Alan Stevens and the other technicians had convinced the administrator that the Crays' brains and cojones were in no danger from the MR and CT scanners; Alan had shown how the basement imaging complex would be electromagnetically isolated from the rest of the world, literally a room within a room. When Dr. Mauberly had still hesitated, Alan brought in the pathologists and ClassVI Biolab glamour boys. The MR and CT equipment might not be necessary for living patients, they pointed out, but it was absolutely vital for the corpsesboth human and animalthat were the raison d'etre of Pathology and Biolab's daily toil. Mauberly had agreed.
Alan met Kate in the basement hallway between the imaging and sealed lab centers. Joshua had been here before and was not afraid of it, although this time there was a nasty surprise as RN Teri Halloway was waiting in the imaging room with an i.v. tube and needle. Joshua wailed as the needle was inserted on the inside of his skinny arm. Kate tried not to wince. She would have handled the transfusion herself, but Teri had a gentler touch. Sure enough, Joshua quit crying after only a Pro forma protest and lay back blinking. Alan and Kate helped set him onto the imaging palette, setting his head firmly in place with pillows and strips of broad tape, also taping his wrists to the pillows. It was disturbing to see, but they could not run the risk of the baby turning and moving during the imaging sequence. Not only would it ruin the CT pictures, but it would dislodge the biosensors Teri was setting in place so they would monitor realtime physiological changes. Kate leaned over and cooed to Joshua during the entire preparation, having his favorite stuffed animala Pooh bear with one eye missingtalk and play with him. He barely seemed to notice when Teri pricked his finger for the first of many blood tests. The nurse nodded at Kate, smiled at Joshua, and hurried off to the adjoining lab.
Finally Kate tucked Pooh in next to her son and left the room. Airlockstyle doors slid shut behind her. She joined Alan at the bank of video monitors.
“Is his runny nose just from crying or have the flu symptoms returned?” asked Alan.
“The last three or four days,” said Kate. “The diarrhea's back, too.”
Alan nodded and pointed toward the biosensor readout. “His temperature is closing in on a hundred. And look at the results of the first test Teri took.”
Kate was looking. Data from the lab was fed directly through to the MR/CT control room. According to the first test, Joshua was showing the characteristic SCID shortage of white blood cellsthe WBC count was at 930 lymphocyte/ Rlas well as the classic drop-off in Tcell, Bcell, and gammaglobulin levels. More than that, liver enzymes were elevated and there were indications of an electrolyte imbalance.
“Look like GVH problems to me,” said Alan.
Kate tapped a pencil against her teeth. “Yes, except it's been almost a month since the last transfusion, and he showed no graftversushost rejection then. It's not the new blood his body has trouble with . . . it's his own system he seems to want to reject.” She glanced at the monitor. Joshua seemed frail and insignificant strapped into his imaging cradle. She could see his mouth move as he cried, but there was no sound. Kate switched on the audio pickup and keyed the microphone so that he could hear her. “It's all right . . . Mama's right here . . . It's all right.”
She nodded at Alan. “Let's do it and get him out of there.”
Alan's fingers played the console as if it were a Wurlitzer keyboard. Joshua's imaging palette slid him into the CT torus, and Kate had the surreal sense that he was a tiny, human artillery shell being loaded into the breech of a plastic cannon. She watched as the display showed that the i.v.drip had been opened to the whole blood, then as the biosensors began to relay Joshua's body's response to it. Threedimensional images of his liver, spleen, and abdominal lymph nodes began to build up on the monitors.
“To do this right,” said Alan, his eyes moving from monitor to monitor, “we should scan his spleen using 99mTc colloid or heatdamaged red blood cells so we could get a detailed fix on any functioning splenic tissue.”
“Too invasive,” snapped Kate. Her eyes stayed glued to the biosensor columns. “We'll stick to the CT, MR, and ultrasound,” she added, her voice softer. “I don't want him to go through any more than he absolutely has to.”
Alan nodded agreement. “OK,” he said, “coming up to the scan of stomach wall . . . right . . . here. “
Kate leaned over, stared at the central monitor, and frowned. “I don't see the abnormality we found last time.”
“The CT can't pick up anything less than two centimeters,” said Alan. “At this point we're dealing with a slightly fibrous mass, smaller and less dense than most tumors. Ultrasound isotopic imaging with 67Ga and “111Inlabeled leukocytes would show it was something worth worrying about, but the CT just gives us the slightest indication of an abscess . . . there, see that shadow?”
Kate did, but only because Alan's finger tapped the monitor at the precise spot. It was the shadow of a shadow. She looked back at the biosensor columns.
“My God,” she whispered, “his temperature is at a hundred and three and rising. Stop the sequence, I've got to get in there.”
Alan grasped her forearm. “No, wait . . . I've got a hunch on this, Kate. We weren't monitoring his temperature last time, just taking pictures. My guess is that whatever's going on with the redistribution of blood to that shadow organ in his stomach wall, it's burning up lots of energy.”
“It's burning him up,” said Kate. “Abort the sequence.”
Alan set his hand above the red master switch, but then raised it and pointed. “Look.”
Joshua's temperature now hovered at 103.5, but the other sensors showed near chaos. His blood pressure spiked, normalized, then spiked again. His heart rate was fifty percent over normal. Skin resistance traced a mountain range of changes.
Kate leaned over the console, her mouth open. “What's happening?”
Alan pushed his glasses higher on his snub nose and pointed to the primary monitor.
The shadow on Joshua's stomach wall had materialized into a veinandcapillaryrich mass. The CT scan showed a nexus of nerves that was almost three centimeters across and growing.
“He's stabilizing,” said Alan, voice tense.
Kate saw that he was right. Temperature, blood pressure, heart rate, and the other vitals were dropping back into the normal range.
“We're finished with the first sequence,” said Alan. The monitor showed the palette sliding out. Joshua was squirming a bit within his restraints, but showed no signs of trauma or discomfort. He was not crying. Alan looked at Kate over the tops of his glasses. “Do you want to go in with Teri for the next round of blood and pictures or shall we scrub this right now?”
Kate hesitated only a second. The mother in her wanted to lift her son out of that torture device now . . . take him home now. The doctor in her wanted to find out what was trying to kill him, and find out now.
“Call Teri,” she said, already heading for the airlock. “Tell her I'll help her draw the next blood sample.”
The three imaging sequences took less than fifty minutes. Joshua had wet his diaperthey'd had a catheter rigged for urine samples but it had overflowedbut other than that and a lot of rage at being restrained for so long, the baby seemed fine as Kate lifted him out and rocked him while Teri and Alan helped detach the biosensors. Teri took the last blood sample, pricking Joshua's big toe again, and the small room echoed to his wails.
As they left the imaging complex, Alan said, “I'll program the entire sequence to deal with different variables and have the enhanced videotapes ready to roll by eight A.M. Shall I start with Tcell rate or the adenosine deaminase curve?”