Coma

19

Tuesday, February 24, 11:00 A.M.

Susan slowed to a deliberate walk, avoiding the questioning expressions of the people using the corridor. Her emotions, she was afraid, could be read from her face like an open book. Usually when she cried or was about to cry, her cheeks and eyelids turned bright crimson. Although she knew she wasn’t going to cry now, the proper neural connections had been made. If someone she knew stopped her and said something innocuous, like “What’s the matter, Susan?” she probably would have cried. So Susan wanted to be alone for a few moments. As it was, she was more angry and frustrated than anything else as the fear generated by her encounter with Harris evaporated. Fear seemed so out of place in the context of a meeting with a professional superior that she wondered if she was becoming delusional. Had she really crossed Harris to the extent that he had had to keep himself in check to avoid some sort of physical encounter? Was he just about to strike her, as she had feared, when he came bounding out from behind his desk? The idea seemed ludicrous and it was difficult for her to believe that the situation had been so precipitous. She knew that she could never make someone else believe what she had felt. It reminded her of the situation with Captain Queeg in The Caine Mutiny.

The stairwell was the only haven she could think of, and she pushed through the metal door. It closed behind her rapidly, cutting off the raw fluorescent lights and the voices. The single bare incandescent bulb above her had a warmer glow and the stairway offered a soothing silence.

Susan was still clutching her notebook and a ballpoint pen. Gritting her teeth, and swearing loudly enough to hear an echo, she threw the notebook and the pen down the course of stairs to the landing below. The notebook bounced on the edge of a stair, then fell flat, cover down, onto the floor. It skidded across the landing and struck the wall, coming to a rest unhurt and open. The pen flipped over the edge of the stairs and a few telltale sounds suggested that it had descended to the bowels of the hospital.

Uninviting as it was, Susan sat down on the top stair, her feet on the very next step, bringing her knees up at acute angles. Her elbows rested on the tops of her knees. She closed her eyes tightly. So much of her experience in medicine with relationships had been reemphasized in the short time she had been at the Memorial. Professional superiors, instructors to professors, reacted to her in a manner that unpredictably varied from warm acceptance to overt hostility. Usually the hostility was more passive-aggressive than Harris’s had been; Nelson’s reaction was more typical. Nelson had been friendly at first, then later had slipped into an obstructive stance. Susan felt an old familiar feeling, a feeling which had developed ever since she had chosen medicine as a career: it was a paradoxical loneliness. Although constantly surrounded by people who reacted to her, she felt apart. The day and a half at the Memorial had not been an auspicious beginning for her clinical years. Even more than during her first days at medical school, she felt that she was entering a male club; she was an outsider forced to adapt, to compromise.

Susan opened her eyes and looked down at her notebook sprawled on the landing below. Throwing the book had given some vent to her frustrations, and she felt a degree more relaxed. Control was returning. At the same time the childish aspect of the gesture surprised her. It was not like her to do such a thing. Perhaps Nelson and Harris were, in the final analysis, right. Perhaps being a medical student so early in training, she was not the right person to investigate such a serious clinical problem. And perhaps her emotionalism was a built-in handicap. Would a male have responded in the same way to Harris’s reaction? Was she more emotional than her male counterparts? Susan thought about Bellows and his cool detached manner, how he could concentrate on the sodium ions while confronting a tragedy. Susan had found fault with his behavior the day before, but now, daydreaming in the stairwell, she was no longer so sure. She wondered if she could achieve that type of detachment if it were necessary.

A door opening somewhere far above brought Susan to her feet. There were some hushed and hurried footsteps on the metal stairs, then the sound of another door, then silence returned. The crude cement walls of the stairwell combined with the curious longitudinal rust-colored stains enhanced Susan’s sense of isolation. In slow motion she descended to where her notebook lay. By chance it had opened to the page copied from Nancy Greenly’s chart. Reaching for the book, Susan read her own handwriting. “Age 23, Caucasian, previous medical history negative except for mononucleosis at age 18.” Quickly Susan’s mind conjured up the image of Nancy Greenly, her ghostly pallor, lying in the ICU. “Age twenty-three,” Susan said aloud. In a rush she re-experienced the intensity of her feelings of transference. Susan felt a rekindling of her commitment to investigating the coma problem to the limit of her abilities despite Harris, despite Nelson. Without questioning why, she felt a strong urge to find Bellows. Within a single day her feeling toward Bellows had taken a one-hundred-and-eighty-degree turn.

“Susan, for Christ’s sake, haven’t you had enough yet?” With his elbows on the table, Bellows placed his palms against his face so that his fingers could lightly massage his closed eyes. His hands rotated, bringing his fingers below his ears. With his face cradled in his hands, he looked at Susan sitting across from him in the hospital coffee shop. The place had a relatively clean appearance with indeterminate modern furnishings. It was primarily meant for visitors to the hospital, although the staff frequented it on occasion. The prices were higher than the cafeteria’s but the quality was equivalently better. At eleven-thirty it was crowded but Susan had found a table in the corner and had paged Bellows. She was pleased when he agreed to see her immediately.

“Susan,” continued Bellows after a pause, “you’ve got to give up this self-destructive crusade. I mean it’s absolutely sure suicide. Susan, there’s one thing about medicine, you’ve got to flow with the river or you’ll drown. I’ve learned that. God, whatever could have possessed you to go to Harris, especially after that little episode yesterday?”

Susan sipped her coffee in silence, keeping her eyes on Bellows. She wanted him to talk because it sounded good; he seemed to care. But also she wanted him to get involved, if that were at all possible. Bellows shook his head as he took a drink of his coffee.

“Harris is powerful, but he’s not omnipotent around here,” added Bellows. “Stark can reverse anything Harris does if he has reason to do so. Stark has raised most of the money for construction around here, millions. So people listen to what he says. So why not give him a reason; why not pretend to be a normal medical student for a few days? Christ, I need it myself. Guess who was on rounds this morning to welcome you medical students? Stark. And the first thing he wanted to know was why there were only three students out of five. Well I told him that, foolishly enough, I had taken you all in to see a case on the first day, and one of you had fainted and smashed his head on the floor. You can guess how that went over. And then I couldn’t think of anything appropriate to say about you. So I said you were doing a literature search on coma following anesthesia. I decided that since I couldn’t think of a good lie I might as well tell the truth. Well he immediately assumed that it had been my idea to put you on the project. I cannot repeat what he said to me in response. It should be enough for me to say that I need you to behave like a normal medical student. I’ve covered for you to the extent that I’m already overdrawn.”

Susan felt an urge to touch Bellows, kind of a reassuring people-to-people hug. But she didn’t; instead she played with her coffee spoon with her head down. Then she looked at Bellows.

“I’m really sorry if I’ve caused you some difficulties, Mark, really I am. Needless to say, it was unintentional. I’m the first to admit this thing has gotten out of hand so rapidly that it’s uncanny. I started because of an emotional crisis of sorts. Nancy Greenly is the same age as I, and I’ve had some occasional irregularities with my periods, probably just like Nancy Greenly. I cannot help but feel some… some kinship with her. And then Berman… what a Goddamned coincidence. By the way, did Berman have an EEG?”

“Yeah, it was completely flat. The brain is gone.”

Susan searched Bellows’s face for some response, some sign of emotion. Bellows lifted the coffee cup to his lips and took a sip.

“The brain is gone?”

“Gone.”

Susan bit her lower lip and looked down into her coffee cup. A small amount of oil opalesced on the surface in colorful swirls. Somehow she had expected the news, but it still cut into her and she fought with her mind, suppressing emotion as best she could.

“Are you OK?” asked Bellows, reaching across and gently lifting her chin with his hands.

“Don’t say anything for a second,” said Susan, not daring to look at him. The last thing she wanted to do was cry and if Bellows persisted, it would happen. Bellows cooperated and returned to his coffee while keeping his eyes on Susan.

After a few moments Susan looked up; her eyelids were slightly reddened.

“Anyway,” continued Susan, avoiding eye contact with Bellows, “I started with an emotional sort of commitment, but that quickly mixed with intellectual commitment. I really thought I had stumbled onto something… a new disease or a new complication of anesthesia or a new syndrome… something, I don’t know what. But then there was another change. The problem loomed bigger than I had imagined initially. They’ve had coma cases on the medical floors as well as in surgery. On top of that, there were those deaths you told me about. I know you think it’s crazy, but I think they are related, and the pathologist intimated they have had a number of such cases. My intuition tells me there is something else in all this, something… I don’t know how to explain it… call it supernatural or call it sinister…”

“Ah, now paranoia,” said Bellows, nodding his head in mock understanding.

“I can’t help it, Mark. There was something very strange about the reaction of Nelson and Harris. You have to admit that Harris’s reaction was totally inappropriate.”

Bellows tapped his forehead in succession with the heel of his hand. “Susan, you’ve been staying up watching old horror movies. Admit it, Susan… admit it or I’ll think you’re having a psychotic break. This is absurd. What do you suspect, some sort of sinister inversion layer spreading evil forces, or is it a crazed killer who hates people with minor ailments? Susan, if you hypothesize so extravagantly and with such creativity, then come up with some ideas of motive. I mean, a demented killer was OK for Hollywood and George C. Scott in Hospital just to create an artificial mystery… but it’s a little too farfetched for reality. I admit Harris’s performance sounds a bit weird, there’s no doubt about that. But at the same time I think I could come up with some reasonable explanation for his unreasonable behavior.”

“Try.”

“OK, I’m sure Harris is already completely uptight about this problem of coma. After all, it’s his department which essentially has to shoulder the responsibility. And here comes a young medical student to drive in the painful spikes a little more. I think it’s understandable for an individual to overreact under that kind of stress.”

“Harris did a little more than overreact. This nut came from behind his desk with the intent of knocking me around the room.”

“Maybe you turned him on.”

“What?”

“On top of everything else maybe he was reacting to you sexually.”

“Come on, Mark.”

“I’m serious.”

“Mark, this guy’s a doctor, a professor, a chief of a department.”

“That does not rule out sexuality.”

“Now you’re the one being absurd.”

“A lot of doctors spend so much time with the nuts and bolts of their profession that they fail to ever really adequately resolve the usual social crises of life. Socially speaking, doctors are not very accomplished, to say the least.”

“Are you speaking for yourself?”

“Possibly. Susan, you have to realize you are a very seductive girl.”

“Fuck you.”

Bellows looked at Susan, stunned. Then he glanced around to see if anyone was listening to their conversation. He had not forgotten they were in the coffee shop. He took a sip of coffee and then regarded Susan for several minutes. She returned his stare.

“Why did you say that?” said Bellows with a lowered voice.

“Because you deserved it. I get a little tired of that kind of stereotyping. When you say I’m seductive you imply to me that I am actively trying to seduce. Believe me, I am not. If medicine has done anything to me, it certainly has cut into my image of myself as conventionally female.”

“All right, maybe it was a bad word. I didn’t mean to imply it was your fault. You’re an attractive girl…”

“Well there’s a helluva difference between saying someone’s attractive and saying someone’s seductive.”

“OK, I meant attractive. Sexually attractive. And there are people who may find that hard to deal with. Anyway, Susan, I didn’t mean to get into an argument. Besides, I’ve got to go. I’ve got a case in fifteen minutes. If you want, we can talk about it tonight over dinner. That is, if you still want to have dinner?” Bellows started to get up, taking his tray.

“Sure, dinner’s fine.”

“Meanwhile, couldn’t you try to be normal for a little while?”

“Well, I have one more stone to turn over.”

“What’s that?”

“Stark. If he doesn’t help me, I’ll have to give up. Without some support I’m doomed to failure, unless of course you want to get the computer information for me.”

Bellows let his tray drop back onto the table. “Susan, don’t ask me to do anything like that, because I can’t. As for Stark, Susan, you’re crazy. He’ll eat you alive. Harris is a jewel in comparison to Stark.”

“That’s a risk I have to take. It’s probably safer than undergoing minor surgery here at the Memorial.”

“That’s not fair.”

“Fair? What a choice word. Why don’t you ask Berman if he thinks it’s fair?”

“I can’t.”

“You can’t?” Susan paused, waiting for Bellows to explain himself. Susan did not want to think of the worst but it came to her automatically. Bellows started toward the tray rack without explaining himself.

“He’s still alive, isn’t he?” asked Susan with a tingle of desperation in her voice. She got up and walked behind Bellows.

“If you call that heart beating being alive, he’s alive.”

“Is he in the recovery room?”

“No.”

“The ICU?”

“No.”

“OK, I give up, where is he?”

Bellows and Susan put their trays into the rack and walked from the coffee shop. They were immediately engulfed by the mob in the hall and forced to quicken their steps.

“He was transferred to the Jefferson Institute in South Boston.”

“What the hell is the Jefferson Institute?”

“It’s an intensive care facility built as part of the area’s Health Maintenance Organization design. Supposedly it’s been designed to curtail costs by applying economics of scale in relation to intensive care. It’s privately run but the government financed construction. The concept and plans came out of the Harvard-MIT health practices report.”

“I’ve never even heard about it. Have you visited it?”

“No, but I’d like to. I saw it from the outside once. It’s very modern… massive and rectilinear. The thing that caught my eye was that there were no windows on the first floor. God only knows why that caught my eye.” Bellows shook his head.

Susan smiled.

“There’s a tour organized for the medical community,” continued Bellows, “to visit the place on the second Tuesday of each month. Those that have gone have been really impressed. Apparently the program is a big success. All chronic-care ICU patients who are comatose or nearly so can be admitted. The idea is to keep the ICU beds in the acute-care hospitals available for acute cases. I think it’s a good idea.”

“But Berman just became comatose. Why would they transfer him so quickly?”

“The time factor is less important than stability. Obviously he’s going to be a long-term-care problem and I guess he was very stable, not like our friend Greenly. God, she’s been a pain in the ass. Just about every complication known, she’s had it.”

Susan thought about emotional detachment. It was difficult for her to understand how Bellows could be so out of touch emotionally with the problem Nancy Greenly represented.

“If she were stable,” continued Bellows, “even threatened stability, I’d transfer her to the Jefferson in a flash. Her case demands an inordinate amount of time with thin rewards. Actually, I have nothing to gain by her. If I keep her alive until the services switch, then at least I’ve suffered no professional harm. It’s like all those Presidents keeping Vietnam alive. They couldn’t win, but they didn’t want to lose either. They had nothing to gain but a lot to lose.”

They reached the main elevators and Bellows made sure one of the silently waiting crowd had pushed the “up” button.

“Where was I?” Bellows scratched his head, obviously preoccupied.

“You were talking about Berman and the ICU.”

“Oh, yeah. Well, I guess he was stable.” Bellows looked at his watch, then eyed the closed doors with hatred. “Goddamn elevators.

“Susan, I’m not one to give advice usually, but I can’t help myself. See Stark if you must, but remember I’ve gone out on a limb for you, so act accordingly. Then after you see Stark, give this crusade up. You’ll ruin your career before you begin.”

“Are you worried about my career or your own?”

“Both, I guess,” said Bellows standing aside for the disembarking elevator passengers.

“At least you’re honest.”

Bellows squeezed into the elevator and waved to Susan, saying something about seven-thirty. Susan presumed he meant their dinner date. At that moment her watch said eleven forty-five.