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.
Chapter 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."
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 majorvessels. ****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.