The scene made Martin feel sick, reminding him of unpleasant episodes in medical school. He shuddered and the feeling passed. Purposefully avoiding the gore, he rounded the table and went through the swinging door into the anesthesia room. With his foot, he kept the door ajar so he could see to turn on the light. But the room wasn’t so dark as he’d expected. The door into the hall was open about six inches, allowing some light to enter from the corridor. Surprised, Philips turned on the overhead fluorescent lights.
In the center of the room, which was half the size of the OR, was a gurney supporting a shrouded body. The corpse was covered by a white sheet, save for the toes, which stuck out obscenely. Philips would have been all right had it not been for the toes. They advertised that the covered mound was indeed a human body. On top of the body, casually placed, was the hospital chart.
Breathing shallowly, as if the presence of death was contagious, Philips skirted the gurney and fully opened the door to the corridor. He could see the sleeping surgeon and several orderlies. He glanced in both directions, wondering if he had tried the wrong door earlier. Unable to figure out the discrepancy, he decided to ignore it, and returned to the chart.
He was about to open it when he was seized by a compulsion to lift the shroud. He knew he did not want to look at the body, yet his hand reached out and slowly pulled back the sheet. Before the head was uncovered, Philips closed his eyes. When he opened them he found himself looking at the lifeless, porcelain face of Lisa Marino. One eye was partially open, revealing a glazed and fixed pupil. The other was closed. On the right side of her shaved bead was a carefully sutured horseshoe-shaped incision. She had been cleaned up from the operation and no blood was visible. Philips wondered if Mannerheim had done that so he could say she died after and not during surgery.
The cold finality of death swept Martin’s mind like an arctic wind. Quickly he covered the hairless head and carried the chart over to the anesthesiologist’s stool. Like most patients at a university’s hospital, Lisa Marino already had a thick chart even though she’d been in the hospital for only two days. There were long workups by various levels of residents and medical students. Philips flipped past wordy consults from Neurology and Ophthalmology. He even found a note by Mannerheim but the scribble was totally illegible. What Martin wanted was the final summary by the Chief Neurosurgical resident, Dr. Newman.
In summary the patient is a twenty-one-year-old Caucasian female with a one-year history of progressive temporal lobe epilepsy, who entered the hospital for a right temporal lobectomy under local anesthesia. The patient’s seizure disorder has been totally unresponsive to maximum medical therapy. The seizures have become more frequent, usually heralded by an aura of obnoxious odor, and
characterized by increasing aggressiveness and sexual acting out. Seizure loci have been mapped in both temporal lobes but significantly more on the right by EEG. There has been no history of trauma or known brain insult. The patient has enjoyed good health until present illness although several atypical Pap smears were reported. Other than the abnormal EEG findings, the entire neurological workup has been normal. All laboratory work, including cerebral angiography and CAT scan have been normal. Subjectively the patient has reported some visual perceptual problems, but these have not been confirmed by either neurology or ophthalmology. The patient has also repeated transient paresthesias and muscle weaknesses, but these have not been documented. A diagnosis of multiple sclerosis with seizures is entertained but not confirmed. The patient was presented at Neurology/Neurosurgery grand rounds, and it was the combined opinion that she was a good candidate for a right temporal lobectomy.
[Signed] George Newman
Philips replaced the chart gingerly on top of Lisa Marino as if she still had sensation. Then he fled back to the lounge to change into his street clothes. He had to admit that the chart hadn’t been as rewarding as he’d hoped. It had mentioned multiple sclerosis as he’d remembered, but offered no information that could take the place of additional X rays or another CAT scan. As Philips finished dressing he kept picturing Lisa’s pale death mask. It reminded him that she would probably be autopsied, having died during surgery. Using the wall phone, he called Dr. Jeffrey Reynolds in Pathology, a friend and former fellow student, and told him about the case.