Brain

Chapter 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 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 bete 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 resemblance 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.

Reynolds saw Philips and walked over. In his hand he held a large autopsy knife like a butcher knife. Martin glanced around the room to keep from looking at the procedure in front of him. The area resembled an operating room. It was new and modern and completely tiled so that it could be easily cleaned. There were five stainless steel tables. On the rear wall were a series of square refrigerator doors.

"Greetings, Martin," said Reynolds, wiping his hands on his apron. "I'm sorry about that Marino case. I would have liked to have helped you."

"I understand. Thanks for trying. Since there wasn't going to be a post, I tried to run a CAT scan on the corpse. It was surprising. Do you know what I found?"

Reynolds shook his head.

"There was no brain," said Philips. "Somebody removed the brain and sewed her back up so you practically couldn't tell."

"No!"

"Yeah," said Philips.

"God. Can you imagine what kind of blowup that could cause if the press got a hold of it, much less the family? They were definite about no autopsy."

"That's why I wanted to talk to you," said Philips.

There was a pause.

"Wait a minute," said Reynolds. "You don't think Pathology was involved."

"I don't know," admitted Philips.

Reynolds' face reddened, and veins appeared on his forehead. "Well I can assure you. The body never came up here. It went directly to the morgue."

"What about Neurosurgery?" asked Philips.

"Well, Mannerheim's boys are crazy, but I don't think that crazy."

Martin shrugged, then told Reynolds the real reason he'd stopped by was to inquire about a patient by the name of Ellen McCarthy who'd arrived dead at the ER about two months previously. Philips wanted to know if she'd been autopsied.

Reynolds snapped off his gloves and pushed his way through the.doors into the main portion of the department. Using Pathology's terminal for the main computer, he typed in Ellen McCarthy's name and unit number. Immediately her name appeared on the computer screen followed by the date and number of the autopsy as well as cause of death: head injury resulting in massive intracerebral hemorrhage and brain-stem herniation. Reynolds quickly located a copy of the autopsy report and handed it to Philips.

"Did you do the brain?" asked Philips.

"Of course we did the brain!" said Reynolds. He grabbed back the report. "You think we wouldn't do the brain on a head-injury case?" His eyes rapidly scanned the paper.

Philips watched him. Reynolds had gained nearly fifty pounds since they'd been lab partners in med school and a fold of skin on the back of his neck concealed the top of his collar. His cheeks bulged out and just beneath the skin there was a fine network of tiny red capillaries.

"She might have had a seizure before the auto accident," said Reynolds, still reading.

"How could that be determined?"

"Her tongue had been bitten multiple times. It's not certain, just presumptive…"

Philips was impressed. He knew that such fine points were usually only picked up by forensic pathologists.

"Here's the brain section," said Reynolds. "Massive hemorrhage. There is something interesting though. A section of the cortex of the temporal lobe showed isolated nerve-cell death. Very little glial reaction. No diagnosis was advanced."

"How about the occipital area?" asked Philips. "I saw some subtle X-ray abnormalities there."

"One slide taken," said Reynolds, "and that was normal."

"Just one. Damn, I wish there had been more."

"You might be in luck;. It indicates here the brain was fixed. Just a minute."

Reynolds walked over to a card catalogue and pulled out the M drawer. Philips felt some mild encouragement.

"Well, it was fixed and saved but we don't have it. Neurosurgery wanted it so I guess it's up in the neurosurgical lab."

After stopping to watch Denise flawlessly and efficiently perform a single-vessel angiogram, Philips headed over to surgery. Dodging patient traffic in the holding area, he walked up to the OR desk.

"I'm looking for Mannerheim," said Philips to the blond nurse. "Any idea when he'll be out of surgery?"

"We know exactly."

"And what time will that be?"

"Twenty minutes ago." The, other two nurses laughed. Apparently things were going smoothly in the OR for them to be in such good moods. "His residents are closing. Mannerheim's in the lounge."

Philips found Mannerheim holding court. The two visiting Japanese doctors were standing on either side of him smiling and bowing at irregular intervals. There were five other surgeons in the group, all drinking coffee. Mannerheim was holding a cigarette in the same hand as his cup. He'd given up smoking a year ago, which meant he didn't buy any cigarettes, but borrowed them from everybody else.

"So you know what I told this smart-ass lawyer?" said Mannerheim, gesturing dramatically with his free hand. "Of course I play God. Who do you think my patients want screwing around inside their brains, a garbage man?"

The group roared with approval, and then began to disperse. Martin approached Mannerheim and looked down on him.

"Well, well, our helpful radiologist."

"We try to please," said Philips pleasantly.

"Well, I can tell you I did not appreciate your little joke on the phone yesterday."

"It wasn't meant to be a joke," said Philips, "I'm sorry that my comment seemed out of place. I didn't know Marino was dead and I'd noticed some very subtle abnormalities on her film."

"You're supposed to look at the X rays before the patient dies," said Mannerheim nastily.

"Look, what I'm interested in discussing is that Marino's brain was removed from her corpse."

Mannerheim's eyes bulged and his full face turned a dull red. Taking Philips by the arm he led him away from the two Japanese doctors.

"Let me tell you something," he snarled, "I happen to know that you moved and X-rayed Marino's body last night without authorization. And I can tell you this, I don't like anybody fucking around with my patients. Especially my complications."

"Listen," said Martin, shaking his arm free from Mannerheim's grasp. "My only interest is some strange X-ray abnormalities that could result in a major research breakthrough. I have no interest in your complications."

"You'd better not. If there was something irregular done to Lisa Marino's body, it would be on your head. You're the only one known to have taken the body from the morgue. Keep that in mind." Mannerheim waved a threatening finger in Philips' face.

A sudden fear of professional vulnerability made Martin hesitate. As much as he hated to admit it, Mannerheim had a point. If it became known that Marino's brain had been removed, the burden would be on him to prove that he didn't do it, Denise, with whom he was having an affair, was his only witness.

"All right, let's forget Marino," he said. "I found another patient with the same X-ray picture. An Ellen McCarthy. Unfortunately she'd been killed in an auto accident. But she was posted here at the Med Center and the brain was fixed and turned over to Neurosurgery. I would like to get ahold of that brain."

"And I'd like you to stay out of my hair. I'm a busy man. I'm taking care of real patients, not sitting on my ass looking at pictures all day."

Mannerheim turned and started away.

Philips felt a surge of fury. He wanted to shout, "You arrogant provincial bastard." But he didn't. That was what Mannerheim expected, maybe even wanted. Instead Martin went for the surgeon's known Achilles' heel. In a calm, understanding voice Martin said: "Dr. Mannerheim, you need a psychiatrist."

Mannerheim whirled, ready for combat, but Philips was already out the door. To Mannerheim, psychiatry represented the absolute antithesis of everything he stood for. For him it was a morass of hyperconceptual nonessence, and to be told he needed one was the worst insult he could absorb. In a blind rage the surgeon crashed through the door into the dressing area, tore off his bloodstained OR shoes and threw them the length of the room. They crashed into a bank of lockers and skidded under the sinks.

Then he snatched the wall phone and made two loud phone calls. First he called the Director of the hospital, Stanley Drake, then he called the Chief of Radiology, Dr. Harold Goldblatt, insisting to each that he wanted something done about Martin Philips. Both men listened in silence: Mannerheim was a powerful individual within the hospital community.

Philips was not the kind of person who got angry very often, but by the time he reached his office, he was steaming.

Helen looked up when he appeared. "Remember you've got the medical-student lecture in fifteen minutes."

Philips mumbled under his breath as he walked by her. To his surprise Denise was sitting in front of his alternator studying McCarthy's and Collins" charts. She looked up when he came in. "How about a bite of lunch, old man?"

"I don't have time for lunch," snapped Philips, throwing himself into his chair.

"You're in a wonderful mood."

Leaning his elbows on the desk, he covered his face with his hands. There was a moment of silence. Denise put the charts down and stood up.

"I'm sorry," said Martin through his fingers. "It's been a trying morning. This hospital is capable of erecting unbelievable barriers to any enlightened inquiry. I might have stumbled onto an important radiological find, but the hospital seems determined to discourage me from looking into it."

"Hegel wrote: 'Nothing great in the world has been accomplished without passion,' " Denise said with a twinkle. Her undergraduate major had been philosophy and she'd discovered that Martin enjoyed her ability to quote some of the great thinkers.

Philips finally took his hands from his face and smiled. "I could have used a little more passion last night."

"Leave it to you to interpret the word in that context. That's hardly what Hegel meant. Anyway, I'm going to have some lunch. You sure you can't join me?"

"Not a chance. I've got a lecture with the medical students."

Denise started toward the door. "By the way, as I was going through those charts of Collins and McCarthy I noticed both had several atypical Pap smears." Denise paused at the door.

"I thought their GYN exams were normal," said Philips.

"Everything was normal except the Pap smears on both patients. They were atypical, meaning they weren't frankly pathological, just not perfectly normal."

"Is that uncommon?"

"No, but it's supposed to be followed up until the test is normal. I didn't see any normal reports. Well, it's probably nothing. Just thought I'd mention it. Bye!"

Philips waved but stayed at his desk, trying to recall Lisa Marino's chart. It seemed to him that he remembered the Pap smear being mentioned there as well. Leaning out into the hall, Philips caught Helen's attention: "Remind me to head down to Gynecology Clinic this afternoon."

At 1:05 P.M., armed with his carousel labeled "CAT Scanner Introductory Lecture," Philips entered the Walowski Memorial Conference room. It was a far cry from the rest of the Department of Radiology, which was utilitarian and crammed into inadequate space. The conference room was inordinately plush, looking more like a Hollywood screening room than a hospital auditorium. The chairs were upholstered with a soft corduroy and arranged in tiers, giving each an unobstructed view of the screen. When Philips entered, the room was already filled.

He put his carousel on the projector and mounted the podium. The students quickly settled into their chairs, giving him their attention. Philips dimmed the lights and flipped on the first slide.

The lecture was polished. Philips had given it many times. It began with the origin of the concept of the CAT scanner by Mr. Godfrey Hornsfield of England, followed by a chronological recounting of its development. Philips very carefully emphasized that although an X-ray tube was used, the picture that resulted was really a mathematical reconstruction after a computer had analyzed the information. Once the students understood that basic concept, he felt the major point of the lecture had been accomplished.

As he talked, Martin's mind began to wander. He was so familiar with the material that it made no difference. His admiration of the people who had developed the CAT scanner included a touch of jealousy. But then he realized that if his own research proved out, he was going to be catapulted into the scientific limelight. His work might have even a more revolutionary impact on diagnostic radiology. It would certainly put him in contention for a Nobel prize.

In the middle of a sentence describing the CAT scanner's ability to pick up tumors, Philips' beeper went off. Turning up the lights, he excused himself and ran to the phone. Philips knew Helen would not page him except in an emergency. But the operator told him it was an outside call, and before he could protest, he was connected to Dr. Donald Travis.

"Donald," said Martin, putting his hand around the receiver. "I'm in the middle of a lecture, can I call you back?"

"Hell no!" yelled Travis. "I've wasted a good portion of my morning looking for your mythical middle-of-the-night transfer."

"You can't find Lynn Anne Lucas?"

"No. In fact, there hasn't been any God-damn transfer from the Med Center for the last week."

"That's strange. I was distinctly told New York Medical Center. Look, I'll speak to Admitting, but please check once more, it's important."

Philips hung up the phone, but let his hand remain on the receiver for a moment. Dealing with bureaucracy was almost as bad as dealing with the likes of Mannerheim. Heading back to the podium, he tried to pick up the pieces of the lecture, but his concentration was completely broken. For the first time since he began teaching, he claimed a false emergency and wound up the lecture.

Back at his office, Helen apologized for the interruption, saying that Dr. Travis was insistent. Philips told her it was all right and she followed him into his office reeling off his messages. She said that the Director of the hospital, Stanley Drake, had called twice and wanted a call back as soon as possible. She said that Dr. Robert McNeally had called from Houston, asking if Dr. Philips would chair the Neuroradiology section at the annual radiology convention in New Orleans. She said he needed an answer within the week. She started to go on to the next topic when Philips abruptly raised his hand.

"That's enough for now!" said Philips.

"But there's more."

"I know there's more. There's always more."

Helen was taken aback. "Are you going to call Mr. Drake?"

"No. You call him and tell him I'm too busy to call him today and I'll speak to him tomorrow."

Helen had the sense enough to know when to leave her boss alone.

Standing on the threshold of his office. Philips looked around the room. The mess made by the stacks of skull films had been removed and in their place were the morning's angiograms. At least his head technician, Kenneth Robbins, had things under control.

Work was Philips' stability. So he sat down, picked up the microphone and began to dictate. He had come to the last angiogram when he realized someone had entered the office and was standing behind him. Expecting Denise, Philips was surprised to look up into the smiling face of Stanley Drake, the Director of the hospital.

To Philips' way of thinking, Drake resembled a smooth, styled politician. He was always very natty in his dark blue pinstriped three-piece suit and gold watch chain. He wore his silk ties with a stud so they stood out horizontally from his starched white shirt. He was the only person Philips knew who still wore large French cufflinks. Somehow he always managed to look tan, even during a rainy April in New York.

Philips turned back to his angiogram and continued dictating. "In conclusion, the patient has a large arteriovenous malformation of the left basal ganglia area supplied by the left middle cerebral and left posterior cerebral choroidal artery. Period. End of Dictation. Thank you."

Putting down the microphone, Martin turned to face the Director. It irked him that there was so little sense of privacy in the hospital that Drake would think nothing of just walking right into his office.

"Dr. Philips, good to see you," said Drake, smiling. "How's the wife?"

Philips looked at him for a moment, not sure whether to laugh or be angry. Finally he said evenly, "I got divorced four years ago." He played it down the middle.

Drake swallowed, his smile faltering for a moment. He switched the subject to how pleased the Board of Directors of the hospital had been with the smooth functioning of the Department of Neuroradiology since Philips' appointment. Then there was a pause. Philips just watched. He knew why Drake was here and he wasn't going to make it any easier for him.

"Well," said the administrator, assuming a more serious tone. His small mouth pulled together. "I'm here to discuss this unfortunate Marino situation."

"What's that?" said Philips.

"The fact that the poor girl's body was irreverently handled and X-rayed without authorization of a postmortem examination."

"And the brain was removed," said Philips. "X-raying a body and removing a brain are not in the same category!"

"Yes, of course. Now, whether you were involved in actually taking the brain is immaterial at this point. The point is…"

"Wait a minute!" Philips sat up in his chair. "I want this perfectly clear. I X-rayed the body, that's true. I did not remove the brain."

"Dr. Philips. I'm not concerned who removed the brain. I'm concerned about the fact that the brain was removed. It's my responsibility at this point to protect the hospital and its staff from bad publicity and financial burden."

"Well I'm concerned about who removed the brain, especially if anybody thinks that it might have been me."

"Dr. Philips, there's no need to be alarmed. The hospital has already spoken to the mortuary. The family will not learn of this unfortunate episode. But I must remind you of your tenuous position in regard to this case and implore you to let the matter drop. It's as simple as that."

"Did Mannerheim put you up to this inquisition?" asked Philips, his composure beginning to wear thin;

"Dr. Philips, please understand my position," said Drake. "I'm on your side. I'm trying to put out a small fire before it flares up and causes damage. It's for everyone's benefit. I'm just asking you to be reasonable."

"Thank you," said Philips, standing up. "Thank you for stopping by. I appreciate your comments, and I'll give them deep thought." Philips hustled Drake out of his office, then closed his door.

As he replayed the conversation, he had trouble believing it had happened. Through the door he could hear Drake talking with Helen, so he knew he hadn't been dreaming. But more than anything to date, it made him determined to be free of the departmental rat race. More than ever he knew that his research had to succeed.

With an increased sense of motivation, Philips picked up the master list of skull films taken over the last ten years. Checking the unit numbers with the stack of films, he quickly determined the order in which they had been stored. He took the first envelope, crossed the name off the list, then pulled out the X rays. He took two matching lateral skull films, replacing the rest. After giving the computer the necessary information, he fed one of the films into the laser scanner. The other went up on his viewer. The old X-ray report was placed next to the print-out console.

Like most compulsive personalities, Martin was a listmaker. He had noted down Marino, Lucas, Collins, and McCarthy when the phone rang. It was Denise, saying that the first afternoon angiogram was all ready to go. Philips thought for a moment, then said that his presence was superfluous and suggested she go ahead with the study as long as she felt comfortable. As he had suspected, she was pleased with the vote of confidence.

Going back to his list, Philips crossed off Collins. After Marino he wrote, "morgue see Werner." Philips had a strong feeling that the diener knew what had happened to Lisa Marino's body. After McCarthy, Philips wrote, "neurosurgical lab."

That left Lucas. He was confident from his conversation with Travis that she was not at New York Medical Center, unless she had been admitted under an alias, but that hardly made sense, so he wrote, "night charge nurse Neuro 14 West" after her name.

Then he picked up the phone and called Admitting again. It took thirty-six rings for someone to answer. Once again the person Philips had to talk to was unavailable. Philips left his name and a request to be called back.

By that time the computer had finished its run. Philips read the report with excitement, comparing it to the old reading, and then checking the film itself. The computer not only picked up everything mentioned on the report, it even found some mild bone thickening and opacity in the frontal sinuses that had been missed on the original reading. Looking at the films, Philips had to agree with the computer. It was amazing.

He was repeating the procedure with the next film, when Helen stuck her head in the door saying in an apologetic voice that the "big boss" wanted to see him as soon as possible.

Dr. Harold Goldblatt's office was situated at the far end of the department, in a wing of the building that stuck out into the central courtyard like a small rectangular tumor. Everyone knew when they'd entered his domain because the floor was carpeted and the walls changed to paneled mahogany. It reminded Philips of one of those downtown law firms whose letterhead had as many names as a page in the phone directory.

He knocked on the heavy wood door. Goldblatt was sitting behind his massive mahogany desk. The room had windows on three sides and the desk faced the door. There was more than a casual resemblance to the Oval Office. Goldblatt revered the trappings of power, and after a lifetime of Machiavellian maneuvering, he had become an international figure in radiology. At one time he had been good at neuroradiology; now he was an institution, and his professional knowledge was dated and therefore limited. Although Martin was privately cynical about Goldblatt's understanding of such innovations as the CAT scanner, he still admired the man. He had been a major force in elevating radiology to its current prestigious status.

Goldblatt stood up, to shake Philips' hand and motioned him to a chair facing the desk. Goldblatt was a vigorous sixty-four years old. He still dressed the way he had when he'd graduated from Harvard in 1939. His suit was a boxy three-piece affair with baggy, cuffed trousers, hemmed about an inch above his ankles. He wore a thin bow tie, tied by hand and therefore crooked and asymmetrical. His hair was almost white and cut in a modified crew cut, which allowed a little bit of length over the ears. He peered at Martin over the tops of wire-rimmed Ben Franklins.

"Dr. Philips," began Goldblatt, sitting down. He put his elbows on his desk, clasping his hands together in a solid embrace. "Bringing up cadavers who are barely cold from the morgue to the department in the middle of the night is not my idea of normal practice."

Philips agreed that it sounded preposterous, and as an explanation, not an excuse, he told Goldblatt first about the X-ray reading program that he and William Michaels had developed, and then about the abnormal density the computer program had picked up on Lisa Marino's X ray. He told Goldblatt that he needed more films to characterize the abnormality. He said that he felt it imperative to follow up on the discovery because it could be used to launch the concept of a computer X-ray analyzer.

After Philips had spoken, Goldblatt smiled benignly, nodding, "Listening to you, Martin, makes me wonder if you know exactly what you are doing."

"I believe I do." Goldblatt's comment surprised Philips, and it was difficult not to take offense.

"I don't mean on the technical side of your endeavor. I mean with regard to the implication of your work. Frankly, I don't think the department can support a project whose goal is to alienate the patient even further than he is already from the physician. You're proposing a system whereby a machine replaces the radiologist."

Martin was stunned. He was not prepared to face a charge of heresy from Goldblatt. He'd expected that only from some of the marginally competent radiologists of whom Philips knew there were far too many.

"You have a promising future," continued Goldblatt, "and I'd like to help you keep it. I'm also committed to preserving the integrity of the department here at the Medical Center. It's my feeling that you should alter your research proclivities in a more acceptable direction. In any case, you may not X-ray any more cadavers without authorization. That shouldn't have to be said."

Philips had a sudden insight. Mannerheim must have gotten to Goldblatt. There was no other explanation. But Mannerheim was a prima donna who didn't like to share the spotlight with anyone. Why was he now working with Goldblatt and probably Drake? It didn't make sense.

"One last point," said Goldblatt, forming a steeple with his fingers. "It has been brought to my attention that you have formed some sort of liaison with one of the residents. I do not think the department can condone this kind of fraternization."

Philips abruptly stood up, his eyes narrowed, the muscles of his face tense. "Unless professional performance is compromised," he said slowly, "my personal life is none of the department's business."

He turned and walked out the office. Goldblatt called after him, saying something about the department's image, but Philips did not stop.

He passed Helen without a glance, although she stood up, message pad in her hand. He slammed his door, sat down in front of the alternator and picked up his microphone. It was best to work and allow a little time to pass before confronting his feelings. The phone rang and he ignored it. Helen answered it and buzzed. Philips went to the door and in pantomime asked Helen who it was. Dr. Travis, she said.

Travis told Martin that there was definitely no Lynn Anne Lucas at New York Medical Center. He'd searched the hospital, investigating every conceivable way the transfer could have been screwed up. He then asked Philips what he'd learned from the Admitting department.

"Not much," said Philips lamely. He was embarrassed to say he had not checked after putting Travis to so much effort. As soon as he hung up he called Admitting. Persistence paid off and finally he got to speak with the woman in charge of discharges and transfers. He asked her how a patient could leave the hospital in the middle of the night.

"Patients are not prisoners," said Admitting. "Was the patient admitted through the ER?"

"Yes," said Philips.

"Well, that's common," said the woman. "Often ER admissions are transferred after they have been stabilized, if the private physician does not have privileges here."

Philips grunted understanding, then asked for the details concerning Lynn Anne Lucas. Since the data-processing computer used by Admissions was keyed by unit number or date of birth, the woman said she'd have to get the unit number from the ER record before she could get any information. She'd call back as soon as she could.

Martin tried to go back to dictating, but it was difficult to concentrate. Right in front of his nose were Collins' and McCarthy's hospital charts. He remembered Denise's comment about the Pap smears. What he knew about gynecology in general and Pap smears in particular was negligible. Putting on his long white coat and taking Katherine Collins' chart, Philips left his office. Passing Helen, he told her he'd be back shortly and instructed her to page him only in an emergency.

The first step was the library. Passing several outpatients in foul-weather gear, Philips decided to use the tunnel. The new medical-school building was reached by taking the same right fork that Philips used to get to his apartment. It was just beyond the stairs that led up to the old medical school, which had been abandoned two years previously when the new facilities had been completed.

The old building was supposed to have been renovated to provide sorely needed space for the burgeoning clinical departments like radiology, but owing to enormous cost overruns, money had run out when the new school neared completion. After two years even a portion of the new building was still waiting for additional funding. So the old medical-school project had been indefinitely postponed and the clinical departments had to wait.

The new school was a far cry from Philips' student experience: particularly the library. Money had been no object, which was surely the reason the old medical school lay mostly abandoned. The foyer was spacious and carpeted with two mirror-imaged, curved staircases, which swept up to the floor above.

The library's card catalogue was under the lip of the balcony that formed the mezzanine. Philips got the call number of a standard gynecology text. Although he was interested in reading about the Papsmear, or Papanicolaou Smear, he wasn't interested in an exhaustive textbook of cytology. He was already aware of the efficacy of the test; as cancer-screening procedure, it was probably the best and most reliable. He'd even performed it himself, as a student, so he knew it was extremely easy, just a light scrape of the cervical surface with a tongue depressor, then smear the material on a glass slide. What he couldn't remember was the classification of the results, and what was supposed to be done if the report came back "atypical." Unfortunately the textbook wasn't too helpful. All it said was that any suspicious cervix should be followed up with a Schiller's test, which was an iodine-staining technique of the cervix-to determine abnormal areas, or a biopsy, or colposcopy. Philips had no idea what colposcopy was and had to use the index. It turned out to be a procedure whereby a microscope-like instrument was used to examine the cervix.

The thing that surprised Philips the most was learning ten to fifteen percent of new cases of cervical cancer occurred in twenty to twenty-nine year olds. He'd had the mistaken impression that cervical cancer was a problem of an older age group. There couldn't have been any better argument in favor of the annual gynecological examination.

Martin returned the text and made his way to the university's GYN clinic. He remembered that this portion of the service had been out of bounds for medical students, which had been like dangling meat in front of hungry animals since the women were usually cute college coeds. The patients available to the medical students were the old multiparous clinic regulars, and the contrast made the college coeds all look as if they were Playboy centerfolds.

Philips felt distinctly out of place as he approached the receptionist. When he stopped in front of her, she batted her eyes and sucked in a deep breath to elevate her flat chest. Martin stared at her because something seemed very strange about her face. He averted his gaze when he realized it was just that her eyes were unusually close set.

"I'm Dr. Martin Philips."

"Hi, I'm Ellen Cohen."

Involuntarily Philips glanced back at Ellen Cohen's eyes. "I'd like to talk with the doctor in charge."

Ellen Cohen again fluttered her eyelids. "Dr. Harper is examining a patient at present, but he'll be out soon."

In any other department Philips probably would have walked directly back into the examining area. Instead he turned to face the waiting room, feeling as self-conscious as he remembered he'd been at age twelve waiting for his mother in a hair salon. There were half-a-dozen young women sitting staring at him. The moment they caught his eye, they turned back to their magazines.

Martin sat down in a chair immediately adjacent to the receptionist's desk. Stealthily Ellen Cohen slid her paperback novel off the desk and dropped it into one of her drawers. When Philips happened to glance in her direction, she smiled.

Philips let his mind drift back to Goldblatt. The nerve of the man to think that he had the right to dictate Philips' personal life, or even his research, was astounding. Perhaps if the department funded Philips' research there might be some justification, but it didn't. Radiology's contribution was Martin's time. Funding that had been needed for hardware and programming fees, which had been considerable, came from sources available through Michaels' Department of Computer Science.

Suddenly Martin realized that a patient had approached the receptionist and was asking the meaning of an atypical Pap smear. She seemed to speak with effort, and she leaned weakly on the receptionist's desk.

"That, dearie," said Ellen Cohen, "is something you'll have to ask Ms. Blackman about." The receptionist immediately sensed Philips' attention. "I'm not a doctor," she laughed, mostly for his benefit. "Sit down. Ms. Blackman will be out shortly."

Kristin Lindquist had had all the frustration she could deal with that day.

"I was told that I'd be seen immediately," she said, and went on to tell the receptionist that she'd experienced a headache, dizziness, and changes in her vision that morning, so that she really could not wait like she had the day before. "Please tell Ms. Blackman right away that I'm here. She'd phoned me and promised there would be no delay."

Kristin turned and made her way over to a chair across from Philips. She moved slowly, like a person unsure of her balance.

Ellen Cohen rolled her eyes when she caught Philips', suggesting that the girl was unreasonably demanding, but she did get up to find the nurse. Martin turned to look at Kristin. His mind was busy making associations between atypical Pap smears and vague neurological symptoms. Kristin had closed her eyes so Philips could look at her without making her feel self-conscious. He guessed she was about twenty. Quickly Philips opened Katherine Collins' chart and rapidly flipped through the pages until he'd found the initial neurological note. Headache, dizziness, and visual symptoms were described as the presenting complaints.

He looked back at Kristin Lindquist. Could this woman in front of him be another case with the same radiological picture? Philips felt it was possible. With all the difficulties he'd encountered trying to get more X rays on the other patients, the idea of finding a new case was enormously seductive. He could take all the proper X rays right from the beginning.

Needing no more encouragement, he walked over and tapped Kristin on the shoulder. She jumped in surprise and brushed a wisp of blond hair from her face. The fear in her expression gave her a particularly vulnerable appearance and Martin suddenly became aware of the girl's beauty.

Choosing his words carefully, Martin introduced himself, saying he was from the Department of Radiology, and that he'd overheard her describe her symptoms to the receptionist. He told her that he had seen X rays on four girls with similar problems and felt it might be to her advantage to have an X ray. He was careful to emphasize that it was purely precautionary and that she should not be alarmed.

For Kristin, the hospital was full of surprises. On her first visit the day before she'd been kept waiting for hours. Now she was confronted by a doctor who was apparently soliciting patients.

"I'm not very fond of hospitals," she said. She wanted to add doctors, but it seemed too disrespectful.

"To tell you the truth, I feel the same way," said Philips. He smiled. He'd taken an immediate liking to this attractive young woman and he felt protective. "But an X ray wouldn't take long."

"I still feel ill and I think it would be best if I get home as quickly as possible."

"It will be quick," said Philips. "I can promise you that. One film. I'll take you over myself."

Kristin hesitated. On the one hand she detested the hospital. On the other hand she still felt ill and she was susceptible to Philips' concern.

"How about it?" he said persistently.

"All right," said Kristin finally.

"Wonderful. How long will you be here at the clinic?"

"I don't know. They said not long."

"Good. Don't leave without me," said Martin.

Within minutes Kristin was called. Almost simultaneously another door opened and Dr. Harper emerged.

Philips recognized Harper as one of the residents he'd seen on occasion in and around the hospital. He'd never met the man but his polished head was hard to forget. Philips got up and introduced himself. There was an awkward pause. As a resident, Harper did not have an office and since both examining rooms were occupied, there was no place to talk. They ended up in the narrow corridor.

"What can I do for you?" asked Harper, somewhat suspiciously. It was bizarre for the Assistant Director of Neuroradiology to be visiting Gynecology, since their interests and expertise lay at opposite ends of the medical spectrum.

Philips began his questioning in rather vague terms, expressing an interest in the way the clinic was manned, how long Harper had been there, and whether he enjoyed it. Harper's responses were abrupt and his small eyes darted over Philips' face as he explained that the university's clinic was a two-month elective rotation for a senior resident, adding that it had become a symbolic stepping-stone for being asked to join the staff following completion of the residency.

"Look," Harper said after a pause, "I've got a lot of patients to see." Martin realized that instead of making the man relax, his questions were making him more ill-at-ease.

"Just one more thing," said Philips. "When a Pap smear is reported as atypical, what's usually done?"

"That depends," said Harper warily. "There're two categories of atypical cells. One is atypical but not suggestive of tumor, whereas the other is atypical and suggestive of tumor."

"Whether it's in either class, shouldn't something be done? I mean, if it's not normal, it should be followed up. Isn't that right?"

"Yeah," said Harper evasively. "Why are you asking me these questions?" He had the distinct feeling he was being backed into a corner.

"Just out of interest," said Martin. He held up Collins' chart. "I've come across several patients who'd had atypical Pap smears in this clinic. But reading the GYN notes, I can't find any reference to Schiller's test, thoughts about a biopsy, or colposcopy… just repeat smears. Isn't that… irregular?" Philips eyed Harper, sensing his discomfort. "Look, I'm not here casting any blame. I'm just interested."

"I couldn't say anything unless I saw the chart," said Harper. He'd intended the comment to end the conversation.

Philips handed Collins' chart to Harper and watched as the resident opened it. When Harper read the name, "Katherine Collins," his face became tense. Martin watched curiously as the man rapidly flipped through the chart, too quickly to read anything adequately. When he got to the end, he looked up and handed it back.

"I don't know what to say."

"It is irregular, isn't it?" asked Martin.

"Put it this way: It's not the way I'd handle it. But I've got to get back to work now. Excuse me." He pushed past Philips, who had to press up against the wall to give him room to go by.

Surprised at the precipitous end to the conversation, Martin watched the resident hurry into one of the examining rooms. Philips had not intended his questions to be taken personally and he wondered if he had sounded more accusatory than he realized. Still the resident's response when he had opened Katherine Collins' chart had been strange. Philips had no doubt about that.

Believing there was no point in trying to talk further with Harper, Martin went back out to the receptionist and inquired after Kristin Lindquist. Ellen Cohen at first acted as if she hadn't heard the question. When Philips repeated it, she snapped that Miss Lindquist was with the nurse and would be out shortly. Having not liked Kristin initially, the receptionist hated her even more now that Philips seemed interested in her. Unaware of Ellen Cohen's jealousies, Martin just felt incredibly confused about the university's GYN clinic.

A few minutes later, Kristin came out of the examining room, aided by a nurse. Martin had seen the nurse before, probably in the cafeteria, remembering her thick black hair, which she wore piled on her head in a tight bun.

He stood up as the woman approached the desk and heard the nurse instruct the receptionist to give Kristin an appointment in four days. Kristin looked very pale.

"Miss Lindquist," Martin called. "Are you finished?"

"I think so," said Kristin.

"How about that X ray?" asked Philips. "Do you feel up to it?"

"I think so," managed Kristin, again.

Suddenly the black-haired nurse strode back to the desk. "If you don't mind my asking, what kind of X rays are you talking about?"

"A lateral skull film," said Martin.

"I see," said the nurse. "The reason I ask is that Kristin has had an abnormal Pap test and we'd prefer she avoid abdominal or pelvic films until her Pap smear status is normal."

"No problem," said Philips. "In my department we're only interested in the head." He'd never heard of such an association between Pap smears and diagnostic X rays, but it sounded reasonable.

The nurse nodded, then left. Ellen Cohen slapped an appointment card in Kristin's waiting hand before turning and pretending to busy herself with her typewriter. "California slut," she muttered under her breath.

Martin guided Kristin away from the bustle of the clinic and led her through a connecting door into the hospital proper. Once the fire door had been passed, the scene looked very pleasant in contrast to the clinic. Kristin was surprised.

"These are private offices for some of the surgeons," explained Philips as they walked down a long carpeted hall. There were even oil paintings on the freshly painted walls.

"I thought the whole hospital was old and decayed," said Kristin.

"Hardly." An image of the subterranean morgue flashed through Philips' mind, immediately merging with his recent vision of the GYN clinic. "Tell me, Kristin, as a patient, how do you find the university's clinic?"

"That's a difficult question," said Kristin. "I hate gynecology appointments so much that I don't think I can give a fair answer."

"How does it compare with your past experience?"

"Well, it is terribly impersonal, at least it was yesterday when I saw the doctor. But today I only saw the nurse and it was better. But then again I didn't have to wait today like I did yesterday, and all they did was draw more blood and recheck my vision. I didn't have another exam. Thank God."

They reached the elevator area and Philips pressed the button.

"Ms. Blackman also had the time to explain my Pap smear. Apparently it wasn't bad. She said it was only Type II, which is common and almost reverts to normal spontaneously. She told me it was probably caused by cervical erosion and that I should use a weak douche and avoid sex."

Martin was momentarily nonplussed at Kristin's forthrightness. Like most physicians, he was surprisingly unaware that his being a doctor encouraged people to make their secrets accessible.

Arriving in X-ray, Philips sought out Kenneth Robbins and put Kristin in his hands for the single lateral skull film he wanted. Since it was after four, the department was relatively quiet and one of the main X-ray rooms was empty. Robbins took the X ray and disappeared into the darkroom to load the film into the automatic developer. While Kristin waited, Martin stationed himself at the slot in the main hall where the film would emerge.

"You look like a cat watching a mouse hole," said Denise. She'd come up behind Philips and surprised him.

"I feel like one. Down in GYN I found a patient with similar symptoms to Marino and the others and I'm holding my breath to see if there's the same radiological picture. How did your angiorams go this afternoon?"

"Very well, thank you. I appreciated your letting me work on my own."

"Don't thank me. You earned it."

At that moment the tip of Kristin's X ray appeared, then oozed out of the roller, dropping into the holding bin. Martin snatched it up and put it on the viewer. His finger scanned back and forth in an area approximately over Kristin's ear.

"Damn," said Philips. "It's clear."

"Oh come on!" protested Denise. "Don't tell me you actually want the patient to have the pathology."

"You're right," said Martin. "I don't mean to wish it on anyone. I just want a ease that I can X-ray properly."

Robbins stepped out of the darkroom. "You want any more films, Dr. Philips?"

Martin shook his head, took the X ray and walked into the room where Kristin was waiting. Denise followed.

"Good news," said Philips, waving the film. "Your X ray is normal." Then he told Kristin that perhaps they should repeat it in a week if her symptoms persisted. He asked her for her phone number and gave her his direct-dial number in case she had any questions.

Kristin thanked him and tried to stand. Immediately she had to support herself by grabbing the X ray table as a wave of dizziness hit her. The room seemed to spin in a clockwise direction.

"Are you all right?" Martin asked, holding her arm.

"I think so," said Kristin, blinking. "It was that same dizziness. But it's already gone." What she didn't say was that she again smelled the familiar obnoxious odor. It was too bizarre a symptom for her to share. "I'll be all right. I think I'd better get home."

Philips offered to get her a taxi but she insisted she was all right. As the elevator door closed she waved and even managed a smile.

"That was a very clever way to get an attractive young woman's phone number," said Denise, as she walked back to Philips' office. Rounding the corner, Martin was relieved when he saw that Helen had left. Denise took one look in his room and gasped in disbelief. "What the hell?"

"Don't say anything," said Philips, making his way through the debris to his desk. "My life is disintegrating and smart comments are not going to help." He picked up the messages Helen had left. As he had expected, there were calls marked important from Goldblatt and Drake. After staring at them for a minute, he allowed the two pieces of paper to waft in a gentle spiral into his large institutional wastebasket.

Then he turned on the computer and fed in Kristin's skull film.

"Well! How's it going?" said Michaels, appearing at the doorway. He could tell from the litter that little had changed since the morning visit.

"Depends on what you're referring to," said Philips. "If you mean the program, the answer is fine. I've only run a few films, but so far it is performing with an accuracy of about a hundred-ten percent."

"Wonderful," said Michaels, clapping his hands.

"It's more than wonderful," said Philips. "It's fantastic! It's the only thing around here that has been going right. I'm just sorry I haven't had more time to work on it. Unfortunately, I'm behind on my regular work. But I'm going to stay here for a while tonight and run as many films as I can." Philips saw Denise turn and look at him. He tried to read her expression but the noisy clatter of the typewriter rapidly spewing out the report captured his attention. Michaels saw what was happening and he came up behind Philips to look over his shoulder. From Denise's perspective, the two of them looked like proud parents.

"It's reading a skull film I just took on a young woman," Martin said. "Her name is Kristin Lindquist. I thought maybe she'd have the same abnormality as those other patients I described to you. But she doesn't."

"Why are you so committed to this one abnormality?" asked Michaels. "Personally, I'd rather see you spending your time on the program itself. There will be time for this kind of investigative fun later."

"You don't know doctors," said Martin. "When we release this little computer on the unsuspecting medical community it's going to be like confronting the Medieval Catholic Church with Copernican astronomy. If we could present a new radiological sign that the program had discovered, it would make acceptance much easier."

When the print-out typewriter paused, Philips tore off the report. His eyes scanned the sheet rapidly, then riveted on one central paragraph. "I don't believe it." Martin grabbed the film and put it back up on his viewer.

With his hands blocking out most of the X ray, Philips isolated a small area at the back of the skull. "There it is! My God! I knew the patient had the same symptoms. The program remembered the other cases and was able to find this very small example of the same abnormality."

"And we thought it was subtle on the other films," said Denise looking over Philips' shoulder. "This just involves the tip of the occipital pole, not the parietal or temporal region."

"Maybe it's just earlier in the progress of the disease," suggested Philips.

"What disease?" asked Michaels.

"We don't know for certain," said Martin, "but several of the patients who showed this same density abnormality were suspected of multiple sclerosis. It's a shot in the dark."

"I don't see a thing," admitted Michaels. He put his face very close to the X ray, but it was no use.

"It's a textural quality," said Martin. "You have to be aware of what the normal texture is before you can appreciate the difference. Believe me, it's there. The program is not making it up. Tomorrow I'll get the patient back and cone down right over the area. Maybe with some better films you'll be able to see it."

Michaels admitted that his appreciation of the abnormality was not critical. After turning down an offer of dinner in the hospital cafeteria, Michaels excused himself. At the door he again begged Martin to spend more time running old films through the computer, saying there was a good chance the program would pick up all sorts of new radiologic signs, and if Philips took time to follow up each one, the program would never get debugged. With a final wave, Michaels departed.

"He's eager, isn't he," said Denise.

"With good reason," said Martin. "He told me today that to handle the program they have designed a newer processor that has a more efficient memory. Apparently it's going to be ready shortly. When it is, I'll be the only one holding them up."

"So you're planning to work tonight?" asked Denise.

"Of course." Martin looked at her and for the first time noticed how tired she was. She'd gotten almost no sleep the night before and had worked all day.

"I was hoping you'd be interested in coming over to my apartment for a little dinner and perhaps finish what we had started last night."

She was being deliberately erotic and Martin was an easy target. Sexual expression would be a wonderful way to deal with the frustrations and exasperations of the day. But he knew he had to do some work and Denise was too important to just be used as he had the nurses when he was an intern needing to diffuse his tension.

"I've got to catch up a little," he said at last. "Why don't you go home early. I'll call and perhaps come over later."

But Denise insisted on waiting while he went over all the angiograms and the day's CAT scans, which had been dictated by the neuroradiology fellows. Even if his name did not appear on the reports, Philips checked everything done in the department.

It was a quarter to seven when they scraped back their chairs and stood up to stretch. Martin turned to look at Denise, but she hid her face.

"What's the matter?"

"I just don't like you to see me when I look so awful."

Shaking his head in disbelief, he reached out and tried to lift her chin, but she shook off his hand. It was amazing how within seconds of switching off the viewer she had changed from an engrossed academician to a sensitive woman. As far as Martin was concerned she appeared tired but as appealing as ever. He tried to tell her, but she wouldn't believe it. She kissed him quickly, then said she was going home for a long bath, and that she hoped to see him later. Like a bird in flight, she left.

It took Martin a few moments to collect himself. Denise had the power to short-circuit his brain. He was in love and he knew it. Getting out Kristin's telephone number he dialed, but there was no answer. He decided to take a file of correspondence to proofread while he ate dinner in the cafeteria.

It was nine-fifteen when Martin cleared up the last of the dictation and correspondence. During the same time he had been able to run twenty-five more old films through the flawlessly functioning computer. Meanwhile Randy Jacobs was making frequent trips back and forth from the file room. He'd been returning the completed envelopes, but since he'd pulled several hundred additional ones, Philips' office was even more jumbled and disorganized than before.

Using the phone at his desk, Philips again tried Kristin's number. She answered on the second ring.

"I'm a little embarrassed," he said, "but looking at your X ray more closely, I think there is a very small area that needs closer examination. I was hoping you'd be willing to come back, like tomorrow morning?"

"Not in the morning," said Kristin. "I've missed classes two days in a row. I'd rather not miss more."

They agreed on three-thirty. Martin assured her that she would not have to wait. When she arrived she was supposed to come directly to Philips' office.

Hanging up, Martin leaned back in his chair and let the day's problems wash over him. The conversations with Mannerheim and Drake were exasperating, but at least they were consistent with the personalities of the two men. The conversation with Goldblatt was different. Philips had not expected such an attack from someone who had been his mentor. Martin was quite sure that Goldblatt had been responsible for his being named Assistant Chief of Neuroradiology four years ago. So it didn't make sense. If hostility to the computer work was behind Goldblatt's conduct, they were in for more trouble than either Philips or Michaels had anticipated. The thought made Martin sit up and search for the list he'd made of the patients with the potentially new radiologic sign. Corroboration of the new diagnostic technique had assumed greater importance. He found the list and added Kristin Lindquist's name.

Even allowing for Goldblatt's dislike of the new computer unit, his behavior still did not make sense. It suggested collusion with Mannerheim and Drake, and for Goldblatt to be siding with Mannerheim, if that were the case, something out of the ordinary had to be going on. Something very bizarre.

Philips sat up and snatched his list: Marino, Lucas, Collins, McCarthy and Lindquist. After McCarthy he had written "Neurosurgical lab." If Mannerheim could be devious, so could he. Philips walked out of his dim office into the brightness of the corridor. Toward the fluoroscopy rooms he saw what he was looking for: the cleaning carts of the janitorial staff.

Having accustomed himself to working long hours, Martin had had numerous opportunities to become acquainted with the cleaning crew. On several occasions they had cleaned his office with him in it, joking that he secretly lived under his desk. It was an interesting group composed of two men in their middle twenties, one white and one black, and two older women, one Puerto Rican, the other Irish. Philips wanted to speak to the Irish woman. She'd worked for the center for fourteen years and was their nominal supervisor.

Philips found the crew inside one of the fluoroscopy rooms having their coffee break. "Listen, Dearie," said Martin to the woman. Dearie was her nickname, because it was how she addressed everyone else. "Can you get into the Neurosurgical Research lab?"

"I can get into everything in this hospital except the narcotics cabinets," said Dearie proudly.

"Wonderful," said Martin. "I'm going to make you an offer you can't refuse." He went on to say that he wanted to borrow her passkey for fifteen minutes to get a specimen from the Neurosurgical lab which he wanted to X-ray. In return she could have a free CAT scan!

It took Dearie a full minute to stop laughing. "I'm not supposed to give this out, but considering who you are… Just have it back before we leave Radiology. That gives you twenty minutes."

Philips used the tunnel to get to the Watson Research Building. The elevator was waiting in the deserted lobby and he got right in and pressed his floor. Although Martin was in the middle of a busy medical center within a populous and sprawling city, he felt isolated and alone. Research was done between eight and five and the building was vacant. The only sound was the wind hissing in the elevator shaft as the car sped upward.

The doors opened and he stepped out into a poorly illuminated foyer. Passing through a fire door he found himself in a long hallway that ran the length of the building. To conserve energy nearly all the lights were out. Dearie hadn't given him a key, she'd given him her whole brass ring of keys and it jangled in the silence of the empty building.

The Neurosurgical lab was the third door on the left, close to the other end of the corridor, and as Martin got closer, he felt himself tense. The door to the lab was metal with a central frosted pane of glass. After glancing over his shoulder, he slipped the passkey into the lock. The door swung open. Philips quickly stepped in and closed the door. He tried to laugh at his own sense of suspense, but it didn't do any good. His nervousness had increased out of proportion to what he was doing. He decided he'd make a lousy burglar.

The light switch made an inordinately loud snap when he turned it on. Banks of fluorescent light bathed the huge lab. Two central counter tops ran down half of the room, complete with sinks, gas jets, and overlying shelves of laboratory glassware. At the far end was an animal surgical area, which looked like a modern operating room in three-quarter size. It had operating lights, a small operating table, and even an anesthesia machine. There was no separation between the operating area and the lab except that the operating area was tiled. All in all it was an impressive setup and stood as tribute to Mannerheim's ability to obtain research grants.

Philips had no idea where a brain specimen would be stored, but he thought there might be a collection, so he only looked in the larger cabinets. He drew a blank but noticed there was another door down near the surgical area. It had a clear glass panel with embedded wire mesh and he leaned against the window, peering into a dark room beyond. Just beyond the door he could see a series of bookshelves containing glass jars; a whole group of which held brains immersed in preserving fluid.

With every second that passed Martin's anxiety continued to increase. The moment he saw the brains, he wanted to find McCarthy's and leave. He pushed open the door and began quickly scanning the labels. A strong animal smell assaulted his nose and in the darkness to the left he caught a glimpse of cages. But the jars held his interest; each was labeled with a name, a unit number and a date. Guessing that the date was the death of the patient, Philips walked quickly down the long row of jars. Since the only light was that which came through the glass panel.in the door, he had to lean closer to the jars with each step. McCarthy's was at the very far end of the room near an exit door.

Reaching up to grasp the specimen, Philips was devastated by a bloodcurdling scream that reverberated around the small room. It was immediately followed by a crash of metal against metal. Philips' legs buckled as he spun around to defend himself, his shoulder hitting the wall. Another scream shattered the air, but an attack did not materialize. Instead Martin found himself staring into the face of a caged monkey. The animal was in an absolute rage. His eyes were burning black coals. His lips were drawn back exposing his teeth, two of which had broken when he had tried to bite through the steel bars of his prison. From the top of the monkey's head protruded a group of electrodes like multicolored spaghetti.

Philips realized he was looking at one of the animals Mannerheim and his boys had turned into a screaming monster. It was well known in the Med Center that Mannerheim's latest interest was finding the exact location in the brain associated with rage reaction. The fact that other researchers felt that there was not one single center had not deterred Mannerheim at all.

As Philips' eyes adjusted to the dim light, he could see many cages. Each contained a monkey with all varieties of head mutilation. Some had the entire back of their skulls replaced by Plexiglas hemispheres through which passed hundreds of embedded electrodes. A few were docile as if they had been lobotomized.

Philips pushed himself back to a standing position. Keeping an eye on the raging animal who continued to scream and noisily shake his cage, Philips lifted the jar containing McCarthy's partially dissected brain. Behind it was a group of slides bound by a rubber band. Philips took those as well. He started to leave when he heard the outer door of the lab open and close, followed by muffled noises.

Martin panicked. Balancing the jar, the slides, and the ring of keys, he opened the back door of the animal room. In front of him the fire stairs plunged down in an endless series of retreating angles. Philips paused at the top stair and realized that fleeing was not the answer. Catching the door before it clicked shut, he returned to the lab.

"Doc Philips," said a startled security man. His name was Peter Chobanian. He was on the Med Center's intermural basketball team and had had several late-night conversations with Philips. "What are you doing up here?"

"Needed a snack," said Martin with a straight face. He held up the specimen jar.

"Ahh," said Chobanian, looking away. "Before I worked here I thought only psychiatrists were nuts!"

"Seriously," said Philips, walking ahead on rubbery legs. "I'm going to X-ray this specimen. I was supposed to pick it up today but didn't…" He nodded to the other security man whom he didn't know.

"You oughtta let us know when you're coming up here," said Chobanian. "Some of the microscopes have been walking outta this building and we're trying to tighten up."

Philips got one of the evening radiology technicians to come over to Neuroradiology between ER trauma cases to offer an opinion. Philips had tried unsuccessfully to take an X ray of McCarthy's partially dissected brain, which he had put on a paper plate. No matter what Philips did, the X rays were bad. On all the films it was difficult to make out the internal structure. He'd tried reducing the kilovoltage, but it didn't help. The technician took one look at the brain and turned green. After he left, Martin finally decided what the problem was. Even though the brain had been in formaldehyde, the internal structure must have decomposed enough to blur any radiological definition. Plopping the brain back into its jar, Philips took it and the pack of slides up to Pathology.

The lab wasn't locked up but it was deserted. If someone wanted to steal microscopes, this is where they should come, thought Philips. He opened — the door to the autopsy room. No one there either. Walking down the long central table supporting a whole line of microscopes, each with its dictation unit next to it, Philips remembered the first time he had looked at his own blood. He recalled his terror that the slide would be leukemia. Medical school had been a time for imaginary diseases and Martin had contracted almost all of them.

Toward the back of the room he found a Bunsen burner busily boiling a beaker of water. Putting down the jar and the slides, he waited. It wasn't long. A grossly overweight pathology resident waddled in. He wasn't expecting company because he was zipping his fly as he came through the door. His name was Benjamin Barnes.

Philips introduced himself and asked if Barnes would do him a favor.

"What kind of favor? I'm trying to get this autopsy done so I can get my ass out of here."

"I've got a few slides. I wonder if you would take a quick look at them?"

"There's plenty of scopes here. Why don't you help yourself?"

It was a presumptuous way to treat a staff man even if he was from another department, but Martin forced himself to suppress his irritation. "It's been a few years," he said. "Besides, it's a brain and I was never good at brain."

"It would be better to wait for Neuropath in the morning," said Barnes.

"I'm interested in a quick impression now," Martin said.

Philips had never found fat people to be jolly, and the pathologist was confirming his impression.

Barnes reluctantly took the slides and placed one under the scope. He scanned around, then put in another. It took about ten minutes to go through the group.

"Interesting," he said. "Here, take a look at this." He moved aside so Philips could see.

"See that open area?" asked Barnes.

"Yeah."

"Used to be a nerve cell there."

Philips looked at Barnes.

"All these slides with the red-grease-pencil marks have areas where the neurons are either missing or in bad shape," said the resident. "The curious thing is that there's very little if any inflammation. I don't have any idea what it is. I'd have to describe it as 'multifocal, discrete neuron death,' etiology unknown."

"You don't even want to guess the cause?" asked Philips.

"Nope."

"What about multiple sclerosis?" asked Philips.

The resident made a strange face, wrinkling his forehead. "Maybe. Occasionally there's some gray matter lesions in multiple sclerosis, even though the lesions usually are all white matter.

But they don't look like this. There'd be more inflammation. But to be sure I'd have to do a myelin stain."

"How about calcium?" asked Philips. Philips knew there weren't too many things that affected X-ray density, but calcium was one of them.

"I didn't see anything that suggested calcium. Again, I'd have to do a stain."

"One other thing," said Philips. "I'd like to have some slides made from the occipital lobe." He patted the top of the glass jar.

"I thought you only wanted me to look at the slides," said Barnes.

"That's right. I don't want you to look at the brain, just section it." Martin had had a bad day and he wasn't in a mood to deal with a lazy pathology resident.

Barnes" had sense enough not to say anything else. He picked up the glass jar and waddled into the autopsy room. Philips followed. With a scoop, Barnes took the brain out of the formaldehyde and put it on the stainless steel counter next to the sink. Brandishing one of the large autopsy knives, he allowed Philips to point to the area he wanted. Barnes then took several half-inch slices and put them in paraffin.

"The sections will be done tomorrow. What kind of stains do you want?"

"Everything you can think of," said Philips. "And one last thing. Do you know the diener who works nights down in the morgue?"

"You mean Werner?"

Philips nodded.

"Vaguely. He's a little weird but he's reliable and a good worker. He's been there for years."

"Do you think he's on the take?"

"I don't have any idea. What could he be on the take for?"

"Anything. Pituitary glands for growth hormone; gold teeth; special favors."

"I don't know. But I guess it wouldn't surprise me."

After the unsettling experience in the Neurosurgical lab, Philips felt particularly ill-at-ease as he followed the red line toward the morgue in the sub-basement. The huge, dark, cavern-like room outside of the morgue looked like the perfect setting for some gothic horror. The quartz window in the door of the incinerator glowed in the darkness like the eye of a cyclopean monster.

"For God's sakes, Martin. What the hell is wrong with you?" said Philips, trying to fortify his waning confidence. The morgue looked exactly as it had the evening before. The bulbless hooded light fixtures hanging down on their wires gave the scene a weird unearthliness. There was a faint odor of decay. The door to the refrigerator was ajar and a bit of its interior light spilled out along with a current of cold mist.

"Werner!" called Philips. His voice echoed in the old tiled room. There was no response. Philips stepped into the room and the door closed insistently behind him. "Werner!" The silence was only broken by a dripping faucet. Tentatively Philips advanced to the refrigerator and glanced within. Werner was struggling with one of the corpses. It had apparently fallen from its gurney because Werner was lifting the naked, stiff cadaver and awkwardly trying to reposition it on the movable stretcher. He could have used some help but Philips stayed where he was and watched. When Werner succeeded in getting the body onto the gurney, Martin stepped into the refrigerator.

"Werner!" Martin's voice sounded wooden.

The diener flexed his knees and lifted his hands like a jungle creature about to attack. Philips had startled the man.

"I want to talk to you," said Philips. He had decided to be authoritative, but his voice sounded weak. Surrounded by the dead, his defenses dissolved. "I understand your position and I don't want to cause any trouble, but I need some information."

Recognizing Philips, Werner relaxed, but he didn't move. His breath came in short puffs of condensed vapor.

"I have to find Lisa Marino's brain. I don't care who took it or for what reason. I just want a chance to look at it for a research project."

Werner was like a statue. Except for his visible breaths he was like one of the dead.

"Look," said Martin. "I'll pay." He had never bribed anyone in his life.

"How much?" said Werner.

"A hundred dollars," said Philips.

"I don't know anything about Marino's brain."

Philips looked at the frozen features of the man. Under the circumstances he felt impotent. "Well, give me a call in X ray if you suddenly remember." He turned and walked out, but in the corridor he found himself running to the bank of elevators.

Entering the outer foyer of Denise's apartment building, Philips scanned the nameplates. He knew approximately where hers was, but there were so many, that he always had to search a little. After pushing the black button he waited with his hand on the front doorknob for the buzzer to let him in.

Inside the building it smelled as if everyone had sauted onions for their dinner. Philips started up the stairs. There was an elevator, but if it wasn't already waiting in the lobby it took too long to arrive. Denise only lived on the third floor and Philips didn't mind climbing the stairs. But on the last flight, he began to realize how tired he was. It had been a long grueling day.

Denise had again metamorphosed. She no longer looked tired and she said she'd taken a short nap after her bath. Her shining hair had been released from its barrette and cascaded from her head in gentle waves. She was dressed in a pink satin camisole with matching tap pants that left just the right amount to the imagination. Some of Martin's fatigue lifted. He was always amazed by her ability to drop her efficient hospital personality, though he understood that she was confident enough in her intellectual abilities that she could indulge her feminine fantasies. It was a rare and wonderful balance.

They embraced at the door, and then without speaking they walked arm in arm into the bedroom. Martin pulled her down onto the bed. At first she just acquiesced, enjoying his eagerness, but then she joined, her passion matching his until they both spent themselves in mutual fulfillment.

For some time they lay together, just enjoying the closeness and wishing to retain in their minds the pleasure they gave to each other. Finally Martin propped himself up on an elbow so he could trace his finger down her finely crafted nose and across her lips.

"I think this relationship is getting entirely out of hand," he said, smiling.

"I agree."

"I've shown symptoms for a couple of weeks, but it's only been over the last two days that I'm sure of the diagnosis. I'm in love with you, Denise."

For Denise the word had never had more meaning. Martin had not mentioned love before, even when he told her how much he cared for her.

They kissed lightly. The words hadn't been necessary but they added a new dimension of closeness.

"Admitting my love for you," said Martin after a few moments, "scares me in one way. Medicine destroyed my previous relationship and I worry it could do it again."

"I don't think so."

"I do. It has a way of holding one hostage by ever increasing demands."

"But I understand those demands."

"I'm not so sure you do. Not yet," said Martin. He was aware the comment sounded condescending but he knew at this point in Sanger's career it would be impossible to convince her that running a department made day-to-day medicine as much of a rat race as most other businesses. Besides, Goldblatt's challenge to their relationship was very much in Philips' mind, so the worry was not hypothetical.

"I think I understand more than you think," said Denise. "I think you've changed since your divorce. Back then I think you had a kind of macho belief you could get most of your fulfillment from your career. Now I think that's changed. I believe you realize that the greater part of your satisfaction is going to come from your own interpersonal relationships."

There was a silence. Martin was stunned at his transparency as well as Denise's clairvoyance. Denise broke the silence. "The only thing I can't understand is if you're interested in having more of a life outside the hospital, why not ease up on your research?"

"Because it can be the key to my freedom," said Martin holding her close. "You have become my promise for fulfillment and research has the power of giving me what I want from medicine as well as more time with you."

They kissed, secure in their newly expressed affection for each other. But as they lay there in each other's arms, they began to feel their fatigue and knew they should go to sleep.

Denise went to brush her teeth, while Martin let his mind drift back to Lynn Anne's mysterious disappearance. Glancing at the closed bathroom door, he decided to make a quick call to the hospital, reminding the nurse Lynn Anne had been admitted through the ER, then immediately transferred. The nurse recalled the case because the transfer had come right after she'd finished all the admission paper work. Martin asked if she remembered where the patient had been sent, but the nurse said she did not. Philips thanked her and hung up.

In bed he curled up against Denise's back, but had trouble falling asleep. He began telling her about his disturbing experience with the monkeys with the electrodes in their heads, and asked if she thought the information Mannerheim obtained was worth the sacrifice. Denise, on the verge of sleep, just grunted, but Martin's overstimulated mind jumped back to his visit to the university's GYN clinic.

"Hey, have you ever been to the GYN clinic in the hospital?" He pushed himself up on his elbow rolling Denise over on her back. The movement awakened her.

"No. I haven't."

"I visited there today and the place gave me a strange feeling."

"What do you mean?"

"I don't know. It's hard to say, but then again I haven't been in too many GYN clinics."

"They're really fun," said Denise sarcastically, and turned back op her side away from Martin.

"Would you do me a favor and check it out?"

"You mean as a patient?"

"I don't care. I'd like to know your opinion about the personnel."

"Well I'm a bit late on my annual checkup. I suppose I could have it done there. In fact, I'll call tomorrow."

"Thanks," said Martin, finally settling himself to sleep.