Coma

18

Tuesday, February 24, 10:48 A.M.

In Dr. Harris’s office there was an entire bookcase full of the latest books on anesthesiology, some still in prepublication bound galleys, sent for his endorsement. For Susan this was a boon, and her eyes scanned the titles for any books specifically on complications. She located one, and she wrote down the title and publisher. Next she looked for any general texts which she had not seen in the library. And her eyes registered another find: Coma: Pathophysiological Basis of Clinical States. Excitedly she withdrew the volume and thumbed through it, noticing the chapter headings. She wished she had had the book at the onset of her reading.

The door to the office opened and Susan looked up to face Dr. Robert Harris for the second time. Instantly she felt a certain sense of intimidation or scorn as Dr. Harris regarded her without the slightest sign of recognition or friendliness. It had not been Susan’s idea to wait for him in his office; it had been the direct order of the secretary who had arranged the meeting for Susan. Now Susan felt an uneasiness, as if she were an interloper in Dr. Harris’s private sanctum. The fact that she was holding one of his books made it that much worse.

“Be sure to put the volume back where you found it,” said Harris as he turned to close the door, his speech slow and deliberate as if addressed to a child. He removed his long white coat and hung it on the hook on the back of the door. Without another word he retreated behind his desk to open a large ledger and make several notations. He acted as if Susan were not even there.

Susan closed the textbook and replaced it on the shelf. Then she returned to the director’s chair in which she had started her wait for Dr. Harris thirty minutes before.

The only window was directly behind Harris, and its light, combining with the overhead fluorescent light, gave a strange shimmering quality to Harris’s appearance. Susan had to squint against the glare coming directly at her.

The smooth tawny color of Harris’s arms was a perfect setting for the gold digital watch on his left wrist. His forearms were massive, tapering to surprisingly narrow shafts. Despite the time of year and the temperature, Dr. Harris was dressed in a short-sleeved blue shirt. Several minutes went by before he finished with the ledger. After closing the cover he pressed a buzzer for his secretary to come in and take it. Only then did he turn and acknowledge Susan’s existence.

“Miss Wheeler, I am certainly surprised to see you in my office.” Dr. Harris slowly leaned back in his chair. He seemed to have some difficulty looking directly at Susan. Because of the background lighting Susan could not see the details of his face. His tone was cold. There was a silence.

“I would like to apologize,” began Susan, “for my apparent impertinence yesterday in the recovery room. As you probably are aware, this is my first clinical rotation, and I’m unaccustomed to the hospital environment, particularly to the recovery room. On top of that there had been a strange coincidence. About two hours prior to our meeting I had spent some time with the very patient you were attending. I had started his I.V. prior to surgery.”

Susan paused, hoping for some sign of acknowledgment from the faceless figure in front of her. There was none. There was no movement whatsoever. Susan continued.

“The fact of the matter was that my conversation with the patient had not remained on an entirely professional level; in fact, we had tentatively agreed to meet sometime on a social basis.”

Susan paused again but silence continued from Dr. Harris.

“I’m offering this information more as an explanation than an excuse for my reaction in the recovery room. Needless to say, when I was confronted with the reality of the patient’s condition, I became quite upset.”

“So you reverted to the vestiges of your sex,” said Harris condescendingly.

“Excuse me?” Susan had heard his comment, but by reflex she questioned whether she had heard him correctly.

“I said, so you reverted to the vestiges of your sex.”

Susan felt a flush spread across her cheeks. “I’m not sure how to take that.”

“Take it at face value.”

There was an awkward pause. Susan fidgeted, then spoke. “If that is your opinion of being a woman, then I plead guilty; emotionalism under such circumstances is understandable from any human being. I admit the fact that I was not the archetypical professional at the first meeting with the patient, but I think that if the roles had been reversed, I being the patient and the patient being the doctor, it probably would have come out the same. I hardly think that susceptibility to human responses is a frailty reserved for female medical students, especially when I have to put up with the patronizing attitudes of my male counterparts with the female nurses. But I did not come here to discuss such matters. I came here to apologize for impertinence to you and that is all. I’m not apologizing for being a woman.”

Susan paused again, expecting some sort of reply. None was forthcoming. Susan felt a definite feeling of irritation spread through her.

“If my being a woman bothers you, then that’s your problem,” said Susan with emphasis.

“You’re being impertinent again, my dear,” said Harris.

Susan stood up. Gazing down, she looked at Harris’s face, his narrowed eyes, his full cheeks and broad chin. Light played through the edge of his hair, making it appear like silver filigree.

“I can see this is getting us nowhere. I’m sorry I came. Goodbye, Dr. Harris.”

Susan turned and opened the door to the corridor.

“Why did you come?” said Harris after her.

With her hand on the door, Susan looked out into the corridor and considered Harris’s question. Obviously debating with herself whether to leave or not, she finally turned and faced the Chief of Anesthesiology again.

“I thought I’d apologize so that we could let bygones be bygones. I had the irrational hope that you might be willing to lend me some assistance.”

“In what regard?” said Harris, his voice relaxing its aloofness by a degree.

Susan hesitated again, debating, then let the door shut. She walked up to the chair she had been sitting in but she did not sit down. She eyed Harris and thought that she had nothing to lose and should say what she had originally come to say despite his coldness.

“Since you said that there have been six cases of prolonged coma following anesthesia during the last year, I decided to look into the problem as a potential subject for my third-year paper. Well, I found out that you were absolutely correct. There have been six cases following anesthesia during the last year. But there also have been five cases of sudden. unexplained coma occurring in patients on the medical floors during the past year. Yesterday there were two deaths for apparent respiratory arrest. These patients gave no history to suggest that such an event might take place. They were in the hospital for essentially peripheral problems; one had a minor foot operation followed by phlebitis, the other had Bell’s palsy. Both were essentially well individuals, except one of them had glaucoma. There was no explanation for their respiratory arrest and I have a feeling that they are possibly related to the other coma cases. In other words, I think I have twelve cases representing gradations of the same problem. And if Berman turns out to be in the same boat as the others, then there are thirteen people suffering from some unexplained phenomenon. Perhaps worst of all, the incidence seems to be on the upswing, especially for the cases occurring during anesthesia. The interval between cases seems to be getting shorter and shorter. Anyway, I have decided to try to look into the problem. In order for me to continue my investigation I need some help from someone like yourself. I need authorization to search the data bank and see how many cases the computer could find if it’s asked directly. Also I need the charts of the previous victims.”

Harris leaned forward and slowly placed his arms on his desk.

“So the Medical Department has had some trouble too,” he murmured. “Jerry Nelson didn’t mention that.”

Looking up at Susan, he spoke louder.

“Miss Wheeler, you are dabbling in troubled waters. It’s refreshing to hear someone, fresh from the basic science years of medical school, interested in clinical research. But this is not the proper subject for you. There are many reasons for my saying this. First of all, the problem of coma is far more complex than might-be apparent to you. It is a wastepaper-basket term, a mere description. And for someone to immediately assume all cases of coma are related simply because the causative agent is not precisely known is intellectually absurd. Miss Wheeler, I advise you to stick to something more specific, less speculative, for your so-called third year paper. As far as helping you is concerned, I must admit I do not have the time. And let me admit something else that might be rather apparent to you. I don’t try to hide it. I’m not keen on women in medicine.”

Harris pointed his finger at Susan and aimed across it almost as if were a gun.

“They treat it like a game, something to do for now… something chic… later, who knows. It’s a fad. And on top of that, they are invariably, impossibly emotional and…”

“Dr. Harris, cut the bullshit,” interrupted Susan, lifting up the back of the chair and letting it fall a few inches. She was furious. “I didn’t come here to listen to this type of nonsense. In fact it’s people like you who keep medicine in the old rut, unable to respond to the challenge of relevancy and change.”

Harris pounded the top of the desk with his open hand causing a few papers and pencils to flee for safety. Almost in one step he came from behind his desk with a speed that caught Susan off guard. His movement brought his face only inches from Susan’s. She froze before the unexpected fury she had unleashed.

“Miss Wheeler, you do not know your place here,” hissed Harris, holding himself in check with great difficulty. “You are not to be the Messiah who is going to miraculously deliver us from a problem which has already been under the scrutiny of the best minds in this hospital. In fact, I see you as a very destructive influence and I can promise you this: you’ll be out of this hospital in twenty-four hours. Now get out of my office.”

Susan backed up, afraid to expose her unguarded back to this man who seemed about to explode with hatred. She opened the door and ran down the corridor, feeling the tears well up from her mixture of fear and anger.

Behind her, Harris kicked the door shut and snatched the phone off the hook. He told his secretary to get him the director of the hospital without delay.