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AUTHOR’S NOTE
This is a work of fiction. Names, characters, places, and incidents are either the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events or locales is entirely coincidental.
BRAIN
A Signet Book / published by arrangement with the author
All rights reserved.
Copyright © 1979 by Robin Cook
This book may not be reproduced in whole or part, by mimeograph or any other means, without permission. Making or distributing electronic copies of this book constitutes copyright infringement and could subject the infringer to criminal and civil liability.
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The Berkley Publishing Group, a division of Penguin Putnam Inc.,
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ISBN: 978-1-1012-0902-8
A SIGNET BOOK®
Signet Books first published by The Signet Publishing Group, a member of Penguin Putnam Inc.,
375 Hudson Street, New York, New York 10014.
Signet and the “S” design are trademarks belonging to Penguin Putnam Inc.
Electronic edition: May, 2002
This book is dedicated
to Barbara with love.
From the brain, and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, griefs and tears . . .
—Hippocrates
The Sacred Disease
Sect. XVII
translated by W.H.S. Jones
1
March 7
Katherine Collins mounted the three steps from the sidewalk with a fragile sense of resolve. She reached the combination glass and stainless steel door and pushed. But it didn’t open. She leaned back, gazed up at the lintel, and read the incised inscription, “Hobson University Medical Center: For the Sick and Infirm of the City of New York.” For Katherine’s way of thinking it should have read, “Abandon All Hope Ye Who Enter Here.”
Turning around, her pupils narrowed in the morning March sunlight; her urge was to flee and return to her warm apartment. The last place in the world that she wanted to go was back into the hospital. But before she could move, several patients mounted the steps and brushed past her. Without pausing they opened the door to the main clinic and were instantly devoured by the ominous bulk of the building.
Katherine closed her eyes for an instant, marveling at her own stupidity. Of course, the doors to the clinic opened outward! Clutching her parachute bag to her side, she pulled open the door and passed into the netherworld within.
The first thing that assaulted Katherine was the smell. There was nothing like it in her twenty-one years of experience. The dominant odor was chemical, a mixture of alcohol and sickeningly sweet deodorant. She guessed the alcohol was an attempt to check the disease that lurked in the air; she knew the deodorant was to cover the biological smells that hovered around illness. Any remnants of denial that Katherine had been using to help herself make this visit evaporated under the onslaught of the smell. Until her first visit to the hospital a number of months previously she had never considered her own mortality and had accepted health and well-being as her due. Now it was different and as she entered the clinic with its smell, the thought of all her recent health problems flooded into her consciousness. Biting her lower lip to keep her emotions under control, she pushed her way toward the elevators.
The hospital crowds were troublesome for Katherine. She wanted to draw into herself like a cocoon to avoid being touched, breathed or coughed on. She had difficulty looking at the distorted faces, scaly rashes and oozing eruptions. It was worse in the elevator, where she was pressed up against a group of humanity that reminded her of the crowds in a painting by Brueghel. Keeping her eyes glued to the floor indicator, she tried to ignore her surroundings by rehearsing the speech she was going to give to the receptionist at the GYN clinic. “Hello, my name is Katherine Collins. I’m a university student and I’ve been here four times. I’m about to go home to have my medical problems handled by my family internist and I’d like a copy of my gynecology records.”
It sounded simple enough. Katherine allowed her eyes to wander to the elevator operator. His face was tremendously broad, but when he turned sideways, his head was flat. Katherine’s eyes involuntarily fixed on the distorted image and when the operator turned to announce the third floor, he caught Katherine’s stare. One of his eyes looked down and to the side. The other bore into Katherine with an evil intensity. Katherine averted her gaze, feeling her face redden. A large hairy man pushed past her to disembark. Steadying herself with her hand against the side of the elevator, she looked down at a blond five-year-old girl. One green eye returned her smile. The other was lost beneath the violaceous folds of a large tumor mass.
The elevator door closed and the car lifted. A dizzy sensation swept over Katherine. It was different from the dizziness that had presaged the two seizures she’d experienced the month before, but still it was frightening within the closed environment of the stuffy elevator. She shut her eyes and battled against the sense of claustrophobia. Someone coughed behind her and she felt a fine mist on her neck. The car jolted, the doors opened, and Katherine emerged on the fourth floor of the clinic. She moved over to the wall and leaned against it, letting the people behind her push by. Her dizziness cleared rapidly. Once she felt back to normal she turned left down a hall that had been painted light green twenty years before.
The corridor expanded into the waiting area for the GYN clinic. It was dense with patients, children, and cigarette smoke. Katherine crossed this central area and entered a cul-de-sac to the right. The university’s GYN clinic, which served all the colleges as well as the hospital employees, had its own waiting area, although the decor and furniture were the same as the main room. When Katherine entered there were seven women sitting on tubular steel and vinyl seats. All were nervously flicking the pages of outdated magazines. The receptionist sat behind a desk, a bird-like woman of about twenty-five with bleached hair, pale skin, and narrow features. Her name tag pinned firmly to her flat chest proclaimed her name to be Ellen Cohen. She looked up as Katherine approached the desk.
“Hello, my name is Katherine Collins . . .” She noticed that her voice lacked the assertiveness she had intended. In fact, when she got to the end of her request she realized that she sounded as if she were pleading.
The receptionist looked at her for a moment. “You want your records?” she asked. Her voice reflected a mixture of disdain and incredulity.
Katherine nodded and tried to smile.
“Well, you have to talk with Ms. Blackman about that. Please have a seat.” Ellen Cohen’s voice became brusque and authoritarian. Katherine turned and found a seat near to the desk. The receptionist went to a file cabinet and pulled Katherine’s clinic chart. She then disappeared through one of the several doors leading to the examining rooms.
Unconsciously, Katherine began smoothing her shiny brown hair, pulling it down over her left shoulder. It was a common gesture for Katherine, particularly when she was under strain. She was an attractive young woman with bright attentive gray-blue eyes. Her height was five-two-and-a-half, but her energetic personality made her seem taller. She was well liked by her friends at college, probably because of her openness, and deeply loved by her parents, who worried about the vulnerability of their only daughter in the jungle of New York Ci
ty. Yet it had been Katherine’s parents’ concern and overprotectiveness that had led to Katherine choosing a college in New York, believing the city would help her demonstrate her innate strength and individuality. Up until the current illness, she had been successful, scoffing at her parents’ warnings. New York had become her city and she loved its throbbing vitality.
The receptionist reappeared and sat down to her typing.
Katherine’s eyes surreptitiously swept around the waiting room, recording the bowed heads of the young women waiting their turns like unknowing cattle. Katherine was immensely thankful she was not waiting for an exam herself. She loathed the experience, which she had endured four times: the last just four weeks ago. Coming to the clinic had been her most difficult act of independence. In reality she would have much preferred to return to Weston, Massachusetts, and see her own gynecologist, Dr. Wilson. He’d been the first and only other doctor to examine her. Dr. Wilson was older than the residents who staffed the clinic and he had a sense of humor, which had defused the humiliating aspects of the experience, making it at least tolerable. Not so here. The clinic was impersonal and cold, and combined with the city hospital environment, each visit became a nightmare. Yet Katherine had persisted. Her sense of independence demanded it, at least until her illness.
The nurse practitioner, Ms. Blackman, emerged from one of the rooms. She was a stocky forty-five-year-old woman with jet black hair pulled back into a tight bun on the crown of her head. She was dressed in a spotless white uniform, starched to a professional crispness. Her attire reflected the way she liked to run the clinic: with cool efficiency. She’d worked for the Med Center for eleven years.
The receptionist spoke to Ms. Blackman, and Katherine heard her name mentioned. The nurse nodded, turning to look in Katherine’s direction for a moment. Belying her crisp exterior, Ms. Blackman’s dark brown eyes gave an impression of great warmth. Katherine suddenly thought that outside of the hospital, Ms. Blackman was probably a good deal nicer.
But Ms. Blackman did not come over to talk with Katherine. Instead she whispered something to Ellen Cohen, then returned to the examination area. Katherine felt her face redden. She guessed she was being deliberately ignored; it would be a way for the clinic personnel to show their displeasure about her wish to see her own doctor. Nervously she reached for a coverless year-old copy of Ladies’ Home Journal, but she couldn’t concentrate.
She tried to pass the time thinking about her arrival home that night; how surprised her parents would be. She could imagine herself walking into her old room. She hadn’t been there since Christmas, but she knew it would look exactly as she’d left it. The yellow bedspread, the matching curtains, all the mementos of her adolescence carefully preserved by her mother. The reassuring image of her mother made Katherine question again if she should call and tell her parents she was coming home. The plus was that they would meet her at Logan Airport. The minus was that she’d probably be coerced into an explanation about why she was coming home, and Katherine wanted to discuss her illness face to face, not over the telephone.
Ms. Blackman reappeared after twenty minutes and again conversed with the receptionist in muted tones. Katherine pretended to be absorbed in her magazine. Finally the nurse broke off and came over to Katherine.
“Miss Collins?” said Ms. Blackman with subtle irritation.
Katherine looked up.
“I’ve been told you have requested your clinic records?”
“That’s correct,” said Katherine, putting the magazine down.
“Have you been unhappy with our care?” asked Ms. Blackman.
“No, not at all. I’m going home to see our family internist and I want a complete set of my medical records to take with me.”
“This is rather irregular,” said Ms. Blackman. “We’re accustomed to sending records only when they are requested by a physician.”
“I’m leaving for home tonight and I want the records with me. If my doctor needs them, I don’t want to have to wait for them to be sent.”
“This just isn’t the way we do things here at the Med Center.”
“But I know it’s my right to have a copy of my records if I want it.”
For Katherine an uncomfortable silence followed her last comment. She was not accustomed to such assertiveness. Ms. Blackman stared at her like an exasperated parent with a recalcitrant child. Katherine stared back, transfixed by Ms. Blackman’s dark and fluid eyes.
“You’ll have to speak to the doctor,” said Ms. Blackman abruptly. Without waiting for a response she walked away from Katherine and stepped through one of the nearby doors. The latch engaged after her with mechanical finality.
Katherine drew in a breath and looked around her. The other patients were regarding her warily as if they shared the clinic personnel’s disdain for her wish to upset the normal protocol. Katherine struggled to maintain her self-control, telling herself that she was being paranoid. She pretended to read her magazine, feeling the stares of the other women. She wanted to pull inside herself like a turtle or get up and leave. She couldn’t do either. Time inched painfully forward. Several more patients were called for their exams. It was now obvious she was being ignored.
It was three-quarters-of-an-hour later when the clinic physician, dressed in rumpled white jacket and trousers, appeared with Katherine’s chart. The receptionist nodded in her direction, and Dr. Harper sauntered over to stand directly in front of her. He was bald save for a frieze of hair that started over each ear and dipped down to meet in a wiry bush at the nape of his neck. He’d been the doctor who’d examined Katherine on two previous occasions, and Katherine had distinctly remembered his hairy hands and fingers, which had had an alien appearance when matted with the semi-transparent latex rubber gloves.
Katherine glanced up into the man’s face, hoping for a glimmer of warmth. There wasn’t any. Instead he silently flipped open her chart, supporting it with his left hand and following his reading with his right index finger. It was as if he were about to give a sermon.
Katherine let her glance drop. Along the front of his left pant leg was a series of minute bloodstains. Hooked onto his belt on the right was a piece of rubber tubing, on the left a beeper.
“Why do you want your gynecology records?” he said without looking at her.
Katherine reiterated her plans.
“I think it’s a waste of time,” said Dr. Harper, still flipping through the pages. “Really, this chart has almost nothing in it. A couple of mildly atypical Pap smears, some gram positive discharge explainable by a slight cervical erosion. I mean, this isn’t going to help anybody. Here you had an episode of cystitis, but it had been undoubtedly caused by sex the day before the symptoms started, which you had admitted to . . .”
Katherine felt her face flush with humiliation. She knew everyone in the waiting room could hear.
“ . . . look, Miss Collins, your seizure problem has nothing to do with Gynecology. I’d suggest you head up to Neurology clinic . . .”
“I’ve been to Neurology,” interrupted Katherine. “And I have those records already.” Katherine fought back the tears. She wasn’t usually emotional, but the rare times she felt like crying, she had great difficulty controlling herself.
Dr. David Harper raised his eyes slowly from the chart. He took a breath and expressed it noisily through partially pursed lips. He was bored. “Look, Miss Collins, you’ve received excellent care here . . .”
“I’m not complaining about my care,” said Katherine without looking up. Tears had filled her eyes and threatened to run down her cheeks. “I just want my records.”
“All I’m saying,” continued Dr. Harper, “is that you don’t need any second opinions about your gynecological status.”
“Please,” said Katherine slowly. “Are you going to give me my records, or do I have to go to the administrator?” Slowly she looked up at Dr. Harper. With her knuckle she caught the tear that had spilled over her lower lid.
The doct
or finally shrugged and Katherine could hear him curse beneath his breath as he tossed the chart onto the receptionist’s desk, telling the woman to make a copy. Without saying goodbye or even looking back, he disappeared into the examining area.
As Katherine put on her coat she realized she was trembling and again felt light-headed. She walked over to the receptionist’s desk and grasped the outer edge, leaning on it for support.
The bird-like blonde chose to ignore her while she completed typing a letter. When she put the envelope into the machine, Katherine reminded the receptionist of her presence.
“All right, just a moment,” said Ellen Cohen with irritated emphasis on each word. Not until she’d typed the envelope, stuffed, sealed and stamped it, did she get to her feet, take Katherine’s chart, and disappear around the corner. During the entire time she avoided Katherine’s eyes.
Two more patients were called before Katherine was handed a manila envelope. She managed to thank the girl, but wasn’t given the courtesy of a response. Katherine didn’t care. With the envelope under her arm and her bag over her shoulder, she turned and half-ran, half-walked out into the confusion of the main GYN waiting room.
Katherine paused in the heavy air as a smothering wave of dizziness descended over her. Her fragile emotional state combined with the sudden physical effort of rapid walking had been too much. Her vision clouded and she reached out and groped for the back of a waiting-room chair. The manila envelope slipped from under her arm and fell to the floor. The room spun and her knees buckled.
Katherine felt strong hands grasp her upper arms, supporting her. She heard someone try to reassure her and tell her that everything was going to be all right. She wanted to say that if she could sit down for just a moment she’d be fine, but her tongue wouldn’t cooperate. Vaguely she was aware she was being carried upright down a corridor, her feet, like those of a marionette, bumping ineffectually along the floor.