At one of the terminals of the hospital's central computer he painfully typed out what he wanted: a printout of the names and unit numbers of all patients having had skull X rays in the last ten years. When he was finished he pushed the "enter" button and swung around in the chair to face the output printer. There was a short delay. Then the machine spewed out paper at an alarming rate. When it finally stopped, Philips found himself holding a list of thousands of names. Just looking at it made him feel tired.
Undaunted, he sought out Randy Jacobs, one of the department's evening employees, hired to file the day's X rays and pull the films needed for the following day. He was a full-time pharmacy student, a talented flautist, and an out-of-the-closet gay. Martin found him sharp-witted, ebullient, and a fabulous worker.
To start, Martin asked Randy to pull the X rays on the first page of the list. That represented about sixty patients. With his usual efficiency, Randy had twenty lateral skull films on Philips' alternator in as many minutes. But Philips did not run the films on the computer as Michaels had asked. Instead he began to examine them closely, unable to resist the temptation to look for more of the abnormal densities he had discovered on Marino's and Lucas's X rays. Using his paper with the hole as a screening device, he began to go from one film to another, advancing the viewing screens as needed by depressing the electrical lever with his foot. He'd processed about half of the X rays when Denise arrived.
"All your big talk about wanting to leave clinical radiology and you're looking at X rays when it's almost midnight."
"It is a bit silly," said Martin, leaning back in his chair and rubbing his eyes with his knuckles, "but I had these old films pulled and I thought I'd check to see if I could find another case like Lucas or Marino."
Denise came up behind him and rubbed his neck. His face looked tired.
"Have you found any?" she asked.
"No," said Philips. "But I've only looked at a dozen or so films."
"Have you narrowed down your field?"
"What do you mean?"
"Well, you've seen two cases. Both are recent, both are women, and both are about twenty."
Philips looked at the row of films in front of him and grunted. It was his way of acknowledging that Denise had a good point without saying so. He wondered why he hadn't thought of it himself.
She followed him back to the main computer terminal maintaining a steady stream of commentary about the busy evening in the ER. Philips listened with half an ear while he made his entry. He asked for the names and unit numbers of female patients, aged fifteen to twenty-five, who'd had skull films within the last two years. When the output printer came alive it only typed one line. It told Philips that the data bank was not keyed to retrieve skull films by sex. Philips adjusted his demand on the keyboard. When the printer reactivated, it typed at a vicious rate, but only for a short interval. The list comprised only a hundred and three patients. A quick scan suggested that somewhat less than half were female.
Randy liked the new list. He said the size of the other was demoralizing. While they waited, he pulled seven envelopes saying it would give them something to start with while he gathered the others.
Back in his office, Martin admitted that he was beat and that fatigue was beginning to erode his enthusiasm. He dropped the X rays in front of his alternator and put his arms around Denise, pressing her against him. His head dropped over her shoulder. She hugged him back, her hands just beneath his shoulder blades. They stood there for a moment supporting each other, not speaking.
Finally Denise looked up into Martin's face and pushed his blond hair from his forehead. His eyes were closed.
"Why not call it a day," she said.
"Good idea," said Philips, opening his eyes. "Why don't you come on back to my apartment? I'm still a bit manic; I need to talk."
"Talk?" asked Denise.
"Whatever."
"Unfortunately, I'm certain I'll be called back to the hospital."
Philips lived in an apartment building called the Towers, which had been built by the Med Center and was contiguous with the hospital. Although it had been designed with very little creativity, it was new, safe, and superbly convenient. It was also built on the river and Martin had one of the riverside units. Denise, on the other hand, lived in an old building on a cluttered side street. Her apartment was on the third floor and its windows faced a forever dark air shaft.
Martin pointed out that his apartment was as close to the hospital as the on-call room in the nurses' quarters, which was available for Denise's use, and three times closer than her own apartment. "If you get called, you get called," he said.
She hesitated. Seeing each other while she was on call was a new experience and Denise was afraid that escalating the relationship was going to force a decision.
"Maybe," she said. "First, let me check the ER and make sure there aren't any problems brewing."
While he waited for her, he began putting some of the new X rays on his viewer. He had three of them up before his eyes were pulled back to the first. Leaping from his chair, he put his nose to the film. Another case! There was the same speckling starting in the very back of the brain and running forward. Philips looked down at the envelope. The name was Katherine Collins, age twenty-one. The typed X-ray report glued to the envelope listed "seizure disorder" as the clinical information.
Taking Katherine Collins' X ray back to the small computer, he fed it to the scanner. Then he grabbed the remaining four envelopes and extracted a skull film from each. He began putting them on his viewer, but before his hand even left the edge of the first film, he knew he'd found yet another case. His eyes were now very sensitized to picking up the subtle changes. Ellen McCarthy, age twenty-two, clinical information: headaches, visual disturbance, and weakness of right extremities. The other films were normal.
Using a matched pair of lateral skull films from Ellen McCarthy's envelope, that had been taken at slightly different angles, Philips switched on the light in his stereo viewer. Looking through the eyepiece, he had great difficulty perceiving any speckling at all. What he could see seemed to be superficial, in the cerebral cortex rather than deeper in the nerve fibers of the white matter. That was somewhat disturbing information. The lesions of multiple sclerosis were usually in the white matter of the brain. Tearing off the printout from the computer, Philips read the report. At the top of the page was a THANK YOU referring to when Philips had inserted the film. This was followed by a girl's name and a fictitious phone number. It was more of Michaels' humor.
The report itself was just as Philips expected. The densities were described and as it had with Lynn Anne Lucas, the computer asked again to be advised as to the significance of the un-programmed abnormalities.
Almost simultaneously Denise returned from the ER and Randy arrived with fifteen more envelopes. Philips gave Denise a resounding kiss. He told her that thanks to her suggestion he'd found two more cases, both young women. He took the new films from Randy and was about to start on them, when Denise put her hand on his shoulder.
"The ER is quiet now. An hour from now, who knows?"
Philips sighed. He felt like a child with a new toy being asked to abandon it for the night. Reluctantly he put the envelopes down and told Randy to pull the rest of the films from the second list and stack them on his desk. Then if he had any time left he could begin pulling the films from the main list, and stack them against the back wall, behind the worktable. As an afterthought Martin asked Randy to call Medical Records and have the hospital charts of Katherine Collins and Ellen McCarthy sent up to his office.