autopsy slab. It had not been used since the twenties, and standing amid the debris, it appeared like an ancient pagan altar. Autopsies were currently done in the department of Pathology on the fifth floor, in a modern stainless steel setting.

Numerous doors lined the walls of the room, including a massive wooden one that resembled a meat refrigerator in a butcher shop. On the far wall was an inclined corridor that led up in utter darkness to a door opening on a back alley of the hospital complex. It was deathly quiet. The only noise was an occasional drip from a sink and the hollow sounds of their own footsteps.

Martin parked the gurney and hung up the IV bottle.

"Here," he said, handing Denise a corner of one of the fresh sheets and directing her to tuck it around the pad on the gurney.

He went over to the large wooden door, pulled the pin from the latch, and with great effort opened it up. An icy mist flowed out, layering itself on the terrazzo floor.

After finding the light switch Martin turned and noticed Denise had not budged.

"Come on! And bring the gurney."

"I'm not moving until you tell me what's going on," she said.

"We're pretending it's the fifteenth century."

"What do you mean?"

"We're going to snatch a body for science."

"Lisa Marino?" asked Denise incredulously.

"Exactly."

"Well I'm not going to have any part of this." She backed up as if about to flee.

"Denise, don't be silly. All I'm going to do is get the CAT scan and X rays I wanted. Then the body is coming right back. You don't think I'm going to keep it, do you?"

"I don't know what to think."

"What an imagination," said Philips as he grabbed the end of the gurney and pulled it into the antique walk-in refrigerator. The IV bottle clanked against its metal pole. Denise followed, her eyes rapidly exploring the interior which was completely tiled; walls, ceiling and floor. The tiles had once been white; now they were an indeterminate gray. The room was thirty feet long and twenty feet wide. Parked in rows on each side were old wooden carts with wheels the size of those on a bicycle. Down the center of the room was an open lane. Each cart supported a shrouded corpse.

Philips slowly moved down the center aisle, glancing from side to side. At the back of the room he turned around and began lifting the corner of each sheet. Denise shivered in the damp cold. She tried not to look at the bodies closest to her, which had been the gory result of one of the rush-hour traffic accidents. A foot, still wearing its shoe, stuck out at a crazy angle, advertising that the leg had been broken in mid-calf. Somewhere out of sight an old compressor chugged to life.

"Ah, here she is," said Philips, peering under one of the sheets. Thankfully, for Denise, he left the shroud in place and motioned for her to bring the gurney down. She did it like an automaton.

"Help me lift her," said Philips.

Denise grabbed Lisa Marino's ankles through the sheet to avoid touching the corpse. Philips hefted the torso. On the count of three, they moved the body, noticing that it had already become stiff. Then with Denise pulling, and Martin pushing, they guided the gurney back out of the refrigerator. Philips closed and secured the door.

"What's the IV for?" asked Sanger.

"I don't want people to think we're pushing around a corpse," said Philips. "And for that effect, the IV is the maestro's touch." He pulled the sheet down, exposing Lisa Marino's bloodless face. Denise looked away as Martin raised the head and shoved the pillow under it. Then he ran the blank IV line beneath the sheet. Stepping back, he checked the effect. 'Perfect." Then he patted the corpse's arm, saying, "Are you comfortable now?"

"Martin, for God's sake, do you have to be so gruesome?"

"Well, to tell you the truth, it's a defense. I'm not sure we should be doing this."

"Now he tells me", moaned Denise as she helped guide the gurney through the double door.

They retraced their steps through the subterranean labyrinth and entered the patient's elevator. To their dismay, it stopped on the first floor. Two orderlies were standing with a patient in a wheelchair. Martin and Denise stared at each other for a moment, in fear. Then Denise looked away, castigating herself for becoming involved in this ridiculous caper.

The orderlies wheeled the patient onto the elevator so that he was facing the rear, which they weren't supposed to do. They were involved in a conversation about the upcoming baseball season, and if they had noticed Lisa Marino's appearance, they didn't mention it. But the patient was different. He looked over and saw the huge sutured horseshoe incision on the side of Lisa Marino's head.

"She have an operation?" he asked.

"Yeah," said Philips.

"She going to be alright?"

"She's a little tired," said Philips. "She needs some rest."

The patient nodded as if he understood. Then the doors opened on the second floor, and Philips and Sanger got off. One of the orderlies even helped pull the gurney out.

"This is ridiculous," said Sanger as they made their way up the empty hallway. "I feel like a criminal."

They entered the CAT scan room. The redheaded technician saw them through the leaded window from the control room, and came in to help. Philips told him it was an emergency scan. After the technician adjusted the table, he positioned himself behind Lisa Marino's head and put his hands under her shoulders, preparing to lift. Feeling the ice-cold, lifeless flesh, he jumped back.

"She's dead!" he said, shocked.

Denise covered her eyes.

"Let's say she's had a hard day," said Philips. "And you're not to talk about this little exercise."

"You still want a CAT scan?" asked the technician incredulously.

"Absolutely," said Philips.

Pulling himself together, the technician helped Martin lift Lisa onto the table. Since there was no need for immobilization restraints, he immediately activated the table and Lisa's head slid into the machine. After checking the position, he directed Philips and Sanger into the control room.

"She might be pale," said the technician, "but she looks better than some of the patients we get from neurosurgery." He pushed the button to start the scanning process and the huge doughnut-shaped machine abruptly came to life and began its rotation around Lisa's head.

Grouping themselves in front of the viewing screen, they waited. A horizontal line appeared at the top of the screen, then moved down the face, seemingly unveiling the first image. The bony skull was apparent but no definition could be determined within. Inside the skull it was dark and homogeneous.

"What the hell?" said Martin.

The technician walked over to the control console and checked his settings. He came back, shaking his head. They waited for the next image. Again the skull outline was seen but the interior was uniform.

"Has the machine been working okay tonight?" asked Philips.

"Perfect," answered the technician.

Philips reached out and adjusted the viewing controls, called the window level and window width. "My God," he said after a minute. "You know what we're looking at? Air! There's no brain. It's gone!"

They stared at one another with a shared sense of surprise and disbelief. Abruptly Martin turned and ran back into the scanner room. Denise and the technician followed. Martin grasped Lisa's head with both hands and lifted. Owing to stiffness, the corpse's whole torso came up from the table. The technician lent a hand, enabling Philips to see the back of Lisa's head. He had to look closely at the livid skin, but he found it: a fine U-shaped incision extending around the base of her skull, which had been closed with a subcuticular stitch so that no sutures could be seen.

"I think we'd better get this body back to the morgue," said Martin uneasily.

The trip back was fast with very little talk. Denise did not want to go but she knew Martin would need help lifting Lisa from the gurney. When they reached the incinerator, he again checked to make sure the morgue was empty. Holding the doors open, he waved Denise in, helping push the gurney over to the refrigerator. Quickly he opened the massive wooden door. Denise watched his breath coming in short puffs in the cold air as he backed down the aisle, pulling on the stretcher. They aligned it with the old wooden cart and were about to lift the body when a shocking sound reverberated in the frigid air.

Denise and Martin felt their hearts jump, and it took them several seconds before they realized the noise was Denise's beeper. She switched it off hurriedly, embarrassed as if the intrusion were her fault, grabbed Lisa's ankles, and on the count of three helped lift her onto the cart.

"There's a wall phone out in the morgue," said Martin lifting the shroud. "Answer your page while I make sure the body looks the way we found it."

Needing no more encouragement, Denise hurried out. She was totally unprepared for what happened. As she turned toward the phone, she ran directly into a man who had been approaching the open refrigerator door. An involuntary whimper escaped from her, and she had to put her hands up to absorb the impact.

"What are you doing here?" snapped the man. His name was Werner and he was the hospital diener. He reached out and grabbed one of Sanger's upright wrists.

Hearing the commotion, Martin appeared at the refrigerator's threshold. "I'm Dr. Martin Philips and this is Dr. Denise Sanger." He wanted his voice to sound strong, instead it sounded hollow and dull.

Werner let go of Denise's wrist. He was a gaunt man with high cheekbones, and a cavernous face. The dim light made it impossible to see his deeply set eyes. The eye sockets were blank, like burnt holes in a mask. His nose was narrow and sharp, like a hatchet. He was dressed in a black turtleneck, fronted by a black rubber apron.

"What are you doing with my bodies?" asked Werner, pushing past the doctors and the gurney. Inside the refrigerator he counted the corpses. Pointing to Marino, he said, "Did you take this one out of here?"

Having recovered from his initial shock, Philips marveled at the diener's proprietary feeling toward the dead. "I'm not sure it's correct to say 'your bodies,' Mr…."

"Werner," said the diener, walking back to Martin and poking a large index finger in Philips' face. "Until somebody signs for these corpses, they're my bodies. I'm responsible."

Philips thought it better not to argue. Werner's mouth with its narrow lips was set in a firm, uncompromising line. The man seemed like a coiled spring. Philips started to speak but his voice came out in an embarrassing squeak. Clearing his throat, he started again: "We want to talk to you about one of these bodies. We believe it's been violated."

Sanger's beeper went off for the second time. Excusing herself she hurried over to the wall phone and answered her page. "Which body are you talking about?" snapped Werner. His gaze never left Martin's face.

"Lisa Marino," said Philips, pointing to the partially covered corpse. "What do you know about this woman?"

"Not much," said Werner, turning toward Lisa and relaxing to a degree. "Picked her up from surgery. I think she's going out later tonight or early in the morning."

"What about the body itself?" Martin noticed the diener wore his hair in a crew cut, brushed straight up along the sides.

"Nice," said Werner, still looking at Lisa.

"What do you mean, nice?" asked Philips.

"Best looking woman I've had for some time," said Werner. As he turned to face Martin, his mouth pulled back in an obscene smile.

Momentarily disarmed, Martin swallowed. His mouth was dry and he was glad when Denise returned saying, "I've got to go. I've been paged from the ER to check a skull film."

"All right," said Martin, trying to arrange his thoughts. "Meet me in my office when you're free."

Denise nodded, and with a sense of relief, she left.

Martin, distinctly ill-at-ease alone with Werner in the morgue, forced himself to walk over to Lisa Marino. Pulling back the sheet he rotated Lisa's corpse by pulling up her shoulder. Pointing to the carefully sutured incision, Philips said, "What do you know about this?"

"I don't know anything about that," said Werner quickly.

Philips wasn't even sure the diener had seen what Martin was pointing to. Letting Lisa's body roll back on the cart, Philips studied the man. His rigid countenance reminded Martin of a Nazi cliche.

"Tell me," said Philips. "Have any of Mannerheim's boys been down here today?"

"I don't know," said Werner. "I was told there was to be no autopsy."

"Well, that's no autopsy incision," said Philips. Grabbing the edge of the sheet, Philips pulled it over Lisa Marino. "Something strange is going on. Are you sure you don't know anything about this?"

Werner shook his head.

"We'll see," said Philips. He walked out of the refrigerator, leaving the gurney for Werner to deal with. The diener waited until he heard the outer doors close. Then he grabbed the cart and gave it a powerful shove. It shot out of the refrigerator, sped halfway across the morgue, and crashed into the corner of the marble autopsy table, tipping over with a tremendous clatter. The IV bottle smashed into a million shards.

Dr. Wayne Thomas leaned against the wall, his arms folded across his chest. Lynn Anne Lucas was sitting on the old examining table. Their eyes were on the same level; his, alert and contemplative; hers, drained and exhausted.

"What about this recent urinary infection?" said Dr. Thomas. "It cleared up on the sulfa drugs. Is there anything else about that illness that you haven't mentioned?"

"No," said Lynn Anne, slowly, "except they did send me to a urologist. He told me that I had a problem of too much urine being in my bladder after I'd gone to the bathroom. He told me to see a neurologist."

"Did you?"

"No. The problem cleared up on its own, so I didn't think it mattered."

The curtain parted and Dr. Sanger poked her head in.

"Excuse me. Someone called for a consult on a skull film."

Thomas pushed off from the wall, saying he'd just be a minute. As they walked back to the lounge he gave Denise a thumbnail sketch of Lynn Anne's case. He told her that he thought the X ray was normal but wanted confirmation about the pituitary area.

"What's the diagnosis?" asked Denise.

"That's the problem," said Thomas opening the door to the lounge. "The poor thing has been here for five hours, but I can't put it all together. I thought maybe she was a druggie but she's not. She doesn't even smoke grass."

Thomas snapped the film up on the viewer. Denise scanned it in an orderly fashion, starting with the bones.

"I've been getting some crap from the rest of the ER staff," Thomas said. "They think I'm interested in the case because the patient is a piece of ass."

Denise broke off from studying the X ray to eye Thomas sharply.

"But that's not it," said Thomas. "There's something wrong with this girl's brain. And whatever it is, it's widespread."

Sanger redirected her attention to the film. The bony structure was normal, including the pituitary area. She looked at the vague shadows within the skull. For orientation purposes she checked to see if the pineal gland was calcified. It wasn't. She was about to declare the film normal when she perceived a very slight variation in texture. Forming a small open area with her two hands, she studied the particular section of the film. It was a trick similar to the one she saw Philips do with the hole in the paper. Taking her hands away she was convinced I She'd found another example of the density change Martin had shown to her earlier on Lisa Marino's film.

"I want someone else to see this film," said Denise, pulling it from the viewer.

"You find something?" asked Thomas, encouraged.

"I think so. Keep the patient here until I get back." Denise was gone before Thomas could reply.

Two minutes later she was in Martin's office.

"Are you sure?" he asked.

"I'm pretty sure." She handed the film to him.

Martin took the X ray but didn't put it up immediately. He fingered it, afraid he would be faced with another disappointment.

"Come on," said Denise. She was eager to have her suspicions confirmed.

The X ray slid under the clips. The light in the viewer blinked, then came on. Philips' trained eye traced an erratic path over the appropriate area. "I think you're right," he said. Using the piece of paper with the hole in it, he examined the X ray more closely. There was no doubt that the same abnormal density pattern he'd seen on Lisa Marino's X ray existed on this film. The difference was that on the new one it was less pronounced and not so extensive.

Trying to control his excitement, Martin switched on Michaels' computer. He keyed in the name. Turning to Denise, he asked what the patient's present complaint was. Denise told him it was difficulty in reading associated with blackout spells. Philips entered the information, then stepped over to the laser reader. When the little red light came on, he pushed in the edge of the film. The output typewriter snapped into action. Thank you, it said. Take a nap I

While they waited, Denise told Martin what else she'd learned about Lynn Anne Lucas, but he was most excited about the fact that the patient was alive and in the emergency room.

As soon as the typewriter ceased its rapid staccato, Philips tore off the report. He read it with Denise looking over his shoulder.

"Amazing!" said Philips when he'd finished. "The computer certainly agrees with your impression. And it remembered that it had seen the same density pattern on Lisa Marino's X ray, and on top of that it asks me to tell it what this density variation is! This thing is God-damn amazing. It wants to learn! It's so human it scares me. The next thing I know is that it will want to get married to the CAT scan computer and take the whole summer off."

"Married?" said Sanger, laughing.

Martin waved her off. "Administrative worries. Don't get me started! Let's get this Lynn Anne Lucas up here and do the CAT scan and X rays I couldn't do on Lisa Marino."

"You realize it is a bit late. The CAT scan technician closes the unit down at ten and leaves. We'd have to call him in. Are you sure you want to do all this tonight?"

Philips looked at his watch. It was ten-thirty. "You're right. But I don't want to lose this patient. I'm going to see that she's admitted at least for the night."

Denise accompanied Martin back down to the ER, leading him directly into one of the large treatment rooms. She motioned for him toward the right corner, and pulled back a curtain separating a small examining area. Lynn Anne Lucas looked up with bloodshot eyes. She'd been sitting next to the table, leaning on it, with her head on her arm.

Before Denise could introduce Philips, her beeper went off and she left Martin to talk with Lynn Anne by himself. It was immediately apparent to him that the woman was exhausted. He smiled at her warmly, then asked if she would mind staying overnight so that they could get some special X rays in the morning. Lynn Anne told him she didn't care, so long as she was taken out of the emergency room and could go to sleep. Philips gave her arm a gentle squeeze. He told her he'd arrange it.

At the main desk, Philips had to act like he was in a bargain basement, pushing, yelling and even hitting the countertop with an open palm to get the attention of one of the harried clerks. He asked about Lynn Anne Lucas, wanting to know who was in charge of the patient. The clerk checked the main roster and told him it was Dr. Wayne Thomas who was currently down in room 7 with a stroke.

When Philips walked in he found himself in the middle of a cardiac arrest. The patient was an obese man who draped over the examining table like a huge pancake. A bearded black fellow, who Philips soon learned was Dr. Thomas, was standing on a chair giving the patient cardiac massage. With each compression Dr. Thomas's hands disappeared into folds of flesh. On the other side of the patient, a resident was holding defibrillator paddles while he watched the tracing on the cardiac monitor. At the patient's head, an anesthetist was ventilating him with an ambu bag, coordinating her efforts with Dr. Thomas.

"Hold up," said the resident with the defibrillator.

Everyone backed up while he positioned the paddles over the conductive grease on the patient's ill-defined thorax. When he compressed the button on top of the anterior chest lead, a surge of current raced through the patient's chest, spreading electrical havoc. The patient's extremities fluttered ineffectually like a fat chicken trying to fly.

The anesthetist immediately recommenced respiratory assistance. The monitor readjusted itself and a slow but regular tracing appeared.

"I got a good carotid pulse," said the anesthetist with her hand pressing on the side of the patient's neck.

"Good," said the resident with the defibrillator. He hadn't taken his eyes from the monitor, and when the first ectopic ventricular spike occurred, he ordered "seventy-five milligrams of Lidocaine."

Philips walked over to Thomas and got his attention by tapping his leg. The resident climbed down from his chair and stepped back, although he kept an eye on the table.

"Your patient, Lynn Anne Lucas," said Philips. "She has some interesting X-ray findings in her occipital area extending forward."

"I'm glad you found something. My intuition has been telling me there's something wrong with the girl but I don't know what it is."

"I can't help with the diagnosis yet," said Philips. "What I'd like to do is take more films tomorrow. How about admitting her for the night."

"Sure," said Thomas. "I'd love to but I'm going to take a lot of flak from the boys if I don't have even a provisional diagnosis."

"How about multiple sclerosis?"

Thomas stroked his beard. "Multiple sclerosis. That's a little out on a limb."

"Is there any reason it couldn't be multiple sclerosis?"

"No," said Thomas. "But there isn't much reason to suggest it either."

"How about very early inks course."

"Possible, but multiple sclerosis is usually diagnosed later when its characteristic pattern becomes apparent."

"That's just the point. We're suggesting the diagnosis earlier rather than later."

"All right," said Thomas, "but I'm going to specifically say in my admitting note that Radiology suggested that diagnosis."

"Be my guest," said Philips. "Just be sure to write on the order sheet that CAT scan and polytomography are to be done tomorrow. I'll take care of scheduling it from Radiology."

Back at the desk Philips endured the crowd long enough to obtain Lynn Anne Lucas's emergency room chart and hospital record. He took both into the deserted lounge and sat down.

First he read Dr. Huggens" and Dr. Thomas's workups. There was nothing exciting. Next he looked at the chart. By the color coding on the edge of the pages, he noticed there was a radiology report. He opened the chart to that page, which described a skull X ray at age eleven secondary to a roller-skating mishap. The X ray had been read by a resident Philips knew. He'd been several years behind Philips and now was in Houston. The X ray was described as normal.

Working backward through the chart, Philips read entries over the last two years related to upper respiratory infections treated at the dispensary on campus. He also glanced over a series of GYN clinic visits where mildly atypical Pap smears had been noted. Philips had to admit to himself that the information was not so informative as it should have been because of the embarrassing amount of general medicine he'd forgotten since his house staff days. From 1969 to 1970 there were no entries on the chart.

Philips returned the chart to the ER desk before starting back to his office. He took the stairs by twos, his energy level spurred by a wonderful sense of investigative excitement. After the disappointment with Marino, the discovery of Lucas was that much more titillating. Back in his office, he pulled down the dusty internal medicine textbook and looked up multiple sclerosis.

As he had remembered, the diagnosis of the disease was circumstantial. There was no consistent laboratory aid save for autopsy. The obvious and immense value of a radiological diagnosis again occurred to Philips. He read on, noticing that the classic features of the disease included abnormalities in vision as well as bladder dysfunction. After reading the first two sentences of the next paragraph, Philips stopped. He went back and read them aloud:

Diagnosis may be uncertain in the early years of the disease. Long latent periods between a minor initial symptom, which may not even come to medical attention, and the subsequent development of more characteristic ones may delay the final diagnosis.

Philips grabbed the phone and punched out Michaels' home number. With a sensitive radiological diagnosis, delay of the final diagnosis would be avoided.

It was only after the phone had already started to ring that Martin glanced at his watch. He was shocked to realize it was after eleven. At that moment Michaels' wife, Eleanor, whom Philips had never met, answered the phone. Philips immediately launched into a lengthy apology for calling so late although she did not sound as if she'd been asleep. Eleanor assured him that they never retired before midnight and put her husband on the line.

Michaels laughed at what he called Philips' adolescent enthusiasm, when he learned that Martin was still in his office.

"I've been busy," explained Philips. "I've had a cup of coffee, something to eat, and taken a nap."

"Don't let everybody see those printouts," said Michaels, laughing anew. "I programmed some obscene suggestions as well."

Philips went on to tell Michaels excitedly that the reason he was calling was that he'd found another patient in the ER, named Lynn Anne Lucas, who had the same abnormal density pattern he'd seen on the Marino film. He told Michaels that he had not been able to follow up on Marino, but was going to get definitive films in the morning. He added that the computer had actually asked him to tell it what the abnormal density changes were. "The God-damn thing wants to learn!"

"Remember," said Michaels, "the program approaches radiology the same way you do. It's your techniques that it utilizes."

"Yeah, but it's already better than me. It picked up this density variation when I didn't see it. If it uses my techniques, how do you explain that?"

"Easy. Remember, the computer digitizes the image into a two-hundred-fifty-six by two-hundred-fifty-six grid of pixel points with gray values between zero and two hundred. When we tested you, you only could differentiate gray values of zero to fifty. Obviously the machine is more sensitive."

"I'm sorry I asked," said Philips.

"Have you run the program against any old skull X rays?"

"No," admitted Philips, "I'm about to start."

"Well, you don't have to do everything in one night. Einstein didn't. Why not wait until morning?"

"Shut up," said Philips good-naturedly and hung up.

Armed with Lynn Anne Lucas's hospital number, Philips found her X ray file with relative ease. It contained only two recent chest films and the skull series taken after the roller-skating accident when she was eleven. He put one of the old lateral skull films up on the viewer next to the X ray taken that evening. Comparing them, Philips ascertained that the abnormal density had developed since age eleven. To be perfectly certain. Philips fed one of the older films into the computer. It concurred.

Philips put Lynn Anne's old X rays back into the envelope and put the new ones on top. Then he put the package on his desk, where he knew Helen wouldn't touch it. Until Lynn Anne had her new studies, there was nothing else to be done on her case.

Martin wondered what he should do. Despite the hour he knew he was still too excited to sleep and besides he wanted to wait for Denise. He was hoping she'd come by his office when she finished whatever she was doing. He thought about paging her, but then thought better of it.

He decided to pass the time by getting some old skull X rays from the file room. He thought he might as well start the process of checking the computer program. In case Denise came back before he did he left a note for her on the door. "I'm in Central Radiology."

At one of the terminals of the hospital's central computer he painfully typed out what he wanted: a printout of the names and unit numbers of all patients having had skull X rays in the last ten years. When he was finished he pushed the "enter" button and swung around in the chair to face the output printer. There was a short delay. Then the machine spewed out paper at an alarming rate. When it finally stopped, Philips found himself holding a list of thousands of names. Just looking at it made him feel tired.

Undaunted, he sought out Randy Jacobs, one of the department's evening employees, hired to file the day's X rays and pull the films needed for the following day. He was a full-time pharmacy student, a talented flautist, and an out-of-the-closet gay. Martin found him sharp-witted, ebullient, and a fabulous worker.

To start, Martin asked Randy to pull the X rays on the first page of the list. That represented about sixty patients. With his usual efficiency, Randy had twenty lateral skull films on Philips' alternator in as many minutes. But Philips did not run the films on the computer as Michaels had asked. Instead he began to examine them closely, unable to resist the temptation to look for more of the abnormal densities he had discovered on Marino's and Lucas's X rays. Using his paper with the hole as a screening device, he began to go from one film to another, advancing the viewing screens as needed by depressing the electrical lever with his foot. He'd processed about half of the X rays when Denise arrived.

"All your big talk about wanting to leave clinical radiology and you're looking at X rays when it's almost midnight."

"It is a bit silly," said Martin, leaning back in his chair and rubbing his eyes with his knuckles, "but I had these old films pulled and I thought I'd check to see if I could find another case like Lucas or Marino."

Denise came up behind him and rubbed his neck. His face looked tired.

"Have you found any?" she asked.

"No," said Philips. "But I've only looked at a dozen or so films."

"Have you narrowed down your field?"

"What do you mean?"

"Well, you've seen two cases. Both are recent, both are women, and both are about twenty."

Philips looked at the row of films in front of him and grunted. It was his way of acknowledging that Denise had a good point without saying so. He wondered why he hadn't thought of it himself.

She followed him back to the main computer terminal maintaining a steady stream of commentary about the busy evening in the ER. Philips listened with half an ear while he made his entry. He asked for the names and unit numbers of female patients, aged fifteen to twenty-five, who'd had skull films within the last two years. When the output printer came alive it only typed one line. It told Philips that the data bank was not keyed to retrieve skull films by sex. Philips adjusted his demand on the keyboard. When the printer reactivated, it typed at a vicious rate, but only for a short interval. The list comprised only a hundred and three patients. A quick scan suggested that somewhat less than half were female.

Randy liked the new list. He said the size of the other was demoralizing. While they waited, he pulled seven envelopes saying it would give them something to start with while he gathered the others.

Back in his office, Martin admitted that he was beat and that fatigue was beginning to erode his enthusiasm. He dropped the X rays in front of his alternator and put his arms around Denise, pressing her against him. His head dropped over her shoulder. She hugged him back, her hands just beneath his shoulder blades. They stood there for a moment supporting each other, not speaking.

Finally Denise looked up into Martin's face and pushed his blond hair from his forehead. His eyes were closed.

"Why not call it a day," she said.

"Good idea," said Philips, opening his eyes. "Why don't you come on back to my apartment? I'm still a bit manic; I need to talk."

"Talk?" asked Denise.

"Whatever."

"Unfortunately, I'm certain I'll be called back to the hospital."

Philips lived in an apartment building called the Towers, which had been built by the Med Center and was contiguous with the hospital. Although it had been designed with very little creativity, it was new, safe, and superbly convenient. It was also built on the river and Martin had one of the riverside units. Denise, on the other hand, lived in an old building on a cluttered side street. Her apartment was on the third floor and its windows faced a forever dark air shaft.

Martin pointed out that his apartment was as close to the hospital as the on-call room in the nurses' quarters, which was available for Denise's use, and three times closer than her own apartment. "If you get called, you get called," he said.

She hesitated. Seeing each other while she was on call was a new experience and Denise was afraid that escalating the relationship was going to force a decision.

"Maybe," she said. "First, let me check the ER and make sure there aren't any problems brewing."

While he waited for her, he began putting some of the new X rays on his viewer. He had three of them up before his eyes were pulled back to the first. Leaping from his chair, he put his nose to the film. Another case! There was the same speckling starting in the very back of the brain and running forward. Philips looked down at the envelope. The name was Katherine Collins, age twenty-one. The typed X-ray report glued to the envelope listed "seizure disorder" as the clinical information.

Taking Katherine Collins' X ray back to the small computer, he fed it to the scanner. Then he grabbed the remaining four envelopes and extracted a skull film from each. He began putting them on his viewer, but before his hand even left the edge of the first film, he knew he'd found yet another case. His eyes were now very sensitized to picking up the subtle changes. Ellen McCarthy, age twenty-two, clinical information: headaches, visual disturbance, and weakness of right extremities. The other films were normal.

Using a matched pair of lateral skull films from Ellen McCarthy's envelope, that had been taken at slightly different angles, Philips switched on the light in his stereo viewer. Looking through the eyepiece, he had great difficulty perceiving any speckling at all. What he could see seemed to be superficial, in the cerebral cortex rather than deeper in the nerve fibers of the white matter. That was somewhat disturbing information. The lesions of multiple sclerosis were usually in the white matter of the brain. Tearing off the printout from the computer, Philips read the report. At the top of the page was a THANK YOU referring to when Philips had inserted the film. This was followed by a girl's name and a fictitious phone number. It was more of Michaels' humor.

The report itself was just as Philips expected. The densities were described and as it had with Lynn Anne Lucas, the computer asked again to be advised as to the significance of the un-programmed abnormalities.

Almost simultaneously Denise returned from the ER and Randy arrived with fifteen more envelopes. Philips gave Denise a resounding kiss. He told her that thanks to her suggestion he'd found two more cases, both young women. He took the new films from Randy and was about to start on them, when Denise put her hand on his shoulder.

"The ER is quiet now. An hour from now, who knows?"

Philips sighed. He felt like a child with a new toy being asked to abandon it for the night. Reluctantly he put the envelopes down and told Randy to pull the rest of the films from the second list and stack them on his desk. Then if he had any time left he could begin pulling the films from the main list, and stack them against the back wall, behind the worktable. As an afterthought Martin asked Randy to call Medical Records and have the hospital charts of Katherine Collins and Ellen McCarthy sent up to his office.

Glancing around the room Martin said, "I wonder if I'm forgetting anything."

"Yourself," said Denise with exasperation. "You've been here for eighteen hours. Good gravy, let's go."

Since the Towers was part of the medical center, it was connected to the hospital by a well-lit and cheerfully painted basement tunnel. Power and heat traveled the same route, concealed in the tunnel's ceiling, behind acoustical tiles. As Martin and Denise walked hand in hand they passed first under the old medical school and then the new medical school. Farther on they passed branching tunnels leading to the Brenner Pediatric Hospital and the Goldman Psychiatry Institute. The Towers was at the end of the tunnel and represented the current limit of the cancerous spread of the medical center into the surrounding community. A flight of steps led directly into the lower foyer of the apartment house. A guard behind a bulletproof glass recognized Philips and buzzed them in.

The Towers was a posh residential address inhabited mostly by MDs and other professionals from the medical center. A few other professors from the university lived there as well but they generally found the rents on the expensive side. Of the physicians, most were divorced, although there was a rising contingent of young turks with their aggressively career-minded wives. There were almost no children except for weekends when it was Dad's turn with the kids. Martin also knew there were quite a few psychiatrists, and he'd noticed not an insignificant number of gays.

Martin was one of the divorced. It had happened four years previously after six years of matrimonial suburban stalemate. Like most of his colleagues Martin had married during his residency as a kind of reaction against his demanding academic life. His wife's name was Shirley and he had loved her, at least he thought he'd loved her. He'd been shocked at the time when she upped and left him. Luckily they'd had no children. His reaction to the divorce had been depression, which he'd dealt with by working even longer hours, if that was possible. Gradually as time passed he was able to view the experience with the necessary detachment to realize what had happened. Philips had been married to medicine, his wife had been the mistress. Shirley had picked the year he'd been appointed Assistant Chief of Neuroradiology as the time to leave because she'd finally understood his value system. Before his selection his excuse to his wife for his seventy hours per week was that he was shooting to become the Assistant Chief. Once he got the position his excuse for the same work week was that he was the Chief. Shirley had seen the light even if Philips hadn't. She had refused to be married and alone and so she left.

"Have you come to any conclusion about Marino's missing brain?" asked Denise, bringing Martin back to the present.

"No," said Philips. "But Mannerheim must have been responsible in some way."

They were waiting for the elevator beneath a huge, gaudy chandelier. The carpet was burnt orange with interlocking gold circles.

"Are you going to do anything about it?"

"I don't know what I can do. I sure wouldn't mind finding out why it was removed."

The nicest aspect of Philips' apartment was the view of the river and the graceful curve of the bridge. Otherwise it was very unremarkable. Philips had moved suddenly. He'd rented the apartment by telephone and had hired a rental firm to furnish it And that's what he got-furniture: a couch; a couple of end tables; a coffee table; a couple of chairs for the living room; a dinette set; and a bed with matching side table for the bedroom. It wasn't much, but it was only temporary. The fact that Philips had been living there for four years didn't occur to him.

Martin was not a drinker but tonight he wanted to relax so he splashed some scotch over ice. To be polite he held the bottle up for Denise but she shook her head as he'd expected. She only drank wine or an occasional gin and tonic, and certainly not while she was on call. Instead she got herself a tall glass of orange juice from the refrigerator.

In the living room Denise listened to Martin's chatter, hoping that he'd burn himself out quickly. She was not interested in talking about research or missing brains. She was remembering his admission of affection. The possibility of his being serious excited her and it allowed her to admit her own feelings.

"Life can be amazing," Martin was saying. "In a single day it can take such wonderful twists."

"What are you referring to?" Denise asked, hoping he was going to talk about their relationship.

"Yesterday, I had no idea we were so close to producing the X-ray reading program. If things go…"

Exasperated, she got up and pulled him to his feet and began pulling at his shirttails telling him that he should relax and forget the hospital. She looked up into his bemused face with a teasing smile, so that no matter what happened it wouldn't be awkward.

Philips agreed that he was wound up and said he'd feel better if he took a quick shower. It wasn't quite what she had in mind, but he encouraged her to come into the bathroom and keep him company. She watched him through the shower glass, which was frosted on one side and beveled on the other. The image of Philips' naked body was fractured and softened in a curiously erotic way as he twisted and turned under the jet of water.

Denise sipped her orange juice while Martin tried to carry on a conversation over the din of the water. She couldn't hear a word, which she thought was just as well. At the moment she preferred watching rather than listening. Affection welled up inside of her, filling her with warmth.

Finished, Martin turned off the water and, grabbing his towel, stepped out of the shower. To Denise's disgust he was still talking about computers and doctors. Annoyed, she snatched the towel and began to dry his back. When she was finished she turned him back around.

"Do me a favor," she said as if she were angry, "and shut up." Then she grabbed his hand, and pulled him out of the bathroom. Confused at her sudden outburst, Philips allowed himself to be led into the darkened bedroom. There in full view of the silent river and the dramatic bridge, Denise threw her arms around his neck and passionately kissed him.

Martin responded instantly. But before he could even undress Denise, her beeper filled the room with its insistent sound. For a moment they just held each other, postponing the inevitable, and enjoying their closeness. Without saying it, they both knew that their relationship had reached a new plateau.

It was 2:40 A.M. when a city ambulance pulled into the receiving area of the Medical Center. There were already two similar ambulances parked there, and the new one backed up between them until its bumper thumped the rubber guard. The engine choked and died before the driver and the passenger alighted from the cab. With their heads bowed against the steady April rain, they trotted back and leaped up on the platform. The thinner of the two swung open the rear door of the ambulance. The other more muscular man reached in and pulled out an empty stretcher. Unlike the other ambulances this one was not bringing an emergency. It had come to pick up a patient. Not an uncommon occurrence.

The men lifted the stretcher from each end and, like an ironing board, its legs dropped down. Instantly the stretcher was converted into a narrow but functional gurney. Together they pushed through the automatic sliding door of the emergency room and looking neither right nor left, turned down the main corridor and took an elevator to Neurology West on the fourteenth floor. There were two RNs and five LPNs assigned to the floor for the shift, but one of the nurses and three of the aides were on their break, so Ms. Claudine Arnette, RN, was in charge. It was to her that the thinner man presented the transfer documents. The patient was being moved to a private room at New York Medical Center, where her own doctor had admitting privileges.

Ms. Arnette checked the papers, swore under her breath because she had just finished her paper work on the admission and signed the form. She asked Maria Gonzales to accompany the men down to room 1420. Then she went back to her narcotic check before her own break. Even in the reduced light she'd noticed that the driver had amazingly green eyes.

Maria Gonzales opened the door to room 1420, and tried to awaken Lynn Anne. It was difficult. She explained to the ambulance attendants that they'd received a phone call order for a double dose of sleep medication as well as phenobarbital because of the possibility of seizure. The men told Maria it didn't matter, and they positioned the stretcher and arranged the blankets. With a smooth, practiced maneuver, they lifted the patient and settled her with the blankets. Lynn Anne Lucas never even woke up.

The men thanked Maria, who had already begun to strip Lynn Anne's bed. Then they wheeled her out into the hallway. Ms. Arnette didn't look up when they passed the nurses' station and got back on the elevator. An hour later the ambulance pulled away from the Med Center. There was no need for the siren or rotating light. The ambulance was empty.