Brainwaves Page 2

  Shuster looked over at the monitor. The picture showed the tip of the catheter a centimeter away from the blood clot. “Would you like me to accompany the patient back to the I.C.U?”

  “If you would,” Karen said. “And while you’re there, please write the usual orders and start the streptokinase therapy.”

  “The initial bolus injected through the catheter should be twenty thousand units. Right?”

  “Correct. And follow that with a continuous drip of two thousand units a minute for sixty minutes.”

  “Got it.”

  Shuster reached for a pen and wrote down the dosage for the thrombolytic agent, then glanced over at the screen showing the blocked artery. A slow drip of streptokinase might dissolve the clot and restore the blood flow to John Gladstone’s brain, Shuster thought. And if the patient was lucky, his brain tissue would still be viable and he would have return of function. If he was unlucky, his life was about to turn into a never-ending horror show.

  Karen stripped off her gloves and walked over to John Gladstone. “I’ll see you in the I.C.U, Mr. Gladstone. Let’s hope for good things.”

  Gladstone stared up at her. “Who are you?”

  “I’m your doctor,” Karen said simply, and headed for the door.

  “Where am I?” Gladstone called after her.

  As Karen hurried down the deserted corridor, her stomach growled loudly, reminding her that she had skipped both lunch and dinner. She took the elevator to the main floor of the hospital and strode across the lobby, which was empty except for a young Hispanic couple on a couch near the information booth.

  Karen went into a small cafeteria that was kept open for the staff on night call. She picked up a Diet Coke and a tuna sandwich, then returned across the lobby and down a wide corridor. With her back she pushed through a set of double doors and entered a glass-enclosed bridge that connected the main floor of Memorial with the second floor of the Neuropsychiatric Institute. Outside, the night was dark and moonless with a heavy mist rolling in from the sea. Karen groaned to herself, wishing she was home sipping cognac in front of a nice fire. She glanced down at her cold tuna sandwich and cursed under her breath, then walked on.

  At the far end of the bridge an armed guard jumped up from his chair and watched her approach. After a moment he recognized her and waved.

  “Hi, Doc,” the guard said cordially. “Late night, huh?”

  “Aren’t they all?” Karen asked, giving him a half smile.

  “Don’t forget, we lock these doors at midnight.”

  Karen nodded as she went by him, remembering back to a time when the doors were left open twenty four hours a day. But that ended three years ago when a nurse was beaten and raped late at night by an assailant who had gained access to the institute through the glass-enclosed bridge. Now the bridge was guarded from 9 p.m. to midnight, and the doors locked

  securely from midnight to 7 a.m. The only way into the institute after midnight was through the front entrance, where two guards were permanently stationed. Despite these precautions, a breakin had occurred last year. A nurse’s purse and a long list of valuables belonging to patients had been stolen. The campus police never solved the crime, but went out of their way to tell everyone that it had to be an inside job. As if that would give the personnel some comfort. It reassured no one, Karen included.

  She rode the elevator to the tenth floor, where the Brain Research Institute was located. Stepping out of the elevator car, she heard loud conversation and laughter coming from the far end of the well-lighted corridor. For a moment she was uneasy, wondering if she had forgotten some departmental function. No, that wouldn’t be it, she thought. Not this late at night, not at 9:48 p.m. Then she remembered that her colleagues met on Wednesday night to discuss their ongoing research projects. But they never included her. Never.

  Karen flicked her wrist disdainfully, then turned and walked toward her laboratory. For the hundredth time she wondered why her colleagues had never really accepted her as part of the group. Part of the reason was gender-related. She was relatively young and female. They were the kind of men who would never consider a woman their professional equal, regardless of her talent. But the main reason for her exclusion from the group was her independence. From the beginning she had demanded and got her own laboratory, and insisted on doing her own research projects. She would collaborate with the others, but only as their equal. And she refused to become involved in

  experiments that she knew were dead ends. This infuriated her superiors, who preferred that the junior faculty work under them. Gradually she found herself isolated, her research work separate from the others. At times her colleagues barely acknowledged her existence. But that was okay, too. Her research was now going well and the best was yet to come. Screw them,

  she thought bitterly. They can do their work and I’ll do mine.

  Entering her small, darkened laboratory, Karen decided not to turn on the lights. Her technician was gone but had left everything shipshape. The work benches were cleared except for some neatly arranged racks of test tubes. Two small centrifuges were open and airing out. A dim light shone through the glass door of an incubator in the far corner, casting eerie shadows on the wall.

  Karen went into a crowded adjoining office and slumped down wearily into a swivel chair. She turned on a desk lamp, then opened her can of soda and sipped from it. Reaching across from her desk, she switched on a machine with a small screen that was identical to the one she had used in the Angiography Unit. She kicked off a shoe and rubbed a sore bunion as a Technicolor image appeared on the screen. It showed the interior of John Gladstone’s middle cerebral artery. The clot was still present, but Karen thought it might be smaller than before. Just a little smaller. Karen sighed to herself, knowing that if the clot didn’t dissolve within a few hours, it never would. And John Gladstone would never recover. He’d live the rest of his life in the past.

  Karen switched off the monitor and pushed her swivel chair over to an adjacent machine that resembled a television set. Its front was virtually all screen, with the control buttons and dials on the side. Karen pushed a button and the screen lit up instantly. The image looked like falling snowflakes. Then the sound came on loudly. It was all static. She carefully adjusted the dials, but the snowflakes stayed on the screen and the static only got louder.

  Karen leaned back, discouraged by what she saw. Her latest research project had seemingly made a big breakthrough a few days ago, with an earlier patient who received the catheter treatment. She had shrieked, “Eureka!” so loudly, she must have woken up half the hospital. But then the images on the screen had gone blurry, and they’d been blurry ever since. The electrical impulses weren’t sending enough information.

  The telephone on her desk rang. Karen turned down the sound and pushed herself over to the phone. It was Todd Shuster, calling from the I.C.U. John Gladstone was having a seizure.

  “Is it focal or generalized?” Karen asked.

  “Focal,” Shuster answered. “It’s mainly twitches in his right arm.”

  “Have you started the thrombolytic agent?”

  “Twenty minutes ago,” Shuster told her. “He’s now on a continu&us infusion of streptokinase.”

  Karen nervously strummed her fingers on the desktop, carefully considering the diagnostic possibilities. Seizures occurred with either cerebral thrombosis or cerebral hemorrhage, but they were seen far more frequently in patients who had hemorrhaged. She was certain Gladstone had a cerebral thrombosis. That was documented by a CAT scan and by the endoscopic study. But he could still be hemorrhaging around the

  thrombus as a result of the streptokinase injection. One of its side effects was localized bleeding, and if that was the case, John Gladstone could end up dead or a vegetable.

  “Dr. Crandell?” Shuster broke into her thoughts.

  “Is the patient still alert and answering questions?”

  “Just like before.”

  “And what about his right-sided weakness?”

  “That’s unchanged.”

  Karen hesitated again. She considered stopping the streptokinase infusion and getting a repeat CAT scan to determine if hemorrhaging had occurred. But that would take at least an hour and the thrombus would remain in place, blocking all blood flow through the cerebral artery. And that would kill off more brain cells, dooming John Gladstone’s chances of recovery. Karen felt like she was caught between a rock and a hard place. “Is the patient still having seizures?”

  “Not now,” Shuster reported. “We started him on Valium and Dilantin a few minutes ago.”

  “Good,” Karen said. “Keep the streptokinase infusion going, and call me if there’s any change in Mr. Gladstone’s status.”

  “I guess I’d better stick around the I.C.U for the next few hours.”

  “I think that’s a good idea.”

  Karen placed the phone down, still second-guessing herself. Was she putting the patient’s life in danger? Her decision to continue the streptokinase in the face of possible bleeding was risky. Everybody would agree to that. But all of her experience and instincts told her that no hemorrhage had occurred. God! She hoped she was right.

  She glanced over at the unappetizing sandwich on

  her desk and tried to ignore her hunger pangs. But her stomach growled again, so she reached for the sandwich and slowly unwrapped it. She took a small bite and immediately put the sandwich down. The tuna was soggy and tasteless. She decided to pick up fast food on the way home.

  From across the office Karen heard a strange sound. The machine that resembled a television set was no longer emitting garbled static. Now it sounded like a flock of geese. And the picture had changed, too. There was still a snowflake pattern on the screen, but between the white dots Karen thought she saw figures.

  She hurriedly pushed her swivel chair over to the machine and carefully adjusted the controls. A red light blinked. Karen pushed a button and the light turned green. Abruptly the sound sharpened, now clearer and more discernible. It wasn’t geese, Karen thought excitedly. It was people! People were talking! Some words were distinct, others were muffled by a background hum.

  Karen stared at the machine, not believing what she was hearing. It couldn’t be this good. It just couldn’t. She turned the sound up louder and now she could hear sentences. Someone was asking for directions to the nearest subway station.

  Karen could only hope that it wasn’t her imagination playing tricks on her. Or maybe the machine was somehow picking up a radio wave transmission from a local station. Yes, that would explain it. But why would it do it now when it never did it before?

  Quickly she turned her attention to the screen on the machine. She still saw the snowflakes, but the dark figures seemed more pronounced and more numerous. Very slowly Karen adjusted a dial on the side of the machine, and the images brightened and became more distinct. They were people! Men and women were walking briskly down a wide sidewalk.

  Karen’s pulse began to race with excitement. Oh, Lord! Is this really happening? The picture started to blur and darken. Again Karen adjusted the dial. Now she could see the entire sidewalk as well as the adjacent avenue. Traffic was heavy with double-deck buses and scores of black taxis moving slowly along. There was a park of some sort across the way.

  The picture on the screen went off for a moment, then returned, but the images were blurry. Karen again turned a dial and the people reappeared. Now she could see their features very clearly. Most of the men were wearing business suits with striped ties. Some were carrying briefcases, all had umbrellas. Up ahead, people were turning into a large entrance. The sign above it read marble arch station.

  Karen’s jaw dropped as she suddenly realized what she was looking at. The people. The street. The sounds.

  “My God!” she blurted out. “I’ve done it.”

  Karen didn’t see the intruder standing behind her in the shadows, watching her and the picture on the screen. Nor did she hear the swoosh of the blunt weapon that crushed her skull in. Instantly unconscious, Karen slid down in the swivel chair, her bloodied head coming to rest on a chair arm.

  The intruder fumbled with switches and knobs on the machine until he found the one that turned it off. He quickly extinguished the small lamp on the desk, and then, using a pocket flashlight, began searching the drawers. He found nothing in them except for

  pens and stationery and other office supplies. He saw a handheld dictating machine atop the desk and took it. Next he went to the file cabinet in the corner, but its drawers were locked. He cursed under his breath and went back to the desk to look for keys. From down the hall he heard loud conversation coming closer and closer. The intruder crouched down in the darkness and waited. The sound of the conversation drew even closer, then stopped. An elevator door opened and closed. The sounds disappeared.

  The intruder searched the desk drawers for a key to the file cabinet, but couldn’t find it. Then, using a nail file, he tried to pick the lock but was unsuccessful. Again he heard the sound of conversation in the corridor.

  The intruder quickly reached down and reset the woman’s wristwatch before smashing it with his weapon. As he leaned over to lift up the woman, he saw a word processor on a small table against the wall. He smiled and walked over to it. There was one more thing he wanted to do before he threw Karen Crandell to her death.

  2

  Her name was Elizabeth Ryan. She was twenty-eight years old with soft features, pale blue eyes, and perfectly contoured lips. Her hair had been shaved off, her skull surgically opened. She had died in the operating room the day before.

  Dr. Dan Rubin, a neurosurgery intern, looked down at the corpse and remembered the first time he had seen her. She was so elegant and charming, with no outward signs of the brain tumor that would soon kill her. He studied her marble white skin, now cold as ice, and thought again how tragic it was when young people died. It seemed so damn unfair. But then, life wasn’t fair. He had learned that the hard way.

  Rubin gazed around the brightly lighted autopsy room with its white tile walls and eight stainless steel tables lined up in rows of two. He couldn’t understand why anyone would choose to become a pathologist and be constantly surrounded by death and decay. He glanced at the corpses on the tables and the pathologists dissecting them. The work appeared so tedious to Rubin. It was the exact opposite of the excitement and drama created daily in the operating room. And that’s where Rubin wanted to be now. The

  only reason he was here for the autopsy was a hard and fast rule laid down by Dr. Christopher Moran, the chief of neurosurgery at Memorial. Whenever one of Moran’s patients died, a member of his surgical team had to attend the autopsy to answer any questions and, more important, to learn the cause of death and report it immediately to Moran.

  Rubin looked at the wall clock: It was 10:02. If the autopsy moved along quickly, he might have time to scrub up for the rhizotomy that Dr. Moran was scheduled to do at noon.

  Rubin turned as a woman wearing a green scrub suit approached. She was young and petite, with long auburn hair, green eyes, and a flawless complexion except for freckles scattered across her nose and cheeks. Rubin cleared his throat. “Are you Dr. Blalock?”

  “No,” Lori McKay said, smiling up at him. “I’m Dr. McKay, an associate of Dr. Blalock.”

  “I’m Dan Rubin,” he said, realizing how foolish his question was. Joanna Blalock was director of forensic pathology at Memorial. She wouldn’t be a twenty something-year-old with freckles.

  Lori moved in closer and studied the name tag pinned to Rubin’s scrub suit. “You’re the surgery intern, huh?”

  “Right,” Rubin answered, wondering what position this woman held in the department. Probably a postdoctoral fellow. She was too young to be on the staff. “Have you been working down here long?”

  Lori’s eyes narrowed. She hated it when people judged her by her youthful appearance. “I’m an assistant professor, and I’ve been on the faculty for four years. Is that long enough?”

  “I guess so,” Rubin said, ignoring the sharpness in her voice.

  “Well, now that we have that out of the way, let’s look at your patient.”

  Lori slipped on a pair of latex gloves, carefully wiggling her ringers in. With her peripheral vision she continued to study the surgery intern. He was older than most of the house staff—at least in his mid thirties, and handsome with a square jaw and wavy brown hair. And no wedding band on his ring finger. She turned back to the corpse, eyeing first the surgical window in the skull and the glistening brain beneath it. “As I understand it, she died just as the surgery was beginning.”

  Rubin nodded. “We were mapping the brain to determine how much tissue around the tumor could be safely resected. We had just put in the final metallic clips.”

  Lori had seen the mapping procedure done on several occasions while she was in medical school. She shivered to herself, remembering how it was performed. With the patient awake and under local anesthesia, an electrical stimulator was applied to various areas adjacent to the tumor in order to determine what those particular parts of the brain did. Lori recalled one patient with a temporal lobe tumor who was reciting the names of his children. When an area near the superior aspect of the temporal lobe had been stimulated, his speech became garbled and he could no longer remember names. This indicated that that particular area was important to speech and memory, and thus could not be surgically removed. The procedure had seemed so barbaric to Lori back then, but it was the only way to accurately construct a

  map that set the boundaries on what could and could not be resected. The procedure was considered safe with no real dangers. But like everything else in medicine, Lori thought, there were no guarantees.

  “And she suddenly convulsed,” Rubin broke into her thoughts. “For no reason.”

  “Oh, there was a reason,” Lori countered.

  “I meant, we weren’t stimulating the brain when things went wrong,” Rubin corrected himself.