A Brain (10 page)

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

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

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

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

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

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

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

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

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

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

Dr. Huggens nodded.

“And I can smell something,” said Lynn Anne.

“What was that?”

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

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

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

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

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

“I want to see Neurology now,” said Lynn Anne.

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

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

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

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

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

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

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

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

Lynn Anne waited again.

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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