Coma (15 page)

Robert Harris’s eyes began to narrow as Susan began her tirade. Then he interrupted her with an obvious edge to his voice. Bellows’s mouth had dropped open in total dismay.

“I happen to be the Chief of Anesthesia, young lady. And who, may I ask, are you?”

Susan started to speak, but Bellows cut in nervously. “This is Susan Wheeler, Dr. Harris, a third-year medical student who is rotating on surgery, and, ah . . . we just wanted to get this blood drawn here, then we’ll be off.” Bellows recommenced his prep on Berman’s right wrist, stroking rapidly with the Betadine sponge.

“Miss Wheeler,” continued Harris in a condescending tone, “your emotionalism is out of place and frankly will not serve constructive purposes. What one needs in these cases is to establish a causal factor. I’ve just mentioned to Dr. Bellows that the anesthetic agent was different in these two cases. The anesthetic care was unimpeachable save for a few minor debatable points. In short, both these cases were obviously unavoidable idiosyncratic reactions to the combination of anesthesia and surgery. One needs to try to determine from these people if there is a way in order to forecast this kind of disastrous sequelae. To condemn anesthesia across the board and deprive the populace of needed surgery would be far worse than to accept a certain minimal risk involved in anesthesia. What . . .”

“Two cases in eight days is hardly a minimal risk,” interrupted Susan contentiously.

Bellows tried to catch Susan’s eye to get her to break off with Harris, but Susan was staring directly at Harris, converting her emotionalism to defiance.

“How many such cases have there been in the last year?” asked Susan.

Harris’s eyes scanned Susan’s face for several seconds before he responded. “I suddenly find this conversation somewhat akin to being cross-examined, and in that sense intolerable and unnecessary.” Without waiting for a response, Harris walked past Susan toward the recovery room door.

Susan turned to face him. Bellows reached for her right arm to try to shut her up. Susan fended him off. She called after Harris, “Without wishing to sound impertinent, it does seem to me that some questions need to be asked by someone, and something done.”

Harris stopped abruptly about ten feet from Susan and turned very slowly. Bellows shut his eyes tightly, as if he expected to receive a blow to the head.

“And I suppose that someone should be a medical student! For your information, in case you are planning to be our Socratic gadfly, there have been six cases prior to this present problem in the last few
years. Now if I may have your permission, I will get back to work.”

Harris turned again and started for the door.

“I suppose
your
emotionalism serves constructive purposes,” called Susan. Bellows supported himself by leaning onto the bed. Harris stopped for the second time, but he did not turn around. Then he continued, and he too blasted open the door to the hall.

Bellows put his left hand up to his forehead. “Holy fuck, Susan, what are you trying to do, commit medical suicide?” Bellows reached out and turned Susan around to face him. “That was Robert Harris, Chief of Anesthesia. Christ!”

Bellows commenced the prep for the third time, rapidly, nervously. “You know, just being here with you when you act like that makes me look bad. Shit, Susan, why did you want to get him pissed?” Bellows palpated the radial artery and then jammed the needle of the heparinized syringe into the skin on the thumb side of Berman’s wrist. “I’m going to have to say something to Stark before he hears about it through the grapevine. Susan, I mean, what’s the point of getting him mad? You obviously don’t have any idea what hospital politics are like.”

Susan watched Bellows performing the arterial stick. She consciously avoided looking at Berman’s sickly face. The syringe began to fill with blood spontaneously. The blood was a very bright crimson.

“He got mad because he wanted to get mad. I don’t think I was impertinent until that last question, and he deserved that.”

Bellows didn’t answer.

“Anyway I really didn’t want to make him angry . . . well, maybe I did in a way.” Susan thought for a few moments. “You see, I talked with this patient only an hour or so ago. He was the patient I had to leave the ICU for. It’s just so unbelievable; he was a functioning, normal human being. And . . . I . . . we had a conversation and I felt like I knew something about him. I even took a liking to him in a way. That’s what makes me mad or sad or both. And Harris, his attitude made it worse.”

Bellows didn’t respond immediately. He searched in the tray for a syringe cap. “Don’t tell me any more,” he said at length. “I don’t want to hear about it. Here, hold the syringe for me.” Bellows gave Susan
the syringe while he prepared the ice bed. “Susan, I’m afraid you’re going to be poison for me around here. You have no idea how miserable someone like Harris can make it. Here, put pressure on the puncture site.”

“Mark?” said Susan pressing on Berman’s wrist but looking at Bellows directly. “You don’t mind if I call you Mark, do you?”

Bellows took the syringe and placed it into the ice bath. “I’m not sure, to be perfectly honest.”

“Well, anyway, Mark, you have to admit that six, and maybe seven, cases, if Berman proves to be like Greenly, represents a lot of cases of brain death, or vegetables, as you call them.”

“But a lot of surgery goes on here, Susan. It’s often more than a hundred cases a day, some twenty-five thousand per year. That drops the six cases below some two hundredths of one percent in incidence. That’s still within the surgical anesthesia risk.”

“That may be true, but these six cases represent only one type of possible complication, not surgical-anesthesia risk in general. Mark, it’s got to be too high. In fact, down in the ICU this morning you said that the particular complication Nancy Greenly represented occurred only about one in a hundred thousand. Now you’re trying to tell me that six in twenty-five thousand is OK. Bullshit. It’s too high whether you or Harris or anybody in the hospital accept it. I mean would
you
want to have some minor surgery tomorrow with that kind of risk? You know this whole thing really bothers me, the more I think about it.”

“Well then, don’t think about it. Come on, we’ve got to get moving.”

“Wait a minute. You know what I’m going to do?”

“I can’t guess and I’m not sure I want to know.”

“I’m going to look into this particular problem. Six cases. That should be enough for some reasonable conclusions. I do have a third-year paper to do and I think I owe that much to Sean here.”

“Oh for Christ’s sake, Susan, let’s not be melodramatic.”

“I’m not being melodramatic. I think I’m responding to a challenge. Sean challenged me earlier with my image of myself as a doctor. I failed. I wasn’t detached or professional. You might even say I acted like a schoolgirl. Now I’m challenged again. But this time intellectually with a problem, a serious problem. Maybe I can respond to this challenge in a more commendable fashion. Maybe these cases represent a new
symptom complex or disease process. Maybe they represent a new complication of anesthesia because of some peculiar susceptibility these people had from some previous insult which they suffered in the past.”

“All the more power to you,” said Bellows getting the remains from the arterial stick together. “Frankly though, it sounds like a hell of a hard way to work out some emotional or psychological adjustment problem of your own. Besides, I think you’ll be wasting your time. I told you before that Dr. Billing, the anesthesiology resident on Greenly’s case, went over it with a fine-tooth comb. And believe me, he’s bright. He said that there was absolutely no explanation for what happened.”

“Your support is appreciated,” said Susan. “I’ll start with your patient in the ICU.”

“Just a minute, Susan dear. I want to make one point crystal clear.” Bellows held up his index and middle finger like Nixon’s victory sign. “With Harris on the rag, I don’t want to be involved, no how. Understood? If you’re crazy enough to want to get involved, it’s your bag from A to Z.”

“Mark, you sound like an invertebrate.”

“I just happen to be aware of hospital realities and I want to be a surgeon.”

Susan looked Mark directly in the eye. “That, Mark, in a nutshell, is probably your tragic flaw.”

February 23

1:53 P.M.

The cafeteria at the Memorial could have been in any one of a thousand hospitals. The walls were a drab yellow that tended toward mustard. The ceiling was constructed of a low-grade acoustical tile. The steam table was a long L-shaped affair with brown, stained trays stacked at the beginning.

The excellence of the Memorial’s clinical services did not extend into the food service. The first food seen by an unlucky customer coming into the cafeteria was the salad, the lettuce invariably as crisp as wet Kleenex. To heighten the disagreeable effect, the salads were stacked one on top of the other.

The steam table itself presented the hot selections, which posed a baffling mystery. So many things tasted alike that they were indistinguishable. Only carrots and corn stood aside. The carrots had their own disagreeable taste; the corn had absolutely no taste at all.

By quarter to two in the afternoon, the cafeteria was almost empty. The few people who were sitting around were mostly kitchen employees, resting after the mad lunchtime rush. As bad as the food was, the cafeteria was still heavily patronized because it enjoyed a monopoly. Few people in the hospital complex took more than thirty minutes for lunch, and there simply was not enough time to go elsewhere.

Susan took a salad but after one look at the limp lettuce, she replaced it. Bellows went directly to the
sandwich area and took one.

“There’s not much they can do to a tuna sandwich,” he called back to Susan.

Susan eyed the hot entrees and moved on. Following Bellows’s lead, she selected a tuna sandwich.

The woman who was supposed to be at the cash register was nowhere to be seen.

“Come on,” motioned Bellows, “we ain’t got much time.”

Feeling a bit like a shoplifter by not paying, Susan followed Bellows to a table and sat down. The sandwich was repellent. Somehow too much water had gotten into the tunafish and the tasteless white bread was soggy. But it was food and Susan was famished.

“We’ve got a lecture at two,” garbled Bellows through a huge bite of sandwich. “So eat hearty.”

“Mark?”

“Yeah?” said Bellows as he gulped half his milk in one swig. It was apparent that Bellows was a speed eater of Olympic caliber.

“Mark, you wouldn’t be hurt if I cut your first surgery lecture, would you?” Susan had a twinkle in her eye.

Bellows stopped the second half of his tuna sandwich midway to his mouth and regarded Susan. He had an idea that she was flirting with him, but he dismissed it.

“Hurt? No, why do you ask?” Bellows had a helpless feeling that he was being manipulated.

“Well I just don’t think I could sit through a lecture at this moment in time,” said Susan, opening her milk carton. “I’m a little spaced from this affair with Berman. . . .
Affair
is not the right word. Anyway I’m really uptight; I couldn’t handle a lecture. If I do something active I’ll be much better off. I was thinking that I’d go to the library and look up something about anesthesia complications. It will give me a chance to start my ‘little’ investigation as well as sort out this morning in my mind.”

“Would you like to talk about it?” asked Bellows.

“No, I’ll be OK, really.” Susan was surprised and touched by his sudden warmth.

“The lecture isn’t critical. It’s an introductory kind of thing by one of the emeritus professors. Afterwards I planned for you students to come on the ward to meet your patients.”

“Mark?”

“What?”

“Thanks.”

Susan stood up, smiled at Bellows, and left.

Bellows put the second half of his tuna sandwich into his mouth and chewed it on the right side, then he moved it over to the left cheek. He wasn’t even sure what Susan had thanked him for. He watched her cross the cafeteria and deposit her tray in the rack. She rescued her unfinished milk and sandwich before leaving. At the door she turned and waved. Bellows waved in return but by the time he got his hand up, she had already disappeared.

Bellows looked around self-consciously, wondering if anyone had noticed him with his hand in the air. Replacing his hand on the table, he thought about Susan. He had to admit that she attracted him in a refreshing, basic way, reminding him of the way he felt early in his social career: an excitement, an unsettling impatience. His imagination conjured up sudden romantic pursuits with Susan as the object. But as soon as he did so, he reprimanded himself for being juvenile.

Bellows polished off his milk with another gigantic gulp while carrying his tray to the dirty-dish cart. En route he wondered if he dared to ask Susan out. There were two problems. One was the residency and Stark. Bellows had no idea how the chief would react to one of his residents dating a student assigned to him. Bellows was not sure if such a worry was rational or not. He did know that Stark tended to favor married residents. The idea was that the married ones would be more dependable, which, as far as Bellows was concerned, was pure bunk. But there was little hope of keeping a relationship between himself and one of the students a secret. Stark would find out and it could be bad. The second problem was Susan herself. She was sharp; there was no question about that. But could she be warm? Bellows had no idea. Maybe she was just too busy, or too intellectualized, or too ambitious. The last thing that Bellows wanted to do was to squander his limited free time on some cold, castrating bitch.

And what about himself? Could Bellows handle a sharp girl who was in his own field even if she were warm and lovable? He had dated a few nurses, but that was different because nurses were allied with but
distinct from doctors. Bellows had never dated another doctor or even doctor-to-be. Somehow the idea was a bit disturbing.

Leaving the cafeteria, Susan enjoyed a greater sense of direction than she had felt all day. Although she had no idea how she was actually going to investigate the problem of prolonged coma after anesthesia, she felt that it represented an intellectual challenge which could be met by applying scientific methods and reasoning. For the first time all day she had a feeling that the first two years of medical school had meant something. Her sources were to be the literature in the library and the charts of the patients, particularly Greenly’s and Berman’s.