“I suppose you have an emergency slide for me to read,” said Barnes sarcastically.
“No. I just want some information. I want to know if radiation can cause an atypical Pap smear.”
Barnes thought for a moment before answering. “I’ve never heard of it from diagnostic radiology but certainly radiotherapy will affect the cervical cells and hence the Pap smear.”
“If you looked at an atypical smear, could you tell if it was caused by radiation?”
“Maybe,” said Barnes.
“Remember those slides you looked at for me last night?” continued Philips. “The brain sections. Could those nerve-cell lesions be caused by radiation?”
“I kinda doubt it,” said Barnes. “The radiation would have to have been aimed with a telescopic sight. The nerve cells right next to the damaged ones looked fine.”
Philips face went blank while he tried to put together the inconsistent facts. The patients had absorbed enough radiation to show up on a X ray, yet, on a cellular level, one cell was totally knocked out while a neighbor was all right.
“Are Pap smear specimens saved?” he asked finally.
“I think so. At least for a while, but not here. They’re over in the Cytology lab, which operates on bankers’ hours. They’ll be in in the morning after nine.”
“Thanks,” said Philips, sighing. He wondered if he should try to get into the lab right away. Perhaps if he called Reynolds. He was about to leave when he thought of something else. “When they read Pap smears, is the result in the chart just the classification, or do they describe the pathology?”
“I think so,” said Barnes. “The results are stored on tape. All you need is the patient’s unit number and you can read the report.”
“Thanks a lot,” said Philips. “I know you’re busy so I appreciate your time.”
Barnes gave a slight nod of acknowledgment, then put his eyes back to his microscope.
The Pathology computer terminal was separated from the lab by a series of room dividers. Pulling up a chair, Martin sat down in front of the unit. It was similar to the terminal in Radiology with a large TV-like screen directly behind the keyboard. Taking out the list of five patients, Philips keyed in the name Katherine Collins, followed by her unit number and the code for Papanicolaou Smear. There was a pause, then letters appeared on the screen as if someone were typing. First it spelled out Katherine Collins very rapidly, followed by a slight pause. Then the date of the first Pap smear followed by:
Adequate smear, good fixation, and proper staining. Cells show normal maturation and differentiation. Estrogen effect normal: 0/20/80. A few Candida organisms seen. Result: negative. Philips checked the date of the first smear while the machine spelled out the next report. The date corresponded to the first date Philips had written on the list. Looking back up at the computer screen, Philips’ disbelieving eyes read that the second Pap smear on Collins was also negative!
Philips cleared the screen and rapidly entered Ellen McCarthy’s name, her unit number, and the proper code. He felt his stomach tighten into a knot as the machine began to spell out the information. It was the same-negative!
As he went back downstairs, Martin felt stunned. In medicine he had learned to believe what he read in charts, especially in regard to laboratory reports. They were the objective data while the symptom of the patients and the impressions of the doctors were the subjective. Philips knew that there was a small chance there could be an error in laboratory tests just as he knew there was a possibility that he could miss or misinterpret something on an X ray. But the low probability of error was a far cry from deliberate falsification. That required some sort of conspiracy, and Philips took it very personally.
Sitting at his desk, Martin cradled his head in his hands and rubbed his eyes. His first impulse was to call the hospital authorities, but that meant Stanley Drake, and he decided against it. Drake’s response would be to keep it out of the papers, cover it up. The police! Mentally he ran through a hypothetical conversation: “Hello, I’m Dr. Martin Philips and I want to report that something funny is going on at Hobson University Medical Center. Girls get Pap smears that are normal but are entered into the chart as atypical.” Philips shook his head. It sounded too ridiculous. No, he needed more information before the police were involved. Intuitively he felt the radiation was connected even though it didn’t make any sense. In fact, radiation might cause an atypical Pap smear and it seemed to Philips that if someone wanted to avoid discovery of the radiation, they might report atypical Paps as normal, but not vice versa.