A Brain

by Robin Cook

  She followed him back to the main computer terminal maintaining a steady stream of commentary about the busy evening in the ER. Philips listened with half an ear while he made his entry. He asked for the names and unit numbers of female patients, aged fifteen to twenty-five, who’d had skull films within the last two years. When the output printer came alive it only typed one line. It told Philips that the data bank was not keyed to retrieve skull films by sex. Philips adjusted his demand on the keyboard. When the printer reactivated, it typed at a vicious rate, but only for a short interval. The list comprised only a hundred and three patients. A quick scan suggested that somewhat less than half were female.

  Randy liked the new list. He said the size of the other was demoralizing. While they waited, he pulled seven envelopes saying it would give them something to start with while he gathered the others.

  Back in his office, Martin admitted that he was beat and that fatigue was beginning to erode his enthusiasm. He dropped the X rays in front of his alternator and put his arms around Denise, pressing her against him. His head dropped over her shoulder. She hugged him back, her hands just beneath his shoulder blades. They stood there for a moment supporting each other, not speaking.

  Finally Denise looked up into Martin’s face and pushed his blond hair from his forehead. His eyes were closed.

  “Why not call it a day,” she said.

  “Good idea,” said Philips, opening his eyes. “Why don’t you come on back to my apartment? I’m still a bit manic; I need to talk.”

  “Talk?” asked Denise.

  “Whatever.”

  “Unfortunately, I’m certain I’ll be called back to the hospital.”

  Philips lived in an apartment building called the Towers, which had been built by the Med Center and was contiguous with the hospital. Although it had been designed with very little creativity, it was new, safe, and superbly convenient. It was also built on the river and Martin had one of the riverside units. Denise, on the other hand, lived in an old building on a cluttered side street. Her apartment was on the third floor and its windows faced a forever dark air shaft.

  Martin pointed out that his apartment was as close to the hospital as the on-call room in the nurses’ quarters, which was available for Denise’s use, and three times closer than her own apartment. “If you get called, you get called,” he said.

  She hesitated. Seeing each other while she was on call was a new experience and Denise was afraid that escalating the relationship was going to force a decision.

  “Maybe,” she said. “First, let me check the ER and make sure there aren’t any problems brewing.”

  While he waited for her, he began putting some of the new X rays on his viewer. He had three of them up before his eyes were pulled back to the first. Leaping from his chair, he put his nose to the film. Another case! There was the same speckling starting in the very back of the brain and running forward. Philips looked down at the envelope. The name was Katherine Collins, age twenty-one. The typed X-ray report glued to the envelope listed “seizure disorder” as the clinical information.

  Taking Katherine Collins’ X ray back to the small computer, he fed it to the scanner. Then he grabbed the remaining four envelopes and extracted a skull film from each. He began putting them on his viewer, but before his hand even left the edge of the first film, he knew he’d found yet another case. His eyes were now very sensitized to picking up the subtle changes. Ellen McCarthy, age twenty-two, clinical information: headaches, visual disturbance, and weakness of right extremities. The other films were normal.

  Using a matched pair of lateral skull films from Ellen McCarthy’s envelope, that had been taken at slightly different angles, Philips switched on the light in his stereo viewer. Looking through the eyepiece, he had great difficulty perceiving any speckling at all. What he could see seemed to be superficial, in the cerebral cortex rather than deeper in the nerve fibers of the white matter. That was somewhat disturbing information. The lesions of multiple sclerosis were usually in the white matter of the brain. Tearing off the printout from the computer, Philips read the report. At the top of the page was a THANK YOU referring to when Philips had inserted the film. This was followed by a girl’s name and a fictitious phone number. It was more of Michaels’ humor.

  The report itself was just as Philips expected. The densities were described and as it had with Lynn Anne Lucas, the computer asked again to be advised as to the significance of the unprogrammed abnormalities.

  Almost simultaneously Denise returned from the ER and Randy arrived with fifteen more envelopes. Philips gave Denise a resounding kiss. He told her that thanks to her suggestion he’d found two more cases, both young women. He took the new films from Randy and was about to start on them, when Denise put her hand on his shoulder.

  “The ER is quiet now. An hour from now, who knows?”

  Philips sighed. He felt like a child with a new toy being asked to abandon it for the night. Reluctantly he put the envelopes down and told Randy to pull the rest of the films from the second list and stack them on his desk. Then if he had any time left he could begin pulling the films from the main list, and stack them against the back wall, behind the worktable. As an afterthought Martin asked Randy to call Medical Records and have the hospital charts of Katherine Collins and Ellen McCarthy sent up to his office.

  Glancing around the room Martin said, “I wonder if I’m forgetting anything.”

  “Yourself,” said Denise with exasperation. “You’ve been here for eighteen hours. Good gravy, let’s go.”

  Since the Towers was part of the medical center, it was connected to the hospital by a well-lit and cheerfully painted basement tunnel. Power and heat traveled the same route, concealed in the tunnel’s ceiling, behind acoustical tiles. As Martin and Denise walked hand in hand they passed first under the old medical school and then the new medical school. Farther on they passed branching tunnels leading to the Brenner Pediatric Hospital and the Goldman Psychiatry Institute. The Towers was at the end of the tunnel and represented the current limit of the cancerous spread of the medical center into the surrounding community. A flight of steps led directly into the lower foyer of the apartment house. A guard behind a bulletproof glass recognized Philips and buzzed them in.

  The Towers was a posh residential address inhabited mostly by MDs and other professionals from the medical center. A few other professors from the university lived there as well but they generally found the rents on the expensive side. Of the physicians, most were divorced, although there was a rising contingent of young turks with their aggressively career-minded wives. There were almost no children except for weekends when it was Dad’s turn with the kids. Martin also knew there were quite a few psychiatrists, and he’d noticed not an insignificant number of gays.

  Martin was one of the divorced. It had happened four years previously after six years of matrimonial suburban stalemate. Like most of his colleagues Martin had married during his residency as a kind of reaction against his demanding academic life. His wife’s name was Shirley and he had loved her, at least he thought he’d loved her. He’d been shocked at the time when she upped and left him. Luckily they’d had no children. His reaction to the divorce had been depression, which he’d dealt with by working even longer hours, if that was possible. Gradually as time passed he was able to view the experience with the necessary detachment to realize what had happened. Philips had been married to medicine, his wife had been the mistress. Shirley had picked the year he’d been appointed Assistant Chief of Neuroradiology as the time to leave because she’d finally understood his value system. Before his selection his excuse to his wife for his seventy hours per week was that he was shooting to become the Assistant Chief. Once he got the position his excuse for the same work week was that he was the Chief. Shirley had seen the light even if Philips hadn’t. She had refused to be married and alone and so she left.

  “Have you come to any conclusion about Marino’s missing brain?” asked Denise, bringing M
artin back to the present.

  “No,” said Philips. “But Mannerheim must have been responsible in some way.”

  They were waiting for the elevator beneath a huge, gaudy chandelier. The carpet was burnt orange with interlocking gold circles.

  “Are you going to do anything about it?”

  “I don’t know what I can do. I sure wouldn’t mind finding out why it was removed.”

  The nicest aspect of Philips’ apartment was the view of the river and the graceful curve of the bridge. Otherwise it was very unremarkable. Philips had moved suddenly. He’d rented the apartment by telephone and had hired a rental firm to furnish it. And that’s what he got-furniture: a couch; a couple of end tables; a coffee table; a couple of chairs for the living room; a dinette set; and a bed with matching side table for the bedroom. It wasn’t much, but it was only temporary. The fact that Philips had been living there for four years didn’t occur to him.

  Martin was not a drinker but tonight he wanted to relax so he splashed some scotch over ice. To be polite he held the bottle up for Denise but she shook her head as he’d expected. She only drank wine or an occasional gin and tonic, and certainly not while she was on call. Instead she got herself a tall glass of orange juice from the refrigerator.

  In the living room Denise listened to Martin’s chatter, hoping that he’d burn himself out quickly. She was not interested in talking about research or missing brains. She was remembering his admission of affection. The possibility of his being serious excited her and it allowed her to admit her own feelings.

  “Life can be amazing,” Martin was saying. “In a single day it can take such wonderful twists.”

  “What are you referring to?” Denise asked, hoping he was going to talk about their relationship.

  “Yesterday, I had no idea we were so close to producing the X-ray reading program. If things go . . .”

  Exasperated, she got up and pulled him to his feet and began pulling at his shirttails telling him that he should relax and forget the hospital. She looked up into his bemused face with a teasing smile, so that no matter what happened it wouldn’t be awkward.

  Philips agreed that he was wound up and said he’d feel better if he took a quick shower. It wasn’t quite what she had in mind, but he encouraged her to come into the bathroom and keep him company. She watched him through the shower glass, which was frosted on one side and beveled on the other. The image of Philips’ naked body was fractured and softened in a curiously erotic way as he twisted and turned under the jet of water.

  Denise sipped her orange juice while Martin tried to carry on a conversation over the din of the water. She couldn’t hear a word, which she thought was just as well. At the moment she preferred watching rather than listening. Affection welled up inside of her, filling her with warmth.

  Finished, Martin turned off the water and, grabbing his towel, stepped out of the shower. To Denise’s disgust he was still talking about computers and doctors. Annoyed, she snatched the towel and began to dry his back. When she was finished she turned him back around.

  “Do me a favor,” she said as if she were angry, “and shut up.”

  Then she grabbed his hand, and pulled him out of the bathroom. Confused at her sudden outburst, Philips allowed himself to be led into the darkened bedroom. There in full view of the silent river and the dramatic bridge, Denise threw her arms around his neck and passionately kissed him.

  Martin responded instantly. But before he could even undress Denise, her beeper filled the room with its insistent sound. For a moment they just held each other, postponing the inevitable, and enjoying their closeness. Without saying it, they both knew that their relationship had reached a new plateau.

  It was 2:40 A.M. when a city ambulance pulled into the receiving area of the Medical Center. There were already two similar ambulances parked there, and the new one backed up between them until its bumper thumped the rubber guard. The engine choked and died before the driver and the passenger alighted from the cab. With their heads bowed against the steady April rain, they trotted back and leaped up on the platform. The thinner of the two swung open the rear door of the ambulance. The other more muscular man reached in and pulled out an empty stretcher. Unlike the other ambulances this one was not bringing an emergency. It had come to pick up a patient. Not an uncommon occurrence.

  The men lifted the stretcher from each end and, like an ironing board, its legs dropped down. Instantly the stretcher was converted into a narrow but functional gurney. Together they pushed through the automatic sliding door of the emergency room and looking neither right nor left, turned down the main corridor and took an elevator to Neurology West on the fourteenth floor. There were two RNs and five LPNs assigned to the floor for the shift, but one of the nurses and three of the aides were on their break, so Ms. Claudine Arnette, RN, was in charge. It was to her that the thinner man presented the transfer documents. The patient was being moved to a private room at New York Medical Center, where her own doctor had admitting privileges.

  Ms. Arnette checked the papers, swore under her breath because she had just finished her paper work on the admission and signed the form. She asked Maria Gonzales to accompany the men down to room 1420. Then she went back to her narcotic check before her own break. Even in the reduced light she’d noticed that the driver had amazingly green eyes.

  Maria Gonzales opened the door to room 1420, and tried to awaken Lynn Anne. It was difficult. She explained to the ambulance attendants that they’d received a phone call order for a double dose of sleep medication as well as phenobarbital because of the possibility of seizure. The men told Maria it didn’t matter, and they positioned the stretcher and arranged the blankets. With a smooth, practiced maneuver, they lifted the patient and settled her with the blankets. Lynn Anne Lucas never even woke up.

  The men thanked Maria, who had already begun to strip Lynn Anne’s bed. Then they wheeled her out into the hallway. Ms. Arnette didn’t look up when they passed the nurses’ station and got back on the elevator. An hour later the ambulance pulled away from the Med Center. There was no need for the siren or rotating light. The ambulance was empty.

  8

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

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

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

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

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

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

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

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

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

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