Dr. Huggens nodded, but it was apparent that Lynn Anne's symptoms were not falling into any simple category. "Anything else?"
"Some dizziness, and my legs feel heavy, and it's happening mere often now, almost every time I try to read."
Dr. Huggens put down the chart and examined Lynn Anne. He looked into her eyes and ears; he looked into her mouth and listened to her heart and lungs. He tested her reflexes, had her touch things, walk in a straight line, and remember sequences of numbers.
"You seem pretty normal to me," said Dr. Huggens. "I think maybe you should take two doctors and come back and see us in the aspirin." He laughed at his own joke. Lynn Anne didn't laugh. She had decided she wasn't going to be brushed off that easily, especially after waiting so long. Dr. Huggens noticed she wasn't responding to his humor. "Seriously. I think you should take some aspirin for symptomatic relief and come back to Neurology tomorrow. Maybe they'll be able to find something."
"I want to see Neurology now," said Lynn Anne.
"This is an emergency room, not a clinic," said Dr. Huggens firmly.
"I don't care," said Lynn Anne. She shielded her emotions with defiance.
"Okay, Okay!" said Dr. Huggens. "I'll get Neurology. In fact I'll get Ophthalmology too, but it might be a wait."
Lynn Anne nodded. She was afraid to talk for the moment lest her defense dissolve to tears.
And a wait it was. It was after six when the curtain was pulled aside again. Lynn Anne looked up into the bearded face of Dr. Wayne Thomas. Dr. Thomas, a black from Baltimore, surprised Lynn Anne, who had never been treated by a black doctor. But she quickly forgot her initial reaction and responded to his exacting questions.
Dr. Thomas was able to uncover several more facts he felt were significant. About three days previously Lynn Anne had had one of her "episodes" as she called them, and had immediately jumped up from her bed where she had been reading. The next thing she remembered was that she "came to" on the floor, having fainted. Apparently she had hit her head, because she had suffered a large lump on the right side of her scalp. Dr. Thomas also learned that Lynn Anne had had two atypical Pap smear tests and was currently scheduled to return to GYN clinic in a week. She also had had a recent urinary-tract infection successfully treated with sulfur.
After finishing the history, Dr. Thomas called in an LPN and did the most complete physical examination Lynn Anne had ever had. He did everything Dr. Huggens did and more. Most of the tests were a total mystery to Lynn Anne, but his thoroughness encouraged her. The only test she disliked was the lumbar puncture. Curled up on her side with her knees to her chin, she felt a needle pierce the skin of her lower back, but it only hurt for a moment.
When he finished, Dr. Thomas told Lynn Anne that he wanted to take some X rays to make sure she had not fractured her skull when she had fallen. Just before he left her he told her that all he found during the examination was that certain areas of her body seemed to have lost sensation. He admitted that he didn't know if it was significant or not. Lynn Anne waited again.
"Can you believe it?" asked Philips while he shoved more turkey tetrazzini into his mouth. He chewed quickly and swallowed. "Mannerheim's first OR death and it has to be a patient I wanted more film on."
"She was only twenty-one, wasn't she?" said Denise.
"That's right." Martin put more salt and pepper on his food to give it some taste. "Tragedy, actually a double tragedy since I can't get those films."
They had taken their hospital cafeteria trays to the farthest corner from the steam table, trying to isolate themselves as much as possible from the institutional environment. It was difficult. The walls were painted a dirty mustard; the floor was covered with gray linoleum; and the molded plastic chairs were an awful yellow-green. In the background the hospital paging system maintained a steady monotone of doctors' names and the extension number they were to call.
"Why was she having the surgery?" asked Denise, picking at her chef's salad.
"Seizure disorder. But the interesting thing was that she might have had multiple sclerosis. After you left this afternoon, it occurred to me that the density changes we saw on her X ray might represent some sort of widespread neurological disease. I checked her chart. Multiple sclerosis was being considered."
"Have you pulled any films of patients with known multiple sclerosis?" asked Denise.
"That starts tonight," said Philips. "In order to check Michaels' program I've got to run as many skull films as possible. It will be very interesting if I can find any other cases with the same radiologic picture."
"It sounds as if your research project has really taken off."
"I hope so." Martin took one bite of his asparagus and decided against taking any more. "I'm trying not to let myself get too excited this early, but, my God, it looks good. That's why I got so excited about this Marino case. It promised something immediately tangible. Actually there's still a chance. She's being autopsied tonight, so I'll try to correlate the radiological picture with the Path findings. If it is multiple sclerosis, we're back in the ball game. But I tell you, I've got to find something to get me away from this clinical rat race, even if it's only a couple of days a week."
Denise put down her fork and looked into Martin's reitless blue eyes. "Get away from clinical? You can't do that. You're one of the best neuroradiologists there is. Think of all the patients that benefit from your skills. If you leave clinical radiology, that will be a real tragedy."
Martin put down his fork, and grasped her left hand. For the first time he didn't care who in the hospital might be watching. "Denise," he said softly. "At the present time in my life there are only two things I really care about: you and my research. And if there were some way I could make a living out of being with you, I might even forget the research."
Denise looked at Martin uncertain whether to be flattered or wary. She'd become more and more confident of his affection but she had no idea that he had even the potential for commitment. From the beginning she'd been awed by his reputation and seemingly encyclopedic knowledge of radiology. He had been both a lover and professional idol and she hadn't allowed herself the thought that maybe their relationship had a future. She wasn't sure she was ready for it.
"Listen," Martin continued. "This is neither the time nor the place for this kind of conversation." He pushed his asparagus out of the way as if to make a point. "But it's important that you know where I'm coming from. You're at an early stage in your clinical training, which is very fulfilling. You spend all your time learning and dealing with patients. Unfortunately I spend the smallest part of my time doing that. The major part is spent trying to handle administrative headaches and bureaucratic bullshit. I've had it up to here."
Denise raised her left hand, which was still firmly grasped in his, and lightly brushed his knuckles with her lips. She did it quickly, then looked at him from under her dark eyebrows. She was being purposefully coquettish, knowing that it would defuse his sudden anger. It worked as it usually did and Martin laughed. He squeezed her hand before letting go, then glanced around to see if anyone had seen.
His beeper shocked them both as it went off. He got up immediately and strode over to the hospital phones. Denise watched him. She had been attracted to him since they met, but she found herself increasingly drawn by his humor and surprising sensitivity, and now his new admission of dissatisfaction and vulnerability seemed to heighten her feelings.
But was it true vulnerability? Was Philips' excuse about administrative burdens only a rationalization to explain a dissatisfaction with having to grow older, and having to admit that, professionally speaking, his life had become predictable? Denise didn't know. As long as she had known Martin, he'd always approached his work with such compulsion that she'd never considered the possibility of dissatisfaction, but she was moved that he would share his feelings with her. It must mean he believed their relationship was more important than she thought he had.