A Brain (4 page)

“I don't believe it,” said Philips, afraid that Michaels was teasing him again.

“Neither do we,” admitted Michaels. “Everything just suddenly fell together.” He walked over and patted the top of the computer unit. “All the work you'd done in breaking down the problem-solving and pattern-recognition aspects of radiology not only made it apparent we needed new hardware but also suggested the way to design it. This is it.”

“Looks simple from the outside.”

“As usual, appearances are deceptive,” said Michaels. “The innards of this unit are going to revolutionize the computer world.”

“And think what it's going to do to the field of radiology if it can really read X rays,” said Martin.

“It will read them,” said Michaels, “but there could still be bugs in the program. What you have to do now is run the program against as many skull X rays as you can find that you have read in the past. If there are problems, I think they will be in the area of false negatives. Meaning the program will say the X ray is normal when pathology is really present.”

“That's the same problem with radiologists,” said Philips.

“Well, I think we'll be able to eliminate that in the program,” said Michaels. “It's going to be up to you. Now to work this thing, first turn it on. I think even a doctor of medicine will be able to do that.”

“Without doubt,” said Philips, “but we'll need a Ph.D. to plug it in.”

“Very good,” Michaels laughed. “Your humor is improving. Once the unit is plugged in and turned on, you insert the cassette program into the central unit. The output printer will then inform you when to insert the X-ray film into the laser scanner.”

“What about the orientation of the film?” asked Philips.

“Doesn't matter, except the emulsion side has to be down.”

“Okay,” said Philips, rubbing his hands together and eyeing the unit like a proud parent. “I still can't believe it.”

“I can't, either,” said Michaels. “Who would have guessed four years ago that we could have made this kind of progress? I can still remember the day you arrived unannounced in the Department of Computer Science, plaintively asking if anyone was interested in pattern recognition.”

“It was just pure luck that I bumped into you,” returned Philips. “At the time I thought you were one of the undergraduates. I didn't even know what the Division of Artificial Intelligence was.”

“Luck plays a role in every scientific breakthrough,” agreed Michaels. “But after the luck, there's lots of hard work, like what's facing you. Remember the more skull films you run with the program, the better
it will be, not only to debug the program, but also because the program is heuristic.”

“Let's not pull any big words on me,” said Philips. “What do you mean ‘heuristic'?”

“So you don't like some of your own medicine,” laughed Michaels. “I never thought I'd hear a doctor complain about incomprehensible words. A heuristic program is one that is capable of learning.”

“You mean this thing will get smarter?”

“You got it,” said Michaels, moving toward the door. “But it's up to you now. And, remember, the same format will be applicable to other areas of radiology. So in your spare time, as if you're going to have any, start the flow sheet for reading cerebral angiograms. I'll talk to you later.”

Closing the door behind Michaels, Philips went over to the worktable and eyed the X-ray-reading apparatus. He was eager to begin to work with it immediately, but he knew the burden of his daily routine proscribed it. As if in confirmation, Helen walked in with a pile of correspondence, telephone messages, and the cheerful news that the X-ray machine in one of the cerebral angiography rooms wasn't functioning properly. Reluctantly Philips turned his back on the new machine.

“Lisa Marino?” asked a voice, causing Lisa to open her eyes. Leaning over her was a nurse named Carol Bigelow, whose dark brown eyes were the only portion of her face visible. A flower-print hat contained her hair. Her nose and mouth were covered by a surgical mask.

Lisa felt her arm lifted and rotated so the nurse could read her identification bracelet. The arm was replaced and patted. “Are you ready for us to fix you up, Lisa Marino?” asked Carol, releasing the brake mechanism on the gurney with her foot, and pulling the bed out from the wall.

“I don't know,” admitted Lisa, trying to see up into the nurse's face. But Carol had turned away saying, “Sure you are,” as she pushed the bed past the white Formica desk.

The automatic doors closed behind them as Lisa began her fateful journey down the corridor to OR #21. Neurosurgery was usually done in one of four rooms: Number 20, 21, 22, or 23. These rooms were
fitted out with the special needs of brain surgery in mind. They had overhead mounted Zeiss operating microscopes, closed-circuit video systems with recording capabilities, and special OR tables. OR #21 also had a viewing gallery and was the favorite of Dr. Curt Mannerheim, Chief of Neurosurgery, and Chairman of the Department for the medical school.

Lisa had hoped that she'd be sleeping at this point, but such was not the case. If anything, she seemed particularly aware and all her senses sharp. Even the sterile chemical smell seemed exceptionally pungent to her. There was still time, she thought. She could get out of the bed and run. She didn't want to be operated on, especially not her head. In fact, anything but her head.

The movement stopped. Turning her gaze, she saw the nurse disappear around a corner. Lisa had been parked like a car at the side of a busy thoroughfare. A group of people passed her, transporting another patient who was retching. His chin was being held back by one of the orderlies pushing the bed, and his head was a bandaged nightmare.

Tears began to run down Lisa's cheeks. The patient reminded her of her own upcoming ordeal. Her central being was going to be rudely cracked open and violated. Not just a peripheral part of her, like a foot or an arm, but her head . . . where her personality and very soul resided. Would she be the same person afterward?

When Lisa had been eleven she'd had acute appendicitis. The operation had certainly seemed scary at the time, but nothing like what she was experiencing now. She was convinced that she was going to lose her identity if not her life. In either case, she was
fragmenting, and the pieces were there for people to pick up and examine.

Carol Bigelow reappeared.

“Okay, Lisa, we're ready for you.”

“Please,” whispered Lisa.

“Come now, Lisa,” said Carol Bigelow. “You wouldn't want Dr. Mannerheim to see you crying.”

Lisa didn't want anyone to see her crying. She shook her head in response to Carol Bigelow's question, but her emotion switched to anger. Why was this happening to her? It wasn't fair. A year ago she'd been a normal college girl. She'd decided to major in English, hopefully to prepare for law school. She loved her literature courses and had been a superior student, at least until she'd met Jim Conway. She knew she'd let her studies go, but it had only been a month or so. Before meeting Jim she'd had sex on several occasions, but it had never been satisfying and she'd questioned why there was so much fuss about it. But with Jim it had been different. She knew immediately that with Jim, sex was the way it was supposed to be. And she hadn't been irresponsible. She did not believe in the Pill, but she'd made the effort to be fitted with a diaphragm. She could remember very distinctly how hard it had been for her to find the courage to make that first GYN clinic visit and go back when it was necessary.

The gurney moved into the operating room. It was completely square, about twenty-five feet on a side. The walls were constructed of gray ceramic tile up to the glass-faced gallery above. The ceiling was dominated by two large stainless steel operating room lights shaped like inverted kettle drums. In the center of the room stood the operating table. It was a narrow, ugly piece of equipment, reminding Lisa of an
altar for some pagan rite. At one end of the table was a round piece of padding with a hole in the center, which Lisa instinctively knew was to hold her head. Totally out of keeping with the environment, the Bee Gees crooned from a small transistor radio in the corner.

“There, now,” said Carol Bigelow. “What I want you to do is slide over here onto the table.”

“Okay,” said Lisa. “Thank you.” She was annoyed at her response. Thank you was the farthest thing from her mind. Yet she wanted the people to like her because she knew she depended on them to take care of her. Moving from the gurney to the operating table, Lisa held on to the sheet in a vain attempt to retain a modicum of dignity. Once on the table she lay still, staring up at the operating lights. Just to the side of the lights she recognized the glass partitions. Because of reflections, it was difficult to see through the glass, but then she saw the faces staring down at her. Lisa closed her eyes. She was a spectacle.

Her life had become a nightmare. Everything had been wonderful until that fateful evening. She had been with Jim and they both had been studying. Progressively, she had become aware that she was having difficulty reading, particularly when she came to a specific sentence beginning with the word “Ever.” She was certain she knew the word but her mind refused to give it to her. She had to ask Jim. His response was a smile, thinking she was teasing. After she persisted, he told her “ever.” Even after Jim had told her the word, when she looked at its printed form, it wouldn't come to her. She remembered feeling a powerful sense of frustration and fear. Then she began to smell the strange odor. It was a bad smell, and although she sensed she'd smelled it before, she could not say
what it was. Jim denied smelling anything and that was the last thing Lisa remembered. What had followed was her first seizure. Apparently it had been awful, and Jim was shaking when she regained consciousness. She had struck him several times and scratched his face.

“Good morning, Lisa,” said a pleasant male voice with an English accent. Looking up behind her, Lisa met the dark eyes of Dr. Bal Ranade, an Indian doctor who had trained at the university. “You remember what I told you last night?”

Lisa nodded. “No coughing or sudden movements,” said Lisa, eager to please. She remembered Dr. Ranade's visit vividly. He'd appeared after her dinner, announcing himself as the anesthesiologist who was going to take care of her during her operation. He had proceeded to ask her the same questions about her health she'd answered many times before. The difference was that Dr. Ranade did not seem to be interested in the answers. His mahogany face did not change its expression, except when Lisa described her appendectomy at age eleven. Dr. Ranade nodded when Lisa said she'd had no trouble with the anesthesia. The only other information that interested him was her lack of allergic reaction. He nodded then too.

Usually Lisa preferred outgoing people. Dr. Ranade was the opposite. He expressed no emotion, just a quiet intensity. But for Lisa, under the circumstances this cool affectation was appropriate. She was glad to find someone for whom her ordeal was routine. But then Dr. Ranade had shocked her. In the same precise Oxford accent he said: “I presume that Dr. Mannerheim has discussed with you the anesthetic technique which will be used.”

“No,” said Lisa.

“That's odd,” said Dr. Ranade at length.

“Why?” asked Lisa, sensing trouble. The idea that there could be any breakdown in communication was alarming. “Why is that odd?”

“We usually use a general anesthesia for craniotomy,” said Dr. Ranade. “But Dr. Mannerheim has informed us that he wants local anesthesia.”

Lisa had not heard her operation described as a craniotomy. Dr. Mannerheim had said he was going to “turn a flap” and make a small window in her head so that he could remove the damaged part of her right temporal lobe. He'd told Lisa that somehow, a part of Lisa's brain had been damaged, and it was that section that was causing her seizures. If he could take just the damaged part out the seizures would stop. He'd done almost a hundred such operations with wonderful results. At the time Lisa had been ecstatic because up until Dr. Mannerheim all she could get from her doctors was compassionate head shaking.

And the seizures were horrible. Usually she knew when they were coming because she would smell the strangely familiar odor. But sometimes they came without warning, descending on her like an avalanche. Once in a movie theater, after she'd been given a long course of heavy medication and assurances that the problem was under control, she smelled the horrid odor. In a panic she'd jumped up, stumbled to the aisle, and ran back toward the lobby. At that point she became unaware of her actions. Later she “came to” propped up against the lobby wall by the candy machine, with her hand between her legs. Her clothes were partially off, and like a cat in heat, she'd been masturbating. A group of people was staring at her as if she were a freak, including Jim, whom she'd punched and kicked. Later she
learned she'd assaulted two girls, injuring one enough to be hospitalized. At the time she'd “come to” all she could do was close her eyes and cry. Everyone was afraid to come near her. In the distance she remembered hearing the sound of the ambulance. She thought that she was going insane.

Lisa's life had come to a standstill. She wasn't insane, but no medication controlled her seizures. So when Dr. Mannerheim appeared, he seemed like a savior. It wasn't until Dr. Ranade's visit that she began to comprehend the reality of what was going to happen to her. After Dr. Ranade, an orderly had arrived to shave her head. From that moment on, Lisa had been frightened.

“Is there some reason why he wants local anesthesia?” asked Lisa. Her hands had begun to tremble. Dr. Ranade had thought carefully about his answer.

“Yes,” he said finally, “he wants to locate the diseased part of your brain. He needs your help.”

“You mean, I'll be awake when . . .” Lisa didn't finish her sentence. Her voice had trailed off. The idea seemed preposterous.

“That's correct,” said Dr. Ranade.

“But he knows where the diseased part of my brain is,” protested Lisa.

“Not well enough. But don't worry. I'll be there. There'll be no pain. All you have to remember is no coughing and no sudden movements.”

Lisa's reverie was cut short by a feeling of pain in her left forearm. Looking up she could see tiny bubbles rising up in a bottle over her head. Dr. Ranade had started the IV. He did the same thing in her right forearm, threading into her a long thin plastic tube. Then he adjusted the table so that it tilted slightly downward.

“Lisa,” said Carol Bigelow. “I'm going to catheterize you.”

Picking up her head, Lisa looked down. Carol was busy unwrapping a plastic covered box. Nancy Donovan, another scrub nurse, pulled back Lisa's sheet exposing her from the waist down.

“Catheterize?” questioned Lisa.

“Yes,” said Carol Bigelow, pulling on loose rubber gloves. “I'm going to put a tube into your bladder.”

Lisa allowed her head to fall back. Nancy Donovan grasped Lisa's legs and positioned them so that the soles of her feet were together while her knees were widely apart. She lay exposed for the world to see.

“I'm going to be giving you a medicine called mannitol,” explained Dr. Ranade. “It causes you to make a lot of urine.”

Lisa nodded as if she understood while she felt Carol Bigelow begin to scrub her genitals.

“Hi, Lisa, I'm Dr. George Newman. Do you remember me?”

Opening her eyes, Lisa gazed into another masked face. These eyes were blue. On the other side of her was another face with brown eyes.

“I'm the Chief Resident in Neurosurgery,” said Dr. Newman, “and this is Dr. Ralph Lowry, one of our Junior Residents. We'll be helping Dr. Mannerheim as I explained to you yesterday.”

Before Lisa could respond she felt a sudden sharp pain between her legs, followed by a curious fullness in her bladder. She took a breath. She felt tape being placed on the inner part of her thigh.

“Just relax now,” said Dr. Newman without waiting for her to respond. “We'll have you fixed up in no
time.” The two doctors directed their interest to the series of X rays that lined the back walls.

The pace in the OR quickened. Nancy Donovan appeared with a steaming stainless steel tray of instruments, and with a loud crash she heaved it on top of a nearby table. Darlene Cooper, another scrub nurse, who was already gowned and gloved, reached into the sterile instruments and began to arrange them on a tray. Lisa turned her head when she saw Darlene Cooper lift out a large drill.

Doctor Ranade wrapped a blood pressure cuff around Lisa's right upper arm. Carol Bigelow exposed Lisa's chest and taped on EKG leads. Soon the sonar-like beeps from the cardiac monitor competed with John Denver on the transistor.

Dr. Newman came back from studying the X rays and positioned Lisa's shaved head. With his pinky on her nose and his thumb on the top of her head, he drew a line with a marking pen. The first line went from ear to ear over the top of her head. The second line bisected this one, starting at the middle of the forehead and extending back to the occipital area.