A Brain

by Robin Cook

  “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 film, 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 pantomine 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 Admiting 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 Pap smear, 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 ra
diological 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.”