“Is there any reason it couldn’t be multiple sclerosis?”
“No,” said Thomas. “But there isn’t much reason to suggest it either.”
“How about very early inks course.”
“Possible, but multiple sclerosis is usually diagnosed later when its characteristic pattern becomes apparent.”
“That’s just the point. We’re suggesting the diagnosis earlier rather than later.”
“All right,” said Thomas, “but I’m going to specifically say in my admitting note that Radiology suggested that diagnosis.”
“Be my guest,” said Philips. “Just be sure to write on the order sheet that CAT scan and polytomography are to be done tomorrow. I’ll take care of scheduling it from Radiology.”
Back at the desk Philips endured the crowd long enough to obtain Lynn Anne Lucas’s emergency room chart and hospital record. He took both into the deserted lounge and sat down.
First he read Dr. Huggens” and Dr. Thomas’s workups. There was nothing exciting. Next he looked at the chart. By the color coding on the edge of the pages, he noticed there was a radiology report. He opened the chart to that page, which described a skull X ray at age eleven secondary to a roller-skating mishap. The X ray had been read by a resident Philips knew. He’d been several years behind Philips and now was in Houston. The X ray was described as normal.
Working backward through the chart, Philips read entries over the last two years related to upper respiratory infections treated at the dispensary on campus. He also glanced over a series of GYN clinic visits where mildly atypical Pap smears had been noted. Philips had to admit to himself that the information was not so informative as it should have been because of the embarrassing amount of general medicine he’d forgotten since his house staff days. From 1969 to 1970 there were no entries on the chart.
Philips returned the chart to the ER desk before starting back to his office. He took the stairs by twos, his energy level spurred by a wonderful sense of investigative excitement. After the disappointment with Marino, the discovery of Lucas was that much more titillating. Back in his office, he pulled down the dusty internal medicine textbook and looked up multiple sclerosis.
As he had remembered, the diagnosis of the disease was circumstantial. There was no consistent laboratory aid save for autopsy. The obvious and immense value of a radiological diagnosis again occurred to Philips. He read on, noticing that the classic features of the disease included abnormalities in vision as well as bladder dysfunction. After reading the first two sentences of the next paragraph, Philips stopped. He went back and read them aloud:
Diagnosis may be uncertain in the early years of the disease. Long latent periods between a minor initial symptom, which may not even come to medical attention, and the subsequent development of more characteristic ones may delay the final diagnosis.
Philips grabbed the phone and punched out Michaels’ home number. With a sensitive radiological diagnosis, delay of the final diagnosis would be avoided.
It was only after the phone had already started to ring that Martin glanced at his watch. He was shocked to realize it was after eleven. At that moment Michaels’ wife, Eleanor, whom Philips had never met, answered the phone. Philips immediately launched into a lengthy apology for calling so late although she did not sound as if she’d been asleep. Eleanor assured him that they never retired before midnight and put her husband on the line.
Michaels laughed at what he called Philips’ adolescent enthusiasm, when he learned that Martin was still in his office.
“I’ve been busy,” explained Philips. “I’ve had a cup of coffee, something to eat, and taken a nap.”
“Don’t let everybody see those printouts,” said Michaels, laughing anew. “I programmed some obscene suggestions as well.”
Philips went on to tell Michaels excitedly that the reason he was calling was that he’d found another patient in the ER, named Lynn Anne Lucas, who had the same abnormal density pattern he’d seen on the Marino film. He told Michaels that he had not been able to follow up on Marino, but was going to get definitive films in the morning. He added that the computer had actually asked him to tell it what the abnormal density changes were. “The God-damn thing wants to learn!”