Robin Cook: Terminal

“I wouldn’t stand for it,” Dorothy said. “I used to think my husband’s golf fetish was bad, but it’s nothing compared to what you’re talking about. Are there women involved in these Friday night escapades?”

“Sometimes they go up to Revere. There’s a strip joint there. But mostly it’s just Sean and the boys, drinking beer, telling jokes, and watching sports on a big-screen TV. At least that’s how he’s described it. Obviously I’ve never been there.”

“Maybe you should ask yourself why you’re involved with this man,” Dorothy said.

“I have,” Janet said. “Particularly lately, and especially since we’ve had so little communication. It’s hard even to find time to talk with him. Not only does he have all the work associated with med school, but he has his research too. He’s in an M.D.-Ph.D. program at Harvard.”

“He must be intelligent,” Dorothy offered.

“It’s his only saving grace,” Janet said. “That and his body.”

Dorothy laughed. “At least there’s a couple of things to justify your anguish. But I wouldn’t let my husband get away with that juvenile Friday night stuff. Hell, I’d march right in and embarrass the heck out of him. Men will be boys, but there have to be some limits.”

“I don’t know if I could do that,” Janet said. But as she took a sip from her coffee, she gave the idea some thought. The problem was that she’d always been so passive in her life, letting things happen, then reacting after the fact. Maybe that’s how she got herself into this kind of trouble. Maybe she needed to encourage herself to be more assertive.

“Damn it, Marcie!” Louis Martin shouted. “Where the hell are those projections? I told you I wanted them on my desk.” To emphasize his displeasure, Louis slapped his hand on his leather-bound blotter, sending a flurry of papers wafting off into the air. He had been feeling irritable ever since he’d awakened at four-thirty that morning with a dull headache. While in the bathroom searching for aspirin, he’d vomited into the sink. The episode had shocked him. His retching had come with no warning and no accompanying nausea.

Marcie Delgado scurried into her boss’s office. He’d been yelling at her and criticizing her all morning. Meekly she reached across the desk and pushed a stack of papers bound with a metal clip directly in front of the man. In block letters on the front cover was: PROJECTIONS FOR BOARD MEETING FEBRUARY 26.

Without even an acknowledgment, much less an apology, Louis snatched up the documents and stormed out of the office. But he didn’t get far. After half a dozen steps, he couldn’t recall where he was going. When he finally remembered he was headed for the boardroom, he wasn’t sure which door it was.

“Good afternoon, Louis,” one of the directors said, coming up behind him and opening the door on the right.

Louis stepped into the room feeling disoriented. He hazarded a furtive glance at the people sitting around the long conference table. To his consternation, he was unable to recognize a single face. Lowering his eyes to stare at the packet of papers he’d carried in with him, he let them slip from his grasp. His hands were shaking.

Louis Martin stood for another moment while the babble of voices in the room quieted. All eyes were drawn to his face, which had turned ghostly pale. Then Louis’s eyes rolled up inside his head, and his back arched. He fell backward, his head striking the carpeted floor with a dull thump. Simultaneous with the impact on the floor, Louis’s body began to tremble before being overwhelmed by wild tonic and clonic muscular contractions.

None of Louis’s board of directors had ever seen a grand mal seizure, and for a moment they were all stunned. Finally, one man overcame his shock and rushed to the side of his stricken chairman. Only then did others respond by racing off to nearby telephones to call for help.

By the time the ambulance crew arrived, the seizure had passed. Except for a residual headache and lethargy, Louis felt relatively normal. He was no longer disoriented. In fact, he was dismayed to be told he’d had a seizure. As far as he was concerned, he’d only fainted.

The first person to see Louis in the emergency room at the Boston Memorial Hospital was a medical resident who introduced himself as George Carver. George seemed harried but thorough. After conducting a preliminary examination he told Louis that he would have to be admitted even though Louis’s private internist, Clarence Handlin, had not yet been consulted.

“Is a seizure serious?” Louis asked. After his prostate operation two months earlier, Louis was not happy about the prospect of being hospitalized.

“We’ll get a neurology consult,” George said.

“But what’s your opinion?” Louis asked.

“Seizures with sudden onset in an adult suggests structural brain disease,” George said.

“How about talking English,” Louis said. He hated medical jargon.

The resident fidgeted. “Structural means exactly that,” he said evasively. “Something abnormal with the brain itself, not just its function.”

“You mean like a brain tumor?” Louis asked.

“It could be a tumor,” George said reluctantly.

“Good Lord!” Louis said. He felt himself break out in a cold sweat.

After calming the patient the best he could, George went into the “pit,” as the center of the emergency room was called by those that worked there. First he checked to see if Louis’s private physician had called in yet. He hadn’t. Then he paged a neurology resident stat. He also told the ER clerk to call the medical student who was up for the next admission.

“By the way,” George said to the clerk as he was returning to the cubicle where Louis Martin was waiting. “What’s the name of the medical student?”

“Sean Murphy,” the clerk said.

“Crap!” Sean said as his beeper went off. He was certain that Janet had long since disappeared, but just to be sure, he opened the door carefully and scanned the area. He didn’t see her, so he pushed through. He had to use the phone out in the nurses’ station since Peter was hogging the one in the back room, trying to get last-minute lab reports.

Before Sean called anybody, he approached Carla Valentine, the head nurse. “You guys looking for me?” he asked expectantly. He was hoping they were because then the page would involve some easily performed scut work. What Sean feared was that the page was coming from either admitting or the ER.

“You’re all clear for the moment,” Carla said.

Sean then dialed the operator and got the bad news. It was the ER with an admission.

Knowing the sooner he got the history and physical done, the better off he’d be, Sean bid farewell to Peter, who was still on the phone, and went downstairs.

Under normal circumstances Sean liked the ER and its constant sense of excitement and urgency. But on the afternoon of his last day on his medicine rotation, he didn’t want another case. The typical Harvard medical student’s workup took hours and filled between four and ten pages of tightly written notes.

“It’s an interesting case,” George said when Sean arrived. George was on hold on the phone with radiology.

“That’s what you always say,” Sean said.

“Truly,” George said. “Have you ever seen papilledema?”

Sean shook his head.

“Grab an ophthalmoscope and look at the guy’s nerve heads in both eyes. They’ll look like miniature mountains. It means the intracranial pressure is elevated.” George slid the ER clipboard along the countertop toward Sean.

“What’s he got?” Sean asked.

“My guess is a brain tumor,” George said. “He had a seizure at work.”

At that moment someone came on the phone line from radiology, and George’s attention was directed at scheduling an emergency CAT scan.