Brain

Chapter 8

Moments before the alarm was due to sound, Martin pressed in the knob on the clock and lay there, looking up at the ceiling. His body was so used to waking at five-twenty-five that he rarely needed assistance, no matter what time he went to sleep. Marshaling his strength, he rose quickly and donned his jogging clothes.

The nighttime rain had saturated the air with moisture, and a stringy fog hung over the river, making the stanchions of the bridge appear as if they were supported by vaporous clouds. The dampness deadened the sound so that the early-morning traffic did not interrupt his thoughts, which were mostly about Denise.

It had been years since he had felt the excitement of romantic love. For a couple of weeks he hadn't even recognized the reason for his insomnia and odd mood swings, but then when he found himself remembering what Denise wore each day, the reality finally dawned on him with a mixture of cynicism and delight. The cynicism came from having watched several of his colleagues who were also forty plus make fools of themselves with new, young loves. The delight came from the relationship itself. Denise Sanger wasn't just a young body to be used to deny the inevitability of time. She was a fascinating combination of mischievous inventiveness and penetrating intelligence. The fact that she was so pretty was like icing on the cake. Philips had to admit that he was not only crazy about her, but was also becoming dependent upon her as a means of rescue from the self-fulfilling prophecy his life had become.

When he reached the 2.5-mile mark, Philips turned and headed back. There were more joggers now, some of whom he recognized; but he tended to ignore them as they did him. His breathing became a little heavier but he continued to maintain a strong smooth pace all the way to his apartment.

Philips knew that as much as he'd liked medicine, he'd used it as an excuse for not expanding any other parts of his life. The shock of his wife's flight had been the biggest single cause of this realization. What to do about it was another issue. For Martin, research had become the potential salvation. While he continued his grading day-to-day commitments, he'd expanded his research hoping that it would eventually win some freedom for him. He didn't want to give up clinical medicine, just loosen the stranglehold it had on his life. And now that Denise had come along, he was even more committed. He vowed he would not make the same mistake again. If things worked out between them, Denise was going to be his wife in the full sense of the word. But to do that his research had to succeed. By 7:15 he had showered, shaved and was at his office door. When he went inside he stopped, amazed. Overnight the room appeared as if it had been transformed into a dump for old X rays. Randy Jacobs with his usual efficiency had pulled a great percentage of the films he'd requested. The envelopes from the master list were stacked in precarious piles behind the worktable. Those from the second, smaller list were stacked by Philips' alternator. Lateral skull films had been taken from each of the envelopes of the latter group and mounted on the viewing screens.

Philips experienced a new wave of enthusiasm and sat down in front of the alternator. He immediately began scanning the films for abnormalities similar to those he'd seen with Marino, Lucas, Collins, and McCarthy. He'd gotten through almost half when Denise walked in.

She looked exhausted. Her normally shiny hair seemed oily and her face was pale with dark circles under her eyes.

She gave him a quick hug and sat down. Looking at her wan expression he suggested she take a few hours off for a nap. He'd see her in the angiography room when she felt like returning. Meaning, of course, he'd start the case.

"Hold on," said Denise. "No special concessions for the boss's mistress. It's my turn to be in the cerebral angiography room and I'll be there whether I've slept or not."

Martin realized he'd made a mistake. Denise would never be anything but professional about her work. He smiled and patted her hand, telling her he was glad she felt the way she did.

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 Robbing 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 through 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.