"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 of 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.
"I think these densities should be explored and I'd like to get more skull films and another CAT scan as soon as the patient can tolerate it. That is, of course, if you agree."
An uncomfortable pause followed. Philips was about to speak when Mannerheim snarled, "Is this some kind of a joke? If it is, it's in very bad taste."
"It's no joke," said Martin, bewildered.
"Listen," shouted Mannerheim. His voice was rising, "It's a bit late for Radiology to be reading X rays now. Christ!"
There was a click and a dial tone. Mannerheim's egocentric behavior seemed to have reached new heights. Martin hung up the phone, thinking. He knew he couldn't let his emotions intervene; besides, there was another approach. He was aware that Mannerheim didn't follow his post-op patients that carefully, and that it really was Newman, the Chief Resident, who was responsible for their day-to-day management. Martin decided to get in touch with Newman and see if the girl was still in the recovery room.
"Newman?" asked the OR desk. "He's been gone for some time."
"Oh!" said Philips. He switched the phone to the other ear. "Is Lisa Marino still in the recovery room?"
"No," said the OR desk. "Unfortunately she never made it."
"Never made it?" Philips suddenly comprehended Marmerheim's behavior.
"Died on the table," said the nurse. "Tragedy, especially since it was Mannerheim's first."
Philips turned back to his viewer. Instead of seeing Lisa Marino's X ray, he saw her face as it had been that morning in the patient-holding area outside of surgery. He remembered his image of a bird without its feathers. It was disturbing and Philips forced his attention back to the X ray. He wondered what could have been learned. Impulsively Martin slid off his stool. He wanted to go over Lisa Marino's chart; he wanted to see if he could associate the pattern on the X ray with any clinical signs and symptoms of multiple sclerosis in Lisa Marino's neurological workup. It wouldn't take the place of more X rays, but it was something.