Coma

2

Monday, February 23, 7:30 A.M.

The Boston Memorial Hospital is certainly not an architectural landmark, despite the disproportionately large number of architects in the Boston area. The central building is attractive and interesting. It was constructed over a century ago with brownstone blocks carefully fitted together with skill and feeling. But the structure is inconveniently small and only two stories tall. Besides, it was designed with large, general wards, now outmoded. Hence its present-day practicality is minuscule. Only the ooze of medical history which permeates its halls keeps the wreckers and the planners at bay.

The innumerable larger buildings are studies in American gothic. Extending off at obtuse angles, millions upon millions of bricks join together to hold up dirty windows and flat monotonous roofs. The buildings were added in spurts, responding to the purported need for beds or the availability of funds. There is no doubt that it is an ugly combination of buildings, except perhaps for a few smaller research buildings. Those had architects and money to burn.

But very few people ever noticed the appearance of the buildings. The whole is larger than the sum of its parts; perception is too clouded by innumerable layers of emotional response. The buildings are not buildings by themselves. They are the famed Boston Memorial Hospital, containing all the mystery and wizardry of modern medicine. Fear and excitement intermingle in an ambivalent dialogue as lay people approach the structure. And for the professional individual, it is the mecca: the pinnacle of academic medicine.

The setting for the hospital adds very little. On one side a maze of railroad tracks leading to North Station and a bewildering array of elevated highways forms an enormous sculpture of rusting steel. On the other side is a modern housing project for low income families. Somehow that goal got mixed up in the renowned corruptness of the Boston government. The apartment buildings look like housing for the underprivileged because of their lack of outward design. But the rents are out of sight and only the rich and privileged live there. In front of the hospital is a stagnant corner of Boston Harbor with water like Mack coffee, sweetened with sewer gas. Separating the hospital and the water is a cement playground filled with discarded newspapers.

By seven-thirty this Monday morning all the operating rooms at the Memorial hummed with activity. Within a five-minute interval, twenty-one scalpels sliced through unresisting human skin as the scheduled operations commenced. The fate of a sizable number of people depended on what was done or not done, what was found or not found in the twenty-one tiled rooms. A furious pace was set which would not slow down until two or three in the afternoon. By eight or nine o’clock in the evening only two rooms would still be functioning, and they often continued until the seven-thirty rush the following morning.

In sharp contrast to the bustle in the OR area, the surgical lounge presented a luxuriant hush. Only two people were there, because the coffee break pattern did not begin until after nine. By the sink was a sickly-looking man appearing much older than his sixty-two years. He was busy trying to clean the sink without moving the twenty-odd coffee cups left there half-filled with water by their owners. Walters was his name, although few knew if it was his first or last name. His whole name was Chester P. Walters. No one at all knew what the P stood for, not even Walters himself. He’d been an employee of the Memorial OR since he was sixteen, and no one had the temerity to fire him despite the fact that he did almost nothing. He wasn’t well, he’d say, and, indeed, he did not look well. His skin was” a pasty white and every few minutes he’d cough. His cough rattled with phlegm deep within his bronchial tubes, but he never coughed hard enough to get it up and out. It was as if he was content to merely keep his tubes grossly patent without disturbing the cigarette he had constantly in the right corner of his mouth. Half the time he had to have his head cocked over to the left so that the smoke would not burn his eyes.

The other occupant of the surgical lounge was an intermediate surgical resident, Mark H. Bellows. The H stood for Halpern, his mother’s maiden name. Mark Bellows was busy writing on a yellow legal tablet. Walters’s coughing as well as Walters’s cigarette definitely bugged Bellows, and Bellows would look up each time Walters started yet another coughing sequence. To Bellows it was incomprehensible how an individual could do so much bodily damage to himself and still keep it up. Bellows did not smoke; Bellows had never smoked. It was equally incomprehensible to Bellows how Walters managed to stay around the OR despite his appearance, personality, and the fact that he didn’t do a damn thing. Surgery at the Memorial was the apogee, the zenith of the art of modern surgery, and being on its staff offered Nirvana, as far as Bellows was concerned. Bellows had striven hard and long for his appointment as a resident. Yet here, smack in the middle of all this excellence, was, as Bellows put it to his fellow residents, this ghoul. It seemed too ridiculously inconsistent.

Under normal circumstances Mark Bellows would have been inside one of the twenty-one operating rooms contributing to or directing one of the acts of mayhem. But on February 23 he was adding five medical students to his burgeoning list of responsibilities. Bellows was currently assigned to Beard 5, meaning the fifth floor of the Beard Building. It was a good general surgical rotation, maybe the best. As the intermediate resident of Beard 5, Bellows was also in charge of the surgical intensive care unit physically adjacent to the ORs.

Bellows reached for the table next to his chair and grasped a coffee mug without looking up from his work. He sipped the hot coffee loudly before abruptly replacing the cup with a minor clatter. He’d thought of another “attending” who would be good at lecturing to the students, and he quickly penciled the name onto the tablet. In front of him on a low table lay a piece of Surgical Department stationery. He picked it up and studied the names of the five students: George Niles, Harvey Goldberg, Susan Wheeler, Geoffrey Fairweather III, and Paul Carpin. Only two of the names made any impression. The Fairweather name made him smile and conjure up the image of a spoiled, slender fellow with glasses, Brooks Brothers shirts, and a long New England genealogy. The other name, Susan Wheeler, caught his eye purely because Bellows liked women in a general way. He also thought that women liked him in return; after all, he was athletic and a doctor. Bellows was not very subtle in his social concepts; he was rather naive, like most of his fellow doctors. Looking at the name Susan Wheeler, he reflected that having one female student might make the next month a little bit less of a pain in the ass. His mind didn’t struggle to find a mental image for the name Susan Wheeler. The part of his brain concerned with stereotypes told him it wasn’t worth it.

Mark Bellows had been at the Memorial for two and one half years. Things had been going well, and he was reasonably sure of finishing the program. In fact, it had begun to look as if he might have a fighting chance for the chief resident position if everything went smoothly. Having been selected while he was an intermediate resident to get a group of medical students was certainly auspicious, although a bother. It had been an unexpected turn and was the immediate result of Hugh Casey coming down with hepatitis. Hugh Casey was one of the senior residents whose job included teaching two groups of medical students during the course of the year. The hepatitis came on only three weeks earlier. Right after that Bellows had received the message to come to Dr. Howard Stark’s office. Bellows had never associated the message with Casey’s illness. In fact, with the usual paranoia following a request to come to the Chief of the Department of Surgery’s office, Bellows had mentally tried to relive all his latest blunders so as to be prepared for the tirade he expected. But contrary to his usual self, Stark had been very pleasant and had actually commended Bellows on his performance related to a recent Whipple procedure Bellows had done. After the unanticipated honeyed words, Stark had asked if Bellows would be interested in taking the medical students scheduled to be with Casey. Truthfully, Bellows would have preferred to pass up the chance while being on the Beard 5 rotation, except that one did not pass up a request by Stark even if it were carefully couched in the form of an offer. It would have been professional suicide for Bellows to have done so and he knew it Bellows comprehended the vengeance of the affronted surgical personality, so he had agreed with the proper amount of alacrity.

With a straightedge Bellows filled the front page of his yellow legal tablet with little squares about an inch on a side. He then proceeded to fill in the dates of the subsequent thirty or so days the medical students were scheduled to be under his tutelage. Within each square he blocked off morning and afternoon. Each morning he planned to give a lecture; each afternoon he was going to enlist one of the attendings to give a lecture. Bellows wanted to schedule all the topics in advance to avoid duplication.

Bellows was twenty-nine years old, having just celebrated a birthday the week before. However, it was relatively hard to guess his age. His skin was smooth for a man and he was in excellent physical shape. Almost without fail he jogged two to three miles per day. The only outward evidence of the fact that he was almost thirty was the thinning area on the crown of his head and the slightly receding hairline at the temples. Bellows had blue eyes and an almost imperceptible salting of gray over his ears. He had a friendly face, and he was endowed with the enviable quality of making people feel comfortable. Most everyone liked Mark Bellows.

Two interns were also assigned to the Beard 5 rotation. Under the new terminology they were called first-year residents, but Bellows and most of the other residents still called them interns. They were Daniel Cartwright from Johns Hopkins and Robert Reid from Yale. They had been interns since July and hence had come a long way. But in February they were both experiencing the familiar intern depression. Enough of the year had passed to blunt the uniqueness of their roles as well as the terror of the responsibility, and yet so much remained before the year would be over and they would earn relief from the burden of every other night on call. Hence they demanded a certain amount of attention from Bellows. Cartwright was presently assigned to the intensive care unit, while Reid was on Beard 5. Bellows decided he would also use them for the medical students. Cartwright was a bit more outgoing and would probably be more helpful. Reid was black and had recently begun to attribute being called and harassed so much to his color and not his role as an intern. That was just another symptom of the February blues, but Bellows decided that Cartwright would be more helpful.

“Terrible weather,” said Walters, presumably to Bellows but in an offhand undirected way. That was what Walters always said because to him the weather was always terrible. The only conditions which made him feel comfortable were seventy-six degrees and thirty percent humidity. That temperature and water content apparently agreed with the ailing bronchial tubes in the depths of Walters’s lungs. Boston weather rarely fulfilled such narrow limits, so to Walters the weather was always terrible.

“Yeah,” said Bellows in a noncommittal sort of way while he directed his attention outside. Most people would have agreed with Walters at that point The sky was darkened by racing gray clouds. But Bellows wasn’t thinking about the weather. Rather suddenly he was pleased about the pending five medical students. He decided that they probably would help him in his standing in the program. And if that were the case, then the time investment was more than worthwhile. Bellows was Machiavellianly practical in the final analysis; he had to have been to have got a position at the Memorial. The competition was fierce.

“Actually, Walters, this is my favorite kind of weather,” said Bellows, getting up from the lounge chair, indecently teasing the coughing Walters. Walters’s cigarette twitched in the corner of his mouth as he looked up at Bellows. But before he could say anything Bellows was through the door, on his way to meet his five medical students. He was convinced he could turn the burden into an asset.