Brain

by Robin Cook

  “I don’t think so.”

  “I do. It has a way of holding one hostage by ever increasing demands.”

  “But I understand those demands.”

  “I’m not so sure you do. Not yet,” said Martin. He was aware the comment sounded condescending but he knew at this point in Sanger’s career it would be impossible to convince her that running a department made day-to-day medicine as much of a rat race as most other businesses. Besides, Goldblatt’s challenge to their relationship was very much in Philips’ mind, so the worry was not hypothetical.

  “I think I understand more than you think,” said Denise. “I think you’ve changed since your divorce. Back then I think you had a kind of macho belief you could get most of your fulfillment from your career. Now I think that’s changed. I believe you realize that the greater part of your satisfaction is going to come from your own interpersonal relationships.”

  There was a silence. Martin was stunned at his transparency as well as Denise’s clairvoyance. Denise broke the silence. “The only thing I can’t understand is if you’re interested in having more of a life outside the hospital, why not ease up on your research?”

  “Because it can be the key to my freedom,” said Martin holding her close. “You have become my promise for fulfillment and research has the power of giving me what I want from medicine as well as more time with you.”

  They kissed, secure in their newly expressed affection for each other. But as they lay there in each other’s arms, they began to feel their fatigue and knew they should go to sleep.

  Denise went to brush her teeth, while Martin let his mind drift back to Lynn Anne’s mysterious disappearance. Glancing at the closed bathroom door, he decided to make a quick call to the hospital, reminding the nurse Lynn Anne had been admitted through the ER, then immediately transferred. The nurse recalled the case because the transfer had come right after she’d finished all the admission paper work. Martin asked if she remembered where the patient had been sent, but the nurse said she did not. Philips thanked her and hung up.

  In bed he curled up against Denise’s back, but had trouble falling asleep. He began telling her about his disturbing experience with the monkeys with the electrodes in their heads, and asked if she thought the information Mannerheim obtained was worth the sacrifice. Denise, on the verge of sleep, just grunted, but Martin’s overstimulated mind jumped back to his visit to the university’s GYN clinic.

  “Hey, have you ever been to the GYN clinic in the hospital?” He pushed himself up on his elbow rolling Denise over on her back. The movement awakened her.

  “No. I haven’t.”

  “I visited there today and the place gave me a strange feeling.”

  “What do you mean?”

  “I don’t know. It’s hard to say, but then again I haven’t been in too many GYN clinics.”

  “They’re really fun,” said Denise sarcastically, and turned back on her side away from Martin.

  “Would you do me a favor and check it out?”

  “You mean as a patient?”

  “I don’t care. I’d like to know your opinion about the personnel.”

  “Well I’m a bit late on my annual checkup. I suppose I could have it done there. In fact, I’ll call tomorrow.”

  “Thanks,” said Martin, finally settling himself to sleep.

  10

  It was after seven when Denise woke up and grabbed for the clock. She was horrified at the time. Being so accustomed to Martin getting up before six, she didn’t set the alarm when he slept over. Throwing back the covers, she dashed into the bathroom to jump into the shower. Philips opened his eyes in time to catch her bare back heading down the hallway. It was a wonderful image to start the day.

  Oversleeping had been Philips’ deliberate gesture of defiance to his old life, and he stretched luxuriously in the warm bed. He thought about going back to sleep but then decided showering with Denise was a better idea.

  In the bathroom, he found she was almost finished and in no mood to kid around. Entering the shower stall he got in her way and she petulantly reminded him that she had to present the X rays at the CPC at 8:00 A.M.

  “Why don’t we make love again?” crooned Martin. “I’ll give you a doctor’s excuse for being late.”

  Denise draped her wet washcloth over Martin’s head, and stepped out onto the bath mat. While she dried herself she spoke to Philips over the sound of the water. “If you finish at a decent hour, I’ll make some dinner tonight.”

  “I’m not accepting any bribes,” shouted Martin. “I’m going to see what Pathology says about my sections on McCarthy’s brain, and I’m hoping to take some polytomes and a CAT scan on Kristin Lindquist. Besides, I’ve got to run a bunch of old skull films through the computer. Today research is going to get top billing.”

  “I think you’re stubborn,” said Denise.

  “Compulsive,” said Martin.

  “When do you want me to go to the GYN clinic?”

  “As soon as possible.”

  “Okay. I’ll make it for tomorrow.”

  While Sanger used the hair dryer, conversation was impossible. Philips got out of the shower and shaved with one of her disposable razors. The two of them had to do a complicated dance in the confines of the small bathroom.

  As Denise leaned close to the mirror to put on her eye makeup she asked, “What do you think is causing the density variation on those X rays?”

  “I really don’t know,” said Philips, trying to tame his thick blond hair. “That’s why I’ve got the section in Pathology.”

  Denise leaned back to assay her efforts. “It seems that answering that question would be the first step rather than associating the abnormality with a specific disease like multiple sclerosis.”

  “You’re right,” said Philips. “The multiple sclerosis idea originated from the charts. It was a stab in the dark. But you know something? You’ve just given me another idea.”

  Philips entered the old medical-school building from the tunnel. The entrance from the street had long since been sealed off. As he climbed the stairs to the lobby, he felt a surprising sentimentality for that time in his life when the future held nothing but promise. When he reached the familiar dark wood doors with the worn red leather panels, he paused. The carefully lettered sign saying MEDICAL SCHOOL had been desecrated by a crude board nailed haphazardly across it. Below, held in place with thumbtacks, was a cardboard sign which read, “Medical School located in the Burger Building.”

  Beyond the venerable old doors, the decor deteriorated. The old foyer had been demolished, its oak wainscoting sold at auction. The renovation funds had dried up even before the demolition had been completed.

  Martin followed a path cleared of debris that ran around what had been an information booth, and started up the curved staircase. Looking down the length of the foyer he could see the barred entrance from the street. The doors had been chained together.

  Philips’ destination was the Barrow Amphitheatre. When he arrived he noticed a new sign that read DE- PARTMENT OF COMPUTER SCIENCE: DIVISION OF ARTIFI- CIAL INTELLIGENCE. Philips opened the door and, walking up to the iron piping that formed the railing, looked down into the semi-circular auditorium. The seats had been removed. Arranged in intervals on the various tiers were all sorts of components. Down in the pit were two large units constructed similarly to the small processor that had been brought to Philips’ office. A young man in a short-sleeved white coat was working on one of them. He had a soldering gun in one hand and wire in the other.

  “Can I help you?” he shouted.

  “I’m looking for William Michaels,” yelled Philips.

  “He’s not here yet.” The man put down his tools and worked his way up toward Philips. “Would you like to leave a message?”

  “Just tell Mr. Michaels to give Dr. Philips a call.”

  “You’re Dr. Philips. Nice to meet you. I’m Carl Rudman, one of Mr. Michaels’ graduate students.” Rudman stuck his hand out t
hrough the railing. Philips grasped it, looking out over the impressive equipment.

  “Quite a setup you have down here.” Martin had never visited the computer lab before and had not imagined that it was so extensive. “It gives me a strange feeling to be in this room,” he admitted. “I went to med school here and back in sixty-one, I took microbiology in this amphitheater.”

  “Well,” said Rudman. “At least we’re putting it to good use. We probably wouldn’t have gotten any space if they hadn’t run out of money for the med-school renovation. And this place is perfect for computer work because there’s never any people.”

  “Are the microbiology labs still intact behind the amphitheater?”

  “They sure are. In fact, we’re using them for our memory research. The isolation is perfect. I’ll bet you don’t realize how much spying goes on in the computer world.”

  “You’re right,” said Philips as his beeper began its insistent sound. He switched it off and asked, “Do you know anything about the skull-reading program?”

  “Of course. That’s our prototype artificial intelligence program. All of us know a great deal about it.”

  “Well, maybe you can answer my question. I wanted to ask Michaels if the subroutine dealing with densities can be separately printed.”

  “Sure can. Just ask the computer. That thing will do just about everything but polish your shoes.”

  By eight-fifteen Pathology was in full swing. The long counter top with its line of microscopes was packed with residents. Frozen sections had begun arriving fifteen minutes earlier from surgery. Martin found Reynolds in his small office in front of an elaborate microscope fitted with a thirty-five-millimeter camera on the top so he could photograph whatever he was looking at.

  “You got a minute?” asked Philips.

  “Sure. In fact I already looked at those sections you brought up last night. Benjamin Barnes brought them in to me this morning.”

  “He’s a pleasant fellow,” said Martin sarcastically.

  “He is cantankerous, but an excellent pathology resident. Besides, I like having him around. He makes me feel skinny.”

  “What did you find on the slides?”

  “Very interesting. I want someone from Neuropath to look at them because I don’t know what it is. Focal nerve cells have either dropped out or are in bad shape with dark, disintegrating nuclei. There’s little or no inflammation. But the most curious thing is that the nerve-cell destruction is in narrow columns perpendicular to the surface of the brain. I’ve never seen anything like it.”

  “How about the various stains. What did they show?”

  “Nothing. No calcium or heavy metals if that’s what you mean.”

  “Then there’s nothing that you could see that would show up on an X ray?” asked Philips.

  “Absolutely not,” answered Reynolds. “Certainly not the microscopic columns of cell death. Barnes said you mentioned multiple sclerosis. Not a chance. There were no myelin changes.”

  “If you had to hazard a diagnosis, what would you say?”

  “That would be tough. Virus, I guess. But I wouldn’t feel confident. This stuff looks bizarre.”

  When Philips got to his office Helen was waiting with a virtual ambush. She jumped up and tried to bar entrance with a handful of telephone messages and correspondence. But Philips faked left and went around her to the right, grinning the whole time. The night with Denise had changed his whole outlook.

  “Where have you been? It’s almost nine o’clock.” Helen began to give him his calls as he rummaged around on his desk for Lisa Marino’s skull film. It was under the hospital charts, which were under the master skull-film list. With the X ray under his arm, Philips walked over to the small computer and turned it on. To Helen’s annoyance he began keying in the information on the input typewriter. He instructed the machine to display the density sub-routine.

  “Dr. Goldblatt’s secretary called twice,” said Helen, “and you’re supposed to call the instant you arrive.”

  The output unit activated and asked Martin if he wanted a digital and/or analog display. Philips didn’t know so he asked for both. The printout told him to insert the film.

  “Also,” droned Helen, “Dr. Clinton Clark, Chief of Gynecology called, not his secretary, the doctor himself. And he sounded very angry. He wants you to call. And Mr. Drake wants a call too.”

  The printout leaped into action and began spewing out page after page of paper filled with numbers. Philips watched with mounting confusion. It was as if the little machine had had some sort of nervous breakdown.

  Helen elevated her voice to compete with the rapid staccato typing. “William Michaels called and said he was sorry he wasn’t in when you paid your surprise visit to the computer lab. He wants you to phone. The people from Houston called about your chairing the Neuroradiology section at the national meeting. They said they have to know by today. Let’s see what else.”

  While Helen shuffled through her messages, Philips was lifting up the incomprehensible sheets of computer paper covered with thousands of digits. The printer finally stopped producing the numbers and then drew a schematic of the lateral skull where the various areas were letter-coded. Philips realized that by finding the proper letter code he could find the sheet corresponding to the areas he was interested in. But still the printout did not stop. It then produced a schematic of the various areas of the skull and the density values were printed in shades of gray. That was the analog printout and it was easier to look at.

  “Oh yeah,” said Helen. “The second angioroom is going to be out all day today while they install a new film loader.”

  At that point Philips was not listening to Helen at all. Comparing areas in the analog printout, Martin saw that the abnormal areas had an overall density less than the surrounding normal areas. This came as a surprise because even though the changes were subtle, he’d had the mistaken impression the density was greater. Looking at the digital readout, Philips understood why. In the digital form it was apparent that there were wide jumps between the values of neighboring digits, which was why on the X rays he had thought there might have been little flecks of calcium or some other dense material. But the machine was telling him that the abnormal areas were overall less dense or more lucid than the normal tissue, meaning the X rays could pass through more easily. Philips thought about the nerve-cell death he’d seen in Pathology, but clearly that wasn’t enough to affect X-ray absorption. It was a mystery that Philips could not explain.

  “Look at this,” he said, showing the digital readout to Helen. Helen nodded and pretended to understand.

  “What does it mean?” she asked.

  “I don’t know, unless . . .” Martin stopped in mid-sentence.

  “Unless what?” asked Helen.

  “Get me a knife. Any kind of knife.” Philips sounded excited.

  Helen got the one from the peanut butter jar by the coffee urn, marveling at her weird boss. When she returned to his office, she gagged, unprepared for what she saw. Philips was lifting a human brain out of a formaldehyde jar, and putting it on a newspaper, its familiar convolutions glistening in the light from the X-ray viewer. Fighting off a wave of nausea, Helen watched as Philips proceeded to cut a ragged slice from the back of the specimen. After returning the brain to the formaldehyde he headed for the door, carrying the slice of brain on the newspaper.

  “Also, Dr. Thomas’ wife is ready for you in the myelogram room,” said Helen, when she saw Philips was leaving.

  Martin didn’t answer. He went quickly down the hall to the darkroom. It took his eyes a few minutes to adjust to the dim red light. When he could see adequately, he took out some unexposed X-ray film, put the brain slice on top of it, and put both into an upper cabinet. Sealing the cabinet with tape, he added a sign: “Unexposed film. Do not open! Dr. Philips.”

  Denise called the GYN clinic when she got out of the CPC conference. Deciding she would be better able to evaluate the personnel if they did not know s
he was a physician she just indicated that she was part of the university community. She was surprised when the receptionist put her on hold. When the next person picked up, Denise was impressed with the amount of information the clinic requested prior to an appointment. They insisted on knowing about her general health, and even her neurological status, as well as her gynecological history.

  “We’ll be happy to see you,” said the woman finally. “In fact, we have an opening this afternoon.”

  “I couldn’t make that,” said Denise. “How about tomorrow?”

  “Fine,” said the woman. “About eleven forty-five?”

  “Perfect,” said Denise. After she hung up she wondered why Martin seemed suspicious about the clinic. Her initial reaction was very positive.

  Leaning closer to the myelogram X ray on his viewer, Philips tried to figure out exactly what the orthopedic surgeon had done to Mrs. Thomas’ back. It appeared as if she’d had an extensive laminectomy involving the fourth lumbar vertebra.

  At that moment Philips’ office door burst open, and an angry Goldblatt stormed in. His face was flushed and his glasses clung to the very tip of his nose. Martin gave him a glance, then went back to his X rays.

  Being snubbed added to Goldblatt’s fury. “Your impudence is astounding,” he growled.

  “I believe you stormed in here without knocking, sir. I respected your office. I think I should be able to expect the same from you.”

  “Your recent behavior regarding private property doesn’t warrant such courtesy. Mannerheim called me at the crack of dawn screaming that you’d broken into his research lab and stolen a specimen. Is that correct?”

  “Borrowed it,” said Philips.

  “Borrowed it, Christ!” shouted Goldblatt. “And yesterday you just borrowed a cadaver out of the morgue. What the hell has gotten into you, Philips? Do you have a professional suicide wish? If that’s the case, tell me. It will be easier on both of us.”

  “Is that all?” asked Philips with deliberate calm.