A Brain (19 page)

Ellen Cohen rolled her eyes when she caught Philips', suggesting that the girl was unreasonably demanding, but she did get up to find the nurse. Martin turned to look at Kristin. His mind was busy making associations between atypical Pap smears and vague neurological symptoms. Kristin had closed her eyes so Philips could look at her without making her feel self-conscious. He guessed she was about twenty. Quickly Philips opened Katherine Collins' chart and rapidly flipped through the pages until he'd found the initial neurological note. Headache, dizziness, and visual symptoms were described as the presenting complaints.

He looked back at Kristin Lindquist. Could this woman in front of him be another case with the same radiological picture? Philips felt it was possible. With all the difficulties he'd encountered trying to get more X rays on the other patients, the idea of finding a new case was enormously seductive. He could take all the proper X rays right from the beginning.

Needing no more encouragement, he walked over and tapped Kristin on the shoulder. She jumped in surprise and brushed a wisp of blond hair from her face. The fear in her expression gave her a particularly vulnerable appearance and Martin suddenly became aware of the girl's beauty.

Choosing his words carefully, Martin introduced himself, saying he was from the Department of Radiology, and that he'd overheard her describe her symptoms to the receptionist. He told her that he had seen
X rays on four girls with similar problems and felt it might be to her advantage to have an X ray. He was careful to emphasize that it was purely precautionary and that she should not be alarmed.

For Kristin, the hospital was full of surprises. On her first visit the day before she'd been kept waiting for hours. Now she was confronted by a doctor who was apparently soliciting patients.

“I'm not very fond of hospitals,” she said. She wanted to add doctors, but it seemed too disrespectful.

“To tell you the truth, I feel the same way,” said Philips. He smiled. He'd taken an immediate liking to this attractive young woman and he felt protective. “But an X ray wouldn't take long.”

“I still feel ill and I think it would be best if I get home as quickly as possible.”

“It will be quick,” said Philips. “I can promise you that. One film. I'll take you over myself.”

Kristin hesitated. On the one hand she detested the hospital. On the other hand she still felt ill and she was susceptible to Philips' concern.

“How about it?” he said persistently.

“All right,” said Kristin finally.

“Wonderful. How long will you be here at the clinic?”

“I don't know. They said not long.”

“Good. Don't leave without me,” said Martin.

Within minutes Kristin was called. Almost simultaneously another door opened and Dr. Harper emerged.

Philips recognized Harper as one of the residents he'd seen on occasion in and around the hospital. He'd never met the man but his polished head was hard to forget. Philips got up and introduced himself.
There was an awkward pause. As a resident, Harper did not have an office and since both examining rooms were occupied, there was no place to talk. They ended up in the narrow corridor.

“What can I do for you?” asked Harper, somewhat suspiciously. It was bizarre for the Assistant Director of Neuroradiology to be visiting Gynecology, since their interests and expertise lay at opposite ends of the medical spectrum.

Philips began his questioning in rather vague terms, expressing an interest in the way the clinic was manned, how long Harper had been there, and whether he enjoyed it. Harper's responses were abrupt and his small eyes darted over Philips' face as he explained that the university's clinic was a two-month elective rotation for a senior resident, adding that it had become a symbolic stepping-stone for being asked to join the staff following completion of the residency.

“Look,” Harper said after a pause, “I've got a lot of patients to see.” Martin realized that instead of making the man relax, his questions were making him more ill-at-ease.

“Just one more thing,” said Philips. “When a Pap smear is reported as atypical, what's usually done?”

“That depends,” said Harper warily. “There're two categories of atypical cells. One is atypical but not suggestive of tumor, whereas the other is atypical and suggestive of tumor.”

“Whether it's in either class, shouldn't something be done? I mean, if it's not normal, it should be followed up. Isn't that right?”

“Yeah,” said Harper evasively. “Why are you asking me these questions?” He had the distinct feeling he was being backed into a corner.

“Just out of interest,” said Martin. He held up Collins' chart. “I've come across several patients who'd had atypical Pap smears in this clinic. But reading the GYN notes, I can't find any reference to Schiller's test, thoughts about a biopsy, or colposcopy . . . just repeat smears. Isn't that . . . irregular?” Philips eyed Harper, sensing his discomfort. “Look, I'm not here casting any blame. I'm just interested.”

“I couldn't say anything unless I saw the chart,” said Harper. He'd intended the comment to end the conversation.

Philips handed Collins' chart to Harper and watched as the resident opened it. When Harper read the name, “Katherine Collins,” his face became tense. Martin watched curiously as the man rapidly flipped through the chart, too quickly to read anything adequately. When he got to the end, he looked up and handed it back.

“I don't know what to say.”

“It is irregular, isn't it?” asked Martin.

“Put it this way: It's not the way I'd handle it. But I've got to get back to work now. Excuse me.” He pushed past Philips, who had to press up against the wall to give him room to go by.

Surprised at the precipitous end to the conversation, Martin watched the resident hurry into one of the examining rooms. Philips had not intended his questions to be taken personally and he wondered if he had sounded more accusatory than he realized. Still the resident's response when he had opened Katherine Collins' chart had been strange. Philips had no doubt about that.

Believing there was no point in trying to talk further with Harper, Martin went back out to the receptionist and inquired after Kristin Lindquist. Ellen
Cohen at first acted as if she hadn't heard the question. When Philips repeated it, she snapped that Miss Lindquist was with the nurse and would be out shortly. Having not liked Kristin initially, the receptionist hated her even more now that Philips seemed interested in her. Unaware of Ellen Cohen's jealousies, Martin just felt incredibly confused about the university's GYN clinic.

A few minutes later, Kristin came out of the examining room, aided by a nurse. Martin had seen the nurse before, probably in the cafeteria, remembering her thick black hair, which she wore piled on her head in a tight bun.

He stood up as the woman approached the desk and heard the nurse instruct the receptionist to give Kristin an appointment in four days. Kristin looked very pale.

“Miss Lindquist,” Martin called. “Are you finished?”

“I think so,” said Kristin.

“How about that X ray?” asked Philips. “Do you feel up to it?”

“I think so,” managed Kristin, again.

Suddenly the black-haired nurse strode back to the desk. “If you don't mind my asking, what kind of X ray are you talking about?”

“A lateral skull film,” said Martin.

“I see,” said the nurse. “The reason I ask is that Kristin has had an abnormal Pap test and we'd prefer she avoid abdominal or pelvic films until her Pap smear status is normal.”

“No problem,” said Philips. “In my department we're only interested in the head.” He'd never heard of such an association between Pap smears and diagnostic X rays, but it sounded reasonable.

The nurse nodded, then left. Ellen Cohen slapped
an appointment card in Kristin's waiting hand before turning and pretending to busy herself with her typewriter. “California slut,” she muttered under her breath.

Martin guided Kristin away from the bustle of the clinic and led her through a connecting door into the hospital proper. Once the fire door had been passed, the scene looked very pleasant in contrast to the clinic. Kristin was surprised.

“These are private offices for some of the surgeons,” explained Philips as they walked down a long carpeted hall. There were even oil paintings on the freshly painted walls.

“I thought the whole hospital was old and decayed,” said Kristin.

“Hardly.” An image of the subterranean morgue flashed through Philips' mind, immediately merging with his recent vision of the GYN clinic. “Tell me, Kristin, as a patient, how do you find the university's clinic?”

“That's a difficult question,” said Kristin. “I hate gynecology appointments so much that I don't think I can give a fair answer.”

“How does it compare with your past experience?”

“Well, it is terribly impersonal, at least it was yesterday when I saw the doctor. But today I only saw the nurse and it was better. But then again I didn't have to wait today like I did yesterday, and all they did was draw more blood and recheck my vision. I didn't have another exam. Thank God.”

They reached the elevator area and Philips pressed the button.

“Ms. Blackman also had the time to explain my Pap smear. Apparently it wasn't bad. She said it was only Type II, which is common and almost reverts to
normal spontaneously. She told me it was probably caused by cervical erosion and that I should use a weak douche and avoid sex.”

Martin was momentarily nonplussed at Kristin's forthrightness. Like most physicians, he was surprisingly unaware that his being a doctor encouraged people to make their secrets accessible.

Arriving in X-ray, Philips sought out Kenneth Robbins and put Kristin in his hands for the single lateral skull film he wanted. Since it was after four, the department was relatively quiet and one of the main X-ray rooms was empty. Robbins took the X ray and disappeared into the darkroom to load the film into the automatic developer. While Kristin waited, Martin stationed himself at the slot in the main hall where the film would emerge.

“You look like a cat watching a mouse hole,” said Denise. She'd come up behind Philips and surprised him.

“I feel like one. Down in GYN I found a patient with similar symptoms to Marino and the others and I'm holding my breath to see if there's the same radiological picture. How did your angiograms go this afternoon?”

“Very well, thank you. I appreciate your letting me work on my own.”

“Don't thank me. You earned it.”

At that moment the tip of Kristin's X ray appeared, then oozed out of the roller, dropping into the holding bin. Martin snatched it up and put it on the viewer. His finger scanned back and forth in an area approximately over Kristin's ear.

“Damn,” said Philips. “It's clear.”

“Oh come on!” protested Denise. “Don't tell me you actually want the patient to have the pathology.”

“You're right,” said Martin. “I don't mean to wish it on anyone. I just want a case that I can X-ray properly.”

Robbins stepped out of the darkroom. “You want any more films, Dr. Philips?”

Martin shook his head, took the X ray and walked into the room where Kristin was waiting. Denise followed.

“Good news,” said Philips, waving the film. “Your X ray is normal.” Then he told Kristin that perhaps they should repeat it in a week if her symptoms persisted. He asked her for her phone number and gave her his direct-dial number in case she had any questions.

Kristin thanked him and tried to stand. Immediately she had to support herself by grabbing the X ray table as a wave of dizziness hit her. The room seemed to spin in a clockwise direction.

“Are you all right?” Martin asked, holding her arm.

“I think so,” said Kristin, blinking. “It was that same dizziness. But it's already gone.” What she didn't say was that she again smelled the familiar obnoxious odor. It was too bizarre a symptom for her to share. “I'll be all right. I think I'd better get home.”

Philips offered to get her a taxi but she insisted she was all right. As the elevator door closed she waved and even managed a smile.

“That was a very clever way to get an attractive young woman's phone number,” said Denise, as she walked back to Philips' office. Rounding the corner, Martin was relieved when he saw that Helen had left. Denise took one look in his room and gasped in disbelief. “What the hell?”

“Don't say anything,” said Philips, making his way through the debris to his desk. “My life is disintegrating and smart comments are not going to help.”
He picked up the messages Helen had left. As he had expected, there were calls marked important from Goldblatt and Drake. After staring at them for a minute, he allowed the two pieces of paper to waft in a gentle spiral into his large institutional wastebasket.

Then he turned on the computer and fed in Kristin's skull film.