Terminal (3 page)

“So she’s an unfortunate exception,” Peter commented.

“Not really an exception,” Sean said. “Twenty percent of medulloblastomas are seen in patients over the age of twenty. What surprised everyone and why no one even came close to guessing the cell type was because she had multiple growths. Originally her attending thought she had metastatic cancer, probably from an ovary. But he was wrong. Now he’s planning an article for the
New England Journal of Medicine.
”

“Someone said she was not only beautiful but wealthy,” Peter said, lamenting anew he’d not gotten her as a patient.

“Her father is CEO of Software, Inc.,” Sean said. “Obviously the Cabots aren’t hurting. With all their money, they can certainly afford a place like the Forbes. I hope the people in Miami can do something for her. Besides being pretty, she’s a nice kid. I’ve spent quite a bit of time with her.”

“Remember, doctors are not supposed to fall in love with their patients,” Peter said.

“Helen Cabot could tempt a saint.”

J
ANET
R
EARDON
took the stairs back to pediatrics on the fifth floor. She’d used her fifteen-minute coffee break trying to find Sean. The nurses on seven said they’d just seen him, working on his off-service notes, but had no idea where he’d gone.

Janet was troubled. She hadn’t been sleeping well for several weeks, waking at four or five in the morning, way before her alarm. The problem was Sean and their relationship. When
she’d first met him, she’d been turned off by his coarse, cocky attitude, even though she had been attracted by his appealing Mediterranean features, black hair, and strikingly blue eyes. Before she’d met Sean she hadn’t known what the term “Black Irish” meant.

When Sean had initially pursued her, Janet had resisted. She felt they had nothing in common, but he refused to take no for an answer. And his keen intelligence pricked her curiosity.

She finally went out with him thinking that one date would end the attraction. But it hadn’t. She soon discovered that his rebel’s attitude was a powerful aphrodisiac. In a surprising about-face, Janet decided that all her previous boyfriends had been too predictable, too much the Myopia Hunt Club crowd. All at once she realized that her sense of self had been tied to an expectation of a marriage similar to her parents’ with someone conventionally acceptable. It was then that Sean’s Charlestown rough appeal had taken a firm hold on her heart, and Janet had fallen in love.

Reaching the nurses’ station on the pediatric floor, Janet noticed she still had a few minutes left on her break. Pushing through the door to the back room, she headed for the communal coffee machine. She needed a jolt to get her through the rest of the day.

“You look like you just lost a patient,” a voice called.

Janet turned to see Dorothy MacPherson, a floor nurse with whom she’d become close, sitting with her stockinged feet propped upon the countertop.

“Maybe just as bad,” Janet said as she got her coffee. She only allowed herself half a cup. She went over and joined Dorothy. She sat heavily in one of the metal desk chairs. “Men!” she added with a sigh of frustration.

“A familiar lament,” Dorothy said.

“My relationship with Sean Murphy is not going anywhere,” Janet said at length. “It’s really bothering me, and I have to do something about it. Besides,” she added with a laugh, “the last thing I want to do is to be forced to admit to my mother that she’d been right about him all along.”

Dorothy smiled. “I can relate to that.”

“It’s gotten to the point that I think he’s avoiding me,” Janet said.

“Have you two talked?” Dorothy asked.

“I’ve been trying,” Janet said. “But talking about feelings is not one of his strong points.”

“Regardless,” Dorothy said. “Maybe you should take him out tonight and say what you’ve just said to me.”

“Ha!” Janet laughed scornfully. “It’s Friday night. We can’t.”

“Is he on call?” Dorothy asked.

“No,” Janet said. “Every Friday night he and his Charlestown buddies get together at a local bar. Girlfriends and wives are not invited. It’s the proverbial boys’ night out. And in his case, it’s some kind of Irish tradition, complete with brawls.”

“Sounds disgusting,” Dorothy said.

“After four years at Harvard, a year of molecular biology at MIT, and now three years of medical school, you’d think he’d have outgrown it. Instead, these Friday nights seem to be more important to him than ever.”

“I wouldn’t stand for it,” Dorothy said. “I used to think my husband’s golf fetish was bad, but it’s nothing compared to what you’re talking about. Are there women involved in these Friday night escapades?”

“Sometimes they go up to Revere. There’s a strip joint there. But mostly it’s just Sean and the boys, drinking beer, telling jokes, and watching sports on a big-screen TV. At least that’s how he’s described it. Obviously I’ve never been there.”

“Maybe you should ask yourself why you’re involved with this man,” Dorothy said.

“I have,” Janet said. “Particularly lately, and especially since we’ve had so little communication. It’s hard even to find time to talk with him. Not only does he have all the work associated with med school, but he has his research too. He’s in an M.D.-Ph.D. program at Harvard.”

“He must be intelligent,” Dorothy offered.

“It’s his only saving grace,” Janet said. “That and his body.”

Dorothy laughed. “At least there’s a couple of things to
justify your anguish. But I wouldn’t let my husband get away with that juvenile Friday night stuff. Hell, I’d march right in and embarrass the heck out of him. Men will be boys, but there have to be some limits.”

“I don’t know if I could do that,” Janet said. But as she took a sip from her coffee, she gave the idea some thought. The problem was that she’d always been so passive in her life, letting things happen, then reacting after the fact. Maybe that’s how she got herself into this kind of trouble. Maybe she needed to encourage herself to be more assertive.

“D
AMN IT
, M
ARCIE
!” Louis Martin shouted. “Where the hell are those projections? I told you I wanted them on my desk.” To emphasize his displeasure, Louis slapped his hand on his leather-bound blotter, sending a flurry of papers wafting off into the air. He had been feeling irritable ever since he’d awakened at four-thirty that morning with a dull headache. While in the bathroom searching for aspirin, he’d vomited into the sink. The episode had shocked him. His retching had come with no warning and no accompanying nausea.

Marcie Delgado scurried into her boss’s office. He’d been yelling at her and criticizing her all morning. Meekly she reached across the desk and pushed a stack of papers bound with a metal clip directly in front of the man. In block letters on the front cover was:
PROJECTIONS FOR BOARD MEETING FEBRUARY
26.

Without even an acknowledgment, much less an apology, Louis snatched up the documents and stormed out of the office. But he didn’t get far. After half a dozen steps, he couldn’t recall where he was going. When he finally remembered he was headed for the boardroom, he wasn’t sure which door it was.

“Good afternoon, Louis,” one of the directors said, coming up behind him and opening the door on the right.

Louis stepped into the room feeling disoriented. He hazarded a furtive glance at the people sitting around the long conference table. To his consternation, he was unable to recognize
a single face. Lowering his eyes to stare at the packet of papers he’d carried in with him, he let them slip from his grasp. His hands were shaking.

Louis Martin stood for another moment while the babble of voices in the room quieted. All eyes were drawn to his face, which had turned ghostly pale. Then Louis’s eyes rolled up inside his head, and his back arched. He fell backward, his head striking the carpeted floor with a dull thump. Simultaneous with the impact on the floor, Louis’s body began to tremble before being overwhelmed by wild tonic and clonic muscular contractions.

None of Louis’s board of directors had ever seen a grand mal seizure, and for a moment they were all stunned. Finally, one man overcame his shock and rushed to the side of his stricken chairman. Only then did others respond by racing off to nearby telephones to call for help.

By the time the ambulance crew arrived, the seizure had passed. Except for a residual headache and lethargy, Louis felt relatively normal. He was no longer disoriented. In fact, he was dismayed to be told he’d had a seizure. As far as he was concerned, he’d only fainted.

The first person to see Louis in the emergency room at the Boston Memorial Hospital was a medical resident who introduced himself as George Carver. George seemed harried but thorough. After conducting a preliminary examination he told Louis that he would have to be admitted even though Louis’s private internist, Clarence Handlin, had not yet been consulted.

“Is a seizure serious?” Louis asked. After his prostate operation two months earlier, Louis was not happy about the prospect of being hospitalized.

“We’ll get a neurology consult,” George said.

“But what’s
your
opinion?” Louis asked.

“Seizures with sudden onset in an adult suggests structural brain disease,” George said.

“How about talking English,” Louis said. He hated medical jargon.

The resident fidgeted. “Structural means exactly that,” he
said evasively. “Something abnormal with the brain itself, not just its function.”

“You mean like a brain tumor?” Louis asked.

“It could be a tumor,” George said reluctantly.

“Good Lord!” Louis said. He felt himself break out in a cold sweat.

After calming the patient the best he could, George went into the “pit,” as the center of the emergency room was called by those that worked there. First he checked to see if Louis’s private physician had called in yet. He hadn’t. Then he paged a neurology resident stat. He also told the ER clerk to call the medical student who was up for the next admission.

“By the way,” George said to the clerk as he was returning to the cubicle where Louis Martin was waiting. “What’s the name of the medical student?”

“Sean Murphy,” the clerk said.

“C
RAP
!” S
EAN
said as his beeper went off. He was certain that Janet had long since disappeared, but just to be sure, he opened the door carefully and scanned the area. He didn’t see her, so he pushed through. He had to use the phone out in the nurses’ station since Peter was hogging the one in the back room, trying to get last-minute lab reports.

Before Sean called anybody, he approached Carla Valentine, the head nurse. “You guys looking for me?” he asked expectantly. He was hoping they were because then the page would involve some easily performed scut work. What Sean feared was that the page was coming from either admitting or the ER.

“You’re all clear for the moment,” Carla said.

Sean then dialed the operator and got the bad news. It was the ER with an admission.

Knowing the sooner he got the history and physical done, the better off he’d be, Sean bid farewell to Peter, who was still on the phone, and went downstairs.

Under normal circumstances Sean liked the ER and its constant sense of excitement and urgency. But on the afternoon
of his last day on his medicine rotation, he didn’t want another case. The typical Harvard medical student’s workup took hours and filled between four and ten pages of tightly written notes.

“It’s an interesting case,” George said when Sean arrived. George was on hold on the phone with radiology.

“That’s what you always say,” Sean said.

“Truly,” George said. “Have you ever seen papilledema?”

Sean shook his head.

“Grab an ophthalmoscope and look at the guy’s nerve heads in both eyes. They’ll look like miniature mountains. It means the intracranial pressure is elevated.” George slid the ER clipboard along the countertop toward Sean.

“What’s he got?” Sean asked.

“My guess is a brain tumor,” George said. “He had a seizure at work.”

At that moment someone came on the phone line from radiology, and George’s attention was directed at scheduling an emergency CAT scan.

Sean took the ophthalmoscope and went in to see Mr. Martin. Sean was far from adept at using the instrument, but after persistence on his part and patience on Louis’s part, he was able to catch fleeting glimpses of the mounded nerve heads.

Doing a medical student history and physical was a laborious task under the best of circumstances, and doing it in the emergency room and then up in X-ray while waiting for a CAT scan made it ten times more difficult. Sean persisted, asking as many questions as he could think of, especially about the current illness. What Sean learned that no one else had was that Louis Martin had had some transient headache, fever, and nausea and vomiting about a week after his prostate surgery in early January. Sean had stumbled onto this information just before Louis began his enhanced CAT scan. The technician had to order Sean out of the CAT scanner room and into the control room moments before the study commenced.

Besides the technician running the CAT scanner, there were a number of other people in the control room including Dr. Clarence Handlin, Louis Martin’s internist, George Carver, the
medical resident, and Harry O’Brian, the on-call neurology resident. They were all grouped around the CRT screen, waiting for the first “cuts” to appear.

Sean pulled George aside and told him about the earlier headache, fever, and nausea.

“A good pickup,” George said while he pulled pensively at the skin at the edge of his jaw. He was obviously trying to relate these earlier symptoms to the current problem. “The fever is the curious part,” he said. “Did he say it was a high fever?”

“Moderate,” Sean said. “102 to 103. He said it was like having a cold or mild flu. Whatever it was, it went away completely.”

“It might be related,” George said. “At any rate this guy is a ‘sickle.’ The preliminary CAT scan showed two tumors. Remember Helen Cabot upstairs?”

“How can I forget?” Sean said. “She’s still my patient.”