“Are you all right, Dr. Philips?” asked Helen.
“Sure,” said Martin, feeling his face redden as he retrieved the X rays. “I’m fine. Just a little excited. I thought you were going to lunch?”
“I’ve been,” said Helen. “I brought a sandwich back to eat at my desk.”
“How about getting William Michaels on the phone for me.”
Helen nodded and disappeared. Philips put the X rays back up. Looking at the subtle white flecks, he pondered what it could mean. It didn’t look like calcium, and it was not oriented in a pattern like blood vessels. He wondered how he could go about determining if the changes were in the gray matter or cellular area of the brain called the cortex, or if they were in the white matter of fiber layer of the brain.
The phone buzzed and Philips reached over and picked up the extension. It was Michaels. Philips’ excitement was obvious as he described the program’s incredibly successful performance. He said it seemed able to pick up a type of density variation that had been previously missed. He spoke so quickly that Michaels had to ask him to slow down.
“Well, I’m glad it’s working as well as we expected,” said Michaels, when Martin finally paused.
“As well as expected? It’s more than I ever hoped.”
“Fine,” said Michaels. “How many old X rays have you run?”
“Really only one,” admitted Martin. “I ran two, but they were both from the same patient.”
“You’ve only run two X rays?” said Michaels, disappointed. “I hope you didn’t wear yourself out.”
“All right, all right. Unfortunately I don’t have much time during the day to spend on our project.”
Michaels said he understood, but implored Philips to run the program against all the skull films he’d read in the last few years, rather than being sidetracked by one positive finding. Michaels emphasized anew that at this juncture of their work, eliminating false negative readings was the most important task.
Martin continued to listen, but he couldn’t stop studying the spidery density changes on Lisa Marino’s X ray. He knew she was a seizure patient and his scientific mind quickly asked if there could be an association between the seizures and these subtle findings on the X ray. Perhaps they represented some diffuse neurological disease…
Philips terminated the conversation with Michaels with a new sense of excitement. He’d remembered that one of Lisa Marino’s tentative diagnoses was multiple sclerosis. What if he’d stumbled on a radiological diagnosis for the disease? It would be a fantastic find. Doctors had been looking for laboratory diagnosis of multiple sclerosis for years. Martin knew he had to get more X rays and a new CAT scan on Lisa Marino. It wasn’t going to be easy since she’d just been operated on, and he’d have to get Mannerheim’s approval. But Mannerheim was research-oriented and Philips decided to approach him directly.
He yelled through the door for Helen to get the neurosurgeon on the phone and went back to Lisa Marino’s X ray. In radiological terms the density changes were called reticular although the fine lines seemed to be parallel rather than net-like. Using a magnifying glass, Martin wondered if nerve fibers could be responsible for the pattern he was seeing. That idea didn’t make sense because of the relatively hard X rays that had to be used to penetrate the skull. His train of thought was interrupted by the buzzer. Mannerheim was on the phone.
Philips began the conversation with some usual pleasantries, ignoring the recent episode about the X rays in the OR. With Mannerheim it was always better to let such encounters slide. The surgeon seemed peculiarly silent so Martin continued, explaining that he was calling because he’d noticed some peculiar densities on Lisa Marino’s X rays.
“I think these densities should be explored and I’d like to get more skull films and another CAT scan as soon as the patient can tolerate it. That is, of course, if you agree.”
An uncomfortable pause followed. Philips was about to speak when Mannerheim snarled, “Is this some kind of a joke? If it is, it’s in very bad taste.”
“It’s no joke,” said Martin, bewildered.