The Diagnosis Read online

  The police cruiser didn’t stop at the main entrance to Boston City Hospital but drove straight to the Emergency Room area on Albany Street, which was aging and ugly like a condemned office building. A thick yellow steam duct protruded from the second-floor brick wall and out across the street.

  “Why are you bringing me here?” Chalmers asked from the backseat of the car. The cruiser was boiling, the dirty blanket was already drenched with his sweat. “Are you going to help me?” The officers said nothing and eased their car next to a couple of ambulances parked with their engines running. Underneath the angled concrete awning, three orderlies were horsing around, smoking and slapping each other on the back and passing around a plastic gallon of Dr Pepper. When they saw the police, they giggled, then became silent. The patrolmen escorted Chalmers past the gaping orderlies, through the sliding glass doors, and up to a massive curved desk. Behind the railing sat a receptionist. More precisely, she hunched over and pecked at a keyboard below the rail, making herself invisible while people with minor emergencies stood about on the other side of the rail waiting to see her.

  At the arrival of the patrolmen, the receptionist stuck her head up. Her hair appeared first, piled in a bun and dyed the same salmon color as the tiles on the floor. She glanced at the officers, then at Chalmers in his dirty blanket. “What you guys brought me today?” she said, chewing gum while she spoke. She looked at Chalmers again. “You got a flasher?”

  “Close,” said the policeman named Ernie. He grinned at the receptionist. “Mister was ninety-five percent through his strip show on the T, fondling a cell phone.”

  “I see,” the receptionist said and raised her upper lip with disgust.

  Chalmers cringed against the railing, his hands shaking. He could sense the jeering gaze of a dozen people behind him. The odor of antiseptic and rubbing alcohol floated down the corridor. Fragments of memories. A noon appointment with a young woman in data systems analysis. Tokyo.

  A telephone rang behind the giant desk. Something electronic buzzed, and the receptionist swatted it like a fly. “Ten minutes ago,” she said looking up at the officers, “some guy come in here with a camera wanting to take pictures. Nervy. Can you believe? I told the bugger no pictures. This is a hospital, not a frigging museum. Am I right? Now, you got papers for me?”

  “We’re putting a hold on him, until CID comes up with an ID,” said Matt.

  The receptionist nodded. A nurse began shouting to someone and waving a clipboard. “Mary Ann,” said the receptionist without explanation. “Can you believe?” she said. It was not clear who she was speaking to. “What do they think I am, a person with three heads? Leila, answer the phone. Leila, check people in. Leila, update the files on the frigging computer. And by the way, Leila, your lunch break has been downsized to thirty minutes. Like I had time to eat lunch. I’m frigging overloaded. This whole place is frigging overloaded.”

  Two physicians in blue scrubs raced down the corridor, stuffing down sandwiches and talking between bites. It must be lunchtime, or past, Chalmers thought, recalling a doughnut he had eaten a century ago. “What time is it?” he asked.

  The receptionist regarded him as if stunned that he could talk. With an inch-long salmon-colored fingernail she pointed to the clock on the wall. “It’s never right,” she said. “I’m extremely busy.” To emphasize her point, she waved toward the people standing beyond her desk. Then she bent down and disappeared again below the railing.

  “Are we done yet, Mr. Matt?” said Ernie. He was leaning against the desk, crumpling up blank registration forms one by one. “I’m awful hungry. I want some of that good barbecue on Mass Ave.”

  “Done,” said Matt.

  “He goes through the double doors on your right to get checked, before Psychiatric,” said an invisible voice from behind the railing. A hospital security guard took Chalmers’s arm. One of the policemen unfastened the handcuffs.

  “Yessiree,” said Ernie. “Goodbye, sweetheart.” He turned to Chalmers. “Have a nice day.” The two patrolmen started to leave.

  Chalmers reached out and tapped Matt on the shoulder. “Are they going to help me?” he asked.

  “Sure,” said Matt. He left with his partner through the sliding glass doors.

  The triage room was barely larger than a walk-in closet. Two chairs, an intercom on the wall, a sink, a table with digital equipment registering Chalmers’s vital statistics in illuminated numbers. Temperature, pulse rate, blood pressure. “How are we doing today?” said the nurse brightly. She received no reply.

  Chalmers sat confused and uncomfortable in his flimsy blue hospital gown and white booties. He had been treated badly, he understood. Now his fear and humiliation were turning to anger. He was not being helped. He had to get back to his office, wherever it was. Suddenly, he had a desperate vision of paper emerging out of a fax machine and fluttering helplessly to the floor. Where was a telephone? His eyes roamed around the room. The intercom didn’t look like a real telephone.

  “What’s your name?” he said finally.

  “Nurse Higley.” The nurse bent over her chart. Chalmers guessed that she was in her early thirties. Her hair fell just to her slender shoulders.

  “Could you please tell me what time it is?”

  “One-fifteen.”

  Oddly, with this little bit of information Chalmers felt a slight relief. Now he knew at least one definite thing. It was 1:15. He stared longingly at the pale white band on his left wrist where a watch had once been.

  “Not much of a job, is it,” he said to the nurse as she wrote.

  “What?”

  “Not much of a job, checking out every Tom, Dick, and Harry who walks in off the street.”

  “You get used to it,” she said without looking up. “It’s a job. It’s not half bad.” She was copying down numbers from the instruments.

  “They think I’m crazy, don’t they. Do you think I’m crazy?”

  “No,” said the nurse. “No crazier than anybody else.” She put down her pen and smiled. “We’re almost finished.” She placed her fingertips lightly on his cheeks and felt the glands in his neck. Abruptly Chalmers slipped his hands around her wrists and kissed her. He was as startled as Nurse Higley, who uttered a small cry and began backing toward the door.

  “I’m extremely sorry,” stammered Chalmers. “I don’t know why I did that, I’ve never done anything like that before.”

  The nurse remained standing by the doorway. “Why do I do this?” she said, suddenly looking exhausted. “I can have an orderly here in one second.”

  “Don’t call the orderly,” said Chalmers. “I promise I won’t touch you again. I don’t know what came over me. Please.”

  Nurse Higley, all of the good cheer sapped from her face, walked slowly back toward the chair where Chalmers was sitting. “I’m almost finished,” she said without any expression in her voice. She shined a light into his eyes.

  “Oh,” she said after examining his eyes, and she stepped back from his chair. She looked again, this time longer. Pursing her lips, she placed the instrument down on the table.

  “What is it?” asked Chalmers.

  “I don’t know,” she said. “Probably nothing. Anyway, we have doctors to make diagnoses. I’ll just have Dr. Barthelme take a look.” She left the room for a few minutes and returned with the doctor.

  “How are we today?” Dr. Barthelme said sleepily. He was young and gaunt, like a marathon runner, and barely awake, as if in the last hour of a twenty-four-hour shift. “I’ll just take a quick peek at your eyes.”

  Nurse Higley closed the door. Immediately, another nurse knocked, opened the door a crack, and whispered to Dr. Barthelme that he was needed urgently to consult with Dr. Chase.

  Dr. Barthelme sighed, brushing his thin blond hair out of his face. “Tell Dr. Chase I’ll be there momentarily,” he said and shut the door.

  He examined Chalmers’s eyes, then frowned and sagged, as if he scarcely had the energy to express an emotion.
“How do you feel?” he asked Chalmers.

  “Fine,” said Chalmers guardedly.

  “No headaches? No dizziness?”

  Chalmers shook his head no. “Do you know what’s wrong with me?”

  “Your eyes don’t look right. Something.” He turned to Nurse Higley. “Nurse, I’d like a CAT scan.” He wrote down some specifications on a yellow slip of paper.

  “Can I have something to eat?” said Chalmers. “I’m starving.”

  “Certainly,” said Barthelme. He turned again to Nurse Higley. “Ask an orderly to get him a box lunch at the cafeteria. Get one for me as well. And black coffee. They’re trying to kill me here. And please notify Dr. Chase and myself as soon as the CT is ready.” He looked at his watch and hurried out of the tiny room.

  Forty-five minutes later, the two doctors stood at the CT console examining the pictures. They spoke in hushed voices. On the computer screen in front of them trembled a digitized X-ray of Chalmers’s brain, a broad cross section passing through the cerebellum, the third ventricle, and the cerebral cortex.

  Chalmers himself lay on the longitudinal positioning board across the room, his head in the hole of the doughnut-shaped X-ray scanner. Over the last twenty minutes, lying within the machine, he had been trying to get a grip on himself. Most likely, he decided, he had suffered some kind of nervous breakdown. But the worst was probably behind him. His memory would return. He needed to be calm. He needed to close his eyes, breathe slowly. He vaguely recalled a television show on meditation, and he focused on his breath. A slow outward breath, a slow inward breath, a slow outward breath, a slow inward breath. To see if he was calming himself, he tried to feel his pulse. He was certainly alert, invigorated by the corned-beef sandwich in his stomach, and, despite the doctors’ low voices, heard everything they said.

  “I’m not sure what this is,” whispered Dr. Chase, who was dressed in a green Polo shirt and slacks.

  “You’re not sure?” whispered Barthelme.

  “Well, I’m sure, yes, of course I’m sure,” said Chase, “but we may need more information.” A dozen numbers glowed along the top of the screen. The senior physician took a mechanical pencil out of his pants pocket and began gnawing mindlessly on its lead point. “Show me another section, Doctor.”

  Barthelme’s skinny fingers fidgeted on the keys. “I’m examining the edges,” whispered Chase. “Just at the periphery, just the outer few millimeters. Let’s check the Hounsfield unit.”

  “You’re the radiologist.”

  “There must be something here.”

  Dr. Barthelme yawned and sat down in a chair.

  A beeper began squawking and Chase shut it off with a slap. “I want to do a microbiopsy,” he said.

  “Shouldn’t we do an MR follow-up?” yawned Barthelme.

  Someone was knocking on the closed door. “Ten minutes,” yelled Chase.

  “We can’t do a biopsy,” whispered Barthelme. “We don’t have authorization.”

  “Shit,” said Chase, looking with irritation at his junior colleague. “Authorization? From whom? Wake up, Frank. This man doesn’t know who he is. Who are you going to get authorization from?”

  “Sooner or later, maybe tomorrow, they’ll find out who he is. Then he’ll have relatives and we’ll need authorization. I’m not breaking the law.”

  “Goddamn,” said Chase. “I don’t want people swarming around me like goddamn Japanese beetles. Listen. We have an opportunity here, Frank, a real opportunity. Now, in a room down the hall, is the brand-new computer-guided aspirator.”

  Barthelme, whose head had been slowly sinking in his chair, popped open his eyes. “I’ve been wondering how Boston City got that CGA.”

  “Never mind,” said Chase. “That’s business. We’ve got one, and I want to use it. I got checked out on it last week. I’ve been waiting to use it. Delay until this guy is identified, and cousins and aunts will be withholding authorizations, who knows what, and the hospital bureaucracy will be telling our asses what we can’t do.” He paused, as if thinking the situation over to himself. “This will be for the patient’s good as well as for ours.”

  “You’re full of it,” said Barthelme. “I don’t like this one bit. I don’t like anything that’s happened here.” He yawned and looked at his watch. “In ten minutes I’m out of here.”

  “Don’t be such a baby starched shirt,” said Chase. “Just come with me and take a look at this machine. It’s state of the art. It’s beautiful. It’s a goddamned miracle.” Chase’s beeper began beeping again. He tossed it into the desk and closed the drawer.

  “What’s that about authorization?” Chalmers interjected.

  At the patient’s surprising and unwelcome outburst, the two doctors ceased talking to themselves. “We won’t be needing anybody’s authorization for anything because we’re not doing anything,” said Dr. Barthelme, addressing himself to the torso protruding from the CT machine.

  “Of course not,” said Chase. “We’re just going to take you next door for a few minutes and then your examination is finished.”

  A disheveled nurse appeared and began working on Chalmers. He felt a needle go into his arm. Then, the sound of wheels on the floor. Someone was shouting about an overdue shipment of rubber gloves. A heavy door opened and closed.

  Silence. The air was dim and thick and pale blue, like at the bottom of a swimming pool. Chalmers found himself propped up in a hospital bed, conscious but unable to speak. Slowly, his eyes adjusted to the faint bluish light. After a few moments, he could make out a dim table to his right on which sat a Sun workstation, bathed in its own blue-green emanations. On the wall, an oval silhouette of dials and regulators of some kind. Other objects were shadows in corners. A console, a desk, a chair. The two doctors stood near the door. In the middle of the dimly lit room, arched majestically over an operating table like a surgeon who never grew tired, was the computer-guided aspirator. It hummed softly. It glowed. It was the size of a man. Even in its dormant condition at this moment, the instrument projected silent blue guide beams down at the operating table and up at the ceiling, so that it appeared to hover in space, suspended from above and below by its own turquoise filigree. Extending down from the bent head of the thing was its single moving part, a syringe with a needle. Electrical cables slithered down from the legs of the instrument like nerve endings, winding their way along the floor to control panels and computers.

  “Jesus H. Christ,” whispered Barthelme, his face reflecting the gauzy blue light. He sat down on the floor, completely awake.

  “Yes,” said Dr. Chase. “Yes.” Smiling, he walked to the machine. He reached out to touch it, then withdrew as if committing a sacrilege, then reached out again and permitted his fingertips to rest lightly on the curved arch. His hand, blue in the blue guide beams, slowly stroked down the back. “I wanted to be an engineer,” he said softly. “Didn’t have the math.” He paused, letting his hand travel cautiously to the titanium mounting. “The needle can be guided to one-hundredth of a millimeter. Made in America, Frank. Made in America. Our country is damn good.” The machine purred, as if waiting.

  “I don’t know what to say,” whispered Barthelme. “It’s beautiful.”

  The voices grew more and more distant. Chalmers felt like he was falling. When he awoke, he found his head completely immobile. Something in his mouth tasted like sharp lemon juice and tingled his tongue. Out of the corner of his eye, he could see a ceramic arch and a needle poised over him, blue beams of light. He screamed, but no sound came from his mouth.

  “Ready?” asked Dr. Chase. The positioning icon of the syringe and a contoured map of Chalmers’s head glowed on the computer screen.

  “Ready,” said Dr. Barthelme excitedly from the Sun station. “Jesus. Oh, Jesus. I can’t believe we’re doing this.”

  The needle descended. There was a grinding sound, like a fine chisel working on rock. After that, the room was silent again, save for the soft purr of the machine. Lights began blinking on the
central console.

  Chase hesitantly left the console and stood, confused, in the middle of the room. He stared toward the lowered syringe of the instrument, turned back toward the flashing lights on the console. “What the devil? I don’t understand,” he muttered and cast a questioning look at Barthelme. “I followed the protocol. I know that I followed the protocol.”

  Dr. Barthelme abandoned his post by the Sun workstation to make his own observation. He bent over the speechless but fully conscious patient, careful not to touch the machine.

  “Something has gone wrong,” said Dr. Chase, frowning and walking slowly around the room. “Nothing seems to have been aspirated. The protection lock has shut the CGA down. Something has gone wrong.”

  “Shit, shit, shit,” said Barthelme. “We shouldn’t have done this. I knew we shouldn’t have done this. I hope he’s okay.”

  “He’s okay,” said Chase, still pacing the room. “I’ll examine him later. But something’s wrong with the machine. I can’t believe it. I followed the protocol. This is a brand-new machine.” The older doctor suddenly seemed to become aware of his consternation. “We’ll have to think hard about this,” he said. Dr. Barthelme nodded. “You go on home,” said Chase. “I’ll have him stitched up and sent to Psychiatric.”

  In the middle of the night, Bill Chalmers awoke from a dream about a pretty auburn-haired woman who was massaging his forehead. He was terribly disappointed to find himself alone in a narrow bed, smelling milk of magnesia instead of her soft skin. His head hurt. He had to escape. In the low light, he could look out of his doorless room into the central service area and beyond. Across the ward, five other patients lay asleep in their doorless rooms, breathing quietly. A nurse sat at the central desk; a guard read in the corner. He waited. After a half-hour, the guard apparently decided that he could risk leaving the outer door unlocked for two minutes while he made one of his trips to the cafeteria for coffee. Immediately, Chalmers placed a pillow under his blanket and eased himself out of his bed. Where were his pants? He moved silently to the bed of another patient, a large man snoring on his back. Chalmers found the man’s bag and put on his pants. The nurse at the desk didn’t notice as he tiptoed out of the ward. Another night nurse, who should have questioned him, trundled groggily on her way to answer a call. Halfway down the hall, a laundry cart provided cover until he could pad in his booties to the stairwell and down to the ground floor. After several tries, he found a door leading to the basement, where he discovered a back stairwell smelling of turpentine. A door opened to the street, locking behind him. Miraculously, he was outside. He was free. Outside, the night air hung humid and warm, and the license plates of parked cars gleamed with the reflection of the moon. Across the street, a feeble light flickered in a window. And Bill Chalmers, wearing a hospital shirt and a pair of pants three sizes too large, chose a direction and walked.