A Brain (8 page)

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.

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.”

Philips closed his eyes and massaged his temples. More medical students! That was all he needed! Christ!

“And the last thing,” said Helen, heading for the door. “Mr. Michael Ferguson called from Administration to say that the room we're using for supplies has to be vacated. They need it for social service.”

“And what, pray tell, are we supposed to do with the supplies?”

“I asked the same question,” said Helen. “He told me you knew all along that space wasn't allocated to Neuroradiology, and that you'd think of something. Well, I'm taking a quick break for lunch. I'll be back shortly.”

“Sure,” said Philips. “Enjoy your lunch.”

Philips waited for a few minutes until his blood pressure fell to normal. Administrative problems were becoming increasingly less tolerable. He walked over to the print-out device and pulled out the report.

Radread, Skull I

 

Marino, Lisa

 

Clinical information

21-yr-old female with one-year history of temporal lobe epilepsy. A single left lateral projection presented from a portable X ray unit. The projection appears to be approximately eight degrees off from true lateral. There is a large lucency in the right temporal region representing an area devoid of bone. The edges of this area are sharp suggesting an iatrogenic origin. This impression is confirmed by a heavy soft tissue area below the bony defect suggesting a large scalp flap. X ray is most likely an operative X ray. Numerous metallic bodies are noted representing surface electrodes. Two narrow cylindrical metallic electrodes appear to be depth electrodes in the temporal lobe, most likely positioned in the amygdala and hippocampus. Brain densities show fine linear variations in the occipital, mid-parietal, and lateral temporal lobes.

 

Conclusion

Operative X ray with large bony defect in the right temporal region. Multiple surface electrodes and
two depth electrodes. Widespread density variations of an unprogrammed nature.

 

Recommendations

Anterio posterior and oblique projections as well as CAT scan recommended for better characterization of the linear density variations and for localization of depth electrodes. Angiographic data recommended to associate position of depth electrodes with major vessels. ****Program requests insertion in central memory unit of the significance of linear density variations.

Thank you and please
send check to
William Michaels, Ph.D.,
and Martin
Philips, M.D.

Philips couldn't believe what he'd just read. It was good; it was better than good, it was fantastic. And with the little piece of humor at the end, it was overwhelming. Philips went back over sections of the report. It was extraordinarily difficult for him to believe that he was reading a report that came from their machine and not another neuroradiologist. Even though the unit had not been programmed for craniotomies, it seemed to have been able to reason with the information it had and come up with the right answer. And then there was the part about density variations. Philips had no idea what that was.

Fetching Lisa Marino's X ray from the laser scanner, Philips put it up on a viewer. He began to feel a little alarmed when he didn't see the variations the printout suggested. Maybe their new method of dealing with densities, which had been the stumbling block from the beginning, was not any good after all.
Philips activated his alternator and X rays flashed by on the screen until he found Lisa Marino's angiogram study. He stopped the alternator and took off one of her earlier lateral skull films. Putting it up next to the operative X ray, he again looked for density variations as described in the printout. To his disappointment the X ray looked normal.

The door to his office opened and Denise Sanger walked in. Philips smiled but then went back to what he was doing. Folding a sheet of paper in half, he cut out a tiny piece. When he opened the paper, there was a small hole in the center.

“So,” Denise said, putting her arms around him for a hug, “I see you've been busy in here making cutouts.”

“Science advances in strange and wondrous ways,” said Philips. “A lot has happened since I saw you this morning. Michaels delivered our first skull-reading unit. Here's the first printout.”

While Denise read it, Philips placed the sheet of paper with the hole in it against Lisa Marino's X ray on the viewer. What the paper did was eliminate all the other complicated aspects of the X ray film except the small section visible through the hole. Martin studied the tiny area very carefully. Taking the paper away he asked Denise if she could see anything abnormal. She couldn't. When he put the paper back she still couldn't, until he pointed to some minute white flecks oriented linearly. Taking the paper away, they could both see it now that their eyes were expecting it.

“What do you think it is?” asked Denise, while she examined the film very closely.

“I haven't the slightest idea.” Philips walked over to the input/output console and prepared the small
computer to accept Lisa Marino's earlier film. He hoped the program would see the same density variation. The laser scanner gobbled up the film with the same relish it had displayed earlier. “But it disturbs me,” added Philips. He stepped back to the input/output unit as it chattered into activity.

“Why?” asked Denise, her face illuminated by the pale light from the X ray viewer. “I think this report is fantastic.”

“It is,” agreed Philips. “That's the point. It suggests that the program can read X rays better than its creator. I never saw those density variations. Reminds me of the Frankenstein stories.” Suddenly Martin laughed.

“Now what's so funny?” asked Denise.

“Michaels! Apparently this thing is programmed so that each time I give it an X ray it tells me to relax while it works. The first time it said have a cup of coffee. This time it says to get a bite to eat.”

“Sounds like a good suggestion to me,” said Denise. “What about that romantic rendezvous you promised in the coffee shop? I don't have much time; I've got to get back to the CAT scanner.”

“I can't leave right now,” said Philips in an apologetic voice. He knew he'd suggested lunch and he didn't want to disappoint her. “I'm really excited about this thing.”

“Okay,” said Denise. “But I'm going to grab a sandwich. Can I bring you back something?”

“No thanks,” said Philips. He noticed the output printer was coming alive.

“I'm really glad that your research is going so well,” she said at the door. “I know how important it is for you.” Then she was gone.

As soon as the output printer stopped, Philips
pulled out the sheet. Like the first one, the report was very complete, and to Philips' delight, the computer again described the density variation and recommended more X rays from different angles as well as another CAT scan.

Throwing his head back, Philips whooped with excitement, pounding the counter top as if it were a kettledrum. A few of Lisa Marino's X rays slipped out from under the retaining clips and fell from the viewer screen. As Philips turned and bent down to pick them up, he spotted Helen Walker. She was standing by the door, watching him as if he were crazy.

“Are you all right, Dr. Philips?” asked Helen.

“Sure,” said Martin, feeling his face redden as he retrieved the X rays. “I'm fine. Just a little excited. I thought you were going to lunch?”

“I've been,” said Helen. “I brought a sandwich back to eat at my desk.”

“How about getting William Michaels on the phone for me.”

Helen nodded and disappeared. Philips put the X rays back up. Looking at the subtle white flecks, he pondered what it could mean. It didn't look like calcium, and it was not oriented in a pattern like blood vessels. He wondered how he could go about determining if the changes were in the gray matter or cellular area of the brain called the cortex, or if they were in the white matter or fiber layer of the brain.

The phone buzzed and Philips reached over and picked up the extension. It was Michaels. Philips' excitement was obvious as he described the program's incredibly successful performance. He said it seemed able to pick up a type of density variation that had
been previously missed. He spoke so quickly that Michaels had to ask him to slow down.

“Well, I'm glad it's working as well as we expected,” said Michaels, when Martin finally paused.

“As well as expected? It's more than I ever hoped.”

“Fine,” said Michaels. “How many old X rays have you run?”

“Really only one,” admitted Martin. “I ran two, but they were both from the same patient.”

“You've only run two X rays?” said Michaels, disappointed. “I hope you didn't wear yourself out.”

“All right, all right. Unfortunately I don't have much time during the day to spend on our project.”

Michaels said he understood, but implored Philips to run the program against all the skull films he'd read in the last few years, rather than being sidetracked by one positive finding. Michaels emphasized anew that at this juncture of their work, eliminating false negative readings was the most important task.

Martin continued to listen, but he couldn't stop studying the spidery density changes on Lisa Marino's X ray. He knew she was a seizure patient and his scientific mind quickly asked if there could be an association between the seizures and these subtle findings on the X ray. Perhaps they represented some diffuse neurological disease . . .

Philips terminated the conversation with Michaels with a new sense of excitement. He'd remembered that one of Lisa Marino's tentative diagnoses was multiple sclerosis. What if he'd stumbled on a radiological diagnosis for the disease? It would be a fantastic find. Doctors had been looking for laboratory diagnosis of multiple sclerosis for years. Martin knew he had to get more X rays and a new CAT scan on Lisa Marino. It wasn't going to be easy since she'd
just been operated on, and he'd have to get Mannerheim's approval. But Mannerheim was research-oriented and Philips decided to approach him directly.

He yelled through the door for Helen to get the neurosurgeon on the phone and went back to Lisa Marino's X ray. In radiological terms the density changes were called reticular although the fine lines seemed to be parallel rather than net-like. Using a magnifying glass, Martin wondered if nerve fibers could be responsible for the pattern he was seeing. That idea didn't make sense because of the relatively hard X rays that had to be used to penetrate the skull. His train of thought was interrupted by the buzzer. Mannerheim was on the phone.

Philips began the conversation with some usual pleasantries, ignoring the recent episode about the X rays in the OR. With Mannerheim it was always better to let such encounters slide. The surgeon seemed peculiarly silent so Martin continued, explaining that he was calling because he'd noticed some peculiar densities on Lisa Marino's X rays.