Coma

28

Wednesday, February 25, 10:41 P.M.

Bellows was exhausted. It was going on eleven, and he was still at it. In fact he had not made rounds yet on Beard 5. He had to do that before he left for home. At the nurses’ station he got the chart rack and wheeled it toward the lounge. A cup of coffee would help him get through the work. Opening the door, he was genuinely surprised to find Susan in the lounge; she was hard at work.

“Excuse me. I must be in the wrong hospital.” Bellows pretended to go back out through the door. Then he looked back at Susan.

“Susan, what in hell’s name are you doing here? I was told in no uncertain terms that you had become persona non grata.” Without meaning to, Bellows’s voice reflected some irritation. It had been a terrible day—with the low spot being his discovery of Walters.

“Who, me? You must be mistaken, sah. I’m Miss Scarlett, the new nurse on 10 West,” said Susan, feigning a higher voice with a southern accent.

“Christ, Susan, cut the bullshit.”

“You started it.”

“What are you doing here?”

“Polishing my shoes, what does it look like I’m doing?”

“OK, OK. Let’s start again.” Bellows came into the room and sat on the counter top. “Susan, this whole scene has become very serious. It’s not that I’m not happy to see you, because I am. I had a fabulous time last night. God, it seems like a week ago. But if you’d been around when the shit hit the fan this afternoon, you’d understand why I’d be a little on edge. Among other things I was told that if I continued to cover and aid you in your, quote, ‘idiotic mission,’ I’d be out looking for a new residency.”

“Ah, poor boy! May have to leave Mama’s warm womb.”

Bellows looked away for a moment, trying to maintain his composure. “I can sense this conversation is going nowhere. Susan, you cannot understand that I have more to lose in this affair than you do.”

“Like hell you do!” Susan’s face lit up with sudden anger! “You’re so Goddamned self-centered and worried about your residency appointment that you couldn’t see a conspiracy if it involved your…. your mother.”

“Jesus Christ! The thanks I get for helping you. What the hell does my mother have to do with all this?”

“Nothing. Absolutely nothing. I just couldn’t think of anything else which would come close to your residency in your warped value system. So I took a chance on your mother.”

“You’re making no sense, Susan.”

“No sense, he says. Look, Mark, you’re so worried about your career that you’re blind. Do I look different to you?”

“Different?”

“Yeah, different. Where’s that old clinical expertise, that keen sense of observation that you’re supposed to have absorbed during your medical training? What do you think this is here under my eye?” Susan pointed to the bruise on her cheek. “And what do you think this is?” Susan garbled the last few words as she held out her lower lip, exposing the laceration.

“It looks like trauma….” Bellows extended his hand to examine Susan’s lip more closely. Susan fended him off.

“Keep your cotton-pickin’ mitts off. And you say that you have more to lose in this whole thing. Well, let me tell you something. I was attacked and threatened this afternoon by a man who scared the shit out of me. This man knew about me and what I’ve been doing these last few days. He even knew about my family. He even included my family in the threat. And you say that you have more to lose!”

“You mean somebody actually hit you?” Bellows was incredulous.

“Oh come on, Mark. Can’t you say something intelligent? Do you think these are self-inflicted wounds to make people feel sorry for me? I’ve stumbled into something big, that I can tell you. And I have a scary feeling that it’s some large organization. I just don’t know how or why or who.”

Bellows looked at Susan for several minutes, his mind racing over her story, which seemed incredible, and his own experience that afternoon.

“I don’t have any literal wounds to show, but I had one hell of an afternoon as well. Remember those drugs I told you about? The ones that were found in a locker in the OR doctor’s lounge? They were found in a locker assigned to me, as I told you. Like it or not, I was immediately implicated. So I decided that I had to settle the whole thing once and for all by getting Walters to explain why I was still assigned to that locker when he had given me another.

“But Walters didn’t come in today. First time in I-don’t-know-how-many years. So I decided to visit him.” Bellows sighed and poured himself some coffee, remembering the grisly details. “The poor bastard committed suicide over this thing, and I had to be the guy who found him.”

“Suicide?”

“Yeah. Apparently he’d learned that the drugs had been found, and he decided to take what he considered the easy way out.”

“Are you sure it was suicide?”

“I’m not sure of anything. I didn’t even see the note. I called the police and have gotten the details from Stark. But don’t suggest it wasn’t suicide. God, I couldn’t handle that. I’d probably be considered a suspect. What on earth could make you suggest such a thing?” Bellows was intense.

“No reason. It just seems another strange coincidence to have happened at this time. Those drugs that were found may be important somehow.”

“I was afraid that your imagination would suggest that they were important. That was one of the reasons why I hesitated to tell you about the drugs in the first place. But look, all this is somewhat peripheral to the present problem, namely your presence here at the Memorial at this rather sensitive time. I mean, Susan, you are not supposed to be here. It’s as simple as that.” Bellows paused and picked up one of the charts Susan had been extracting. “What the hell are you doing anyway?”

“I finally got some of the charts of the coma patients. Not all of them, but some of them.”

“God, you really are amazing. After getting yourself kicked out of the hospital, you still manage to have the balls, so to speak, to come back here and find a way to get these charts. I don’t imagine that they leave them lying around for anybody to look at who happens along. How did you manage to get them?”

Bellows looked expectantly at Susan, sipping his coffee and waiting for a response. Susan only smiled.

“Oh no!” said Bellows putting his hand to his forehead. “The nurse’s uniform.”

“Yup, worked like a charm. Great idea, I must admit.”

“Wait a minute. I don’t want any credit for it, believe me! What did you do? Get security to open McLeary’s or whoever-it-was’s office?”

“You’re getting more and more clever, Mark.”

“You do realize that you’re now breaking the law.”

Susan nodded in agreement, looking down at the pile of paper filled with her tiny writing.

Bellows’s eyes followed hers.

“Well, have they shed any light on this… this crusade of yours?”

“Not much, I’m afraid. At least not yet, or at least I’ve not been clever enough to spot it. I wish I had all the charts. So far the ages have all been relatively young, twenty-five to forty-two. Otherwise they seem to be of random sex, racial background, social background. I can’t find any relationship in their previous medical histories. Their vital signs and progress up until the onset of coma were uncomplicated in all cases. Their personal physicians were all different. Of the surgical cases, only two had the same anesthesiologist. The anesthetic agents were varied, as expected. There were some overlaps in the preoperative medications. A number of the cases had Demerol and Phenergan, but others had totally different agents. Innovar was used on two cases. But all that’s not surprising.

“It does seem, as far as I can tell without going up in the OR, that most if not all the surgical cases occurred in room eight. That does seem a little strange, but then again that’s the room used most often for the shorter operations. And this problem is most often associated with the shorter operations. So that’s probably to be expected as well. Laboratory values are all generally normal. Oh, by the way, all cases seemed to have been blood-typed and tissue-typed. Is that normal procedure?”

“They blood-type most surgical patients, especially if they anticipate much blood loss during the operation. Tissue-typing is not usual, although the lab may be doing it as part of a check on new equipment or new tissue-typing sera. See if there is an accounting number on one of the lab reports on the typing.”

Susan flipped back through the pages of the chart in front of her until she located the tissue-type report.

“No, there’s no accounting number.”

“Well, that explains that, then. The lab is doing it at their expense. That’s not abnormal.”

“The medical patients were all on I.V.s for one reason or another.”

“So are ninety percent of the people in the hospital.”

“I know.”

“Sounds like you got a lot of nothing.”

“I’d have to agree at this point.” Susan paused, sucking on her lower lip. “Mark, before the endotracheal tube is placed in a patient during anesthesia, the anesthesiologist paralyzes the patient with succinylcholine. Isn’t that right?”

“Succinylcholine or curare, but usually succinyl.”

“And when a patient is given a pharmacological dose of succinylcholine, he can’t breathe.”

“That’s true.”

“Couldn’t an overdose of succinylcholine be the way these patients are rendered hypoxic? If they can’t breathe, then oxygen doesn’t get to the brain.”

“Susan, the anesthesiologist gives succinylcholine and then monitors the patient like a hawk; he even breathes for the patient. If there is too much succinylcholine, it just means the anesthesiologist has to breathe the patient for a longer time until the patient metabolizes the drug. The paralyzing effect is completely reversible. Besides, if something like that were being done maliciously, all the anesthesiologists in the hospital would have to be involved, and that’s hardly likely. And maybe even more important is the fact that under the combined eye of the anesthesiologist and the surgeon, who can actually see how red the blood is and how well it is oxygenated, it would be absolutely impossible to alter the patient’s physiologic state without one or both knowing it. When blood is oxygenated, it is bright red. When oxygen gets low, the blood becomes dark brownish-bluish-maroon. The anesthesiologist meanwhile is breathing the patient, constantly checking the pulse and blood pressure, and watching the cardiac monitor. Susan, you are hypothesizing some sort of foul play, and you don’t have a why or a who or a how. You’re not even sure you have a victim.”

“I’m sure I have a victim, Mark. It might not be a new disease but it’s something. One more question. Where do the anesthetic gases come from that the anesthesiologists use?”

“It varies. Halothane comes in cans like ether. It’s a liquid and it’s vaporized as needed in the OR. Nitrous, oxygen, and air come from central sources and are piped into the OR’s. There are standby cylinders of oxygen and nitrous oxide in the OR for emergency use…. Look, Susan, I’ve got a little more work to do, then I’m free. How about coming over to the apartment for a drink?”

“Not tonight, Mark. I want to get a good night’s sleep and I’ve got a few more things to do. But thanks. Also, I’ve got to get these charts back to their hiding place. After that I intend to look around in OR room number eight.”

“Susan, I personally think you should get your ass out of this hospital before you really get yourself in hot water.”

“You’re entitled to your opinion, doctor. It’s just that this patient doesn’t feel like following orders.”

“I think you’re carrying all of this too far.”

“You do, do you? Well, I might not have a who, but I’ve got a number of suspects….”

“Sure you do….” Bellows fidgeted. “Are you going to make me guess or are you going to tell me?”

“Harris, Nelson, McLeary, and Oren.”

“You’re out of your squash!”

“They all act as guilty as hell and want me out of here.”

“Don’t confuse defensive behavior with guilt, Susan. After all, complications are hard to live with in medicine, no matter from what cause.”