Brain – Cook, Robin

Brain

Robin Cook

(1981)

 

   1

 

   March 7

 

   Katherine Collins mounted the three steps from the sidewalk with a fragile sense of resolve. She reached the combination glass and stainless steel door and pushed. But it didn’t open. She leaned back, gazed up at the lintel, and read the incised inscription, “Hobson University Medical Center: For the Sick and Infirm of the City of New York.” For Katherine’s way of thinking it should have read, “Abandon All Hope Ye Who Enter Here.”

 

   Turning around, her pupils narrowed in the morning March sunlight; her urge was to flee and return to her warm apartment. The last place in the world that she wanted to go was back into the hospital. But before she could move, several patients mounted the steps and brushed past her. Without pausing they opened the door to the main clinic and were instantly devoured by the ominous bulk of the building.

 

   Katherine closed her eyes for an instant, marveling at her own stupidity. Of course, the doors to the clinic opened outward I Clutching her parachute bag to her side, she pulled open the door and passed into the netherworld within.

 

   The first thing that assaulted Katherine was the smell. There was nothing like it in her twenty-one years of experience. The dominant odor was chemical, a mixture of alcohol and sickeningly sweet deodorant. She guessed the alcohol was an attempt to check the disease that lurked in the air; she knew the deodorant was to cover the biological smells that hovered around illness. Any remnants of denial that Katherine had been using to help herself make this visit evaporated under the onslaught of the smell. Until her first visit to the hospital a number of months previously she had never considered her own mortality and had accepted health and well-being as her due. Now it was different and as she entered the clinic with its smell, the thought of all her recent health problems flooded into her consciousness. Biting her lower lip to keep her emotions under control, she pushed her way toward the elevators.

 

   The hospital crowds were troublesome for Katherine. She wanted to draw into herself like a cocoon to avoid being touched, breathed or coughed on. She had difficulty looking at the distorted faces, scaly rashes and oozing eruptions. It was worse in the elevator, where she was pressed up against a group of humanity that reminded her of the crowds in a painting by Brueghel. Keeping her eyes glued to the floor indicator, she tried to ignore her surroundings by rehearsing the speech she was going to give to the receptionist at the GYN clinic. “Hello, my name is Katherine Collins. I’m a university student and I’ve been here four times. I’m about to go home to have my medical problems handled by my family internist and I’d like a copy of my gynecology records.”

 

   It sounded simple enough. Katherine allowed her eyes to wander to the elevator operator. His face was tremendously broad, but when he turned sideways, his head was flat. Katherine’s eyes involuntarily fixed on the distorted image and when the operator turned to announce the third floor, he caught Katherine’s stare. One of his eyes looked down and to the side. The other bore into Katherine with an evil intensity. Katherine averted her gaze, feeling her face redden. A large hairy man pushed past her to disembark. Steadying herself with her hand against the side of the elevator, she looked down at a blond five-year-old girl. One green eye returned her smile. The other was lost beneath the violaceous folds of a large tumor mass.

 

   The elevator door closed and the car lifted. A dizzy sensation swept over Katherine. It was different from the dizziness that had presaged the two seizures she’d experienced the month before, but still it was frightening within the closed environment of the stuffy elevator. She shut her eyes and battled against the sense of claustrophobia. Someone coughed behind her and she felt a fine mist on her neck. The car jolted, the doors opened, and Katherine emerged on the fourth floor of the clinic. She moved over to the wall and leaned against it, letting the people behind her push by. Her dizziness cleared rapidly. Once she felt back to normal she turned left down a hall that had been painted light green twenty years before.

 

   The corridor expanded into the waiting area for the GYN clinic. It was dense with patients, children, and cigarette smoke. Katherine crossed this central area and entered a cul-de-sac to the right. The university’s GYN clinic, which served all the colleges as well as the hospital employees, had its own waiting area, although the decor and furniture were the same as the main room. When Katherine entered there were seven women sitting on tubular steel and vinyl seats. All were nervously flicking the pages of outdated magazines. The receptionist sat behind a desk, a bird-like woman of about twenty-five with bleached hair, pale skin, and narrow features. Her name tag pinned firmly to her flat chest proclaimed her name to be Ellen Cohen. She looked up as Katherine approached the desk.

 

   “Hello, my name is Katherine Collins …” She noticed that her voice lacked the assertiveness she had intended. In fact, when she got to the end of her request she realized that she sounded as if she were pleading.

 

   The receptionist looked at her for a moment. “You want your records?” she asked. Her voice reflected a mixture of disdain and incredulity.

 

   Katherine nodded and tried to smile.

 

   “Well, you’ll have to talk with Ms. Blackman about that. Please have a seat.” Ellen Cohen’s voice became brusque and authoritarian. Katherine turned and found a seat near to the desk. The receptionist went to a file cabinet and pulled Katherine’s clinic chart. She then disappeared through one of the several doors leading to the examining rooms.

 

   Unconsciously, Katherine began smoothing her shiny brown hair, pulling it down over her left shoulder. It was a common gesture for Katherine, particularly when she was under strain. She was an attractive young woman with bright attentive gray-blue eyes. Her height was five-two-and-a-half, but her energetic

personality made her seem taller. She was well liked by her friends at college, probably because of her openness, and deeply loved by her parents, who worried about the vulnerability of their only daughter in the jungle of New York City. Yet it had been Katherine’s parents’ concern and overprotectiveness that had led to Katherine choosing a college in New York, believing the city would help her demonstrate her innate strength and individuality. Up until the current illness, she had been successful, scoffing at her parents’ warnings. New York had become her city and she loved its throbbing vitality.

 

   The receptionist reappeared and sat down to her typing.

 

   Katherine’s eyes surreptitiously swept around the waiting room, recording the bowed heads of the young women waiting their turns like unknowing cattle. Katherine was immensely thankful she was not waiting for an exam herself. She loathed the experience, which she had endured four times: the last just four weeks ago. Coming to the clinic had been her most difficult act of independence. In reality she would have much preferred to return to Weston, Massachusetts, and see her own gynecologist, Dr. Wilson. He’d been the first and only other doctor to examine her. Dr. Wilson was older than the residents who staffed the clinic and he had a sense of humor, which had defused the humiliating aspects of the experience, making it at least tolerable. Not so here. The clinic was impersonal and cold, and combined with the city hospital environment, each visit became a nightmare. Yet Katherine had persisted. Her sense of independence demanded it, at least until her illness.

 

   The nurse practitioner, Ms. Blackman, emerged from one of the rooms. She was a stocky forty-five-year-old woman with jet black hair pulled back into a tight bun on the crown of her head. She was dressed in a spotless white uniform, starched to a professional crispness. Her attire reflected the way she liked to run the clinic: with cool efficiency. She’d worked for the Med Center for eleven years.

 

   The receptionist spoke to Ms. Blackman, and Katherine heard her name mentioned. The nurse nodded, turning to look in Katherine’s direction for a moment. Belying her crisp exterior, Ms. Blackman’s dark brown eyes gave an impression of great warmth. Katherine suddenly thought that outside of the hospital Ms. Blackman was probably a good deal nicer.

 

   But Ms. Blackman did not come over to talk with Katherine. Instead she whispered something to Ellen Cohen, then returned to the examination area. Katherine felt her face redden. She guessed she was being deliberately ignored; it would be a way for the clinic personnel to show their displeasure about her wish to see her own doctor. Nervously she reached for a coverless year-old copy of Ladies’ Home Journal, but she couldn’t concentrate.

 

   She tried to pass the time thinking about her arrival home that night; how surprised her parents would be. She could imagine herself walking into her old room. She hadn’t been there since Christmas, but she knew it would look exactly as she’d left it. The yellow bedspread, the matching curtains, all the mementos of her adolescence carefully preserved by her mother. The reassuring image of her mother made Katherine question again if she should call and tell her parents she was coming home. The plus was that they would meet her at Logan Airport. The minus was that she’d probably be coerced into an explanation about why she was coming home, and Katherine wanted to discuss her illness face to face, not over the telephone.

 

   Ms. Blackman reappeared after twenty minutes and again conversed with the receptionist in muted tones. Katherine pretended to be absorbed in her magazine. Finally the nurse broke off and came over to Katherine.

 

   “Miss Collins?” said Ms. Blackman with subtle irritation.

 

   Katherine looked up.

 

   “I’ve been told you have requested your clinic records?”

 

   “That’s correct,” said Katherine, putting the magazine down.

 

   “Have you been unhappy with our care?” asked Ms. Blackman.

 

   “No, not at all. I’m going home to see our family internist and I want a complete set of my medical records to take with me.”

 

   “This is rather irregular,” said Ms. Blackman. “We’re accustomed to sending records only when they are requested by a physician.”

 

   “I’m leaving for home tonight and I want the records with me. If my doctor needs them, I don’t want to have to wait for them to be sent.”

 

   “This just isn’t the way we do things here at the Med Center.”

 

   “But I know it’s my right to have a copy of my records if I want it.”

 

   For Katherine an uncomfortable silence followed her last comment. She was not accustomed to such assertiveness. Ms. Blackman stared at her like an exasperated parent with a recalcitrant child. Katherine stared back, transfixed by Ms. Blackman’s dark and fluid eyes.

 

   “You’ll have to speak to the doctor,” said Ms. Blackman abruptly. Without waiting for a response she walked away from Katherine and stepped through one of the nearby doors. The latch engaged after her with mechanical finality.

 

   Katherine drew in a breath and looked around her. The other patients were regarding her warily as if they shared the clinic personnel’s disdain for her wish to upset the normal protocol. Katherine struggled to maintain her self-control, telling herself that she was being paranoid. She pretended to read her magazine, feeling the stares of the other women. She wanted to pull inside herself like a turtle or get up and leave. She couldn’t do either. Time inched painfully forward. Several more patients were called for their exams; It was now obvious she was being ignored.

 

   It was three-quarters-of-an-hour later when the clinic physician, dressed in rumpled white jacket and trousers, appeared with Katherine’s chart. The receptionist nodded in her direction, and Dr. Harper sauntered over to stand directly in front of her. He was bald save for a frieze of hair that started over each ear and dipped down to meet in a wiry bush at the nape of his neck. He’d been the doctor who’d examined Katherine on two previous occasions, and Katherine had distinctly remembered his hairy hands and fingers, which had had an alien appearance when matted with the semi-transparent latex rubber gloves.

 

   Katherine glanced up into the man’s face, hoping for a glimmer of warmth. There wasn’t any. Instead he silently flipped open her chart, supporting it with his left hand and following his reading with his right index finger. It was as if he were about to give a sermon.

 

   Katherine let her glance drop. Along the front of his left pant leg was a series of minute bloodstains. Hooked onto his belt on the right was a piece of rubber tubing, on the left a beeper.

 

   “Why do you want your gynecology records?” he said without looking at her.

 

   Katherine reiterated her plans.

 

   “I think it’s a waste of time,” said Dr. Harper, still flipping through the pages. “Really, this chart has almost nothing in it. A couple of mildly atypical Pap smears, some gram positive discharge explainable by a slight cervical erosion. I mean, this isn’t going to help anybody. Here you had an episode of cystitis, but it had been undoubtedly caused by sex the day before the symptoms started, which you had admitted to…”

 

   Katherine felt her face flush with humiliation. She knew everyone in the waiting room could hear.

 

   “…look, Miss Collins, your seizure problem has nothing to do with Gynecology. I’d suggest you head up to Neurology clinic…”

 

   “I’ve been to Neurology,” interrupted Katherine. “And I have those records already.” Katherine fought back the tears. She wasn’t usually emotional, but the rare times she felt like crying, she had great difficulty controlling herself.

 

   Dr. David Harper raised his eyes slowly from the chart. He took, a breath and expressed it noisily through partially pursed lips. He was bored. “Look, Miss Collins, you’ve received excellent care here…”

 

   “I’m not complaining about my care,” said Katherine without looking up. Tears had filled her eyes and threatened to run down her cheeks. “I just want my records.”

 

   “All I’m saying,” continued Dr. Harper, “is that you don’t need any second opinions about your gynecological status.”

 

   “Please,” said Katherine slowly. “Are you going to give me my records, or do I have to go to the administrator?” Slowly she looked up at Dr. Harper. With her knuckle she caught the tear that had spilled over her lower lid.

 

   The doctor finally shrugged and Katherine could hear him curse beneath his breath as he tossed the chart onto the receptionist’s desk, telling the woman to make a copy. Without saying goodbye or even looking back, he disappeared into the examining area.

 

   As Katherine put on her coat she realized she was trembling and again felt light-headed. She walked over to the receptionist’s desk and grasped the outer edge, leaning on it for support.

 

   The bird-like blonde chose to ignore her while she completed typing a letter. When she put the envelope into the machine, Katherine reminded the receptionist of her presence.

 

   “All right, just a moment,” said Ellen Cohen with irritated emphasis on each word. Not until she’d typed the envelope, stuffed, sealed and stamped it, did she get to her feet, take Katherine’s chart, and disappear around the corner. During the entire time she avoided Katherine’s eyes.

 

   Two more patients were called before Katherine was handed a manila envelope. She managed to thank the girl, but wasn’t given the courtesy of a response. Katherine didn’t care. With the envelope under her arm and her bag over her shoulder, she turned and half-ran, half-walked out into the confusion of the main GYN waiting room.

 

   Katherine paused in the heavy air as a smothering wave of dizziness descended over her. Her fragile emotional state combined with the sudden physical effort of rapid walking had been too much. Her vision clouded and she reached out and groped for the back of a waiting-room chair. The manila envelope slipped from under her arm and fell to the floor. The room spun and her knees buckled.

 

   Katherine felt strong hands grasp her upper arms, supporting her. She heard someone try to reassure her and tell her that everything was going to be all right. She wanted to say that if she could sit down for just a moment she’d be fine, but her tongue wouldn’t cooperate. Vaguely she was aware she was being carried upright down a corridor, her feet, like those of a marionette, bumping ineffectually along the floor.

 

   There was a door, then a small room. The awful spinning sensation continued. Katherine was afraid she might be sick, and cold perspiration appeared on her forehead. She was conscious of being lowered to the floor. Almost immediately her vision began to clear and the whirling of the room stopped. She was with two doctors dressed in white and they were helping her. With some difficulty they got one of her arms out of her coat and had applied a tourniquet. She was glad she was away from the crowded waiting room so that she was not a spectacle for everyone to stare at.

 

   “I think I feel better,” said Katherine, blinking her eyes.

 

   “Good,” said one of the doctors. “We’re going to give you a little something.”

 

   “What?”

 

   “Just something to calm you down.”

 

   Katherine felt a needle pierce the tender skin on the inside of her elbow. The tourniquet was pulled off and she could feel her pulse in her fingertips.

 

   “But I feel much better,” she protested. She turned her head to see a hand depressing the plunger of a syringe. The doctors were bent over her.

 

   “But I feel okay,” said Katherine.

 

   The two doctors didn’t respond. They just looked at her, holding her down.

 

   “I really feel better now,” said Katherine. She looked from one doctor to the other. One of them had the greenest eyes Katherine had ever seen, like emeralds. Katherine tried to move. The doctor’s grip tightened.

 

   Abruptly Katherine’s vision dimmed and the doctor appeared far away. At the same time she heard a ringing in her ears and her body felt heavy.

 

   “I feel much …” Katherine’s voice was thick and her lips moved slowly. Her head fell to the side. She could see she was on the floor of a storeroom. Then darkness.

 

   2

 

   March 14

 

   Mr. and Mrs. Wilbur Collins supported each other while they waited for the door to be opened. At first the key wouldn’t go into the lock, and the superintendent pulled it out and examined it to make sure it was the key to 92. He tried it again, realizing he’d had it upside down. The door opened and he moved aside to allow the Women’s Dean of the university to step inside.

 

   “Cute apartment,” said the Dean. She was a petite woman, about fifty with very nervous and quick gestures. It was apparent she felt under pressure.

 

   Mr. and Mrs. Wilbur Collins and two uniformed New York City policemen followed the Dean into the room.

 

   It was a small one bedroom apartment, advertised to have a river view. It did, but only from a tiny window in the closet-like bathroom. The two policemen stood aside with their hands clasped behind their backs. Mrs. Collins, a fifty-two-year-old woman, hesitated near the entrance as if she were afraid of what she might find. Mr. Collins, on the other hand, limped directly to the center of the room. He’d had polio in 1952 and it had affected his right lower leg, but not his shrewd ability in business. At fifty-five he was the number two man in the First National City Bank of Boston empire. He was a man who demanded action and respect.

 

   “Since it’s been only a week,” offered the Dean, “maybe your concern is premature.”

 

   “We never should have allowed Katherine to come to New York,” said Mrs. Collins., fidgeting with her hands.

 

   Mr. Collins ignored both comments. He headed for the bedroom and looked in. “Her suitcase is on the bed.”

 

   “That’s a good sign,” said the Dean. “A lot of students react to pressure by leaving school for a few days.”

 

   “If Katherine had left, she would have taken her suitcase,” said Mrs. Collins. “Besides, she would have called us on Sunday. She always calls us on Sunday.”

 

   “As Dean, I know how many students suddenly need a breather, even good students like Katherine.”

 

   “Katherine is different,” said Mr. Collins disappearing into the bathroom.

 

   The Dean rolled her eyes for the benefit of the policeman, who remained impassive.

 

   Mr. Collins limped back into the living room. “She didn’t go anyplace,” he said with finality.

 

   “What do you mean, dear?” asked Mrs. Collins with mounting anxiety.

 

   “Just what I said,” returned Mr. Collins. “She wouldn’t go anywhere without these.” He tossed a half-empty packet of birth control pills onto the seat of the couch. “She’s here in New York and I want her found.” He looked at the policeman. “Believe me, I intend to see action on this case.”

 

   3

 

   April 15

 

   Dr. Martin Philips leaned his head against the wall of the control room; the coolness of the plaster felt good. In front of him four third-year medical students were pressed against the glass partition, watching in total awe as a patient was being prepared for a CAT scan. It was the first day of their radiology elective; they were starting with neuroradiology. Philips had brought them to see the CAT scanner first because he knew it would impress and humble them. Sometimes medical students tended to be smartalecky.

 

   Within the scanner room the technician was bending over, checking the position of the patient’s head in respect to the gigantic doughnut-shaped scanner. He straightened up, peeled off a length of adhesive tape, and bound the patient’s head to a Styrofoam block.

 

   Reaching over to the counter, Philips took the requisition form and the patient’s chart. He scanned both for clinical information.

 

   “The patient’s name is Schiller,” said Philips. The students were so absorbed in the preparations that they did not turn to face him while he spoke. “Chief complaint is weakness of the right arm and right leg. He’s forty-seven.” Philips looked at the patient. Experience told him that the man was probably tremendously frightened.

 

   Philips replaced the requisition form and chart while inside the scanner room the technician activated the table. Slowly the patient’s head slid into the orifice of the scanner as if he were to be devoured. With a final glance at the position of the head, the technician turned and retreated to the control room.

 

   “Okay, step back from the window for a moment,” said Philips. The four medical students obeyed instantly, moving to the side of the computer, whose lights were blinking in anticipation. As he had surmised, they were impressed to the point of submission.

 

   The technician secured the communicating door and took the mike from its hook. “Stay very still, Mr. Schiller. Very still.” With his index ringer the technician depressed the start button on the control panel. Within the scanning room the huge doughnut-shaped mass surrounding Mr. Schiller’s head began abrupt, intermittent rotational movements like the action of the main gear of a gigantic mechanical clock. The clunking sound, loud to Mr. Schiller, was muffled for those on the other side of the glass.

 

   “What’s happening now,” said Martin, “is that the machine is making two hundred and forty separate X-ray readings for each single degree of rotational movement.”

 

   One of the medical students made a face of total incomprehension to his colleague. Martin ignored the gesture and placed his face in his hands with his fingers over his eyes, rubbing carefully and then massaging his temples. He hadn’t had his coffee yet and felt groggy. Normally he’d stop in the hospital cafeteria, but this morning he hadn’t had time because of the medical students. Philips, as Assistant Chief of Neuroradiology, always made it a point to handle the medical students’ introduction to neuroradiology. His compulsiveness in this regard had become a pain in the ass because it cut into his research time. The first twenty to thirty times he had enjoyed impressing the students with his exhaustive knowledge of the anatomy of the brain. But the novelty had worn off. Now it was enjoyable only if a particularly smart student came along, and in neuroradiology that didn’t happen very often.

 

   After a few minutes the doughnut-shaped scanner halted its rotational movement, and the computer console came alive. It was an impressive setup like a control panel in a science-fiction movie. All eyes switched from the patient to the blinking lights, except for Philips, who glanced down at his hands and tried to dislodge a small tab of dead skin alongside the nail of his index finger. His mind was wandering.

 

   “In the next thirty seconds the computer simultaneously solves forty-three-thousand-two-hundred equations of tissue-density measurements,” said the technician, eager to take over Philips’ role. Philips encouraged this. In fact he merely gave the students their formal lectures, allowing the practical teaching to be done by the neuroradiology fellows, or the superbly trained technicians.

 

   Lifting his head, Philips watched the medical students, who were transfixed in front of the computer console. Turning his gaze to the leaded window, Philips could just see Mr. Schiller’s bare feet. Momentarily the patient was a forgotten participant in the unfolding drama. For the students the machine was infinitely more interesting.

 

   There was a small mirror over a first-aid cabinet, and Philips looked at himself. He hadn’t shaved yet and the day-old stubble stood out like bristles on a brush. He always arrived a good hour before anyone else in the entire department, and he’d developed the habit of shaving in the surgical locker room. His routine was to get up, jog, shower and shave in the hospital and stop for coffee in the cafeteria. This usually gave him two hours to work on his research interests without interruption.

 

   Still looking in the mirror, Philips ran a hand through his thick sandy hair, pushing it back. There was such a difference between the lightness of the ends and the darker blond of the roots that some of the nurses kidded Philips about highlighting it. Nothing could have been further from the truth. Philips rarely thought about his looks, occasionally butchering his hair himself when he didn’t have time to go to the hospital barber. But despite his inattention, Martin was a handsome man. He was forty-one and the recent lines that had formed about his eyes and mouth only enhanced his appearance, which earlier had seemed a bit boyish. Now he looked harder, and a recent patient had remarked that he seemed more like a cowboy on TV than adoctor. The comment had pleased him and it wasn’t altogether  without basis. Philips was just under six feet tall with a slight but athletic build, and his face did not give the impression of an academician. It was angular, with a ruler-straight nose and expressive mouth. His eyes were a lively light blue, and they, more than anything else, reflected his basic intelligence. He’d graduated summa cum laude from Harvard, class of 1961.

 

   The cathode-ray tube on the output console came to life as the first image appeared. The technician hastily adjusted the window width and the density to give the best image. The medical students crowded around the small TV-like screen as if they were about to see the Super Bowl, but the picture they saw was oval with a white border and a granular interior. It was a computer-constructed image of the inside of the patient’s head, positioned as if someone was looking down on Mr. Schiller after the top of his skull had been removed.

 

   Martin glanced at his watch. It was a quarter to eight. He was counting on Dr. Denise Sanger to arrive at any moment and take over shepherding the medical students. What really was on Philips’ mind this morning was a meeting with his research collaborator, William Michaels. Michaels had called the day before, saying that he was coming over early in the morning with a little surprise for Philips. By now Martin’s curiosity had been honed to a razor’s edge, and the suspense was killing him. For four years the two men had been working on a program to enable a computer to read skull X rays, replacing the radiologist.

 

   The problem was in programming the machine to make qualitative judgments about the densities of specific areas of X rays. If they could succeed, the rewards would be incredible. Since the problems of interpreting skull X rays were essentially the same as interpreting other X rays, the program would be eventually adaptable to the entire field of radiology. And if they accomplished that…Philips occasionally let himself dream of having his own research department, and even the Nobel Prize.

 

   The next image appeared on the screen bringing Philips’ mind back to the present.

 

   “This slice is thirteen millimeters higher than the previous image,” intoned the technician. With his finger, he pointed to the bottom section of the oval. “Here we have the cerebellum and…”

 

   “There’s an abnormality,” said Philips.

 

   “Where?” asked the technician, who was seated on a small stool in front of the computer.

 

   “Here,” said Philips, squeezing in so that he could point. His finger touched the area the technician had just described as the cerebellum. “This lucency here in the right cerebellar hemisphere is abnormal. It should have the same density as the other side.”

 

   “What is it?” asked one of the students.

 

   “Hard to say at this point,” said Philips. He leaned over to look at the questionable area more closely. “I wonder if the patient has any gait problem?”

 

   “Yes, he does,” said the technician. “He’s been ataxic for a week.”

 

   “Probably a tumor,” said Philips, standing back up.

 

   The faces of all four medical students immediately reflected dismay as they stared at the innocent lucency on the screen. On the one hand they were thrilled to see a positive demonstration of the power of modern diagnostic technology. On the other hand, they were frightened by the concept of a brain tumor; the idea that anybody could have one; even they.

 

   The next image began to wipe off the previous one.

 

   “Here’s another area of lucency in the temporal lobe,” said Philips, quickly pointing to an area already being replaced by the next image. “We’ll see it better on the next slice. But we are going to need a contrast study.”

 

   The technician got up and went in to inject contrast material into Mr. Schiller’s vein.

 

   “What does the contrast material do?” asked Nancy Mc-Fadden.

 

   “It helps outline lesions like tumors when the blood brain barrier is broken down,” said Philips, who had turned to see who was coming into the room. He’d heard the door to the corridor open.

 

   “Does it contain iodine?”

 

   Philips hadn’t heard the last question because Denise Sanger had come in and was smiling warmly at Martin behind the backs of the engrossed medical students.

 

   She slipped out of her short white coat and reached up to hang it next to the first-aid cabinet. It was her way of getting down to work. Its effect on Philips was the opposite. Sanger had on a pink blouse, pleated in the front and topped with a thin blue ribbon tied in a bow. As she extended her arm to hang her coat, her breasts thrust against her blouse, and Philips appreciated the image as a connoisseur appreciated a work of art, for Martin thought Denise was one of the most beautiful women he had ever seen. She said she was five-five, whereas actually she was five-four. Her figure was slight, one hundred and eight pounds, with breasts that were not large but wonderfully shaped and firm. She had thick shiny brown hair, which she usually wore pulled back from her forehead and clasped with a single barrette on the back of her head. Her eyes were lighter brown with flecks of gray, giving her a lively mischievous appearance. Very few people guessed that she had been first in her medical school graduating class three years previously, nor did many believe that she was twenty-eight years old.

 

   With her coat taken care of, Denise brushed past Philips, giving his left elbow a furtive squeeze. It was so fast that Philips couldn’t respond. She sat down at the screen, adjusted the viewing controls to her liking, and introduced herself to the students. The technician returned and announced that the contrast material had been given. He prepared the scanner for another run.

 

   Philips leaned over so that he had to support himself on Denise’s shoulder. He pointed to the image on the screen. “Here’s a lesion in the temporal lobe, and at least one, maybe two, in the frontal.” He turned to the medical students. “I noted in the chart that the patient is a heavy smoker. What does all this suggest to you?”

 

   The students stared at the image afraid to make any gesture. For them it was like being at an auction without money; any slight movement could have been interpreted as a bid,

 

   “Let me give you all a hint,” said Philips. “Primary brain tumors are usually solitary, whereas tumors coming from other parts of the body, what we call metastasis, can be single or multiple.”

 

   “Lung cancer,” blurted one of the students as if he were on a TV game show.

 

   “Very good,” said Philips. “At this stage you can’t be one hundred percent sure, but I’d be willing to put money on it.”

 

   “How long does the patient have to live?” asked the student, obviously overwhelmed by the diagnosis.

 

   “Who’s the doctor?” asked Philips.

 

   “He’s on Curt Mannerheim’s neurosurgical service,” said Denise.

 

   “Then he doesn’t have long to live,” said Martin. “Mannerheim will operate on him.”

 

   Denise turned quickly. “A case like this is inoperable.”

 

   “You don’t know Mannerheim. He operates on anything. Especially tumors.” Martin again bent over Denise’s shoulder, smelling the unmistakable aroma of her freshly washed hair. It was as unique to Philips as a fingerprint, and despite the professional setting, he felt a faint stirring of passion. He stood up to break the spell.

 

   “Doctor Sanger, can I speak to you for a moment,” he said suddenly, motioning her over to a corner of the room.

 

   Denise complied willingly, with a bewildered expression.

 

   “It’s my professional opinion …” said Philips in the same to entertain the idea of leaving the Med Center for another hospital where he would have a shot at the top.

 

   Martin turned down the corridor leading to surgery. He passed through the double swinging doors, whose sign warned visitors that they were entering a restricted area, and went through another set of swinging doors, to the patient-holding room. Here stood a swarm of gurneys filled with anxious patients awaiting their turn to be dissected. At the end of this large area was a long built-in white Formica desk guarding the entrance to the thirty operating rooms and to the recovery area. Three nurses in green surgical scrub dresses were busy behind the desk making sure the right patient got into the right room so he’d get the right operation. With almost two hundred operations in any twenty-four-hour period, this was a full-time job.

 

   “Can someone tell me about Mannerheim’s case?” asked Philips as he leaned over the desk.

 

   All three nurses looked up and began to speak at once. Martin, being one of the few eligible doctors, was a welcome visitor to the OR. When the nurses realized what had happened, they laughed and then made an elaborate ceremony of deferring to one another.

 

   “Maybe I should ask someone else,” said Philips, pretending to leave.

 

   “Oh, no,” said the blond nurse.

 

   “We can go back in the linen closet to discuss it,” suggested the brunette. The OR was the one place in the hospital where inhibitions were relaxed. The atmosphere was totally different from any other service. Philips thought that perhaps it had something to do with everyone wearing the same pajama-like clothing, plus the potential for crisis, where sexual innuendos provided a relief valve. Whatever it was, Philips remembered it very well. He’d been a surgical resident for one year before deciding to go into radiology.

 

   “Which one of Mannerheim’s cases are you interested in?” asked the blond nurse. “Marino?”

 

   “That’s right,” said Philips.     

 

   “She’s right behind you,” said the blond nurse.

 

   Philips turned. About twenty feet away was a gurney supporting the covered figure of a twenty-one-year-old woman. She must have heard her name through the fog of her preoperative medication because her head slowly rolled in Philips’ direction. Her skull was totally shaved in anticipation of her surgery, and the image reminded Philips of a small songbird without its feathers. He’d seen her briefly twice before when she was having her preoperative X rays, and Philips was shocked how different she looked now. He had not realized how small and delicate she was. Her eyes had a pleading quality like an abandoned child, and Philips had all he could do to turn away, directing his attention back to the nurses. One of the reasons he’d switched from surgery to radiology had been a realization he couldn’t control his empathy for certain patients.

 

   “Why haven’t they started her?” he asked the nurse, angry the patient was being left to her fears.

 

   “Mannerheim’s been waiting for special electrodes from Gibson Memorial Hospital,” said the blond nurse. “He wants to make some recordings from the part of the brain he’s going to remove.”

 

   “I see …” said Philips, trying to plan his morning. Manner-heim had a way of upsetting everyone’s schedules.

 

   “Mannerheim’s got two visitors from Japan,” added the blond nurse, “and he’s been putting on a big show all week. But they’ll be starting in just a couple of minutes. They’ve called for the patient. We just haven’t had anybody to send with her.”

 

   “Okay,” said Philips, already starting back across the patient-holding area. “When Mannerheim wants his localization X rays, call my office directly. That should save a few minutes.”

 

   As he retraced his steps, Martin remembered he still had to shave and headed for the surgical lounge. At eight-ten it was almost deserted since the seven-thirty cases were all under way and the “to follow” cases could not hope to begin for some time. Only one surgeon was there talking on the telephone to his stockbroker while absentmindedly scratching himself. Philips passed into the changing area and twirled the combination to his foot-square locker, which Tony, the old man who took care of the surgical area, had allowed him to keep.

 

   As soon as he had his face completely lathered, Philips’ beeper went off making him jump. He hadn’t realized how taut his nerves were. He used the wall phone to answer, trying to keep the shaving cream from the receiver. It was Helen Walker, his secretary, informing him that William Michaels had arrived and was waiting for him in his office.

 

   Philips went back to his shaving with renewed enthusiasm. All his excitement about William’s surprise came roaring back. He splashed himself with cologne and struggled back into his long white coat. Passing back through the surgical lounge, he noticed the surgeon was still on the phone with his broker.

 

   When Martin reached his office he was at a half run. Helen Walker looked up from her typing with a start as the blurred image of her boss passed by her. She began to get up, reaching for a pile of correspondence and phone messages, but stopped when the door to Philips’ office slammed shut. She shrugged and went back to her typing.

 

   Philips leaned against the closed door, breathing heavily. Michaels was casually leafing through one of Philips’ radiology journals.

 

   “Well?” said Philips excitedly. Michaels was dressed as usual in his ill-fitting, slightly worn tweed jacket, which had been purchased during his third year at M.I.T. He was thirty but looked twenty, with hair so blond that it made Philips’ look brown by comparison. He smiled, his small impish mouth expressing satisfaction, his pale blue eyes twinkling.

 

   “What’s up?” he said, pretending to go back to the magazine.

 

   “Come on,” said Philips, “I know you’re just trying to rile me. The trouble is that you’re being too successful.”

 

   “I don’t know what…” began Michaels, but he didn’t get any further. In one swift motion, Philips stepped across the room and tore the magazine from his hands.

 

   “Let’s not play dumb,” said Philips. “You knew that telling Helen you had a ‘surprise’ would drive me crazy. I almost called you last night at four A.M. Now I wish I had. I think you deserved it.”

 

   “Oh, yeah, the surprise,” teased Michaels. “I almost forgot.” He leaned over and rummaged in his briefcase. A minute later he had pulled out a small package wrapped with dark green paper and tied with a thick yellow ribbon.

 

   Martin’s face fell. “What’s that?” He’d expected some papers, most likely computer print-out paper, showing some breakthrough in their research. He never expected a present.

 

   “It’s your surprise,” said Michaels, reaching toward Philips with the package.

 

   Philips’ eyes moved back to the gift. His disappointment was so acute it was almost anger. “Why the hell did you buy me a present?”

 

   “Because you’ve been such a wonderful research partner,” said Michaels, still holding the package toward Philips. “Here, take it.”

 

   Philips reached out. He had recovered from the shock enough to be embarrassed about his reaction. No matter how he felt he didn’t want to hurt Michaels’ feelings. After all, it was a nice gesture.

 

   Philips thanked him while feeling the weight of the package. It was light and about four inches long and an inch high.

 

   “Aren’t you going to open it?” asked Michaels.

 

   “Sure,” said Philips, studying Michaels’ face for an instant. Buying a present seemed so out of character for this boy genius from the Department of Computer Science, It wasn’t that he wasn’t friendly or generous. It was just that he was so completely involved with his research that he usually overlooked amenities. In fact, during the four years they’d been working together, Philips had never seen Michaels socially. Philips had decided that Michaels’ incredible mind never turned off. After all, he had been singled out to head the newly created Division of Artificial Intelligence for the university at twenty-six. He’d completed his Ph.D. at M.I.T. when he was only nineteen.

 

   “Come on,” said Michaels impatiently.

 

   Philips pulled off the bow and dropped it ceremoniously among the debris on his desk. The dark green paper followed. Beneath was a black box.

 

   “There’s a little symbolism there,” said Michaels.

 

   “Oh? “said Philips.

 

   “Yeah,” said Michaels. “You know how psychology treats the brain: like a black box. Well, you get to look inside.”

 

   Philips smiled weakly. He didn’t know what Michaels was talking about. He pulled off the top of the box and separated some tissue. To his surprise he extracted a cassette case labeled Rumors by Fleetwood Mac.

 

   “What the hell,” smiled Philips. He hadn’t the foggiest idea why Michaels would buy him a recording by Fleetwood Mac.

 

   “More symbolism,” explained Michaels. “What’s inside is going to be more than music to your ears!”

 

   Suddenly the whole charade made sense. Philips flipped open the case and pulled out the cassette. It wasn’t a musical recording. It was a computer program.

 

   “How far did we get?” asked Philips almost in a whisper.

 

   “It’s the whole thing,” said Michaels.

 

   “No!” said the incredulous Martin.

 

   “You know the last material you gave me? It worked like a charm. It solved the problem of density and boundary interpretation. This program incorporates everything you’ve included in all your flow sheets. It will read any skull X ray you give it, provided you put it into that piece of equipment over there.” Michaels pointed to the back of Philips’ office. There on the top of Philips’ worktable was a TV-sized electrical apparatus. It was obvious that it was built as a prototype rather than production model. The front was made of a plain stainless steel plate and its attaching bolts protruded. In the upper left-hand corner was a slot that was made to take the program cassette. Two electrical trunks protruded from its sides. One trunk fed into a typewriter input/output device. The other came from a rectangular stainless steel box about four feet square and one foot high. On the front of this metal apparatus was a long slot with visible rollers for the insertion of an X-ray film.

 

   “I don’t believe it,” said Philips, afraid that Michaels was teasing him again.

 

   “Neither do we,” admitted Michaels. “Everything just suddenly fell together.” He walked over and patted the top of the computer unit. “All the work you’d done in breaking down the problem-solving and pattern-recognition aspects of radiology not only made it apparent we needed new hardware but also suggested the way to design it. This is it.”

 

   “Looks simple from the outside.”

 

   “As usual, appearances are deceptive,” said Michaels. “The innards of this unit are going to revolutionize the computer world.”

 

   “And think what it’s going to do to the field of radiology if it can really read X rays,” said Martin.

 

   “It will read them,” said Michaels, “but there could still be bugs in the program. What you have to do now is run the program against as many skull X rays as you can find that you have read in the past. If there are problems, I think they will be in the area of false negatives. Meaning the program will say the X ray is normal when pathology is really present.”

 

   “That’s the same problem with radiologists,” said Philips.

 

   “Well, I think we’ll be able to eliminate that in the program,” said Michaels. “It’s going to be up to you. Now to work this thing, first turn it on. I think even a doctor of medicine will be

 

   able to do that.”

 

   “Without doubt,” said Philips, “but we’ll need a Ph.D. to plug it in.”

 

   “Very good,” Michaels laughed. “Your humor is improving. Once the unit is plugged in and turned on, you insert the cassette program into the central unit. The output printer will then inform you when to insert the X-ray film into the laser scanner.”

 

   “What about the orientation of the film?” asked Philips. “Doesn’t matter, except the emulsion side has to be down. “Okay,” said Philips, rubbing his hands together and eyeing the unit like a proud parent. “I still can’t believe it.”

 

   “I can’t, either,” said Michaels. “Who would have guessed four years ago that we could have made this kind of progress? I can still remember the day you arrived unannounced in the Department of Computer Science, plaintively asking if anyone was interested in pattern recognition.”

 

   “It was just pure luck that I bumped into you,” returned Philips. “At the time I thought you were one of the undergraduates. I didn’t even know what the Division of Artificial

 

   Intelligence was.”

 

   “Luck plays a role in every scientific breakthrough,” agreed Michaels. “But after the luck, there’s lots of hard work, like what’s facing you. Remember the more skull films you run with the program, the better it will be, not only to debug the program, but also because the program is heuristic.”

 

   “Let’s not pull any big words on me,” said Philips. “What do you mean ‘heuristic’?”

 

   “So you don’t like some of your own medicine,” laughed Michaels. “I never thought I’d hear a doctor complain about incomprehensible words. A heuristic program is one that is capable of learning.”

 

   “You mean this thing will get smarter?”

 

   “You got it,” said Michaels, moving toward the door. “But it’s up to you now. And, remember, the same format will be applicable to other areas of radiology. So in your spare time, as if you’re going to have any, start the flow sheet for reading cerebral angiograms. I’ll talk to you later.”

 

   Closing the door behind Michaels, Philips went over to the worktable and eyed the X-ray-reading apparatus. He was eager to begin to work with it immediately, but he knew the burden of his daily routine proscribed it. As if in confirmation, Helen walked in with a pile of correspondence, telephone messages, and the cheerful news that the X-ray machine in one of the cerebral angiography rooms wasn’t functioning properly. Reluctantly Philips turned his back on the new machine.

 

   4

 

   “Lisa Marino?” asked a voice, causing Lisa to open her eyes. Leaning over her was a nurse named Carol Bigelow, whose dark brown eyes were the only portion of her face visible. A flower-print hat contained her hair. Her nose and mouth were covered by a surgical mask.

 

   Lisa felt her arm lifted and rotated so the nurse could read her identification bracelet. The arm was replaced and patted. “Are you ready for us to fix you up, Lisa Marino?” asked Carol, releasing the break mechanism on the gurney with her foot, and pulling the bed out from the wall.

 

   “I don’t know,” admitted Lisa, trying to see up into the nurse’s face. But Carol had turned away saying, “Sure you are,” as she pushed the bed past the white Formica desk.

 

   The automatic doors closed behind them as Lisa began her fateful journey down the corridor to OR #21. Neurosurgery was usually done in one of four rooms: Number 20, 21, 22, or 23. These rooms were fitted out with the special needs of brain surgery in mind. They had overhead mounted Zeiss operating microscopes, closed-circuit video systems with recording capabilities, and special OR tables. OR #21 also had a viewing gallery and was the favorite of Dr. Curt Mannerheim, Chief of Neurosurgery, and Chairman of the Department for the medical school.

 

   Lisa had hoped that she’d be sleeping at this point, but such was not the case. If anything, she seemed particularly aware and all her senses sharp. Even the sterile chemical smell seemed exceptionally pungent to her. There was still time, she thought. She could get out of the bed and run. She didn’t want to be operated on, especially not her head. In fact, anything but her head.

 

   The movement stopped. Turning her gaze, she saw the nurse disappear around a corner. Lisa had been parked like a car at the side of a busy thoroughfare. A group of people passed her, transporting another patient who was retching. His chin was being held back by one of the orderlies pushing the bed, and his head was a bandaged nightmare.

 

   Tears began to run down Lisa’s cheeks. The patient reminded her of her own upcoming ordeal. Her central being was going to be rudely cracked open and violated. Not just a peripheral part of her, like a foot or an arm, but her head … where her personality and very soul resided. Would she be the same person afterward?

 

   When Lisa had been eleven she’d had acute appendicitis. The operation had certainly seemed scary at the time, but nothing like what she was experiencing now. She was convinced that she was going to lose her identity if not her life. In either case, she was fragmenting, and the pieces were there for people to pick up and examine.

 

   Carol Bigelow reappeared.

 

   “Okay, Lisa, we’re ready for you.”

 

   “Please,” whispered Lisa.

 

   “Come now, Lisa,” said Carol Bigelow. “You wouldn’t want Dr. Mannerheim to see you crying.”

 

   Lisa didn’t want anyone to see her crying. She shook her head in response to Carol Bigelow’s question, but her emotion switched to anger. Why was this happening to her? It wasn’t fair. A year ago she’d been a normal college girl. She’d decided to major in English, hopefully to prepare for law school. She loved her literature courses and had been a superior student, at least until she’d met Jim Conway. She knew she’d let her studies go, but it had only been a month or so. Before meeting Jim she’d had sex on several occasions, but it had never been satisfying and she’d questioned why there was so much fuss about it. But with Jim it had been different. She knew immediately that with Jim, sex was the way it was supposed to be. And she hadn’t been irresponsible. She did not believe in the Pill, but she’d made the effort to be fitted with a diaphragm. She could remember very distinctly how hard it had been for her to find the courage to make that first GYN clinic visit and go back when it was necessary.

 

   The gurney moved into the operating room. It was completely square, about twenty-five feet on a side. The walls were constructed of gray ceramic tile up to the glass-faced gallery above. The ceiling was dominated by two large stainless steel operating room lights shaped like inverted kettle drums. In the center of the room stood the operating table. It was a narrow, ugly piece of equipment, reminding Lisa of an altar for some pagan rite. At one end of the table was a round piece of padding with a hole in the center, which Lisa instinctively knew was to hold her head. Totally out of keeping with the environment, the Bee Gees crooned from a small transistor radio in the corner.

 

   “There now,” said Carol Bigelow. “What I want you to do is slide over here onto the table.”

 

   “Okay,” said Lisa. “Thank you.” She was annoyed at her response. Thank you was the farthest thing from her mind. Yet she wanted the people to like her because she knew she depended on them to take care of her. Moving from the gurney to the operating table, Lisa held on to the sheet in a vain attempt to retain a modicum of dignity. Once on the table she lay still, staring up at the operating lights. Just to the side of the lights she recognized the glass partitions. Because of reflections, it was difficult to see through the glass, but then she saw the faces staring down at her. Lisa closed her eyes. She was a spectacle.

 

   Her life had become a nightmare. Everything had been wonderful until that fateful evening. She had been with Jim and they both had been studying. Progressively, she had become aware that she was having difficulty reading, particularly when she came to a specific sentence beginning with the word “Ever.” She was certain she knew the word but her mind refused to give it to her. She had to ask Jim. His response was a smile, thinking she was teasing. After she persisted, he told her “ever.” Even after Jim had told her the word, when she looked at its printed form, it wouldn’t come to her. She remembered feeling a powerful sense of frustration and fear. Then she began to smell the strange odor. It was a bad smell, and although she sensed she’d smelled it before, she could not say what it was. Jim denied smelling anything and that was the last thing Lisa remembered. What had followed was her first seizure. Apparently it had been awful, and Jim was shaking when she regained consciousness. She had struck him several times and scratched his face.

 

   “Good morning, Lisa,” said a pleasant male voice with an English accent. Looking up behind her, Lisa met the dark eyes of Dr. Bal Ranade, an Indian doctor who had trained at the university. “You remember what I told you last night?”

 

   Lisa nodded. “No coughing or sudden movements,” said Lisa, eager to please. She remembered Dr. Ranade’s visit vividly. He’d appeared after her dinner, announcing himself as the anesthesiologist who was going to take care of her during her operation. He had proceeded to ask her the same questions about her health she’d answered many times before. The difference was that Dr. Ranade did not seem to be interested in the answers. His mahogany face did not change its expression, except when Lisa described her appendectomy at age eleven. Dr. Ranade nodded when Lisa said she’d had no trouble with the anesthesia. The only other information that interested him was her lack of allergic reaction. He nodded then too.

 

   Usually Lisa preferred outgoing people. Dr. Ranade was the opposite. He expressed no emotion, just a quiet intensity. But for Lisa, under the circumstances this cool affectation was appropriate. She was glad to find someone for whom her ordeal was routine. But then Dr. Ranade had shocked her. In the same precise Oxford accent he said: “I presume that Dr. Mannerheim has discussed with you the anesthetic technique which will be used.”

 

   “No,” said Lisa.

 

   “That’s odd,” said Dr. Ranade at length.

 

   “Why?” asked Lisa, sensing trouble. The idea that there could be any breakdown in communication was alarming. “Why is that odd?”

 

   “We usually use a general anesthesia for craniotomy,” said Dr. Ranade. “But Dr. Mannerheim has informed us that he wants local anesthesia.”

 

   Lisa had not heard her operation described as a craniotomy. Dr. Mannerheim had said that he was going to “turn a flap” and make a small window in her head so that he could remove the damaged part of her right temporal lobe. He’d told Lisa that somehow, a part of Lisa’s brain had been damaged, and it was that section that was causing her seizures. If he could take just the damaged part out the seizures would stop. He’d done almost a hundred such operations with wonderful results. At the time Lisa had been ecstatic because up until Dr. Mannerheim all she could get from her doctors was compassionate head shaking.

 

   And the seizures were horrible. Usually she knew when they were coming because she would smell the strangely familiar odor. But sometimes they came without warning, descending on her like an avalanche. Once in a movie theater, after she’d been given a long course of heavy medication and assurances that the problem was under control, she smelled the horrid odor. In a panic she’d jumped up, stumbled to the aisle, and ran back toward the lobby. At that point she became unaware of her actions. Later she “came to” propped up against the lobby wall by the candy machine, with her hand between her legs. Her clothes were partially off, and like a cat in heat, she’d been masturbating. A group of people was staring at her as if she were a freak, including Jim, whom she’d punched and kicked. Later she learned she’d assaulted two girls, injuring one enough to be hospitalized. At the time she’d “come to” all she could do was close her eyes and cry. Everyone was afraid to come near her. In the distance she remembered hearing the sound of the ambulance. She thought that she was going insane.

 

   Lisa’s life had come to a standstill. She wasn’t insane, but no medication controlled her seizures. So when Dr. Mannerheim appeared, he seemed like a savior. It wasn’t until Dr. Ranade’s visit that she began to comprehend the reality of what was going to happen to her. After Dr. Ranade, an orderly had arrived to shave her head. From that moment on, Lisa had been frightened.

 

   “Is there some reason why he wants local anesthesia?” asked Lisa. Her hands had begun to tremble. Dr. Ranade had thought carefully about his answer.

 

   “Yes,” he said finally, “he wants to locate the diseased part of your brain. He needs your help.”

 

   “You mean, I’ll be awake when …” Lisa didn’t finish her sentence. Her voice had trailed off. The idea seemed preposterous.

 

   “That’s correct,” said Dr. Ranade.

 

   “But he knows where the diseased part of my brain is,” protested Lisa.

 

   “Not well enough. But don’t worry. I’ll be there. There’ll be no pain. All you have to remember is no coughing and no sudden movements.”

 

   Lisa’s reverie was cut short by a feeling of pain in her left forearm. Looking up she could see tiny bubbles rising up in a bottle over her head. Dr. Ranade had started the IV. He did the same thing in her right forearm, threading into her a long thin plastic tube. Then he adjusted the table so that it tilted slightly downward.

 

   “Lisa,” said Carol Bigelow. “I’m going to catheterize you.”

 

   Picking up her head, Lisa looked down. Carol was busy unwrapping a plastic covered box. Nancy Donovan, another scrub nurse, pulled back Lisa’s sheet exposing her from the waist down.

 

   “Catheterize?” questioned Lisa.

 

   “Yes,” said Carol Bigelow, pulling on loose rubber gloves. “I’m going to put a tube into your bladder.”

 

   Lisa allowed her head to fall back. Nancy Donovan grasped Lisa’s legs and positioned them so that the soles of her feet were together while her knees were widely apart. She lay exposed for the world to see.

 

   “I’m going to be giving you a medicine called mannitol,” explained Dr. Ranade. “It causes you to make a lot of urine.”

 

   Lisa nodded as if she understood while she felt Carol Bigelow begin to scrub her genitals.

 

   “Hi, Lisa, I’m doctor George Newman. Do you remember me?”

 

   Opening her eyes, Lisa gazed into another masked face. These eyes were blue. On the other side of her was another face with brown eyes.

 

   “I’m the Chief Resident in Neurosurgery,” said Dr. Newman, “and this is Dr. Ralph Lowry, one of our Junior Residents. We’ll be helping Dr. Mannerheim as I explained to you yesterday.”

 

   Before Lisa could respond she felt a sudden sharp pain between her legs, followed by a curious fullness in her bladder. She took a breath. She felt tape being placed on the inner part of her thigh.

 

   “Just relax now,” said Dr. Newman without waiting for her to respond. “We’ll have you fixed up in no time.” The two doctors directed their interest to the series of X rays that lined the back walls.

 

   The pace in the OR quickened. Nancy Donovan appeared with a steaming stainless steel tray of instruments, and with a bud crash she heaved it on top of a nearby table. Darlene Cooper, another scrub nurse, who was already gowned and gloved, reached into the sterile instruments and began to arrange them on a tray. Lisa turned her head when she saw Darlene Cooper lift out a large drill.

 

   Doctor Ranade wrapped a blood pressure cuff around Lisa’s right upper arm. Carol Bigelow exposed Lisa’s chest and taped on EKG leads. Soon the sonar-like beeps from the cardiac monitor competed with John Denver on the transistor.

 

   Dr. Newman came back from studying the X rays and positioned Lisa’s shaved head. With his pinky on her nose and his thumb on the top of her head, he drew a line with a marking pen. The first line went from ear to ear over the top of her head. The second line bisected this one, starting at the middle of the forehead and extending back to the occipital area. “Now, Lisa, turn your head to the left,” said Dr. Newman. Lisa kept her eyes closed. She felt a finger palpate the ridge of bone that ran back from her right eye toward her right ear. Then she felt the marking pen trace a looping line that began at her right temple and arched upward and backward ending behind her ears. The line defined a horseshoe-shaped area with Lisa’s ear at its base. This was to be the flap that Dr. Mannerheim had described.

 

   An unexpected drowsiness coursed through Lisa’s body. It felt like the air in the room had become viscous and her extremities leaden. It took great effort for her to open her eyelids. Dr. Ranade smiled down at her. In one hand was her IV line; in the other hand a syringe.

 

   “Something to relax you,” said Dr. Ranade. Time became discontinuous. Sounds drifted in and out of her consciousness. She wanted to fall asleep but her body involuntarily fought against it. She felt herself being turned half on her side with her right shoulder elevated and supported by a pillow. With a sense of detachment she felt both wrists bound to a board that stuck out at right angles from the operating table. Her arms felt so heavy she couldn’t have moved them anyway. A leather cinch went around her waist securing her body. She felt her head scrubbed and painted. There were several sharp needles accompanied by fleeting pain before her head was clamped in some sort of vise. Despite herself, Lisa fell asleep.

 

   Sudden intense pain awoke her with a start. She had no idea how much time had passed. The pain was located above her right ear. It occurred again. A cry issued from her mouth and she tried to move. Except for a tunnel of cloth directly in front of her face. Lisa was covered with layers of surgical drapes. At the end of the tunnel, she could see Dr. Ranade’s face.

 

   “Everything is fine, Lisa,” said Dr. Ranade. “Don’t move now. They are injecting the local anesthetic. You’ll only feel it for a moment.”

 

   The pain occurred again and again. Lisa felt like her scalp was going to explode. She tried to lift her arms only to feel the cloth restraints. “Please,” she shouted, but her voice was feeble.

 

   “Everything is fine, Lisa. Try to relax.”

 

   The pain stopped. Lisa could hear the doctors breathing. They were directly over her right ear.

 

   “Knife,” said Dr. Newman.

 

   Lisa cringed. She felt pressure, like a finger being pressed against her scalp and rotated around the line drawn by the marking pen. She could feel warm fluid on her neck through the drapes.

 

   “Hemostats,” said Dr. Newman. Lisa could hear sharp metallic snaps.

 

   “Raney clips,” said Dr. Newman. “And call Mannerheim. Tell him we’ll be ready for him in thirty minutes.”

 

   Lisa tried not to think about what was happening to her head. Instead she thought about the discomfort in her bladder.’

 

   She called to Dr. Ranade and told him she had to urinate.

 

   “You have a catheter in your bladder,” said Dr. Ranade.

 

   “But I have to urinate,” said Lisa.

 

   “Just relax, Lisa,” said Dr. Ranade. “I’ll give you a little more sleep medicine.”

 

   The next thing Lisa was conscious of was the high-pitched whine of a gas-powered motor combined with a sense of pressure and vibration on her head. The noise was frightening because she knew what it meant. Her skull was being opened by a saw; she didn’t know it was called a craniotome. Thankfully there was no pain, although Lisa braced for it to occur at any moment. The smell of scorched bone penetrated the gauze drapes over her face. She felt Dr. Ranade’s hand take hers, and she was thankful for it. She pressed it as if it were her only hope of survival.

 

   The sound of the craniotome died. The rhythmic beeping of the cardiac monitor emerged from sudden stillness. Then Lisa felt pain again, this time more like the discomfort of a localized headache. Dr. Ranade’s face appeared at the end of her tunnel of vision. He watched her as she felt the blood pressure cuff inflate.

 

   “Bone forceps,” said Dr. Newman.

 

   Lisa heard and felt bone crunching. It sounded very close to her right ear.

 

   “Elevators,” said Dr. Newman.

 

   Lisa felt several more twinges, followed by what seemed to her a loud snap. She knew her head was open.

 

   “Damp gauze,” said Dr. Newman, in a matter-of-fact voice.

 

   While still scrubbing his hands, Dr. Curt Mannerheim leaned over to look through the door into OR #21 and see the clock on the far wall. It was almost nine o’clock. At that moment, he saw his chief resident, Dr. Newman, step back from the table. The resident crossed his gloved hands on his chest, and walked over to study the X rays arranged on the view box. That could mean only one thing. The craniotomy was done and they were ready for the Chief. Dr. Mannerheim knew he didn’t have much time to spare. The investigation committee from the N.I.H. was due to arrive at noon. What was at stake was a twelve-million-dollar research grant that would support his research activities for the next five years. He had to get that grant. If he didn’t, he might lose his entire animal lab, and with it, the results of four years of work. Mannerheim was certain he was on the brink of finding the exact spot in the brain responsible for aggression and rage.

 

   Rinsing the suds, Mannerheim caught sight of Lori Mclnter, the Assistant Director of the OR. He shouted her name and she stopped in her tracks.

 

   “Lori, dear! I’ve got two Jap doctors here from Tokyo.

 

   Could you send someone into the lounge to make sure they find scrub clothes and all that?”

 

   Lori McInter nodded, although she indicated she wasn’t pleased at the request. Mannerheim’s shouting in the corridor irritated her.

 

   Mannerheim caught the silent rebuke and cursed the nurse under his breath. “Women,” he muttered. To Mannerheim, nurses were becoming more and more a pain in the ass.

 

   Mannerheim burst into the OR like a bull into the ring. The congenial atmosphere changed instantly. Darlene Cooper handed him a sterile towel. Drying one hand, then the other, and working down his forearms, Mannerheim bent over to look at the opening in Lisa Marino’s skull.

 

   “God damn it, Newman,” snarled Mannerheim, “when are you going to learn to do a decent craniotomy? If I’ve told you once, I’ve told you a thousand times to bevel the edges more. Christ! This is a mess.”

 

   Under the drapes Lisa felt a new surge of fear. Something had gone wrong with her operation.

 

   “I…” began Newman.

 

   “I don’t want to hear a single excuse. Either you do it properly or you’ll be looking for another job. I got some Japs coming in here and what are they going to think when they see this?”

 

   Nancy Donovan was standing at his side to take the towel, but Mannerheim preferred to throw it on the floor. He liked to create havoc and, like a child, demanded total attention where-ever he was. And he got it. He was considered technically one of the best neurosurgeons in the country, if not the fastest. In his own terms he said, “Once you get into the head, there’s no time to pussyfoot around.” And with his encyclopedic knowledge of the intricacies of human neuroanatomy, he was superbly efficient.

 

   Darlene Cooper held open the special brown rubber gloves that Mannerheim demanded. As he thrust in his hands, he looked into her eyes.

 

   “Ahhh,” he cooed, as if he were experiencing orgastic pleasure from inserting his hands. “Baby, you’re fabulous.”

 

   Darlene Cooper avoided looking into Mannerheim’s gray blue eyes, as she handed him a damp towel to wipe off the powder on the gloves. She was accustomed to his comments, and from experience she knew that the best defense was to ignore him.

 

   Positioning himself at the head of the table with Newman on his right and Lowry on his left, Mannerheim looked down on the semi-transparent dura covering Lisa’s brain. Newman had carefully placed sutures through partial thickness of the dura and had anchored them to the edge of the craniotomy site. These sutures held the dura tightly up to the inner surface of the skull.

 

   “All right, let’s get this show on the road,” said Mannerheim. “Dural hook and scalpel.” The instruments were slapped into Mannerheim’s hand.

 

   “Easy, baby,” said Mannerheim. “We’re not on TV. I don’t want to feel pain each time I ask for an instrument.”

 

   He bent over and deftly tented up the dura with the hook. With the knife he made a small opening. A pinkish gray mound of naked brain could be seen through the hole.

 

   Once under way, Mannerheim became completely professional. His relatively small hands moved with economical deliberation, his prominent eyes never wavering from his patient. He was a physical person with extraordinary eye-hand control. The fact that he was short, five-foot-seven-inches, was a constant source of irritation to him. He felt he’d been cheated of the extra five inches to match his intellectual height, but he kept in excellent condition and looked much younger than his sixty-one years.

 

   With small scissors and cottonoid strips, which he inserted between the dura and the brain for protection, Mannerheim opened up the covering over Lisa’s brain to the extent of the bony window. Using his index finger he gently palpated Lisa’s temporal lobe. With his experience the slightest abnormality could be detected. For Mannerheim, this intimate interaction between himself and a live pulsating human brain was the apotheosis of his existence. During many operations, the sheer excitement made him sexually erect. “Now let’s have the stimulator and the EEG leads,” he said.

 

   Dr. Newman and Dr. Lowry wrestled with the profusion of tiny wires. Nancy Donovan, as his circulating nurse, took the appropriate leads when the doctors handed them to her and plugged them into the nearby electrical consoles. Dr. Newman carefully placed the wick electrodes in two parallel rows. One along the middle of the temporal lobe and the other above the Sylvian vein. The flexible electrodes with the silver balls went under the brain. Nancy Donovan threw a switch and an EEG screen next to the cardiac monitor came alive with fluorescent blips tracing erratic lines.

 

   Dr. Harata and Dr. Nagamoto entered the OR. Mannerheim was pleased not so much because the visitors might learn something, but because he loved an audience.

 

   “Now look,” said Mannerheim, gesturing, “there’s a lot of bullshit in the literature about whether you should take the superior part of the temporal lobe out during a temporal lobectomy. Some doctors fear it might affect the patient’s speech. The answer is, test it.”

 

   With an electrical stimulator in his hand like an orchestral baton, Mannerheim motioned to Dr. Ranade, who bent down and lifted up the drape. “Lisa,” he called.

 

   Lisa opened her eyes. They reflected the bewilderment from the conversation she’d been overhearing.

 

   “Lisa,” said Dr. Ranade. “I want you to recite as many nursery rhymes as you can.”

 

   Lisa complied, hoping that by helping the whole affair would soon be over. She started to speak, but as she did so Dr. Mannerheim touched the surface of her brain with the stimulator. In mid-word her speech stopped. She knew what she wanted to say, but couldn’t. At the same time she had a mental image of a person walking through a door.

 

   Noting the interruption in Lisa’s speech, Mannerheim said, “There’s your answer! We don’t take the superior temporal gyrus on this patient.”

 

   The heads of the Japanese visitors bobbed in understanding.

 

   “Now for the more interesting part of this exercise,” said Mannerheim, taking one of the two depth electrodes he’d gotten from Gibson Memorial Hospital. “By the way, somebody call X ray. I want a shot of these electrodes so we’ll know later where they were.”

 

   The rigid needle electrodes were both recording and stimulating instruments. Prior to having them sterilized, Mannerheim had marked off a point on the electrodes four centimeters from the needle tip. With a small metal ruler he measured four centimeters from the front edge of the temporal lobe. Holding the electrode at right angles to the surface of the brain, Mannerheim pushed it in blindly and easily to the four-centimeter mark. The brain tissues afforded minimal resistance. He took the second electrode and inserted it two centimeters posterior to the first. Each electrode stuck out about five centimeters from the surface of the brain.

 

   Fortunately, Kenneth Robbins, the Chief Neuroradiology X-ray technician, arrived at that moment. If he had been late Mannerheim would have thrown one of his celebrated fits. Since the operating room was outfitted to facilitate X ray, the chief technician needed only a few minutes to take the two shots.

 

   “Now,” said Mannerheim, glancing up at the clock and realizing he was going to have to speed things up. “Let’s stimulate the depth electrodes and see if we can generate some epileptic brain waves. It’s been my experience that if we can, then the chances of the lobectomy helping the seizure disorder are just about one hundred percent.”

 

   The doctors regrouped around the patient. “Dr. Ranade,” said Mannerheim. “I want you to ask the patient to describe what she feels and thinks after the stimulus.”

 

   Dr. Ranade nodded, then disappeared under the edge of the drapes. When he reappeared he indicated to Mannerheim to proceed.

 

   For Lisa the stimulus was like a bomb blast without sound or pain. After a blank period that could have been a fraction of a second or an hour, a kaleidoscope of images merged into the face of Dr. Ranade at the end of a long tunnel. She didn’t recognize Dr. Ranade nor did she know where she was. All she was aware of was the terrible smell that heralded her seizures. It terrified her.

 

   “What did you feel?” asked Dr. Ranade.

 

   “Help me,” cried Lisa. She tried to move but felt the restraints. She knew the seizure was coming. “Help me.”

 

   “Lisa,” said Dr. Ranade, becoming alarmed, “Lisa, everything is all right. Just relax.”

 

   “Help me,” cried Lisa as she lost control of her mind. The fixation of her head held, as did the leather strap at her waist. All her strength concentrated into her right arm, which she pulled with enormous force and suddenness. The wrist restraint snapped and her free arm arched up through the drapes.

 

   Mannerheim was mesmerized by the abnormal recordings on the EEG when he saw Lisa’s hand out of the corner of his eye. If he had only reacted faster he might have been able to avoid the incident. As it was, he was so startled that for a moment he was incapable of reacting. Lisa’s hand, flailing wildly to free her body imprisoned by the OR table, hit the protruding electrodes and drove them straight into her brain.

 

   Philips was on the phone with a pediatrician named George Rees when Robbins knocked and opened the door. Philips waved the technician into his office while he finished his conversation. Rees was inquiring about a skull X ray on a two-year-old male child who was supposed to have fallen down stairs. Martin had to tell the pediatrician that he suspected child abuse because of the old rib fractures he’d seen on the patient’s chest X ray. It was sticky business, and Philips was glad to hang up.

 

   “What have you got?” Philips asked Robbins, swinging around on his seat. Robbins was the Chief Neuroradiology technician whom Philips had recruited, and there was a special rapport between the two men.

 

   “Just the localization films you asked me to do for Mannerheim.”

 

   Philips nodded as Robbins snapped them up on Philips’ viewer. Normally the chief technician didn’t leave the department to take X rays, but Philips had asked him to attend personally to Mannerheim just to avoid any trouble.

 

   Lisa Marino’s operative X rays lit up on the screen. The lateral film showed a polyhedral lucency where the bone flap had been cut. Within this sharply defined area were the bright white silhouettes of the numerous electrodes. The long needle-like depth electrodes Mannerheim had pushed into Lisa Marino’s temporal lobe were the most apparent, and it was the position of these instruments that interested Philips. With his foot, Philips activated the motor on a wall-sized X ray viewer called an alternator. As long as he held his foot on the pedal, the screen in front of him changed. The unit could be loaded with any number of films for him to read. Philips kept the machine running until he found the screen containing Lisa Marino’s previous X rays.

 

   By comparing the new films with the old, Philips could determine the exact location of the deep electrodes.

 

   “Gees,” said Philips. “You take beautiful X rays. If I could clone you, half of my problems would be over.”

 

   Robbins shrugged as if he didn’t care, but the compliment pleased him. Philips was a demanding but appreciative boss.

 

   Martin used a finely calibrated ruler to measure distances associated with minute blood vessels on the older X rays. With his knowledge of the anatomy of the brain and the usual location of these blood vessels, he could form in his mind a three-dimensional image of the area he was interested in. Translating this information to the new films gave him the position of the tips of the electrodes.

 

   “Amazing,” said Philips, leaning back. “Those electrodes are positioned perfectly. Mannerheim is fantastic. If only his judgment equaled his technical skill.”

 

   “Do you want me to take these films back to the OR?” asked Robbins.

 

   Philips shook his head. “No, I’ll take them myself. I want to talk to Mannerheim. I’m going to take some of these older films as well. The position of this posterior cerebral artery bothers me a little.” Philips picked up the X rays and headed for the door.

 

   Although the situation in OR #21 had returned to a semblance of normality, Mannerheim was furious about the accident. Even the presence of the foreign visitors did not temper his anger. Newman and Lowry suffered the greatest abuse. It was as if Mannerheim felt they had deliberately schemed to cause the problem.

 

   He had started the temporal lobectomy as soon as Ranade had inducted Lisa under general endotracheal anesthesia. There had been a panic immediately after Lisa’s seizure although everyone acted superbly. Mannerheim had succeeded in grabbing Lisa’s flailing hand before any more damage had been done. Ranade, the real hero, had reacted instantly, injecting a sleep dose of one hundred and fifty milligrams of thiopental IV, followed by a muscle paralyzer called d-tubocurarine. These drugs had not only put Lisa to sleep, but had also terminated the seizure. Within only a few minutes Ranade had placed the endotracheal tube, started the nitrous oxide, and positioned his monitoring devices.

 

   Meanwhile, Newman had extracted the two inadvertently deeply embedded electrodes while Lowry removed the other surface electrodes. Lowry also had placed moist cottonoid over the exposed brain before covering the site with a sterile towel. The patient had been redraped and the doctors regowned and gloved. Everything had returned to normal except Manner-beim’s mood.

 

   “Shit,” said Mannerheim, straightening up to relieve the tension in his back. “Lowry, if you’d rather do something else when you grow up, tell me. Otherwise hold the retractors so I can see.” From Lowry’s position the resident could not see what he was doing.

 

   The door to the OR opened, and Philips entered, carrying the X rays.

 

   “Watch out,” whispered Nancy Donovan. “Napoleon is in a foul mood.”

 

   “Thanks for the warning,” said an exasperated Philips. It irritated him that everyone tolerated Mannerheim’s adolescent personality, no matter how good a surgeon he was. He put the X rays up on the viewer, aware that Mannerheim had seen him. Five minutes passed before Philips realized that Mannerheim was deliberately ignoring him.

 

   “Dr. Mannerheim,” Martin called over the sound of the cardiac monitor.

 

   All eyes turned as Mannerheim straightened up, shifting his head so that the beam of his miner-like head lamp fell directly on the radiologist’s face.

 

   “Perhaps you don’t realize that we are doing brain surgery here and maybe you shouldn’t interrupt,” Mannerheim said with controlled fury.

 

   “You ordered localization X rays,” said Philips calmly, “and I feel it is my duty to provide the information.”

 

   “Consider your duty done,” said Mannerheim, looking back into his expanding incision.

 

   Philips’ real concern was not the electrodes’ positions, because he knew they were perfect. It was the orientation of the posterior or hippocampal electrode in relation to the formidable posterior cerebral artery. “There’s something else,” said Martin.

 

   Mannerheim’s head shot up. The beam of light from his head strafed the wall, then the ceiling, while his voice lashed out like a whip. “Dr. Philips, would you mind taking yourself and your X rays out of here so that we can finish the operation? When we need your help, we’ll ask for it.”

 

   Then in a normal voice, he asked the scrub nurse for some bayonet forceps and went back to work.

 

   Martin calmly took his X rays down and left the OR. Changing back to his street clothes in the locker room, he tried not to think too much; it was easier on his mood. Heading back to Radiology, he allowed himself to ponder about the conflict in his sense of responsibility that the incident evoked. Dealing with Mannerheim called on resources he never imagined he’d need as a radiologist. He hadn’t resolved anything when he arrived back at the department.

 

   “They are ready for you in the angiography room,” said Helen Walker when he reached his office. She stood up and followed him inside. Helen was an extremely gracious thirty-eight-year-old black woman from Queens who had been Philips’ secretary for five years. They had a wonderful working relationship. It terrorized Philips to think of her ever leaving, because like any good secretary she was instrumental in running Philips’ day-to-day life. Even Philips’ current wardrobe was the result of her efforts. He would have still been wearing the same boxy clothes he’d worn in college if Helen hadn’t teased him into meeting her in Bloomingdale’s one Saturday afternoon. The result had been a new Philips, and the contemporary fitted clothes suited his athletic body. “

 

   Philips tossed Mannerheim’s X rays onto his desk, where they merged with the other X rays, papers, journals and books. It was one place Philips forbade Helen to touch. No matter what his desk looked like he knew where everything was.

 

   Helen stood behind him reading a steady stream of messages she felt obligated to tell him. Dr. Rees had called asking about the CAT scan on his patient, the X ray unit in the second angiography room had been fixed and was functioning normally, the emergency room called saying that they were expecting a severe head injury that was going to need an emergency CAT scan. It was endless and it was routine. Philips told her to handle everything, which was what she’d planned to do anyway, and she disappeared back to her desk.

 

   Philips removed his white coat and put on the lead apron he wore during certain X-ray procedures to protect himself from the radiation. The bib of the apron was distinguished by a faded Superman monogram, which had resisted all attempts at removal. It had been drawn there in jest two years previously by the neuroradiology fellows. Knowing the gesture had been made out of respect, Martin had not been annoyed.

 

   As he was about to leave, his eyes swept across the surface of his desk for a reassuring glimpse of the program cassette, just to make certain he hadn’t fantasized Michaels’ news. Not seeing it, Martin walked over to shuffle through the more recent layers of debris. He found the cassette under Mannerheim’s X rays. Philips started to leave, but again stopped. He picked up the cassette and Lisa Marino’s latest lateral skull X ray. Yelling through the open door for Helen to tell the angio room he’d be right there, he walked over to his worktable.

 

   He took off his lead apron and draped it over a chair. He stared at the computed prototype, wondering if it would really work. Then he held up Lisa Marino’s operative X ray to the light that came from the banks of viewing screens. He wasn’t interested in the electrode silhouettes and his mind eliminated them. What interested Philips was what the computer would say about the craniotomy. Philips knew they had not included the procedure in the program.

 

   He flipped the switch on the central processor. A red light came on and he slowly inserted the cassette. He got it three-quarters of the way in, when the machine swallowed it like a hungry dog. Immediately the typewriter unit came alive. Philips moved over so he could read the output.

 

   Hi! I am Radread, Skull I. Please enter patient name.

 

   Philips pecked out “Lisa Marino” with his two index fingers and entered it.

 

   Thank you. Please enter presenting complaint.

 

   Philips typed: “seizure disorder,” and entered that.

 

   Thank you. Please enter relevant clinical information.

 

   Philips typed: “21-year female, one year history of temporal lobe epilepsy.”

 

   Thank you. Please insert film in laser scanner.

 

   Philips went over to the scanner. The rollers within the lips of the insertion slot were moving. Carefully Philips lined up the X ray with its emulsion side down. The machine grabbed it and pulled it inside. The output typewriter activated. Philips walked over. It said: Thank you. Have a cup of coffee. Philips smiled. Michaels’ sense of humor emerged when least expected.

 

   The scanner emitted a slight electrical buzz; the output device stayed silent. Philips grabbed his lead apron and left the office.

 

   There was silence in OR #21 as Mannerheim mobilized Lisa’s right temporal lobe and slowly lifted it from its base. A few small veins could be seen linking the specimen to the venous sinuses, and Newman skillfully coagulated and divided them. At last it was free, and Mannerheim lifted the piece of the brain out of Lisa’s skull and dropped it into a stainless steel dish held by Darlene Cooper, the scrub nurse. Mannerheim looked up at the dock. He was doing fine. As the operation had progressed, Mannerheim’s mood had changed again. Now he was euphoric and justly pleased with his performance. He’d done the procedure in half the usual time. He was certain he’d be in his office at noon.

 

   “We’re not quite finished,” said Mannerheim, taking the metal sucker in his left hand and forceps in his right. Carefully he worked over the site where the temporal lobe had been, sucking out more brain tissue. He was removing what he called the deeper nuclei. This was probably the riskiest part of the procedure, but it was the part Mannerheim liked the best. With supreme confidence he guided the sucker, avoiding vital structures.

 

   At one point a large globule of brain tissue momentarily blocked the opening of the sucker. There was a slight whistling noise, before the piece of tissue whooshed up the tube. “There go the music lessons,” said Mannerheim. It was a common neurosurgical quip, but coming from Mannerheim after all the tension he’d caused, it was funnier than usual. Everyone laughed, even the two Japanese doctors.

 

   As soon as Mannerheim had finished removing brain tissue, Ranade slowed the ventilation of the patient. He wanted to let Lisa’s blood pressure rise a little while Mannerheim inspected the cavity for any bleeding. After a careful check Mannerheim was satisfied the operative site was dry. Taking a needle holder he began to close the dura, the tough covering over the brain. At that point, Ranade began carefully to lighten Lisa’s anesthesia. When the case was over he wanted to be able to remove the tube in Lisa’s trachea without her coughing, or straining. This required a delicate orchestration of all the drugs he’d been using. It was imperative that Lisa’s blood pressure not go up.

 

   The dural closure went swiftly and with a deft rotation of his wrist, Mannerheim placed the last interrupted stitch. Lisa’s brain was again covered, although the dura dipped down and was darker where Lisa’s temporal lobe had been. Mannerheim cocked his head as he admired his handiwork, then stepping back, he snapped off his rubber gloves. The sound echoed in the room.

 

   “All right,” said Mannerheim, “close her up. But let’s not make it your life’s work.”

 

   Motioning for the two Japanese doctors to come with him, Mannerheim left the room.

 

   Newman took Mannerheim’s position at Lisa’s head. “Okay, Lowry,” said Newman, echoing his boss, “let’s see if you can help me rather than hinder me.”

 

   After dropping the bone flap into place like the top of a Halloween pumpkin and tying the sutures, Newman was ready to close. With a pair of rugged tooth forceps, he grabbed hold of the edge of Lisa Marino’s wound and partially everted it. Then he plunged the needle deep into the skin of the scalp, making sure he picked up pericranium, and brought the needle out in the wound. Detaching the needle holder from its original position on the shank of the needle, he used the instrument to grab the needle tip, bringing the suture out into the wound; With essentially the same technique, he put the silk through the other side of the wound, trailing the suture off into Dr. Lowry’s waiting hand so he could tie the stitch. They repeated this procedure until the wound was closed with black sutures, giving the impression of a large zipper on the side of Lisa’s head.

 

   During this part of the procedure, Dr. Ranade was still ventilating Lisa by compressing a breath bag. As soon as the last stitch was to be placed, he planned to give Lisa one hundred percent oxygen and reverse the remaining muscle paralyzer her body hadn’t metabolized. On schedule his hand again compressed the breathing bag, but this time his experienced fingers detected a subtle change from the previous compression. Over the last few minutes Lisa had begun to make initial efforts to breathe on her own. Those efforts had provided a certain resistance to ventilating her. That resistance had been gone on the last compression. Watching the breathing bag and listening with his esophageal stethoscope, Ranade determined that Lisa had suddenly stopped trying to breathe. He checked the peripheral nerve stimulator. It told him the muscle paralyzer was wearing off on schedule. But why wasn’t she breathing? Ranade’s pulse increased. For him anesthesia was like standing on a secure but narrow ledge on the side of a precipice.

 

   Quickly, Ranade determined Lisa’s blood pressure. It had risen to 150 over 90. During the operation it had been stable at 105 over 60. Something was wrong!

 

   “Hold up,” he said to Dr. Newman, his eyes darting to the cardiac monitor. The beats were regular but slowing with longer pauses between the spikes.

 

   “What’s wrong?” asked Dr. Newman, sensing the anxiety in Dr. Ranade’s voice.

 

   “I don’t know.” Dr. Ranade checked Lisa’s venous pressure while preparing to inject a drug called nitroprusside to bring down her blood pressure. Up to this point Dr. Ranade believed the variation in Lisa’s vital signs was a reflection of her brain responding to the insult of surgery. But now he began to fear hemorrhage! Lisa could be bleeding and the pressure in her head could be going up. That would explain the sequence of signs. He took the blood pressure again. It had risen to 170 over 100. Immediately he injected the nitroprusside. As he did so, he felt that unpleasant sinking feeling in his abdomen associated with terror.

 

   “She might be hemorrhaging,” he said, bending down to lift Lisa’s eyelids. What he saw was what he’d feared. The pupils were dilating. “I’m sure she’s hemorrhaging,” he yelled.

 

   The two residents stared at each other over the patient. Their thoughts were the same. “Mannerheim’s going to be furious,” said Dr. Newman. “We better call him. Go ahead,” he said to Nancy Donovan. “Tell him it’s an emergency.”

 

   Nancy Donovan dashed over to the intercom and called out to the front desk.

 

   “Should we open her back up?” asked Dr. Lowry.

 

   “I don’t know,” said Newman nervously. “If she’s hemorrhaging inside her brain it would be better to get an emergency CAT scan. If she’s bleeding into the operative site, then we have to open her up.”

 

   “Blood pressure still rising,” said Dr. Ranade with disbelief as he watched his gauge. He prepared to give her more medication to bring the blood pressure down.

 

   The two residents remained motionless.

 

   “Blood pressure still rising,” shouted Dr. Ranade. “Do something, for Christ sake!”

 

   “Scissors,” barked Dr. Newman. They were slapped into his hand and he cut the sutures he’d just finished placing. The wound spontaneously gaped open as he got to the end of the incision. As he pulled the scalp flap back, the section of skull they’d removed for the craniotomy pushed up at them. It seemed to be pulsating.

 

   “Let me have the four units of blood that’s on call,” shouted Dr. Ranade.

 

   Dr. Newman cut the two hitch sutures holding the bone flap in place. The piece of bone fell to the side before Dr. Newman picked it up. The dura was bulging out with an ominous dark shadow.

 

   The OR door burst open and Dr. Mannerheim came flying in, his scrub shirt was unbuttoned save for the bottom two.

 

   “What the hell’s going on?” he shouted. Then he caught sight of the pulsating and bulging dura. “Jesus Christ! Gloves! Let me have gloves!”

 

   Nancy Donovan started to open a new pair of gloves, but Mannerheim snatched them away from her and pulled them on without scrubbing.

 

   As soon as a few sutures were cut, the dura burst open, and bright red blood squirted out over Mannerheim’s chest. It soaked him as he blindly cut the rest of the sutures. He knew he had to find the source of the bleeding.

 

   “Sucker,” yelled Mannerheim. With a rude sound, the machine began to draw off the blood. Immediately it became apparent that the brain had shifted or swelled because Mannerheim quickly encountered the brain itself.

 

   “The blood pressure is falling,” said Ranade.

 

   Mannerheim yelled for a brain retractor to help him try to see the base of the operative site, but blood welled up the moment he took the sucker away.

 

   “Blood pressure …” said Dr. Ranade, pausing. “Blood pressure unobtainable.”

 

   The sound of the cardiac monitor, which had been so constant during the operation, slowed to a painful pulse, then stopped.

 

   “Cardiac arrest!” shouted Dr. Ranade.

 

   The residents whipped up the heavy surgical drapes, exposing Lisa’s body and covering her head. Newman climbed up on the stool next to the OR table and began cardiac resuscitation by compressing Lisa’s sternum. Dr. Ranade, having obtained the blood, hung it up. He’d opened all his IV lines, running fluid into Lisa as fast as possible.

 

   “Stop,” yelled Mannerheim, who’d stepped back from the OR table when Dr. Ranade had shouted cardiac arrest. With a feeling of utter frustration, Mannerheim threw the brain retractor to the floor.

 

   He stood there for a moment, his arms at his sides with blood and bits of brain dripping from his fingers. “No more! It’s no use,” he said finally. “Obviously some major artery gave way. It must have been from the God-damned patient pushing in those electrodes. Probably transected an artery and put it into spasm, which was camouflaged by the seizure. When the spasm relaxed it blew. There’s no way you can resuscitate this patient.”

 

   Grabbing his scrub pants before they fell, Mannerheim turned to leave. At the door he looked back at the two residents. “I want you to close her up again as if she were still alive. Understand?”

 

   5

 

   “My name is Kristin Lindquist,” said the young woman waiting at the university’s GYN clinic. She managed a smile, but the corners of her mouth trembled slightly. “I have an appointment with Dr. John Schonfeld at eleven-fifteen.” It was exactly eleven according to the wall clock.

 

   Ellen Cohen, the receptionist, looked up from her paperback novel at the pretty face smiling down at her. Immediately she saw that Kristin Lindquist was everything Ellen Cohen was not. Kristin had real blond hair, which was as fine as silk, a small turned-up nose, big deep blue eyes, and long shapely legs. Ellen hated Kristin instantly, labeling her in her mind as one of those California sluts. The fact that Kristin Lindquist was from Madison, Wisconsin, would not have made any difference to Ellen. She took a long drag on her cigarette, blowing the smoke out her nose as she scanned the appointment book. She crossed off Kristin’s name and told her to take a seat, adding that Kristin would be seeing Dr. Harper, not Dr. Schonfeld.

 

   “Why isn’t Dr. Schonfeld going to see me?” asked Kristin. Dr. Schonfeld had been recommended by one of the girls in the dorm.

 

   “Because he’s not here. Does that answer your question?”

 

   Kristin nodded, but Ellen didn’t notice. She’d returned to her novel, although when Kristin walked away, Ellen watched her with jealous irritation.

 

   It was at that moment that Kristin should have left. She thought about it, realizing that no one would have noticed if she just continued walking the way she’d come. She already disliked the hospital’s dilapidated environment, which reminded her of disease and decay. Dr. Walter Peterson in Wisconsin had an office that was clean and fresh, and although Kristin still did not enjoy her semi-annual exam, at least it hadn’t been depressing.

 

   But she did not leave. It had taken a significant amount of courage for her to make the appointment, and she was compulsive about finishing what she’d started. So she sat down on the stained vinyl waiting-room chair, crossed her legs, and waited.

 

   The hands of the wall clock advanced painfully slowly and after fifteen minutes Kristin realized the palms of her hands were sweating. She recognized she was becoming more and more anxious, and wondered if there was something psychologically wrong with her. There were six other women in the small waiting room, all of whom seemed calm, a fact which magnified Kristin’s distress. It made her sick to think about her internal structure, and coming to the gynecologist forced the whole issue at her in a brutal and unpleasant way.

 

   Picking up a tattered magazine, Kristin tried to divert her mind. She was unsuccessful. Almost every advertisement reminded her of her upcoming ordeal. Then she saw a picture of a man and a woman, and a new concern entered her mind: how long after sex can sperm be found in the vagina? Two nights previously Kristin had seen her boyfriend, Thomas Huron, a senior, and they had slept together. Kristin knew that she’d be humiliated if the doctor could tell.

 

   The relationship with Thomas was the reason Kristin had decided to make an appointment at the clinic. They’d been seeing each other steadily since the fall. As their relationship grew, Kristin realized that trying to decide when it was “safe” was no longer a reasonable method of birth control. Thomas refused to take any responsibility and continually pressured Kristin for more frequent sex. She’d inquired about birth control pills at the student dispensary and had been told she first had to have a gynecological exam at the Med Center. Kristin would have preferred to have gone to her old doctor at home, but her concern for privacy made that impossible.

 

   Taking a deep breath, Kristin realized her stomach was now a knot and she could feel unsettling rumblings in her abdomen. The very last thing she wanted was to get so upset she got diarrhea. Even the thought mortified her. Looking up at the clock, she hoped she wouldn’t have to wait much longer.

 

   One hour and twenty minutes later Ellen Cohen called Kristin into one of the exam rooms. The linoleum felt cold to her feet as she undressed behind a small screen. There was one hook and she hung up all her clothes. As she had been directed, she put on hospital gown, which came to mid-thigh and tied at the front. Looking down she noticed her nipples were erect from the cold, poking out through the worn cotton fabric like two hard buttons. She hoped they’d go down before the doctor saw her.

 

   Emerging from behind the curtain, Kristin saw the nurse, Ms. Blackman, arranging instruments on a towel. Kristin averted her eyes, but not before she’d caught an unwanted glimpse of a host of gleaming stainless steel instruments, including a speculum and some forceps. The mere sight of these devices made Kristin feel weak.

 

   “Ah, very good,” said Ms. Blackman. “You’re quick, and we appreciate that. Come!” Ms. Blackman patted the exam table. “Climb up here now. The doctor will be in shortly.” With her foot Ms. Blackman moved a small stool to a strategic position.

 

   Using both hands to clutch at her flimsy gown, Kristin made her way to the examination table. With the metal stirrups jutting off at the end, the table looked like some medieval torture device. She stepped on the stool and sat down facing the nurse.

 

   Ms. Blackman then took a detailed medical history, which impressed Kristin with its thoroughness. No one had ever taken the time to do such a complete job, which included careful inquiries into Kristin’s family history. When Kristin had first seen Ms. Blackman, she’d been uneasy, fearing that the nurse was going to be as cold and harsh as her appearance suggested. But during the course of the history-taking, Ms. Blackman was so pleasant and so interested in Kristin as a person that Kristin began to relax. The only symptoms of note that Ms. Blackman wrote down were a mild discharge Kristin had noted over the last several months and occasional intermenstrual spotting, which she’d had as long as she could remember.

 

   “All right, let’s get ready for the doctor,” said Ms. Blackman, putting aside the chart. “Lie down now and feet in the stirrups.”

 

   Kristin complied, vainly trying to hold the edges of her gown together. It was impossible and her composure began to fade once again. The metal stirrups felt like ice, sending a chill through her body.

 

   Ms. Blackman shook open a freshly laundered sheet and draped it over Kristin. Lifting up the end, Ms. Blackman looked beneath. Kristin could almost feel the nurse’s gaze on her totally exposed crotch.

 

   “Okay,” said Ms. Blackman, “move yourself down to the end of the table.”

 

   Using a kind of rotational movement of her hips, Kristin walked her backside toward her feet.

 

   Ms. Blackman, still looking under the sheet, wasn’t satisfied. “A little more.”

 

   Kristin moved farther until she felt her buttocks half off the end of the table.

 

   “That’s fine,” said Ms. Blackman, “now relax before Dr. Harper comes in.”

 

   Relax! thought Kristin. How could she relax? She felt like a piece of meat in a rack waiting to be pawed over by customers. Behind her was a window and the fact that its drape was not completely closed bothered her immensely.

 

   Without a knock, the door to the exam room opened and a hospital courier thrust his head in. Where were the blood samples that were going to the lab? Ms. Blackman said she’d show him and disappeared.

 

   Kristin was left by herself in the sterile atmosphere, enveloped by the aseptic smell of alcohol. She closed her eyes and took deep breaths. It was the waiting that made it so bad. The other door opened. Kristin raised her head, expecting to see the doctor, but instead saw the receptionist, who asked I where Ms. Blackman was. Kristin only shook her head. The receptionist left, slamming the door. Kristin put her head back and closed her eyes again. She wasn’t going to be able to take much more.

 

   Just when Kristin thought she’d get up and leave, the door opened and the doctor strode in.

 

   “Hi, dear, I’m Doctor David Harper. How are you today?”

 

   “Fine,” said Kristin limply. Dr. David Harper was not what Kristin had expected. He seemed to be too young to be a doctor. His face had stubby boyish features, which clashed with his almost bald head. His eyebrows were so bushy they didn’t look real.

 

   Dr. Harper went over to the small sink and quickly washed his hands. “You’re a student at the university?” he asked, reading her chart on the counter. “Yes,” answered Kristin. “What are you studying?”

 

   “Art,” said Kristin. She knew that Dr. Harper was just making small talk, but she didn’t care. In fact, it was a relief to talk after the interminable wait.

 

   “Art: Isn’t that nice,” said Dr. Harper indifferently. After drying his hands, he tore open a package of latex rubber gloves. In front of Kristin he thrust his hands into them, snapping them noisily back over his wrists, then adjusting each finger in turn. It was done meticulously, like a ritual. Kristin noticed that Dr. Harper had plenty of hair everywhere but on the top of his head. Seen through the sheer latex, the hair on the backs of his hands looked vulgar.

 

   Walking down to the foot of the table, he quizzed Kristin about her mild discharge and her occasional spotting. Obviously he wasn’t impressed by either symptom. Without any more delay, he sat down on the small stool, disappearing from Kristin’s view. She felt a sense of panic when the bottom edge of the sheet was picked up.

 

   “All right,” said Dr. Harper casually. “I want you to scoot down here toward me.”

 

   As Kristin moved even farther down the table, the door to the exam room opened and Ms. Blackman entered. Kristin was glad to see her. She felt her legs being pushed apart, to their limit. She couldn’t have been more exposed and vulnerable.

 

   “Let’s have the Graves’ speculum,” said Dr. Harper to Ms. Blackman.

 

   Kristin couldn’t see what was going on but she heard the sharp clink of metal hitting against metal and it gave her a sinking feeling in the pit of her abdomen.

 

   “Okay,” said Dr. Harper. “I want you to relax now.”

 

   Before Kristin could respond, a gloved finger spread the lips of her vagina and the muscles of her thighs contracted by reflex. Then she felt the cold intrusion of the metal speculum.

 

   “Come on, relax! When was your last Pap smear?”

 

   It took a few seconds for Kristin to realize the question was being directed at her. “About a year ago.” There was a spreading sensation.

 

   Dr. Harper stayed silent. Kristin had no idea what was happening. With the speculum inside of her, she was terrified to move a muscle. Why was it taking so long? The speculum moved slightly and she could hear the doctor murmuring. Was something wrong with her? Lifting her head, Kristin could see that he wasn’t even looking at her. He had turned and was bending over the small table, doing something that required both hands. Ms. Blackman was nodding and whispering. Lying back down, Kristin wished he’d hurry and take the speculum out. Then she felt it move, followed by a strange deep sinking sensation in her abdomen.

 

   “Okay,” said Dr. Harper finally. The speculum came out as fast as it went in and with only a momentary twinge of pain. Kristin breathed a sigh of relief only to be assaulted by the rest of the examination.

 

   “Your ovaries feel fine,” Dr. Harper said finally as he pulled off his soiled gloves, dropping them into a covered pail.

 

   “I’m glad,” said Kristin, referring more to the termination of the experience.

 

   After a quick breast exam, Dr. Harper told her she could get dressed. He acted curt and preoccupied. Kristin stepped behind the screen, pulling the curtain closed. She put her clothes on as quickly as possible, afraid the doctor might leave before she had the chance to talk with him. When she emerged from the dressing area she was still buttoning her blouse. It was good timing because Dr. Harper was just completing her chart.

 

   “Dr. Harper,” began Kristin. “I wanted to ask about birth control.”

 

   “What would you like to know?”

 

   “I’d like to know what would be the best method for me to use.”

 

   Dr. Harper shrugged. “Each method has its good points and bad points. As far as you’re concerned, I don’t think there’s any contraindication for using any of the methods. It’s a personal choice. Talk to Ms. Blackman about it.”

 

   Kristin nodded. She wanted to ask more, but Dr. Harper’s abrupt manner made her feel self-conscious.

 

   “Your exam,” continued Dr. Harper, as he put his pen back into his jacket pocket and stood up, “was essentially normal. I noticed a slight erosion of your cervix, which would explain your mild discharge. It’s nothing. Perhaps we should check it again in a couple of months.”

 

   “What is an erosion?” asked Kristin. She wasn’t sure she wanted to know.

 

   “It’s just an area devoid of the usual epithelial cells,” said Dr. Harper. “Do you have any other questions?”

 

   Dr. Harper made it apparent he was in a hurry to end the consultation. Kristin hesitated.

 

   “Well, I’ve got more patients,” said Dr. Harper quickly. “If you need more information on birth control, ask Ms. Blackman. She’s very good on counseling. Also, you might bleed a little after the exam, but don’t worry about it. See you again in a couple of months.” With a final smile, and a pat on the top of Kristin’s head, Dr. Harper left.

 

   A moment later the door opened and Ms. Blackman looked in. She seemed surprised that Dr. Harper had left. “That was fast,” said Ms. Blackman, picking up the chart. “Come on in the lab and we’ll finish you up and get you on your way.”

 

   Kristin followed Ms. Blackman into another room with two examining tables as well as long counter tops with all sorts of medical paraphernalia, including a microscope. On the far wall was a glass-fronted instrument cabinet filled with an assortment of evil-appearing devices. Next to it hung an eye chart. Kristin noticed it because it was one of those charts composed only of the letter E.

 

   “Do you wear glasses?” asked Ms. Blackman.

 

   “No,” said Kristin.

 

   “Fine,” said Ms. Blackman. “Now lie down and we’ll draw your blood work.”

 

   Kristin did what she was told. “I get a little weak when blood is drawn.”

 

   “That’s very common,” said Ms. Blackman. “That’s why we ask you to lie down.”

 

   Kristin averted her eyes so she didn’t have to see the needle. Ms. Blackman was very fast and afterward she took Kristin’s blood pressure and pulse. Then she darkened the room for a vision exam.

 

   Kristin tried to get Ms. Blackman to discuss birth control, but it wasn’t until she’d finished her routine that she responded to Kristin’s questions. And then she just referred Kristin back to the Family Planning Center at the university, saying that she would have no problems now that she’d had her gynecological exam. Concerning the erosion, Ms. Blackman made a little sketch to be sure everything was clear. Then she took Kristin’s phone number and told her that she’d be informed if there were any irregularities with her test results.

 

   With great relief Kristin hurried from the clinic. At last it was over. After all the tension she’d experienced, she decided she’d skip her afternoon class. Reaching the center of the GYN clinic, Kristin felt a little disoriented, forgetting which way she’d come. Turning on her heels, she looked for a sign for the elevators. She spied it on the wall of the nearest corridor. But when the image of the word fell on her retina, something strange happened in Kristin’s brain. She felt a peculiar sensation and a slight dizziness, followed by an obnoxious odor. Although she couldn’t place the smell, Kristin felt it was strangely familiar.

 

   With a sense of foreboding Kristin tried to ignore the symptoms and pushed her way down the crowded corridor. She had to get out of the hospital. But the dizziness increased and the corridor began to spin. Grabbing an edge of a doorway for support, Kristin closed her eyes. The spinning sensation stopped. At first she was afraid to open her eyes fearing the symptoms would return, and when she did so, she did it gradually. Thankfully the dizziness didn’t recur, and in a few moments she was able to let go of the doorjamb.

 

   Before Kristin could take a step, a hand grabbed her upper arm and she recoiled in fright. She was relieved when she saw that it was Dr. Harper.

 

   “Are you all right?” he asked.

 

   “I’m fine,” said Kristin quickly, embarrassed to admit her symptoms.

 

   “Are you sure?”

 

   Kristin nodded and for emphasis, pulled her arm from Harper’s grip.

 

   “Sorry to bother you then,” said Dr. Harper, who excused himself and walked away down the hall.

 

   Kristin watched him merge with the crowd. She took a breath and started for the elevators, her legs rubbery.

 

   6

 

   Martin left the angiography room as soon as he was convinced the resident had everything under control and the catheter was out of the patient’s artery. He walked briskly down the corridor. Approaching his office he hoped Helen had gone to lunch, but as he rounded the last corner, she saw him and bounded up like a cat with her omnipresent handful of urgent messages. It wasn’t that Philips did not really want to see her, it was just that he knew she had all sorts of bad news.

 

   “The second angiography room is again nonfunctional,” she said the moment she caught his attention. “It’s not the X-ray unit itself, but rather the machine that moves the film.”

 

   Philips nodded as he hung up his lead apron. He was aware of the problem and he trusted that Helen had already called the company with whom they had a service agreement. He eyed the print-out device on his worktable. He could see a whole page of computer-generated notes.

 

   “Also there’s a problem with Claire O’Brian and Joseph Abbodanza,” said Helen. Claire and Joseph were two neuroradiology technicians they’d been training over the years.

 

   “What kind of problem?” asked Philips.

 

   “They’ve decided to get married.”

 

   “Well,” laughed Philips. “Have they been doing unnatural acts in the darkroom?”

 

   “No!” snapped Helen. “They’ve decided to get married in June, then take the whole summer off for a trip to Europe.”

 

   “Whole summer!” shouted Philips. “They can’t do that! It will be hard enough letting them take their two week vacation at the same time. I hope you told them that.”

 

   “Of course I did,” said Helen. “But they said they don’t care. They’re going to do it even if it means they get fired.”

 

   “Jesus Christ,” said Philips, slapping his forehead. He knew that with their training Claire and Joseph could get work in any major medical center.

 

   “Also,” said Helen. “The Dean of the medical school called. He said they voted in a meeting last week to double the number of medical-student groups rotating in Neuroradiology. He said last year’s students voted the service one of the best electives.”