Brain by Robin Cook. Chapter 5, 6, 7

“The second angiography room is again nonfunctional,” she said the moment she caught his attention. “It’s not the X-ray unit itself, but rather the machine that moves the film.”

Philips nodded as he hung up his lead apron. He was aware of the problem and he trusted that Helen had already called the company with whom they had a service agreement. He eyed the print-out device on his worktable. He could see a whole page of computer-generated notes.

“Also there’s a problem with Claire O’Brian and Joseph Abbodanza,” said Helen. Claire and Joseph were two neuroradiology technicians they’d been training over the years.

“What kind of problem?” asked Philips.

“They’ve decided to get married.”

“Well,” laughed Philips. “Have they been doing unnatural acts in the darkroom?”

“No!” snapped Helen. “They’ve decided to get married in June, then take the whole summer off for a trip to Europe.”

“Whole summer!” shouted Philips. “They can’t do that! It will be hard enough letting them take their two week vacation at the same time. I hope you told them that.”

“Of course I did,” said Helen. “But they said they don’t care. They’re going to do it even if it means they get fired.”

“Jesus Christ,” said Philips, slapping his forehead. He knew that with their training Claire and Joseph could get work in any major medical center.

“Also,” said Helen. “The Dean of the medical school called. He said they voted in a meeting last week to double the number of medical-student groups rotating in Neuroradiology. He said last year’s students voted the service one of the best electives.”

Philips closed his eyes and massaged his temples. More medical students! That was all he needed! Christ!

“And the last thing,” said Helen, heading for the door. “Mr. Michael Ferguson called from Administration to say that the room we’re using for supplies has to be vacated. They need it for social service.”

“And what, pray tell, are we supposed to do with the supplies?”

“I asked the same question,” said Helen. “He told me you knew all along that space wasn’t allocated to Neuroradiology, and that you’d think of something. Well, I’m taking a quick break for lunch. I’ll be back shortly.”

“Sure,” said Philips. “Enjoy your lunch.”

Philips waited for a few minutes until his blood pressure fell to normal. Administrative problems were becoming increasingly less tolerable. He walked over to the print-out device and pulled out the report.

Radread, Skull I Marino. Lisa

Clinical information

21-yr-old female with one-year history of temporal lobe epilepsy. A single left lateral projection presented from a portable X ray unit. The projection appears to be approximately eight degrees off from true lateral. There is a large lucency in the right temporal region representing an area devoid of bone. The edges of this area are sharp suggesting an iatrogenic origin. This impression is confirmed by a heavy soft tissue area below the bony defect suggesting a large scalp flap. X ray is most likely an operative X ray. Numerous metallic bodies are noted representing surface electrodes. Two narrow cylindrical metallic electrodes appear to be depth electrodes in the temporal lobe, most likely positioned in the amygdala and hippocampus. Brain densities show fine linear variations in the occipital, mid-parietal, and lateral temporal lobes.

Conclusion

Operative X ray with large bony defect in the right temporal region. Multiple surface electrodes and two depth electrodes. Widespread density variations of an unprogrammed nature.

Recommendations

Anterio posterior and oblique projections as well as CAT scan recommended for better characterization of the linear density variations and for localization of depth electrodes.

Angiographic data recommended to associate position of depth electrodes with majorvessels. ****Program requests insertion in central memory unit of the significance of linear density variations.

Thank you and please send check to William Michaels, Ph.D., and Martin Philips, M.D.

Philips couldn’t believe what he’d just read. It was good; it was better than good, it was fantastic. And with the little piece of humor at the end, it was overwhelming. Philips went back over sections of the report. It was extraordinarily difficult for him to believe that he was reading a report that came from their machine and not another neuroradiologist. Even though the unit had not been programmed for craniotomies, it seemed to have been able to reason with the information it had and come up with the right answer. And then there was the part about density variations. Philips had no idea what that was.

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