Coma (11 page)

A large sign opposite the elevator directed Susan to the conference room. As she walked down the corridor she could see into the offices. These were the private offices for some of the more established doctors at the Memorial. A few patients were scattered along the corridor, reading and waiting. They all looked up as Susan passed. Their faces were uniformly expressionless.

At the end of the corridor Susan passed the office of the Chief of Surgery, Dr. H. Stark. The door was ajar, and inside Susan caught a glimpse of two secretaries typing furiously. Just beyond Stark’s office and on the other side of the corridor was a second stairwell. At the very end of the corridor, over two swinging mahogany doors an illuminated sign proclaimed: “Conference in Progress.”

Susan entered the conference room, letting the doors close quietly behind her. It took a few moments for her eyes to adjust to the darkness, since the room lights were out. The focal point of light at the end of the room was the projected image of a Kodachrome of a human lung. Susan could just make out the outline of a man with a pointer describing the details of the photograph.

From the gloom in the foreground Susan began to discern the rows of seats and their occupants. The room was about thirty feet wide and some fifty feet long. There was a gentle downward slope of the floor to the podium, which was raised by two steps. The projection equipment was professionally hidden from view. The projected beam of light, however, was visible throughout its entire path due to the swirls of cigarette and pipe smoke. Even in the darkness Susan could tell that the conference room was new, well designed, and sumptuously appointed.

The next color slide was a microscopic section, and it provided relatively more light in the room. Susan was able to pick out the back of Niles’s head with its prominent lump. He was sitting in an aisle seat. She walked down to the proper row and tapped Niles on the shoulder. Susan could see that they had saved a seat
for her. She had to squeeze past Niles and Fairweather before she could sit down. It was next to Bellows.

“Did you do a laparotomy or start an I.V.?” whispered Bellows sarcastically, leaning toward Susan. “You were gone over a half-hour.”

“It was an interesting patient,” said Susan, bracing for another lecture on punctuality.

“You can think of a better one than that, I hope.”

“To tell the truth, it was a dressing change on Robert Redford’s circumcision.” Susan pretended to be absorbed in the projected slide for a few moments. Then she looked over at Bellows, who snickered and shook his head.

“You’re too much, I . . .”

Bellows was interrupted by becoming aware that the man on the podium was directing a question at him. All he heard was “ . . . you can enlighten us on that point, Dr. Bellows, can you not?”

“I’m sorry, Dr. Stark, but I did not hear the question,” said Belows, mildly flustered.

“Has she shown any signs of pneumonia?” repeated Stark. A large X-ray of a chest with the right side clouded silhouetted Stark’s thin figure on the podium. His features could not be seen.

A fellow resident sitting directly behind Bellows, leaned forward and whispered for Bellows’s benefit, “He’s talking about Greenly, you asshole.”

“Well,” coughed Bellows, rising to his feet. “She did have a low-grade temperature elevation yesterday. However, her chest is still clear to auscultation. A chest film two days ago was normal, but we have one pending for today. There has been some bacteria in her urine and we believe that cystitis rather than pneumonitis is the cause of the temperature elevation.”

“Is that the pronoun you intended to use, Dr. Bellows?” demanded Dr. Stark, as he walked over to the lectern, placing his hands on each side. Susan struggled to see the man; this was the infamous and famous Chief of Surgery. But his face was still lost in shadow.

“Pronoun, sir?” intoned Bellows rather meekly and with obvious confusion.

“Pronoun. Yes, pronoun. You do know what a pronoun is, don’t you, Dr. Bellows?”

There was a bit of scattered laughter.

“Yes, I think I do.”

“That’s better,” said Stark.

“What’s better?” persisted Bellows. As soon as he said it he wished that he hadn’t. More laughter.

“Your pronoun choice is better, Dr. Bellows. I’m getting rather tired of hearing
we
or some indeterminate third person singular. Part of your training as surgeons involves being able to deal with information, assimilate it, and then make a decision. When I ask a question of one of you residents, I want
your
opinion, not the group’s. It doesn’t mean that other people don’t contribute to the decision process but once you have made the decision, I want to hear
I
, not
we
or
one.
”

Stark walked a few steps from the lectern and leaned on the pointer. “Now then, back to the care of the comatose patient. I want to stress again that you must be fully vigilant with these patients, gentlemen. Although it can be frustrating because of the intense chronic care that is required and, perhaps, because of the grim ultimate prognosis, the rewards can be fabulous. The teaching aspect alone is priceless. Homeostasis is indeed extremely difficult to maintain over protracted periods of time when the brain . . .”

A red light on the side wall suddenly sprang to life, blinking frantically. All eyes in the conference room turned toward it. Silently a message flashed onto a TV screen below the red light: “Cardiac Arrest Intensive Care Unit Beard 2.”

“Shit,” muttered Bellows as he jumped up. Cartwright and Reid followed at his heels, and the three pushed their way to the aisle. Susan and the other four med students hesitated for a moment, looking at each other for encouragement. Then they followed en masse.

“As I was saying, homeostasis is difficult to maintain when the brain is damaged beyond repair. Next slide, please,” said Stark consulting his notes on the lectern, hardly paying heed to the group storming from the room.

February 23

12:16 P.M.

There was no doubt that Sean Berman was very nervous about being in the hospital, facing imminent surgery. He knew very little about medicine, and although he wished that he were better informed, he had not bothered to inquire intelligently about his problem and its treatment. He was frightened about medicine and disease. In fact he tended to equate the two rather than think of them as antagonists. Hence the thought of undergoing surgery offended his sensibility; there was no way for him to deal rationally with the idea that someone was going to cut his skin with a knife. The thought made his stomach sink and sweat appear on his forehead. So he tried not to think about it. In psychiatric terms this was called
denial.
He had been reasonably successful until he had come to the hospital the afternoon before his scheduled surgery.

“The name is Berman. Sean Berman.” Berman remembered the admission sequence all too well. What should have been a smooth affair got hopelessly caught in the bureaucratic tangle of the hospital.

“Berman? Are you sure you’re to come to the Memorial today?” questioned the well-meaning, overly made-up receptionist, who wore black nail polish.

“Yes, I’m sure,” returned Berman, marveling at the black nail polish. It made him realize that hospitals were monopolies of sorts. In a competitive business someone would have the sense to keep the receptionist from
wearing black nail polish.

“Well, I’m sorry but I don’t have a file for you. You’ll have to take a seat while I handle these other patients. Then I’ll call Admitting and I’ll be with you shortly.”

So commenced the first of several snafus which characterized Sean Berman’s admission. He sat down and waited. The big hand of the clock worked its way through an entire revolution before he was admitted.

“May I have your X-ray request, please?” asked a young and extremely thin X-ray technician. Berman had waited over forty minutes in X-ray before being called.

“I don’t have an X-ray request,” said Berman, glancing through the papers he’d been given.

“You must have one. All admissions have one.”

“But I don’t.”

“You must.”

“I tell you I don’t.”

Despite the obvious frustration, the ridiculous admission sequence had had one positive effect. It had totally occupied Berman’s consciousness, and he did not dwell upon his impending surgery. But once in his room, hearing the random moans through partially closed hospital doors, Sean Berman was forced to confront his imminent experience. Even more difficult to dismiss were the people with bandages or even tubes that issued forth mysteriously from areas of the human body without natural orifices. Once in the hospital environment,
denial
was no longer an effective means of psychological defense.

Berman then tried another tactic; he switched to what the psychiatrists call
reaction formation.
He let himself think about his upcoming operation to the point where he seemingly made light of the idea.

“I’m one of the dieticians and I’d like to discuss your meal selection,” said an overweight woman with a clipboard who entered Berman’s room after a sharp knock. “You are here to have surgery, I presume.”

“Surgery?” Berman smiled. “Yeah, I have it about once a year. It’s a hobby.”

The dietician, the lab technician, anyone who would listen, became a victim of Berman’s offhand comment about his scheduled operation.

To an extent this method of defense was successful, at least until the actual morning of the operation.
Berman had been awakened at six-thirty by the sound of some jangling cart in the corridor. Try as he might, he had been unable to fall back to sleep. Reading had been impossible. The time had dragged horribly, slowly yet inexorably toward eleven, when his surgery was scheduled. His stomach had growled from its emptiness.

At 11:05 the door to his room burst open. Berman’s pulse fluttered. It was one of the harried nurses.

“Mr. Berman, there’s going to be a delay.”

“A delay? How long?” Berman forced himself to be civil. The agony of anticipation was taking its toll.

“Can’t say. Thirty minutes, an hour.” The nurse shrugged.

“But why? I’m starved.” Berman really wasn’t hungry; he was too nervous.

“The OR’s backed up. I’ll be back later to give you your pre-op meds. Just relax.” The nurse departed. Berman’s mouth was open, ready for another question, a hundred questions. Relax? Fat chance. In fact, until Susan’s appearance, Sean Berman had spent the entire morning in an uninterrupted cold sweat, dreading the passage of each moment, yet at the same time wishing time would hurry by. Several times he had felt a tinge of embarrassment at the depth of his anxiety, and he wondered if his feelings were relative to the seriousness of the anticipated surgery. If that were the case, he felt be could never undergo a truly serious operation. Berman was worried about feeling pain, worried that his leg might not be ninety-eight percent better, as his doctor had promised, worried about the cast he would have to wear on his leg for several weeks after the operation. He wasn’t worried about the anesthesia. If anything, he worried that they might not put him to sleep. He did not want local anesthesia; he wanted to be out cold.

Berman did not worry about possible complications, nor did he worry about his mortality. He was too young and healthy for that. If he had, he would have thought twice about having the operation. It had always been one of Berman’s faults, to miss the forest for the trees. Once he had designed an architecturally award-winning building only to have it turned down by the local city council just because it did not fit into the surroundings. Fortunately Berman was unaware of the stricken Nancy Greenly in the ICU.

For Berman, Susan Wheeler had been a star on a cloudy night. In his overly sensitized and anxiety-ridden state, she had seemed like an apparition coming to help him pass the time, to ease his mind. But she
had done more. For the first few moments of the morning Berman had been able to think of something besides his knee and the knife. He had given every ounce of concentration to Susan’s comments and all too brief self-revelation. Whether it was Susan’s attractiveness or her obvious wit or just Berman’s own emotional vulnerability, he had been charmed and delighted and felt immeasurably more comfortable on his ride in the elevator down to the operating room. He also considered that the shot Ms. Sterns had given him might have contributed, because he began to get a little light-headed and images began to be slightly discontinuous.

“Guess you see a lot of people on their way to surgery,” said Berman to the orderly, as the elevator approached floor two. Berman was on his back, his hands beneath his head.

“Yup,” said the orderly, uninterested, cleaning under his nails.

“Have you ever had surgery here?” asked Berman, enjoying a sensation of calmness and detachment spreading through his limbs.

“Nope. I’d never have an operation here,” said the orderly, looking up at the floor indicator as the car eased to a stop on two.

“Why not?” asked Berman.

“I’ve seen too much, I guess,” said the orderly, pushing Berman into the hall.

By the time his gurney was parked in the patient holding area, Berman was happily inebriated. The shot he had received on orders from the anesthesiologist, a Dr. Norman Goodman, was 1 cc of Innovar, a relatively new combination of extremely potent agents. Berman tried to talk to the woman next to him in the patient holding area, but his tongue seemed to have become unresponsive, and he laughed at his own ineffectual efforts. He tried to grab a nurse who walked by, but he missed, and he laughed. Time ceased to be a concern and Berman’s brain no longer recorded what happened.

Down in the OR things were progressing well. Penny O’Rilley was already scrubbed and gowned and had brought in the steaming tray of instruments to put out on the Mayo stand. Mary Abruzzi, the circulating nurse, had located one of the pneumatic tourniquets and had carried it into the room.

“One more to go, Dr. Goodman,” said Mary, activating the foot pedal to raise the operating table to
gurney height.