Coma

21

Tuesday, February 24, 2:36 P.M.

Susan allowed her eyes to wander around the Chief of Surgery’s office. It was spacious and exquisitely decorated. Large windows occupying most of two walls afforded a splendid view of Charleston in one direction and a corner of Boston and the North End in the other. The Mystic River bridge was partially concealed by gray snow clouds. The wind had shifted from the sea and was now blowing in from the northwest with arctic air.

Stark’s teak desk, with its white marble top, was situated eater-corner in the northwest section of the office. The wall behind and to the right of the desk was mirrored from floor to ceiling. The fourth wall contained the door from the reception room and carefully constructed, recessed bookshelves. A section of the shelves was hinged; partly ajar, it revealed gleaming glasses, bottles, and a small refrigerator.

In the southeast corner, where the huge expanse of windows met the bookshelves, there was a low, glass-topped table surrounded by molded fiberglass chairs. Their leather cushions were made of bright colors ranging through the oranges and greens.

Stark himself was seated behind his massive desk. His image was recreated a hundred times in the mirror to the right thanks to the reflection from the tinted window glass to his left The Chief of Surgery had his feet propped up on the corner of his desk so that daylight fell over his shoulder onto the paper he was reading.

He was impeccably dressed in a beige suit tailored to fit close to his lean body, accented by an orange silk scarf in his left breast pocket. His graying hair was moderately long and brushed back from his high forehead, just covering the tops of his ears. His face was aristocratic, with sharp features and a thin nose. He wore executive half-glasses framed in delicate reddish tortoiseshell. His green eyes rapidly scanned back and forth across the sheet of paper in his hand.

Susan would have been greatly intimidated by a combination of the impressive surroundings and Stark’s awe-inspiring reputation as a surgical genius had it not been for his initial smile and his seemingly incongruous posture. The fact that he had his feet up on the corner of the desk made Susan feel more comfortable, as if Stark really didn’t take his power position within the hospital too seriously. Susan correctly surmised that his skill as a surgeon and his ability as a medical administrator-businessman made it possible for Stark to ignore conventional executive posturing. Stark finished reading the paper and looked up at Susan sitting in front of him.

“That, young lady, is very interesting. Obviously I am totally aware of the surgical cases, but I had no idea a similar problem was occurring on the medical floors. Whether they are indeed related is uncertain but I must give you credit for coming up with the idea that they may be related. And these two recent respiratory arrests and deaths; associating them is… well, both far-out and brilliant at the same time. It gives food for thought. You have related them because you feel that depression of respiration is the common ground for all the cases. My first reaction to that—now, this is just my first reaction—is that it does not explain the anesthesia cases because in that circumstance, the respiratory pattern is being artificially maintained. You suggest some previous encephalitis or brain infection making people more susceptible to complications during anesthesia… let me see.”

Stark swung his feet from his desk and turned toward the window. Unconsciously he took his reading glasses from his nose and lightly chewed one of the earpieces. His eyes narrowed in concentration.

“Parkinsonism has now been related to previous unsuspected viral insult, so I suppose your theory is possible. But how could it be proved?”

Stark rotated around, facing Susan.

“And you must be assured that we investigated the anesthesia complication cases ad nauseam. Everything—and I mean everything—was studied with a fine-tooth comb by a host of people, anesthesiologists, epidemiologists, internists, surgeons… everybody we could think of. Except, of course, a medical student.”

Stark smiled warmly and Susan found herself responding to the man’s renowned charisma.

“I believe,” said Susan, her confidence rallying, “the study should start with the central computer bank. The computer information I obtained was only for the past year and called up by an indirect method. I have no idea what data would emerge if the computer was asked directly for all cases over, say, the last five years of respiratory depression, coma, and unexplained death.

“Then with a complete list of the potentially related cases, the charts would have to be painstakingly reviewed to try to elicit any common denominators. The families of the involved patients would have to be interviewed to obtain the best possible record of previous viral illness and patterns of illnesses. The other task would be to obtain serum from all existing cases for antibody screens.”

Susan watched Stark’s face, intently preparing herself for an untoward response like that she had experienced with Nelson and then more dramatically with Harris. In contrast, Stark maintained an even expression, obviously in thought over Susan’s suggestions. It was apparent that he had an open, innovative mind. Finally he spoke.

“Shotgun-style antibody screening is not very productive; it is time-consuming and it is horribly expensive.”

“Counter-immunoelectrophoresis techniques have relieved some of these disadvantages,” offered Susan, encouraged by Stark’s response.

“Perhaps, but it still would represent an enormous outlay of capital with a very low probability of positive results. I’d have to have some specific evidence before I could justify that type of resource commitment. But maybe you should suggest this to Dr. Nelson, down in Medicine. Immunology is his special field.”

“I don’t think Dr. Nelson would be interested,” said Susan.

“Why is that?”

“I haven’t the faintest idea. To tell the truth, I already spoke with Dr. Nelson. So I already know he’s not interested. And he wasn’t the only one. I mentioned my ideas to another department head and I thought I was going to get swatted like some naughty child that needed chastising. Trying to incorporate that episode into the whole picture, I get a feeling that something else could be operating here.”

“And what is that?” asked Stark, glancing over the figures Susan had provided.

“Well, I don’t know what word to use… foul play… or something sinister.”

Susan stopped talking quite suddenly, expecting either laughter or anger. But Stark merely rotated in his chair, looking out over the city again.

“Foul play. You do have an imagination, Dr. Wheeler, no doubt about that.”

Stark turned back toward the room, rising up and walking around his desk.

“Foul play,” he repeated. “I must admit I’d never even considered that.” Stark had been briefed only that morning about Cowley’s discovery of the drugs in locker 338; that information had disturbed him. He leaned against his desk and looked down at Susan.

“If you think about foul play, motive becomes of paramount importance. And there just isn’t any motive for such a series of heartbreaking episodes. They are too dissimilar. And coma? You’d have to implicate some very clever psychopath operating on a premise that’s beyond rationality. But the biggest problem with the idea of foul play is that it would be impossible in the OR. There are too many people involved who are watching the patient too closely.

“Certainly investigative activities should be carried out with an open mind, but I don’t think foul play is possible in this instance. But, I must admit, I had not thought of it.”

“Actually,” said Susan, “I hadn’t planned on suggesting foul play to you, but I’m glad that I did so that I can forget it. But back to the problem itself. If antibody screening is too expensive, the chart review and interviews would, be comparatively cheap. I could take that on myself, except I’d need a little help from you.”

“What kind of help?”

“First of all, I’d need to have authorization to use the computer. That’s number one. Secondly, I’d need authorization to get the charts. Thirdly, I may have run into a problem downstairs.”

“What kind of a problem?”

“Dr. Harris. He’s the one who blew his cool. I think he intends to have my surgical rotation here at the Memorial cut short. It seems that he is not fond of women in medicine, and perhaps I have served to underline that prejudice.”

“Dr. Harris can be difficult to get along with. He’s an emotional type. But at the same time he’s probably the best mind in anesthesiology in the country. So don’t damn him until you see his other side. I believe he has specific personal reasons for his attitude toward women in medicine. It’s not admirable, perhaps, but it is potentially understandable. Anyway, I’ll see what I can do for you. At the same time I must tell you that you have picked a very touchy subject to become involved in. You have undoubtedly considered the malpractice implication, the potential bad publicity for the hospital and even the Boston medical community. Tread lightly, young lady, if you choose to tread at all. You’ll make no friends on the course you are embarking on, and it’s my opinion you should drop the whole affair. If you choose to go on, I’ll try to help you, although I can guarantee nothing. If you do turn up any information, I will be happy to offer an opinion. Obviously the more information you have, the easier it will be for me to get you what you need.”

Stark moved toward the door from his office, opening it.

“Give me a call later this afternoon and I’ll let you know if I’ve had any luck with your requests.”

“Thank you for your time, Dr. Stark.” Susan hesitated in the doorway, looking at Stark. “It is reassuring that you have not lived up to your reputation of being a man-, or should I say, woman-eater.”

“Perhaps you will agree with the others when you find time to come on teaching rounds,” said Stark, with a laugh.

Susan said goodbye and left. Stark returned to his desk and spoke into his intercom, talking to his secretary.

“Call Dr. Chandler and see if he has talked with Dr. Bellows yet. Tell him that I want to get to the bottom of those drugs in the locker room as soon as possible.”

Stark turned and looked out over the complex of buildings that made up the Memorial. His life was so closely linked to the hospital that at certain points they merged. As Bellows had told Susan, Stark had personally raised an enormous amount’ of the money it had taken to revitalize the hospital and build its seven new buildings. It was partly due to his fund-raising abilities that he was Chief of Surgery at the Memorial.

The more he thought about the drugs in 338 and their possible implications, the angrier he got. It was just another glaring example of how people in general could not be trusted to think in terms of the long-run effects.

“Christ,” he said out loud, his eyes mesmerized by the swirling snow clouds. Fools could undermine all his efforts at insuring the Memorial’s position as the number one hospital in the country. Years of work could go down the drain. It underscored his belief that he had to attend to everything if he wanted it done right.