Coma

15

Monday, February 23, 6:55 P.M.

It was a little before seven when Susan alighted from the MBTA at the North Station stop. Crossing the footbridge spanning the street, Susan was exposed to the rush of wind whipping up from the partially frozen harbor water. She bent against its force, clutching her sheepskin ski hat with her left hand and the lapels of her peajacket with her right hand. She tried to keep the cold from her neck by snuggling her chin as far as possible into the recesses of her collar.

When she rounded the edge of the building, the wind increased. An empty beer can tumbled past her into the street. The familiar rush hour sea of red taillights and wisps of exhaust fumes stretched as far as Susan could see. The windows on the cars were frosted, and they reflected the images about them with a silver sheen, giving the impression of the often white, unseeing pupils of the blind.

Susan began to run at a slow jog with an exaggerated to and fro roll of her body since her arms were pressed against herself. The main entrance to the hospital yawned in front of her, and with relief she pushed through the revolving door.

Susan stuffed her hat into the right sleeve of her coat and left it in the coatroom behind the main information desk. Then she used the hospital telephone directory and rang up the computer center.

“Hello, this is the accounting department,” said Susan slightly out of breath and struggling to make her voice sound normal. “Has Mr. Schwartz picked up his material yet?”

The answer was affirmative; he had collected it about five minutes earlier. The timing seemed perfect as far as Susan was concerned, and she left for the Hardy building elevator and the third floor accounting offices.

The evening accounting crew was a mere skeleton compared to the day shift. When Susan entered the room only three people were visible at the far end. Two men and one woman looked up in unison as Susan entered.

“Excuse me,” called Susan, approaching the group. “Can you tell me where I can find Mr. Schwartz?”

“Schwartz? Sure. He’s in the office in the corner,” said one of the men, pointing down the opposite side of the room.

Susan’s eyes followed his finger. “Thanks,” she said, reversing her direction.

Henry Schwartz was in the middle of the computer printout he had requested. The office was small but extraordinarily neat. The books in the bookcase were arranged so that their heights descended in an orderly fashion. The depth of the book backs in the shelves was one inch, no more, no less.

“Mr. Schwartz?” asked Susan smiling and walking up to his desk.

“Yes?” said Schwartz without removing his index finger from his place in the printout.

“It seems that my printout got mixed up with yours, or at least that was the combined opinion upstairs. I was wondering if you had noticed any material you had not requested?”

“No, but I haven’t looked through it all yet. What was it you’re missing?”

“It’s some information on coma we need for a section presentation. Do you mind if I see if it’s included with your material?”

“Not at all,” said Schwartz, lifting sections of the printout to find the break points.

“If it’s there, it would be the last section,” offered Susan. “They said it was run right after yours.”

Schwartz lifted the bulk of the material from the desk. Remaining was the information Susan needed. Attached to the top was her request form.

“That’s it,” said Susan.

“But the form indicates I requested it,” questioned Schwartz glancing at the request form.

“No wonder they got it mixed up with your material,” said Susan, reaching for the material. “But I assure you, you wouldn’t be interested in this stuff. And it’s certainly not your fault, by any means.”

“I’d better say something to George…,” said Schwartz replacing his own printout in front of him.

“No need,” said Susan, exiting. “We already discussed it at length.” Thanks a million.”

“You’re welcome,” said Schwartz, but Susan had already left.

“Susan, you are too much, really too much,” said Bellows between spoonfuls of custard he had taken from the tray of a patient who was too nauseated to eat. “You skip the lecture, afternoon rounds, and avoid your patients, and now you’re hanging around here until eight P.M. The only consistency about your performance so far is constant variation.” Bellows laughed as he scraped the bottom of the custard cup.

Susan and Bellows were sitting in the lounge on Beard 5 where the hospital day had begun for Susan. She was sitting in the same seat she had occupied that morning. Spilling over onto the floor was the IBM printout sheet she had obtained. She was running down the list of names and marking appropriate ones with a yellow felt-tip pen.

Bellows took a drink from his coffee.

“Well, that proves it,” said Susan, putting the cap on the pen.

“Proves what?” asked Bellows.

“Proves that there haven’t been six cases of unexplained coma, excluding Berman, here at the Memorial this last year.”

“Hurray,” cheered Bellows, toasting with his coffee mug. “Now I can stop worrying about anesthesia and have my hemorrhoids fixed.”

“I would recommend that you stick to your suppositories,” said Susan, counting the names she’d marked. “There haven’t been six because there’ve been eleven. And if Berman continues on his present course, then there will have been twelve.”

“Are you sure?” Bellows’s tone changed abruptly and he showed interest in the IBM printout sheet for the first time.

“That’s all that came out on this printout,” said Susan. “I wouldn’t be surprised if there were a few more if I had been able to call up the information straight away.”

“You really think so? God, eleven cases!” Bellows leaned over toward Susan, his tongue working at the empty spoon. “How’d you manage to get this IBM printout?”

“Henry Schwartz was nice enough to help me,” said Susan nonchalantly.

“Who the hell is Henry Schwartz?” asked Bellows.

“Damned if I know.”

“Spare me,” said Bellows covering his eyes with his hand, “I’m too tired for mental games.”

“Is that a chronic ailment or an acute affliction?”

“Cut the crap. How’d you get this data? Something like this has to be cleared through the department.”

“I went upstairs this afternoon, filled out one of those M804 forms, gave it to the nice man at the desk, and then went back tonight and picked it up.”

“I’m sorry I asked,” said Bellows getting up and waving his spoon to suggest he would let the issue ride. “But eleven cases. Did they all happen during surgery?”

“No,” said Susan, going back to the printout. “Harris was on the level when he said six. The other five were from inpatients on the medical service. Their diagnosis was idiosyncratic reaction. Doesn’t that strike you as pretty odd?”

“No.”

“Oh, come on,” said Susan impatiently. “The word idiosyncratic sounds great but it really means that they had no idea what the diagnosis was.”

“That might be true, but Susan, dear, this happens to be a major hospital, not a country club. It serves as a referral base for the whole New England area. Do you know how many deaths we have here on an average in a single day?”

“Deaths have causes… these cases of coma do not… at least not as yet.”

“Well, deaths don’t always have apparent causes. That’s the purpose of autopsy.”

“There, you hit the nail on the head,” said Susan. “When someone dies, then you do an autopsy and you find out what was the cause of death so that you can possibly add to your fund of knowledge. Well, in the coma cases you can’t do an autopsy because the patients are somewhere hovering between life and death. That makes it even more important that you do another kind of ‘opsy,’ a live-opsy, if you will. You study all the clues you have available, short of dismembering the victim. The diagnosis is just as important, maybe even more important than the autopsy diagnosis. If we could find out what was wrong with these people, maybe we could bring them out of their comas. Or better still, avoid the coma in the first place.”

“Even the autopsy,” said Bellows, “doesn’t always provide the answers. There are plenty of deaths where the exact cause is never determined whether they do an autopsy or not. I happen to know that two patients threw in the towel today, and I doubt very much if a diagnosis will be made.”

“Why do you think that the diagnosis won’t be made?” asked Susan.

“Because both patients expired from respiratory arrest. They apparently just stopped breathing, very calmly with no warning. They were just discovered dead. And in respiratory arrest you don’t always find anything to hang the blame on.”

Bellows had captured Susan’s interest. She was staring at him without moving, without blinking.

“Are you OK?” asked Bellows, waving his hand in front of her face. Still Susan did not move until she looked down at the IBM printout.

“What the hell do you have, psychomotor epilepsy or something?” asked Bellows.

Susan looked up at him. “Epilepsy? No, of course not You said these cases today died of respiratory arrest?”

“Apparently. I mean they stopped breathing. They just gave up.”

“What were they in the hospital for?”

“I’m not positive. I think one of them was in for some problem with his leg. Maybe he had phlebitis and they might find a pulmonary embolus or something. The other one was in for Bell’s palsy.”

“Were they both on I.V.s?”

“I don’t remember but I wouldn’t be surprised if they had been. Why do you ask?”

Susan bit her lower lip, thinking about what Bellows had just told her.

“Mark, do you know something? These deaths you mentioned could be related to the coma victims.” Susan patted the printout with the back of her hand. “You might have hit on something. What were the names? Can you remember?”

“For Christ’s sake, Susan, you’ve got this thing on the brain. You’re working overtime and you’re starting to have delusions.” Bellows switched to an artificially concerned tone. “Don’t be concerned, though; it happens to the best of us after we’ve stayed up for two or three nights in a row.”

“Mark, I’m serious.”

“I know you’re serious, that’s what worries me. Why don’t you give yourself a break and forget about it for a day or so? Then you can pick it up and be more objective. I tell you what. I’ve got tomorrow night off and with a little luck I can get out of here by seven. How about some dinner? You’ve only been here a day but you have to get away from the hospital as much as I do.”

Bellows hadn’t planned on asking Susan out quite so soon and in such a fashion. But he was pleased because it had come so apparently spontaneously and consequently it would be easy to deal with a refusal if it occurred. It sounded more like an offer to get together than an actual date.

“Dinner’s fine, can’t pass up an offer for a dinner even with an invertebrate. But really, Mark, what were the names of the two deaths today?”

“Crawford and Ferrer. They were patients on Beard 6.”

Susan pursed her lips as she wrote the names down in her notebook. “I’ll have to look into those in the morning. In fact…” Susan looked at her” watch “… maybe tonight. If they were going to do an autopsy on these cases, when would it be?”

“Probably tonight or first thing in the morning,” shrugged Bellows.

“Well then I better check tonight.”

Susan refolded her printout.

“Thanks, Mark, old boy; you’ve been a help again.”

“Again?”

“Yeah. Thanks for those articles you Xeroxed for me. You’ll make a good secretary someday.”

“Up yours.”

“Tut, tut. See you tomorrow night. How about the Ritz? I haven’t eaten there for several weeks,” teased Susan, heading for the door.

“Not so fast, Susan. I’ll see you at rounds in the morning at six-thirty. Remember our deal. I’ll cover for you another day if you come to rounds.”

“Mark, you’ve been such a dear, really. Let’s not louse it up so soon.” Susan smiled and pulled some of her hair across her face with coquettish exaggeration. “I’ll be up till all hours reading all this material you got for me. I need one more full day. We’ll discuss it further tomorrow night.”

Then she was gone. Again Bellows felt encouraged about Susan as he sipped his coffee. Then he got up. He had plenty of work to do.