Coma

14

Monday, February 23, 5:05 P.M.

As she had been telling Bellows that the incidence of coma following anesthesia at the Memorial was one hundred times the national incidence, Susan had realized that she was basing her calculations on the six cases Harris had mentioned in his outburst. Susan had to check that figure. If it was actually higher, she would have more ammunition to base her commitment to the project. Besides, she needed the names of the coma victims so that she could obtain then” charts. What she needed more than anything else, she recognized, was hard data.

Susan knew that she had to get access to the central computer. Harris would be unwilling to supply the names of the patients. Susan was certain of that. Bellows might have been able to get them if he were sufficiently motivated. But that was a big if. Susan felt that the best route was for her to try to get the information herself. So she was thankful she had taken the introductory course in PL 1 computer programming as a junior in college. Already it had paid off in surprising ways, and her need for the information at hand was just another example.

The computer center in the hospital was located in the Hardy wing, occupying the entire top floor. Many people joked about the symbolic aspects of the computer being above everything else in the hospital, and it had added a new meaning to the phrase “with a little help from above.”

As the elevator door slid open on the foyer of the eighteenth floor, Susan knew she was going to have to improvise if she were to be successful. Beyond the foyer Susan could see through glass partitions into the main computer reception area. The place had the appearance of a bank. The only difference was that the medium of exchange here was information, not currency.

Susan entered the reception room and walked directly to a counter top that ran the length of the room along the right wall. There were about eight other people in the room, most of them sitting in comfortable-looking blue corduroy chairs. A few were at the counter top bent over computer request forms. All looked up as Susan traversed the room, but they quickly returned to their own affairs. Without the slightest hint of uncertainty Susan took one of the computer request forms. Ostensibly concentrating on the form, Susan had her real attention on the room.

In the back of the room, about twelve feet from Susan, was a large white Formica desk. Above it hung a sign: “Information.” It was so appropriate that it brought a smile to Susan’s face. The man at the desk sat motionlessly, a slight proud smile on his face. He was about sixty, pudgy but neat. Behind him, visible through another glass partition, were the gleaming input-output terminals of the computer itself. While Susan was pretending to be absorbed in the form in front of her, the man at the desk accepted several computer request forms. Each time he went over the form, converting the request to computer language and writing it on the lower portion of the form. He also checked the authorization by calling the department involved, unless he knew the requesting individual personally. Finally he placed the form—or several stapled together—in the “in” box on the corner of the desk. The requesting individual was told when to expect the information, depending on the priority assigned to the request.

Having assessed the procedure, Susan gave full attention to the form before her. It was certainly simple enough. She filled in the date in the indicated box. She left blank the box for the authorizing department, and she also omitted the name of the requesting party or organization. Susan also left blank the box reserved for method of payment for computer time. She concentrated on the information desired. Susan was not sure how she should word the request for several reasons. One was the concern that the hospital might be uptight about leaking information on cases of coma resulting from anesthesia. Perhaps they might have programmed a subroutine into the computer so that any requests for information would be automatically canceled, or at least alert the computer that the information had been requested. Another point that occurred to Susan was that a disease or disease process might have several modes or degrees of expression. Prolonged coma after an anesthetic might be one of them, maybe the most severe. Susan wanted to obtain a wide range of information and in that way be able to select what she thought was significant.

But requesting all cases of coma for the past year might yield a printout that was too extensive. Since coma was a symptom and not a disease itself, Susan could end with a list of every heart attack, stroke, and cancer victim who had succumbed to those diseases over the last year. Susan decided to call only for cases of coma occurring in people who had no known chronic or debilitating disease. Then she realized that she was already making assumptions. If she were on the track of a new disease, there was no reason why it couldn’t affect people who had other diseases. In fact, if it were infectious in nature, other disease processes would encourage its expression by lowering defenses.

Susan changed her request to all cases of coma occurring to inpatients (in hospital) which were unrelated to the patient’s known disease processes. Susan next asked for a correlate between her sample and those having surgery during their stay at the Memorial prior to their coma, with a time correlation between surgery and the onset of the coma. With a certain amount of difficulty Susan translated her request into computer language. She had not used it for almost a year, and it took a few moments to get it right. This portion of the request was below two red lines and the admonishment “Do not write below this line.”

Susan then waited for the next request to be turned in to the man at the desk. Luckily she did not have to wait long. About four minutes after she finished writing, the elevator arrived. Through the glass she saw a man squeeze past the elevator door before it had fully opened and approach the reception desk at a lope. About forty, slight of build, with flaxen hair parted from a deeply recessed hairline, the man waved a handful of the computer request forms nervously.

“George,” said the man pulling up in front of the reception desk, “you gotta help me.”

“Ah, my old friend Henry Schwartz,” said the man behind the desk. “We’re always ready to help the accounting department. After all, that’s where our checks come from. What can I do for you?”

Susan carefully penciled in “Henry Schwartz” onto her own form in the box for the requesting party. In the area for authorizing department, Susan wrote “Accounting.”

“I need a couple of things, but most of all I need a list of all the Blue Cross-Blue Shield subscribers who have had surgery in the last year,” said Schwartz in a rapid-fire fashion. “If you asked why I need it, you’d crack up, I swear you would. But I need it and fast. The day shift was supposed to have had it ready for me.”

“We can run it in an hour or so. I’ll have it for you by seven,” said George, stapling Schwartz’s requests together and tossing them into the box.

“George, you’re a lifesaver,” said Schwartz, running his hand through his hair over and over again. He then headed toward the elevator. “I’ll be back at seven sharp.”

Susan watched Schwartz press the “down” button and then walk back and forth in the elevator foyer. It looked as if he was talking to himself. He hit the “down” button several more times. After the elevator picked him up, Susan watched the floor indicator above the elevator. It stopped at six, then three, then one. Susan would have to look up which floor the accounting department was located on.

Susan took another blank request form and, carefully placing it over her own, she headed for the desk.

“Excuse me,” said Susan, marshaling a smile she hoped would be convincing. George looked up at her, over the tops of his black-rimmed glasses, which perched midway down his nose. “I’m a medical student,” continued Susan, making her voice as sweet as possible, “and I’m very interested in the computer here at the hospital.” She held up the request forms, the blank one hiding the one she had filled out.

“You are, are you?” said George, sitting back with a smile broadening on his own face.

“I am,” repeated Susan shaking her head in the affirmative. “I think that the potential of the computer in medicine is very great, and since it is obviously not a part of our formal orientation here, I thought I’d just come up and sort of get acquainted.”

George looked at Susan, then over his shoulder through the glass partition at the gleaming IBM hardware. When he turned back to Susan his pride was effervescing.

“It’s a marvelous set up, Miss…”

“Susan Wheeler.”

“It is a fantastic machine, Miss Wheeler,” said George, leaning forward in his seat and lowering his voice and emphasizing his words, suggesting that he was telling Susan a tremendous secret. “The hospital couldn’t do without it.”

“In order to get an idea how it is used, I’ve been studying the request form here.” Susan held the request forms so that George would see only the blank one, but he had turned again to look into the terminal room.

“I was interested to see a completed form,” continued Susan reaching over and taking the top group of stapled forms from the “in” box. “I was curious about how the requests were fed into the computer. Is it all right if I look at one of these?” She placed the forms Schwartz had delivered over her own.

“Sure,” said George turning back to Susan. He stood up and leaned over toward Susan, placing his left hand on the desk. With his other hand he pointed to the space where the request was written in normal English.

“Here the requesting party indicates what it is they want. Then down here…” George’s finger moved down below the red lines “… we have the area where the request is translated into a language that the computer will understand.”

Susan slipped her blank form from under the pile of Schwartz’s forms, as if comparing them and she put it down on the desk beside them—leaving her own filled-out form beneath Schwartz’s.

“So if someone wants several different kinds of information, they have to fill out separate forms?” asked Susan.

“Exactly, and if…”

Susan turned Schwartz’s first request form back from the rest of them rapidly, pulling it free of the staple in the upper left corner.

“Oh, I’m terribly sorry,” said Susan putting the top sheet back in position. “Look what I’ve done. Let me staple it for you.”

“No matter,” said George, fumbling for the staple machine himself. “One staple will fix it.” George pressed the staple machine as Susan held the completed forms, together with her own request on the underside.

“Let me put these back before I destroy them completely,” said Susan contritely, replacing the forms in the “in” box.

“No harm done,” reassured George.

“Now once the request is in, what happens to it?” asked Susan looking into the terminal room and taking George’s attention from the “in” box.

“Well, I take them inside to the key puncher, who prepares the cards for the card reader. Then…”

Susan was not listening; she was thinking of how best to terminate her visit. About five minutes later she was down at the directory for the hospital, looking up Henry Schwartz of the accounting department.

With a spare hour and a half, Susan left the Memorial for her dorm. Her stomach growled in opposition to her forgetfulness of basic needs. The tuna sandwich, as bad as it was, had long since disappeared into her metabolic mill, and Susan looked forward to dinner.