Brain

by Robin Cook

  “No! It’s not all!” shouted Goldblatt. “Clinton Clark tells me you were haranguing one of his best residents in the GYN clinic. Philips, are you going crazy? You’re a neuroradiologist! And if you weren’t such a good one you’d be outta here on your ear.”

  Philips remained silent.

  “The trouble is,” said Goldblatt, with a voice that was losing its angry edge, “you are an outstanding neuroradiologist. Look, Martin, I want you to keep a low profile for a little while, okay? I know Mannerheim can be a pain in the ass. Just stay out of his way. And Christ! Stay out of his lab. The guy doesn’t like anybody in there, anytime, much less sneaking around at night.”

  For the first time since his arrival, Goldblatt allowed his eyes to roam around Philips’ cluttered office. His jaw slowly dropped in amazement at the unbelievable disorder. Turning back to Philips, he eyed him silently for a full minute.

  “Last week you were fine and doing a wonderful job. You’ve been groomed from the first to eventually run this place. I want you to return to that old Martin Philips. I don’t understand your recent behavior and I don’t understand the way this office looks. But I can tell you this, if you don’t shape up, you’ll be looking for another position.”

  Goldblatt spun on his heels and walked out of the room. Philips sat silently staring after him. He didn’t know whether to be angry or laugh. After all his thoughts of independence, the idea of being fired was terrifying. As a result, Martin became a whirlwind of directed activity. He ran around the department and checked all the cases in progress giving certain suggestions when needed. He read all the morning films that had accumulated. Then he personally did a left cerebral angiogram on a difficult case, which definitely demonstrated the patient did not need surgery. Getting the medical students together he gave them a lecture on the CAT scanner which left them either dazzled or totally confused, depending on their degree of concentration. In between he kept Helen busy answering all the correspondence and messages that had accumulated over the last few days. And in addition to everything else, he had a clerk rearrange the mass of skull films in his office in a systematic way, so that by three in the afternoon he had also managed to run sixty of the old films through the computer and had compared the results to the old reading. The program was functioning superbly.

  At three-thirty, he stuck his head out of his office and asked Helen if there’d been any calls from a Kristin Lindquist. She shook her head. Walking down to the X-ray rooms, Philips asked Kenneth Robbins if the young woman had shown up. The answer was no.

  By four o’clock Philips had run another six films through the computer. Once again the machine suggested it was a better radiologist than was Philips by picking up a trace of calcification that suggested a meningioma tumor. Looking back at the film, Philips had to agree. He put the X ray aside to see if Helen could trace the patient down.

  At four-fifteen Philips dialed Kristin Lindquist’s number. It was answered on the second ring by her roommate.

  “I’m sorry, Dr. Philips, but I haven’t seen Kristin since before she left for the Metropolitan Museum this morning. She missed her eleven and one-fifteen classes, which is not like her.”

  “Would you try to locate her for me and have her give me a call?” said Philips.

  “I’d be glad to. Frankly, I’m a little concerned.”

  At quarter-to-five Helen came into Philips’ office with the day’s correspondence for him to sign so she could post the letters on her way home. A little after five-thirty Denise stopped by.

  “Looks like things are more under control,” she said, looking around appreciatively.

  “Just appearances,” said Philips as the laser scanner snatched an X ray out of his hand.

  He closed his office door and gave her a solid embrace. He didn’t want to let go of her and when he finally did, she looked up and said, “Wow, what did I do to deserve this?”

  “I’ve been thinking about you all day and reliving last night.” He wanted desperately to talk with her about the insecurities Goldblatt had evoked that morning, and tell her that he wanted her to stay with him for the rest of his life. The trouble was that he hadn’t given himself any time to think, and while he didn’t want to let go of her yet, he wanted to be alone, at least for a while. When she reminded him she had promised to make dinner, he hesitated. Seeing her hurt face he said, “What I was thinking is that if I can get a good enough head start running these old films, maybe we could drive out to the island Saturday night.”

  “That would be marvelous,” said Denise, mollified. “Oh, by the way, I called GYN and made an appointment for tomorrow around noon.”

  “Good. Who’d you talk with?”

  “I don’t know. But they were very nice and seemed genuinely happy to accommodate me. Look, if you finish up early why don’t you come over?”

  Denise had been gone about an hour when Michaels arrived, delighted to see that Philips had finally started working on the program in earnest.

  “It’s exceeding all my expectations,” said Martin. “There hasn’t been a single false negative reading.”

  “Fabulous,” said Michaels. “Maybe we’re farther along than we’d guessed.”

  “It certainly looks like it. If this keeps up, we could have a functioning, commercially available system by early fall. We could use the annual radiology meeting to unveil it.” Philips’ mind raced ahead, imagining the impact. It made his professional insecurity that morning seem ridiculous.

  After Michaels left, Philips went back to work. He’d developed a system of feeding the old X rays into the machine that speeded up the process. But as he worked he began to feel progressively more uncomfortable about Kristin Lindquist’s absence. A growing sense of responsibility overtook his initial irritation at her apparent unreliability. It would be too much of a coincidence if something happened to this woman that precluded him from getting more X rays.

  Around nine Martin dialed Kristin’s number again. Her roommate answered it on the first ring.

  “I’m sorry, Dr. Philips. I should have called you. But I cannot find Kristin anyplace. No one has seen her all day. I’ve even called the police.”

  Philips hung up, trying to deny reality by telling himself it couldn’t happen. It was impossible . . . Marino, Lucas, McCarthy, Collins, and now Lindquist! No. It couldn’t be. It was preposterous. Suddenly he remembered he hadn’t heard from Admitting. Lifting the phone, he was surprised when it was answered after four rings. But the woman who was looking into the case had left at five and wouldn’t be back until eight the next morning, and there was no one else who could help him. Philips slammed the receiver down.

  “Damn!” he shouted, getting up from his stool and beginning to pace. Suddenly he remembered the section of McCarthy’s brain he’d put in the cabinet.

  At the darkroom, he had to wait for a technician to finish processing some ER films. As soon as he could, Martin opened the cabinet and retrieved the film and the now dried-up slice of brain. Not knowing what to do with the specimen, he ended up dumping it into the wastebasket. The unexposed film went into the developer.

  Standing out in the hallway next to the slot where his film would emerge, Martin wondered if Kristin’s disappearance could possibly be just another coincidence. And if it were not, what would it mean? More important, what could he do?

  At that moment the X ray dropped into the holding bin. Martin expected the film to be totally dark, so that when he snapped it up on the viewer, he was shocked. “Holy Christ!” His mouth opened in disbelief. There was a lucent area the exact shape of the brain slice. Philips knew that there was only one possible cause. Radiation! The density abnormality on the X rays was from a significant amount of radiation.

  Philips ran all the way down to Nuclear Medicine. In the lab next to the betatron he found what he needed: a radiation detector and a generous-sized, lead-shielded storage box. He could lift the box but it wasn’t something he was interested in carrying so he put it on a gurney.


  His first stop was his office. The jar with the brain was definitely hot so he donned some rubber gloves and put it into the lead box. He also found the newspaper he’d put the brain on and put that in the box. He even went out and found the knife he’d used to cut the brain and put that in the box as well. Then with the radiation detector he went around his room. It was clean.

  Down in the darkroom, Philips got the wastebasket and dumped its contents into the box. Testing the wastebasket afterward, he was satisfied. Back in his office he took off the rubber gloves, threw them into the box, and sealed it. He checked the room again with the radiation detector and was pleased to find only an insignificant amount of radiation. His next step was to take the film out of the dosimeter he wore on his belt and prepare it for processing. He wanted to know exactly how much radiation he’d received from the brain specimen.

  During all this feverish physical activity, Martin tried unsuccessfully to relate all the disparate facts: five young women, presumably all with significantly high levels of radiation in their heads and maybe other parts of their bodies . . . neurological symptoms suggestive of a condition like multiple sclerosis . . . all with gynecological visits and atypical Pap smears.

  Philips had no explanation for these facts, but it seemed to him that the radiation must have been the central issue. He reasoned that high levels of general radiation could cause alterations in cervical cells and therefore an atypical Pap smear. But it was peculiar that all of the cases had had atypical smears. Once again it seemed difficult to explain a specific phenomenon by coincidence. Yet what else could be the explanation?

  When the cleanup was completed, Philips wrote down Collins’ and McCarthy’s unit numbers and the dates of their GYN visits on his list. Then he hurried down the central corridor of Radiology and cut through the main X-ray reading room. At the elevators, he pushed the down button with a rising sense of urgency. He realized that Kristin Lindquist was a walking time bomb. For the radiation in her head to show up on a regular X ray, there had to be a very large amount involved. And to find her, Martin believed he would have to solve all the puzzling events of the last week. To his surprise he found Benjamin Barnes draped over his work stool. The pathology resident might not have a pleasant personality but Martin had to respect the man’s dedication.

  “What brings you up here two nights in a row?” asked the resident.

  “Pap smears,” said Philips with no preamble.

  “I suppose you have an emergency slide for me to read,” said Barnes sarcastically.

  “No. I just want some information. I want to know if radiation can cause an atypical Pap smear.”

  Barnes thought for a moment before answering. “I’ve never heard of it from diagnostic radiology but certainly radiotherapy will affect the cervical cells and hence the Pap smear.”

  “If you looked at an atypical smear, could you tell if it was caused by radiation?”

  “Maybe,” said Barnes.

  “Remember those slides you looked at for me last night?” continued Philips. “The brain sections. Could those nerve-cell lesions be caused by radiation?”

  “I kinda doubt it,” said Barnes. “The radiation would have to have been aimed with a telescopic sight. The nerve cells right next to the damaged ones looked fine.”

  Philips face went blank while he tried to put together the inconsistent facts. The patients had absorbed enough radiation to show up on a X ray, yet on a cellular level, one cell was totally knocked out while a neighbor was all right.

  “Are Pap smear specimens saved?” he asked finally.

  “I think so. At least for a while, but not here. They’re over in the Cytology lab, which operates on bankers’ hours. They’ll be in in the morning after nine.”

  “Thanks,” said Philips, sighing. He wondered if he should try to get into the lab right away. Perhaps if he called Reynolds. He was about to leave when he thought of something else. “When they read Pap smears, is the result in the chart just the classification, or do they describe the pathology?”

  “I think so,” said Barnes. “The results are stored on tape. All you need is the patient’s unit number and you can read the report.”

  “Thanks a lot,” said Philips. “I know you’re busy so I appreciate your time.”

  Barnes gave a slight nod of acknowledgment, then put his eyes back to his microscope.

  The Pathology computer terminal was separated from the lab by a series of room dividers. Pulling up a chair, Martin sat down in front of the unit. It was similar to the terminal in Radiology with a large TV-like screen directly behind the keyboard. Taking out the list of five patients, Philips keyed in the name Katherine Collins, followed by her unit number and the code for Papanicolaou Smear. There was a pause, then letters appeared on the screen as if someone were typing. First it spelled out Katherine Collins very rapidly, followed by a slight pause. Then the date of the first Pap smear followed by:

  Adequate smear, good fixation, and proper staining. Cells show normal maturation and differentiation. Estrogen effect normal: 0/20/80. A few candida organisms seen. Result: negative.

  Philips checked the date of the first smear while the machine spelled out the next report. The date corresponded to the first date Philips had written on the list. Looking back up at the computer screen, Philips’ disbelieving eyes read that the second Pap smear on Collins was also negative!

  Philips cleared the screen and rapidly entered Ellen McCarthy’s name, her unit number, and the proper code. He felt his stomach tighten into a knot as the machine began to spell out the information. It was the same—negative!

  As he went back downstairs, Martin felt stunned. In medicine he had learned to believe what he read in charts, especially in regard to laboratory reports. They were the objective data while the symptom of the patients and the impressions of the doctors were the subjective. Philips knew that there was a small chance there could be an error in laboratory tests just as he knew there was a possibility that he could miss or misinterpret something on an X ray. But the low probability of error was a far cry from deliberate falsification. That required some sort of conspiracy, and Philips took it very personally.

  Sitting at his desk, Martin cradled his head in his hands and rubbed his eyes. His first impulse was to call the hospital authorities, but that meant Stanley Drake, and he decided against it. Drake’s response would be to keep it out of the papers, cover it up. The police! Mentally he ran through a hypothetical conversation: “Hello, I’m Dr. Martin Philips and I want to report that something funny is going on at Hobson University Medical Center. Girls get Pap smears that are normal but are entered into the chart as atypical.” Philips shook his head. It sounded too ridiculous. No, he needed more information before the police were involved. Intuitively he felt the radiation was connected even though it didn’t make any sense. In fact, radiation might cause an atypical Pap smear and it seemed to Philips that if someone wanted to avoid discovery of the radiation, they might report atypical Paps as normal, but not vice versa.

  Philips thought again about the diener. After their abortive meeting the previous evening, Martin had been convinced Werner knew more about Lisa Marino than he’d been willing to disclose. Perhaps one hundred dollars wasn’t enough. Maybe Philips should offer more. After all, the affair was no longer an academic exercise.

  Martin realized that trying to successfully confront Werner in the morgue was an impossibility. Surrounded with the dead, Werner was in his element, whereas Martin found the place totally unnerving and he knew he would have to be forceful and demanding if Werner was going to be made to talk. Philips glanced at his watch. It was twenty-five after eleven. Werner obviously worked the evening shift, four to midnight. Impulsively Martin decided he’d follow Werner home and offer him five hundred dollars.

  With some trepidation he dialed Denise’s number. It rang six times before a sleepy voice answered: “Are you coming over?”

  “No,” said Philips evasively. “I’m in the middle of something an
d I’m going to keep at it.”

  “There’s a nice warm spot here for you.”

  “We’ll make up for it this weekend. Sweet dreams.”

  Martin got his dark blue ski parka out of his closet and put on the Greek captain’s cap he found in the pocket. It was April but the drizzly weather had brought in wind from the northeast and it was chilly.

  He left the hospital through the emergency room, leaping from the platform to the puddle-strewn tarmac of the parking area. But instead of walking out to the street, he turned right, round the corner of the main hospital building and headed down a canyon formed by the north face of the Brenner Childrens Hospital. After fifty yards it opened up to the inner courtyard of the Med Center.

  The hospital buildings soared up into the misty night like sheer cliffs forming an irregular cement valley. The Med Center had been built in spurts without the benefit of a rational overall plan. This fact was obvious in the courtyard, where buildings impinged upon the space with chaotic angles and buttresses. Philips recognized the small wing that housed Goldblatt’s office, and using that as a landmark, was able to orient himself. It was only about twenty-five yards farther on that he found the unmarked platform that he knew led into the depths of the morgue. The hospital did not like to advertise that it dealt in death, and the bodies were stealthily excreted into the waiting black hearses far from the public eye.

  Martin leaned up against the wall and thrust his hands into his pockets. While he waited he tried to review the complicated events he’d experienced since Kenneth Robbins had handed him Lisa Marino’s X ray. It hadn’t even been two days, yet it seemed like two weeks. The initial excitement that he’d felt seeing the strange radiologic abnormality had now changed to a hollow fear. He almost dreaded to find out what was going on in the hospital. It was like a sickness in his own family. Medicine had been his life. If it weren’t for his immediate sense of responsibility about Kristin Lindquist, he wondered if he’d just forget what he knew. Goldblatt’s tirade about professional suicide rang in his ears.