A Brain (2 page)

Dr. David Harper raised his eyes slowly from the chart. He took a breath and expressed it noisily through partially pursed lips. He was bored. “Look, Miss Collins, you've received excellent care here . . .”

“I'm not complaining about my care,” said Katherine without looking up. Tears had filled her eyes and threatened to run down her cheeks. “I just want my records.”

“All I'm saying,” continued Dr. Harper, “is that you don't need any second opinions about your gynecological status.”

“Please,” said Katherine slowly. “Are you going to give me my records, or do I have to go to the administrator?” Slowly she looked up at Dr. Harper. With her knuckle she caught the tear that had spilled over her lower lid.

The doctor finally shrugged and Katherine could hear him curse beneath his breath as he tossed the chart onto the receptionist's desk, telling the woman to make a copy. Without saying goodbye or even looking back, he disappeared into the examining area.

As Katherine put on her coat she realized she was trembling and again felt light-headed. She walked over to the receptionist's desk and grasped the outer edge, leaning on it for support.

The bird-like blonde chose to ignore her while she completed typing a letter. When she put the envelope into the machine, Katherine reminded the receptionist of her presence.

“All right, just a moment,” said Ellen Cohen with irritated emphasis on each word. Not until she'd typed the envelope, stuffed, sealed and stamped it, did she get to her feet, take Katherine's chart, and disappear around the corner. During the entire time she avoided Katherine's eyes.

Two more patients were called before Katherine was handed a manila envelope. She managed to thank the girl, but wasn't given the courtesy of a response. Katherine didn't care. With the envelope under her arm and her bag over her shoulder, she turned and half-ran, half-walked out into the confusion of the main GYN waiting room.

Katherine paused in the heavy air as a smothering wave of dizziness descended over her. Her fragile emotional state combined with the sudden physical effort of rapid walking had been too much. Her vision
clouded and she reached out and groped for the back of a waiting-room chair. The manila envelope slipped from under her arm and fell to the floor. The room spun and her knees buckled.

Katherine felt strong hands grasp her upper arms, supporting her. She heard someone try to reassure her and tell her that everything was going to be all right. She wanted to say that if she could sit down for just a moment she'd be fine, but her tongue wouldn't cooperate. Vaguely she was aware she was being carried upright down a corridor, her feet, like those of a marionette, bumping ineffectually along the floor.

There was a door, then a small room. The awful spinning sensation continued. Katherine was afraid she might be sick, and cold perspiration appeared on her forehead. She was conscious of being lowered to the floor. Almost immediately her vision began to clear and the whirling of the room stopped. She was with two doctors dressed in white and they were helping her. With some difficulty they got one of her arms out of her coat and had applied a tourniquet. She was glad she was away from the crowded waiting room so that she was not a spectacle for everyone to stare at.

“I think I feel better,” said Katherine, blinking her eyes.

“Good,” said one of the doctors. “We're going to give you a little something.”

“What?”

“Just something to calm you down.”

Katherine felt a needle pierce the tender skin on the inside of her elbow. The tourniquet was pulled off and she could feel her pulse in her fingertips.

“But I feel much better,” she protested. She turned
her head to see a hand depressing the plunger of a syringe. The doctors were bent over her.

“But I feel okay,” said Katherine.

The two doctors didn't respond. They just looked at her, holding her down.

“I really feel better now,” said Katherine. She looked from one doctor to the other. One of them had the greenest eyes Katherine had ever seen, like emeralds. Katherine tried to move. The doctor's grip tightened.

Abruptly Katherine's vision dimmed and the doctor appeared far away. At the same time she heard a ringing in her ears and her body felt heavy.

“I feel much . . .” Katherine's voice was thick and her lips moved slowly. Her head fell to the side. She could see she was on the floor of a storeroom. Then darkness.

Mr. and Mrs. Wilbur Collins supported each other while they waited for the door to be opened. At first the key wouldn't go into the lock, and the superintendent pulled it out and examined it to make sure it was the key to 92. He tried it again, realizing he'd had it upside down. The door opened and he moved aside to allow the Women's Dean of the university to step inside.

“Cute apartment,” said the Dean. She was a petite woman, about fifty, with very nervous and quick gestures. It was apparent she felt under pressure.

Mr. and Mrs. Wilbur Collins and two uniformed New York City policemen followed the Dean into the room.

It was a small one bedroom apartment, advertised to have a river view. It did, but only from a tiny window in the closet-like bathroom. The two policemen stood aside with their hands clasped behind their
backs. Mrs. Collins, a fifty-two-year-old woman, hesitated near the entrance as if she were afraid of what she might find. Mr. Collins, on the other hand, limped directly to the center of the room. He'd had polio in 1952 and it had affected his right lower leg, but not his shrewd ability in business. At fifty-five he was the number two man in the First National City Bank of Boston empire. He was a man who demanded action and respect.

“Since it's been only a week,” offered the Dean, “maybe your concern is premature.”

“We never should have allowed Katherine to come to New York,” said Mrs. Collins, fidgeting with her hands.

Mr. Collins ignored both comments. He headed for the bedroom and looked in. “Her suitcase is on the bed.”

“That's a good sign,” said the Dean. “A lot of students react to pressure by leaving school for a few days.”

“If Katherine had left, she would have taken her suitcase,” said Mrs. Collins. “Besides, she would have called us on Sunday. She always calls us on Sunday.”

“As Dean, I know how many students suddenly need a breather, even good students like Katherine.”

“Katherine is different,” said Mr. Collins disappearing into the bathroom.

The Dean rolled her eyes for the benefit of the policeman, who remained impassive.

Mr. Collins limped back into the living room. “She didn't go anyplace,” he said with finality.

“What do you mean, dear?” asked Mrs. Collins with mounting anxiety.

“Just what I said,” returned Mr. Collins. “She wouldn't go anywhere without these.” He tossed a
half-empty packet of birth control pills onto the seat of the couch. “She's here in New York and I want her found.” He looked at the policemen. “Believe me, I intend to see action on this case.”

Dr. Martin Philips leaned his head against the wall of the control room; the coolness of the plaster felt good. In front of him four third-year medical students were pressed against the glass partition, watching in total awe as a patient was being prepared for a CAT scan. It was the first day of their radiology elective; they were starting with neuroradiology. Philips had brought them to see the CAT scanner first because he knew it would impress and humble them. Sometimes medical students tended to be smart-alecky.

Within the scanner room the technician was bending over, checking the position of the patient's head in respect to the gigantic doughnut-shaped scanner. He straightened up, peeled off a length of adhesive tape, and bound the patient's head to a Styrofoam block.

Reaching over to the counter, Philips took the
requisition form and the patient's chart. He scanned both for clinical information.

“The patient's name is Schiller,” said Philips. The students were so absorbed in the preparations that they did not turn to face him while he spoke. “Chief complaint is weakness of the right arm and right leg. He's forty-seven.” Philips looked at the patient. Experience told him that the man was probably tremendously frightened.

Philips replaced the requisition form and chart while inside the scanner room the technician activated the table. Slowly the patient's head slid into the orifice of the scanner as if he were to be devoured. With a final glance at the position of the head, the technician turned and retreated to the control room.

“Okay, step back from the window for a moment,” said Philips. The four medical students obeyed instantly, moving to the side of the computer, whose lights were blinking in anticipation. As he had surmised, they were impressed to the point of submission.

The technician secured the communicating door and took the mike from its hook. “Stay very still, Mr. Schiller. Very still.” With his index finger the technician depressed the start button on the control panel. Within the scanning room the huge doughnut-shaped mass surrounding Mr. Schiller's head began abrupt, intermittent rotational movements like the action of the main gear of a gigantic mechanical clock. The clunking sound, loud to Mr. Schiller, was muffled for those on the other side of the glass.

“What's happening now,” said Martin, “is that the machine is making two hundred and forty separate
X-ray readings for each single degree of rotational movement.”

One of the medical students made a face of total incomprehension to his colleague. Martin ignored the gesture and placed his face in his hands with his fingers over his eyes, rubbing carefully and then massaging his temples. He hadn't had his coffee yet and felt groggy. Normally he'd stop in the hospital cafeteria, but this morning he hadn't had time because of the medical students. Philips, as Assistant Chief of Neuroradiology, always made it a point to handle the medical students' introduction to neuroradiology. His compulsiveness in this regard had become a pain in the ass because it cut into his research time. The first twenty to thirty times he had enjoyed impressing the students with his exhaustive knowledge of the anatomy of the brain. But the novelty had worn off. Now it was enjoyable only if a particularly smart student came along, and in neuroradiology that didn't happen very often.

After a few minutes the doughnut-shaped scanner halted its rotational movement, and the computer console came alive. It was an impressive setup like a control panel in a science-fiction movie. All eyes switched from the patient to the blinking lights, except for Philips, who glanced down at his hands and tried to dislodge a small tab of dead skin alongside the nail of his index finger. His mind was wandering.

“In the next thirty seconds the computer simultaneously solves forty-three-thousand-two-hundred equations of tissue-density measurements,” said the technician, eager to take over Philips' role. Philips encouraged this. In fact he merely gave the students their formal lectures, allowing the practical teaching
to be done by the neuroradiology fellows, or the superbly trained technicians.

Lifting his head, Philips watched the medical students, who were transfixed in front of the computer console. Turning his gaze to the leaded window, Philips could just see Mr. Schiller's bare feet. Momentarily the patient was a forgotten participant in the unfolding drama. For the students the machine was infinitely more interesting.

There was a small mirror over a first-aid cabinet, and Philips looked at himself. He hadn't shaved yet and the day-old stubble stood out like bristles on a brush. He always arrived a good hour before anyone else in the entire department, and he'd developed the habit of shaving in the surgical locker room. His routine was to get up, jog, shower and shave in the hospital and stop for coffee in the cafeteria. This usually gave him two hours to work in his research interests without interruption.

Still looking in the mirror, Philips ran a hand through his thick sandy hair, pushing it back. There was such a difference between the lightness of the ends and the darker blond of the roots that some of the nurses kidded Philips about highlighting it. Nothing could have been further from the truth. Philips rarely thought about his looks, occasionally butchering his hair himself when he didn't have time to go to the hospital barber. But despite his inattention, Martin was a handsome man. He was forty-one and the recent lines that had formed about his eyes and mouth only enhanced his appearance, which earlier had seemed a bit boyish. Now he looked harder, and a recent patient had remarked that he seemed more like a cowboy on TV than a doctor. The comment had pleased him and it wasn't altogether without
basis. Philips was just under six feet tall with a slight but athletic build, and his face did not give the impression of an academician. It was angular, with a ruler-straight nose and expressive mouth. His eyes were a lively light blue, and they, more than anything else, reflected his basic intelligence. He'd graduated summa cum laude from Harvard, class of 1961.

The cathode-ray tube on the output console came to life as the first image appeared. The technician hastily adjusted the window width and the density to give the best image. The medical students crowded around the small TV-like screen as if they were about to see the Super Bowl, but the picture they saw was oval with a white border and a granular interior. It was a computer-constructed image of the inside of the patient's head, positioned as if someone was looking down on Mr. Schiller after the top of his skull had been removed.

Martin glanced at his watch. It was a quarter to eight. He was counting on Dr. Denise Sanger to arrive at any moment and take over shepherding the medical students. What really was on Philips' mind this morning was a meeting with his research collaborator, William Michaels. Michaels had called the day before, saying that he was coming over early in the morning with a little surprise for Philips. By now Martin's curiosity had been honed to a razor's edge, and the suspense was killing him. For four years the two men had been working on a program to enable a computer to read skull X rays, replacing the radiologist. The problem was in programming the machine to make qualitative judgments about the densities of specific areas of X rays. If they could succeed, the rewards would be incredible. Since the problems of interpreting skull X rays were essentially the same as
interpreting other X rays, the program would be eventually adaptable to the entire field of radiology. And if they accomplished that . . . Philips occasionally let himself dream of having his own research department, and even the Nobel Prize.

The next image appeared on the screen bringing Philips' mind back to the present.

“This slice is thirteen millimeters higher than the previous image,” intoned the technician. With his finger, he pointed to the bottom section of the oval. “Here we have the cerebellum and . . .”

“There's an abnormality,” said Philips.

“Where?” asked the technician, who was seated on a small stool in front of the computer.

“Here,” said Philips, squeezing in so that he could point. His finger touched the area the technician had just described as the cerebellum. “This lucency here in the right cerebellar hemisphere is abnormal. It should have the same density as the other side.”

“What is it?” asked one of the students.

“Hard to say at this point,” said Philips. He leaned over to look at the questionable area more closely. “I wonder if the patient has any gait problem?”

“Yes, he does,” said the technician. “He's been ataxic for a week.”

“Probably a tumor,” said Philips, standing back up.

The faces of all four medical students immediately reflected dismay as they stared at the innocent lucency on the screen. On the one hand they were thrilled to see a positive demonstration of the power of modern diagnostic technology. On the other hand, they were frightened by the concept of a brain tumor; the idea that anybody could have one; even they.

The next image began to wipe off the previous one.

“Here's another area of lucency in the temporal
lobe,” said Philips, quickly pointing to an area already being replaced by the next image. “We'll see it better on the next slice. But we are going to need a contrast study.”

The technician got up and went in to inject contrast material into Mr. Schiller's vein.

“What does the contrast material do?” asked Nancy McFadden.

“It helps outline lesions like tumors when the blood brain barrier is broken down,” said Philips, who had turned to see who was coming into the room. He'd heard the door to the corridor open.

“Does it contain iodine?”

Philips hadn't heard the last question because Denise Sanger had come in and was smiling warmly at Martin behind the backs of the engrossed medical students.

She slipped out of her short white coat and reached up to hang it next to the first-aid cabinet. It was her way of getting down to work. Its effect on Philips was the opposite. Sanger had on a pink blouse, pleated in the front and topped with a thin blue ribbon tied in a bow. As she extended her arm to hang her coat, her breasts thrust against her blouse, and Philips appreciated the image as a connoisseur appreciated a work of art, for Martin thought Denise was one of the most beautiful women he had ever seen. She said she was five-five, whereas actually she was five-four. Her figure was slight, one hundred and eight pounds, with breasts that were not large but wonderfully shaped and firm. She had thick shiny brown hair, which she usually wore pulled back from her forehead and clasped with a single barrette on the back of her head. Her eyes were lighter brown with flecks of gray, giving her a lively, mischievous appearance.
Very few people guessed that she had been first in her medical school graduating class three years previously, nor did many believe that she was twenty-eight years old.

With her coat taken care of, Denise brushed past Philips, giving his left elbow a furtive squeeze. It was so fast that Philips couldn't respond. She sat down at the screen, adjusted the viewing controls to her liking, and introduced herself to the students. The technician returned and announced that the contrast material had been given. He prepared the scanner for another run.

Philips leaned over so that he had to support himself on Denise's shoulder. He pointed to the image on the screen. “Here's a lesion in the temporal lobe, and at least one, maybe two, in the frontal.” He turned to the medical students. “I noted in the chart that the patient is a heavy smoker. What does all this suggest to you?”

The students stared at the image afraid to make any gesture. For them it was like being at an auction without money; any slight movement could have been interpreted as a bid.

“Let me give you all a hint,” said Philips. “Primary brain tumors are usually solitary, whereas tumors coming from other parts of the body, what we call metastasis, can be single or multiple.”

“Lung cancer,” blurted one of the students as if he were on a TV game show.

“Very good,” said Philips. “At this stage you can't be one hundred percent sure, but I'd be willing to put money on it.”

“How long does the patient have to live?” asked the student, obviously overwhelmed by the diagnosis.

“Who's the doctor?” asked Philips.

“He's on Curt Mannerheim's neurosurgical service,” said Denise.

“Then he doesn't have long to live,” said Martin. “Mannerheim will operate on him.”

Denise turned quickly. “A case like this is inoperable.”

“You don't know Mannerheim. He operates on anything. Especially tumors.” Martin again bent over Denise's shoulder, smelling the unmistakable aroma of her freshly washed hair. It was as unique to Philips as a fingerprint, and despite the professional setting, he felt a faint stirring of passion. He stood up to break the spell.

“Doctor Sanger, can I speak to you for a moment,” he said suddenly, motioning her over to a corner of the room.

Denise complied willingly, with a bewildered expression.

“It's my professional opinion . . .” said Philips in the same formal tone of voice. He then paused and when he continued he lowered his voice to a whisper “ . . . that you look incredibly sexy today.” Denise's expression was slow to change. It took a moment for the comment to register. When it did, she almost laughed. “Martin, you caught me off-guard. You sounded so severe I thought I'd done something wrong.”