by Robin Cook
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?” ask
ed 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.
Now as Martin walked back to their table, Denise felt a rush of affection, and gratitude. At the same time she recognized he was a man, and she was afraid of assuming a commitment he did not feel.
“This is not my day,” said Martin, sitting down across from her. “That was Dr. Reynolds. Marino is not being autopsied.”
“I thought she’d have to be,” said Denise, surprised and trying to switch her mind back to medicine.
“True. It was a medical examiner’s case, but in deference to Mannerheim, the examiner released the body to our Path department. The Path department approached the family for permission, and the family refused. Apparently they were pretty hysterical.”
“That’s understandable,” said Sanger.
“I suppose,” said Philips, dejectedly. “Damn . . . . Damn!”
“Why not pull some X rays of patients with known multiple sclerosis and see if you can find similar changes.”
“Yeah,” said Philips with a sigh.
“You could think a little about the patient rather than your own disappointment.”
Martin stared at Denise for several minutes, making her feel that she had overstepped an unspoken boundary. She hadn’t meant to be moralizing. Then his face changed and he smiled broadly.
“You’re right!” he said. “In fact you just gave me a fabulous idea.”
Directly across from the emergency room desk was a gray door with a sign that read EMERGENCY ROOM STAFF. It was the lounge for the interns and residents, although it was rarely used for relaxation. In the back was a lavatory with showers for the men; the women doctors had to go upstairs to the Nurses’ lounge. Along the side there were three small rooms with two cots each, but they weren’t used much except for short naps. There was never time.
Dr. Wayne Thomas had taken the one comfortable chair in the lounge: an old leather monster with some of its stuffing extruding through an open seam like a dehisced wound.
“I think Lynn Anne Lucas is sick,” he was saying with conviction.
Around him, either leaning against the desk or seated in one of the wooden chairs, were Dr. Huggens, Dr. Carolo Langone, Resident in Internal Medicine; Dr. Ralph Lowry, Resident in Neurosurgery; Dr. David Harper, Resident in Gynecology; and Dr. Sean Farnsworth, Resident in Ophthalmology. Separated from the group were two other doctors reading EKG’s at a counter.
“I think you must be horny,” said Dr. Lowry with a cynical smile. “She’s the best-looking chick we’ve seen all day and you’re trying to find some excuse to admit her on your service.”
Everyone laughed but Dr. Thomas. He didn’t move except for his eyes, which turned to Dr. Langone.
“Ralph has a point,” admitted Langone. “She’s afebrile, normal vital signs, normal blood work, normal urine, and normal cerebral spinal fluid.”
“And normal skull X ray,” added Dr. Lowry.
“Well,” said Dr. Harper, getting up from his chair. “Whatever it is, it ain’t GYN. She’s had a couple of abnormal Pap smears, but that’s being followed in the clinic. So I’m going to leave you to solve this problem without me. To tell you the truth, I think she’s being hysterical.”
“I agree,” said Dr. Farnswo
rth. “She claims to have trouble seeing but her ophthalmology exam is normal and with this near vision card she can read the small row of numbers with ease.”
“What about her visual fields?” asked Dr. Thomas.
Farnsworth got to his feet, preparing to leave. “Seem normal to me. Tomorrow we can have a Goldmann field done, but we don’t do them on an emergency basis.”
“And her retinas?” asked Dr. Thomas.
“Normal,” said Farnsworth. “Thanks for the consult. It’s been swell.” Picking up his suitcase of instruments, the ophthalmologist left the room.
“Swell! Shit,” said Dr. Lowry. “If I have one more Goddamn prissy eyeball resident tell me they don’t do Goldmann fields at night, I think I’ll punch him out.”
“Shut up, Ralph,” said Dr. Thomas. “You’re starting to sound like a surgeon.”
Dr. Langone stood up and stretched. “I got to be going too. Tell me Thomas, why do you think this girl is sick: just because of her decreased sensation? I mean, that’s pretty subjective.”
“It’s a feeling I have. She’s scared, but I’m sure she’s not hysterical. Besides, her sensory abnormalities are very reproducible. She’s not faking. There’s something screwy going on in her brain.”
Dr. Lowry laughed. “The only thing screwy about this case is what you’d like to be doing if you met her under more social circumstances. Come on, Thomas. If she were a dog, you woulda’ just told her to come back to clinic in the A.M.”
The whole lounge laughed. Dr. Thomas waved them away as he pulled himself from the easy chair. “I give up with you clowns. I’ll handle this case myself.”
