Endorphin Conspiracy, The (8 page)

Chapter 9

“You look like hell, Geoff,” Cathy Johannsen said. They sat at the ICU nursing station. Geoff had recounted the bizarre events of the night before.

“Could I make up a story like that?”

“You have a pretty active imagination, but I have to believe you were there. Your name was all over the papers. ‘Dr. McDreamy of the A-train saves the day.’ You’re the hero of Washington Heights.”

“How’s Karen doing?”

“She’s doing great. She handled herself like a pro. Mark, well, he’s smart but a bit green. No new admissions, by the way, and they were able to get little Jessica off the ventilator.”

“So soon?” Images from his dream flashed in his mind. Jessica clutched tightly in Romero’s arms, the white-hot firestorm engulfing them all.

Karen Choy approached the nursing station. “I guess you heard the good news,” she said with a broad smile.

“Don’t get me wrong, Karen, I think it’s great, but didn’t you take her off the ventilator a little prematurely?”

Karen shifted her weight, massaged the back of her neck, as if she was surprised by his question. “Well, it wasn’t my idea entirely. Howard suggested we do it.”

Geoff was upset. “Kapinsky? He should know better than that. Where is he now?”

“Over there, by Jessica’s bed,” Cathy said. She rolled her eyes, pointed to the far corner of the room. “He’s doing his clown routine.”

Geoff left the nursing station, Karen behind him, and walked towards Jessica’s bed. Kapinsky was standing at the bedside blowing up balloons and twisting them into the shapes of animals. He playfully set each one on Jessica’s table after he made the corresponding animal’s sounds.

Geoff watched the scene in amazement. His anger abated and his instinctual dislike for Kapinsky melted away, however briefly, as he observed the tender interaction. It was hard to believe this was the same abrasive tight-assed geek he had come to loathe over the years.

“And do you know what this one is, sweetie?” asked Kapinsky in his best kindergarten voice. “I’ll give you one hint. Hee-haw, hee-haw.”

Jessica’s eyes were open, like slits. She cracked half a smile, made a feeble attempt to mouth the word donkey.

“Great!” Kapinsky replied. “Now I have one last animal friend for you to meet.”

“Looks like you’ve found a cure for endorphin-coma, Kapinsky,” Geoff said as he and Karen approached the bedside.

Kapinsky smiled and continued about his business of creating a balloon giraffe. “Now, Dr. Geoff, let’s not frighten our patient. She’s never seen you before.”

Geoff’s initial reaction was to get pissed off at Kapinsky’s tone, be he realized immediately Kapinsky was right. “Would you like to introduce us?”

Geoff approached Jessica cautiously, noting the frightened look in her eyes. She was a different child from the grotesque, bloodied little girl he had seen the other day. The endotracheal tube had been removed, and one of the nurses had made braids and tied them together over the shaved area on the top of her head. She was no longer a faceless victim.

“Jessie, this is my friend, Dr. Geoff. He’s your friend, too, so don’t be afraid of him.” Kapinsky placed his arm around Geoff, who had softened enough to tolerate the contact.

Jessica nodded slowly, and her frightened expression relaxed. She attempted to mouth words—obviously using every bit of her strength to do so—words Geoff picked up on right away. “Daddy. Where’s my daddy?”

Geoff turned to Karen with concern. “Have you spoken with the family?”

“Her dad and grandmother spent most of the night here,” Karen said. “They went home to rest about an hour ago. Her mother died a few years ago.”

Geoff grasped Jessica’s hand firmly with his own. “Daddy went home to nap, Jessica. He’ll be back soon.”

He turned to Kapinsky. “I think it’s time to let her rest.”

Jessica nodded slowly as her eyes closed.

The team, lead by Geoff, walked toward the nursing station. “Looks great, doesn’t she?” Kapinsky said with a smug smile.

“Sure does. Tell me how you weaned her off the ventilator so quickly, Karen.”

Karen rubbed the back of her neck and took a breath. “Her vitals had remained stable for almost thirty-six hours and her intracranial pressure had dropped to normal levels. When she became arousable and her pupils were normal and fully reactive to light, we had respiratory therapy evaluate her pulmonary functions. Her pO2/CO2 levels were normal. After checking her chest x-ray and seeing her lung had re-expanded, and after repeating the PET scan, we—Howard and I—thought it was safe to try to wean her off the ventilator.”

“I understand your desire to help her recover as quickly as possible, Karen, but I hope you realize how potentially dangerous what you did was. She could have died. Surely you, Kapinsky, should have known better.”

Karen looked down, avoiding eye contact with Geoff.

“It was done under very controlled conditions, Geoff. I would never have taken the risk with this little girl otherwise,” Kapinsky said.

“Did you check her PET scan first?”

“I haven’t seen the most recent one. I think the hard copy is still in Neuroimaging,” Kapinsky said.

Geoff looked him squarely in the eye, saw insecurity behind the defiant stare. “Just be more cautious and follow standard protocol next time. I don’t want any unnecessary morbidity on our team.”

“Sure, chief,” Kapinsky said.

Geoff looked over his shoulder at the empty bed next door, bed seventeen. A newly vacant bed in the NSICU meant one of three things: the patient was in neuroimaging, on the ward, or in the morgue. Geoff felt a twinge of concern. “Where’s the hang glider?”

“Transferred to the neuro ward around five this morning. He came out of drug-induced coma during the night, and the staffing in the NSICU was a little short. The bed control supervisor asked if it was okay to move him a few hours early,” Kapinsky said. “I mean, I knew we planned on sending him down to the ward today anyway, right?” Kapinsky seemed to sense Geoff’s annoyance.

“Who’s the chief resident, here, Kapinsky? The bed control supervisor is supposed to clear requests like that with me, not with the senior resident.” Geoff glared at Kapinsky.

“Well, she was going to, but I was here, so I told her not to bother calling you. I didn’t think it was that big a deal.”

“You thought wrong. Next time, bother me.” Goddamned Kapinsky. This year might be even longer than Geoff had imagined.

“Whatever you say, chief.”

Something seemed different this morning to Geoff. He wasn’t quite sure what. Maybe it was that the NSICU was quieter than usual at early morning rounds. Phones rang, nurses and medical students chatted, techs came and went, respirators hissed. Smithers. That was it. “Where’s Smithers?”

Geoff looked around the room for the cop he and Karen had admitted from the ER yesterday. The three possibilities flashed through his mind again.

“Neuroimaging,” Kapinsky said. “You wanted him to have a PET scan as soon as he was stable, right?”

“He just had major surgery yesterday and came this close to crumping.” Geoff gestured with his fingers. He felt really uneasy about this one. “He didn’t seem stable enough last night to stand the hour it would take in neuroimaging.” He gave Karen a questioning look. “Who went with him?”

“Brian Phelps and a medical student,” Karen said.

“Great. A first year resident and a med student. I hate July,” Geoff muttered.

“What?” asked Karen.

“Forget it. It’s not your fault.” Geoff looked at Kapinsky. “Did you okay this?”

“Well, yes. I mean he was stable enough to be transferred with a portable respirator—”

“Stable enough?” I don’t like you taking risks with our patients, Kapinsky.” Geoff locked stares with Kapinsky. “You had better get your act together real fast, or this is going to be a long year. For both of us.”

Kapinsky bit his upper lip, squinted, looked down. “Sorry. I was just trying to be helpful, chief.”

Geoff tensed his jaw, nodded. He turned to Karen. “I’ve got some test results to check on the computer. It shouldn’t take me long. Skip the rest of rounds and head down to neuroimaging, check on Smithers. I’ll meet you down there in five minutes.”

“Sure,” Karen said. She grabbed her clipboard off the bedside table and left.

“Kapinsky, I’ll be in the lounge. Don’t extubate or discharge anyone in the next five minutes, okay?”

“Don’t worry, chief.”

“I
do
,” Geoff said. He turned and headed to the front of the NSICU, entered the house staff lounge, and sat at a vacant terminal. He had been curious all morning to find whatever records he could on Romero, search for any hint of mental illness, schizophrenia specifically. He didn’t remember much about him. The face, the name, his accent. The way he said ‘doc,’ just like in the dream. His thoughts flashed back to the disturbing nightmare, and a pulsating horseshoe appeared brightly in his mind’s eye. Geoff wanted to pull Romero’s scan, if for no other reason than to satisfy his curiosity and put the strange dream to rest.

Geoff signed on to the Traumanet system and entered Neurad, the neuroimaging database. Reviewing patient records and test results required a second level security clearance, PET scan data, third level. Geoff viewed this as a tremendous inconvenience. PETronics Corporation insisted it was essential to preserve patient confidentiality.

WELCOME TO THE NEURAD SYSTEM, DR. DAVIS. YOUR ACCESS IS CLEARED. PLEASE ENTER THE PATIENT’S NAME AND BIRTHDATE OR HOSPITAL NUMBER.

Geoff entered the patients name: Romero, Jesus.

He waited for the digitalized image to appear on the screen. The cursor pulsed for what seemed like minutes before delivering the response.

NO SCAN OR FILE WITH NAME: ROMERO, JESUS. PLEASE TRY ALTERNATE SPELLING OR ENTER HOSPITAL NUMBER.

Geoff re-entered the name using different spellings. All resulted in the same response. He switched to the patient record system, tried to pull up Romero’s medical chart and got the same message. There was no record of a Jesus Romero having been to the New York Trauma Center. Geoff rested his hand on his chin, stared blankly at the screen, tapped his finger on the desk. He knew the man had been a patient at the NYTC. Now it was as if he had never existed. Must be a computer error. Geoff made a mental note to see if there was a hard copy of the scan filed in neuroimaging, a chart in medical records. They couldn’t have vanished into thin air.

Chapter 10

Having maneuvered through the maze of limited access elevators and corridors leading to the labyrinthine sub-basement of the PETronics Research Center, Geoff paused at the entrance to PET Scanning. Over the main doorway a large sign, its illuminated red block letters pulsating brightly, issued a stern warning. “Scan In Progress. Do Not Enter.”

“Who designed this medical center, anyway?” a voice reverberated through the hallway.

Geoff startled, turned around. “Karen? I thought you’d be inside with the patient by now.”

“So did I.” Karen shifted her stance, smiled in seeming embarrassment. “I kind of got lost. You’d think that with all of the head trauma that comes through this place, PET scanning would be right next to the ER, not in the outer reaches of Siberia.”

“It all comes down to money,” Geoff said. “And control.”

Karen wrinkled her brow. “What do you mean?”

“The reality of healthcare in the new economy, Dr. Choy. Private-public partnerships, that’s what I mean. It wasn’t a government grant or some grateful benefactor that built this research wing, Karen. PETronics Corporation bankrolled it. They designed it. They control it.”

“A medical equipment company owns this place?”

“That’s right,” Geoff said.

“So we sold out? Is that the answer?”

“I wouldn’t exactly call it that, but control is tied to purse strings. I felt the same way at first, but I spent all of last year working in Balassi’s laboratory, innumerable hours here working with the PET scanner. I was never aware of any attempt on the part of PETronics to control the basic research that was taking place. Dr. Balassi says they’re the ideal silent partner.

“I know it’s hard to believe, but they built this building, donated this state-of-the-art PET scanner, and gave Dr. Balassi, the world pioneer in PET scan research, total freedom to run the program as he sees fit. No more mountains of paperwork, grant applications to the National Institutes of Health, or competition for scant research dollars in Washington. Life’s a tradeoff. So is medicine these days.”

“Maybe,” Karen said. But it just doesn’t feel right. The same way free black bags and stethoscopes from the drug companies didn’t feel right when I graduated medical school. I donated mine to the Nicaraguan Red Cross.”

The lighted “Do Not Enter” sign extinguished.

“So did I.” Geoff smiled. “Let’s go in.” Slowly he opened the oversized door and entered the imaging room, Karen following behind.

A waft of cool air swept over them as the heavy door clicked shut securely behind them, locking out the mustiness of the basement corridor. Their eyes adapted to the change in luminosity, the only light provided by the auxiliary controls on the PET scanner and two dimmed, overhead LED fixtures.

The room was about twenty-five by thirty feet, roughly the same size as the usual CT scan suite. There was nothing conspicuously unique about the place. It could have been, except for the size, any imaging room in any medical center in any city in America. But of course, it was anything but that.

The PET scanner was located at the far end of the room, a white metallic, box-like structure extending from the floor to just below the ceiling, with a central opening large enough to allow entry of any body part to be imaged, the patient being positioned on a retractable exam table. Massive cables surrounded by specially insulated ducting extended from the unit to the ceiling, all wires converging in the complex computer that choreographed the examination and processed the images.

The most unusual aspect of the suite was in what went unseen to the casual observer. Though the PET scanner was the most obvious and most talked-about piece of hardware, the adjacent room housed the cyclotron, a particle accelerator necessary to produce the radioactive compound used in each PET scan study, its close proximity dictated by the short half-life of the materials. A sixteen-ton, Rube Goldberg-like device composed of huge magnetic coils, stainless steel cylinders, vacuum chambers, hoses, and thousands of feet of tubing all surrounded by vast, retractable lead-shielded walls, the cyclotron provided the lifeblood of the PET scan. Like a mad scientist’s garage creation, it was an engineering marvel constructed for the essential function it performed, without regard to form or aesthetics.

The room was deserted, which surprised Geoff given the “Do Not Enter” sign had been turned off just moments ago. No patient, no tech, not even a sign that a scan had recently been performed. Where did everybody go?

Over the quiet hum of the nearby scanner’s cooling system, Geoff could make out the muted voice of a technician in the control room beyond the Plexiglas enclosure.

“Let’s go let the tech know we’re here,” Geoff said, feeling reassured.

Geoff rounded the corner of the Plexiglas partition and was surprised to discover two techs instead of one in the control room. Only one was not a tech. Seated behind the master imaging computer console, frenetically typing in commands, was Dr. Josef Balassi. The brightly colored images on the screen cast a peculiar vermillion hue across his full-bearded face, setting his normally intense, close-set, brown eyes afire. His collar-length, grey hair danced to the symphony of the flickering light of the CRT. Twenty Thousand Leagues Under the Sea, Captain Nemo at the keyboard. He was totally immersed in studying the three dimensional images of the brain appearing on the screen.

“Great images, Walter!” said Balassi in his thick Slavic accent. “The new C-11 isotope compound is labeling the brain just where I thought it would.” Balassi hit the table with his fist triumphantly, nodded his head in self-approval.

Intensely loyal to Balassi, whether out of admiration or fear Geoff didn’t know, Walter Krenholz, the archetypal worker bee smiled his mortician’s smile. “Looks like we have company,” he droned, acknowledging Geoff’s presence at the station.

Balassi hit the enter key, instantaneously storing the data and clearing the screen, then looked up, and recognizing the doctor standing at the console, offered a smile.

“Geoffrey, you’ve only been out of the lab one week, and already the monkeys and I miss you dearly!” He stood up and grabbed Geoff’s hand, shaking it firmly. Things going okay?”

“It’s been interesting. We’ve got a couple of tragic cases in the NSICU.”

“You mean that poor little girl injured at the zoo?” Balassi pursed his lips, nodded his head side to the side.

“She’s one of them. The other one’s the cop whose PET scan I thought you’d still be doing.” Geoff looked around for his patient, puzzled about where he was. It wasn’t that easy to move such a severely injured patient on and off the scanning table. “Where is he?”

“You just missed him. We completed his scan moments before you arrived, Geoff.” Balassi shot a glance at Walter. “He must be in the service elevator by now.”

Walter nodded affirmatively as he busied about the scanner getting it ready for the next study.

“Were there two residents with him?” Geoff felt uneasy, not knowing his patient’s status after the precarious trip from the NSICU and the physical stress of the scan.

“Two or three, I’m not really sure. One had a beard, though, if that helps. What happened to the poor man?” Balassi asked.

“Must be Phelps.”

“What?”

“Brian Phelps, the new resident. He was the one with the patient,” said Geoff.

“A new resident. I understand your concern. If it’s of any reassurance coming from a simple scientist, your patient seemed stable during his scan. I’m sure he’ll be all right. What happened to him?”

“A transit cop, attacked in the 168th Street subway station. Basal skull fracture on MRI. He’s in a bad way.”

“Packs of wolves roaming the subways. I stay out of them whenever I can, and so should everyone else.” Balassi shook his head, stroked his beard. “How’s the little girl doing?”

“Holding her own so far, coming out of her coma. I haven’t seen her admission PET scan yet, but I was told she graded two out of five on the endorphin-coma scale.”

“Actually, I haven’t had a chance to review it yet, either. I’ll have Walter dig it up before you leave,” Balassi said. “Let’s review the study on the last patient, Smithers. Looks like the computer just finished processing the images.” He entered a command on the keyboard, stared at the screen. Balassi looked up at Karen Choy, and as if suddenly aware of her presence, stood and seized her hand. “You must be one of the new residents, as well. A very
beautiful
one.”

“Dr. Balassi,” Karen said, blushing. “It’s an honor to meet you. I’m Karen Choy.”

Balassi smiled. Fifty-eight, divorced twice, now a sworn bachelor, he had an uncanny ability to engage any woman in his presence regardless of her station or marital status. “Beautiful hands, the hands of a fine surgeon, I’m sure, Dr. Choy.”

Karen awkwardly withdrew her hand. “Thank you.”

Balassi motioned towards the work station. “Come in, both of you. Sit down. Let’s look at the results.”

Balassi’s large right hand enveloped the mouse and began clicking a series of commands to the computer, dramatically altering the fuzzy, two-dimensional images that appeared on the screen. A Technicolor, three-dimensional reconstruction of the brain appeared, rotating slowly on its axis, all of its convolutions and fissures in full, finely detailed view.

More than an anatomical study, what was being displayed on the screen was a dynamic, physiological blueprint of the endorphin distribution in the brain, all of the inner workings of the mind potentially visualized on a computer screen, specific patterns and neural pathways mapped out in intricate detail like a genetic map of the human chromosome.

The rotation ceased at a view from above, looking down on the major lobes of the brain, frontal and parietal, separated by a central fissure. Click-click. A fine slice through the brain’s lower regions appeared, bringing the temporal lobes and limbic region—the deep-seated areas responsible for memory and emotion—onto the screen. Central areas of searing vermilion were enveloped by regions of yellow, emerald, and a deep, royal blue, a psychedelic map of the brain’s endorphin receptors.

Click-click. The brilliantly colored patterns dissolved, and a new image emerged, a large central blotch of orange-red, the brainstem, a more primitive area of the brain, responsible for controlling bodily functions, breathing and heart rate. Click-click-click. The central image magnified, honed in on the reticular formation, the gatekeeper of the brain’s conscious awareness, burning red on the CRT, its neuronal endings saturated with beta-endorphins.

“Well, that explains his coma,” said Geoff, pointing out the high concentration of endorphin receptors in the patient’s reticular formation. “Can you quantify it?”

Balassi answered the question with a click, positioning the cross hairs on the center of the hot spot on the screen by manipulating the mouse. Numbers appeared above the image corresponding to the color-hue scale at the top of the screen. Blue areas contained the smallest concentration of receptors, red the largest.

“Fifty picomoles per gram, about two-and-a-half times the normal density of endorphin receptors,” Balassi said matter-of-factly.

“That places him somewhere in the middle on the endorphin coma scale, about a three out of five, I’d say. Prognosis for coming out of his coma, fair,” Geoff said.

Balassi nodded affirmatively, manipulating the mouse and reducing the image magnification to review the slices higher in the brain at the level of the temporal lobe.

“What do those hot spots correspond to?” Karen asked, pointing to two faintly red, almond-shaped islands in a sea of chartreuse surrounding the central red of the brainstem.

“The amygdala, the area of the brain thought to be responsible for rage and fear. It probably contains the highest concentration of endorphins in the brain of a normal subject. But as you can see in our comatose patient, it seems faint relative to the sky high endorphin levels in his reticular formation, the endorphins suppressing his consciousness much the way a drug addict overdosed on morphine or heroine would be comatose. Morphine, heroine, and most narcotics bind to pretty much the same endorphin receptors, except, interestingly, PCP or angel dust, which binds to a class of newly discovered
sigma
endorphin receptors,” Geoff said.

“And the yellow-green area surrounding the amygdala? That indicates a moderate level of endorphin activity?”

“You’re catching on, Karen.” Geoff smiled. “That area is the limbic region, seat of our moods and emotions. The shrinks love to talk about this part of the brain. His limbic endorphin level appears normal. Good thing. The last thing you’d want out on the street is a schizophrenic cop.

“I’ll try and dig up a recent scan of one of the psych patients. The pattern’s completely different. The limbic area glows like a forest fire, and the reticular formation is blue as the ocean, just the opposite of what we see here. Looks kind of like a bright red horseshoe. Once you’ve seen the pattern, you won’t forget it,” Balassi said.

Geoff hadn’t been able to get that horseshoe out of his mind. He had to check for Romero’s scan before he left neuroimaging.

“Easy for you to say. Could just as well be psychedelic photos of the Beatles on the cover of
Life
to me. It all looks so foreign,” Karen said, shaking her head.

“Interesting scan, Geoff. Good case,” said Balassi. He turned to face Geoff. “Be sure to let me know how he does clinically so we can correlate the PET findings. Let’s be sure we keep within the project’s protocol.”

“Will do,” Geoff said. “You said you wanted to review the scan on the girl. There’s another scan I wanted to check for, also, a patient we scanned several months ago.”

Balassi raised his brow. “Oh?”

“His name is Jesus Romero. Ironically, he’s the crazy guy who held the girl hostage at the zoo. I tried to pull his scan up on the Neurad system from a terminal in the NSICU, but the system couldn’t find his record.”

“Why the interest in this Romero, Geoff?”

“Academic interest. That’s all.”

Balassi stroked his beard, hit the intercom button. “Walter, we need your assistance here.”

Seconds later, Walter Krenholz entered the control room. “Yes, Dr. Balassi,” he said, his face an expressionless mask.

“I need you to check the file room for two PET scans. One on Jessica Humphries, the other on a fellow named Romero, Jessie Romero.”

“Jesus is the first name,” said Geoff.

“Sorry. Jesus Romero.”

Bald as a cue ball, Walter’s deep-set, blue eyes appeared deeper still due to the dark circles below them. Sullen and seemingly devoid of personality, not many people at the NYTC, even those who worked directly with him day to day—as Geoff had for a year—knew much about Walter. Except of course, Balassi. The two had worked together for the last twenty years, Walter having accompanied him to the NYTC from the National Institutes of Health.