Coma

38

Thursday, February 26, 11:51 P.M.

The surgical residents’ on-call room at the Memorial was rather minimal in its amenities. It had a bed, a hospital bed, which could be cranked into a number of interesting positions, a small desk; a TV which got two stations provided you didn’t mind a double image; and a collection of torn, stained old Penthouse magazines. Bellows was sitting at his desk, trying to read an article in the American Journal of Surgery, but he couldn’t concentrate. His mind, particularly his conscience, was functioning in an abnormally irritating manner. It kept reminding him of Susan’s appearance a few hours earlier. Bellows had seen her when she entered the Memorial. He knew she had come up behind him, and he had expected her to stop him. It had been a surprise when she didn’t.

Bellows had not looked at Susan directly, but enough to see her matted hair, her bloodied and torn dress. He had felt immediate concern, but at the same time felt a definite inclination to leave well enough alone. His job at the Memorial was on the line. If Susan needed medical help, she had come to the right place. If she needed psychological support, it would have been better to call and meet him outside the hospital. But Susan had not stopped him and had not called.

Now Bellows had learned that Susan had been admitted as a patient, that Stark himself was handling her case. As the senior surgical resident on call, Bellows knew that Susan was scheduled for an appendectomy. It seemed quite a coincidence, but there it was. Stark was going to operate. At first Bellows thought he’d scrub. Then prudence told him he was far from objective about Susan and that could become a handicap in the OR. So he decided to send a junior resident and wait it out.

Bellows looked at his watch. It was almost midnight. He knew that they’d be starting Susan’s appy in ten minutes or so. He tried to go back to the Journal article but something else bothered him. Bellows stared out of the grimy window and brooded. Then he picked up the phone and asked in which room the appy was scheduled.

“Number eight, Dr. Bellows,” said the OR duty nurse.

Bellows put the phone down. Funny. Susan had told him about finding the T-valve in the oxygen line to that room, the room in. which so much had gone wrong.

Bellows looked at his watch again. Suddenly he got up. He’d forgotten about getting his mid rats in the cafeteria. He was hungry. Bellows pulled on his shoes and set off for the cafeteria. But he thought about the T-valve.

He got on the elevator and pushed 1 for the cafeteria. In the middle of the descent he changed his mind and pushed 2. What the hell, he could take a look for that T-valve on the oxygen line himself, while Susan was having her surgery. It was stupid, but he decided to do it anyway. At least it would satisfy his conscience.

A phantasmagoria of geometric images, color and motion emerged from the darkness, gradually expanding. The geometric images collided, split, and recombined into forms and shapes without meaning. Out of the confusion the image of a hand being stabbed by scissors preceded a sequence of chase. The autopsy room at the Memorial appeared with a realism that included auditory and olfactory aspects. A spiral staircase took dominance; then a corridor filled with the face of D’Ambrosio grinning in sadistic delight seemed to move closer and closer. But D’Ambrosio’s face disintegrated and he fell spinning into the abyss. The corridor twisted and turned kaleidoscopically.

Susan regained her consciousness in fluctuating stages. Finally she realized that she was looking at a ceiling, the ceiling of a corridor that was moving. No, she was moving. Susan tried to move her head but it seemed to weigh a thousand pounds. She tried to move her hands. They too were unbelievably heavy, and it took all her concentration just to lift her hands up from her elbows. Susan was lying on her back, moving down a corridor. Sounds started to appear. Voices… but they were unintelligible. She felt someone grip her hands and push them down to her side. But she wanted to get up. She wanted to know where she was. She wanted to know what happened to her. Was she asleep? No, she’d been drugged. Suddenly Susan knew that. She fought with the effects of the drug, to try to lift herself from its grasp. Her mind began to clear. She could understand the voices.

“She’s an emergency appendectomy. Apparently a hot one, too. And she’s a medical student You’d think she would have had enough sense to be seen sooner.”

Another voice, deeper than the first “I understand she had called in sick this morning to the dean’s office, so obviously she knew something was wrong. Maybe she was worried about being pregnant.”

“Maybe you’re right But she tested negative.”

Susan’s mouth tried to form words but no sounds issued from her larynx. She found that her head could move from side to side. The drug was beginning to wear off. Then the movement stopped. Susan recognized the area. She was in the scrub room. By turning her head to the right she could see the scrub sink. A surgeon was scrubbing.

“You want one or two assistants, sir?” said one of the voices behind Susan.

The man at the scrub sink turned. He was wearing a hood and a mask. But Susan recognized him. It was Stark.

“One’s enough for a simple appy. I’ll have it out in twenty minutes.”

“No, no,” cried Susan, voicelessly. Only a bit of air hissed between her lips. Then she began to move toward the operating room. She could see the door open. She saw the number over it. Room No. 8.

The drug was wearing off. Susan could lift her head and her left arm. She saw the huge operating room lights. The glare dazzled her. She knew she had to get up… to run.

Strong arms gripped her waist, her ankles and head. She felt hands thrust under her, and she was lifted effortlessly onto the operating table. Susan lifted her left hand to grasp at anything. She grabbed an arm.

“Please… don’t… I am…” the words came slowly, almost inaudibly from Susan’s throat. She was trying to sit up despite the weight of her head.

A strong arm was laid across her forehead. Her head was pressed back.

“Don’t worry, everything will be all right. Just take, some deep breaths.”

“No, no,” said Susan, her voice gaining slightly in power.

But an anesthesia mask dropped over her face. She felt a sudden pain in her right arm… an I.V. The liquid started into her vein. No. No. She tried to shake her head from side to side but strong arms held her. She looked up and saw a masked face. The eyes looked into hers. She saw an I.V. bottle with bubbles dancing up through the fluid. She saw someone thrust a syringe into the I.V. line. The Pentothal!

“Everything will be all right. Just relax. Take a deep breath. Everything will be all right. Just relax. Take a deep breath….”

The atmosphere in room eight at 12:36 A.M. that February 27 was extremely tense. The junior resident had found himself all thumbs during the case, even dropping clamps and fumbling ties. Stark’s presence and reputation had been too much for the fledgling surgeon, especially after the initial rapport had evaporated.

The anesthesiologist’s handwriting was even more erratic than usual as he put the finishing touches on his anesthesia record. He wanted the case to be over. The patient’s sudden cardiac irregularities in the middle of the case had totally unnerved him. But even worse had been the sudden closure of the non-return valve on the wall oxygen line. In his eight years as an anesthesiologist, it was the first time that piped-in oxygen had actually failed. He had made the transition to the green emergency cylinders smoothly, and he was fairly confident there had been no change in the amount of oxygen he had been delivering. But the experience had been frightening; he knew he could have lost the patient.

“How much longer?” the anesthesiologist asked over the ether screen, putting his pen down.

Stark’s eyes were wildly dancing from the clock to the door, then back to the operative field. He had taken over tying the skin sutures from the bumbling resident.

“Five minutes, tops,” said Stark as he ran a knot down with his deft fingers. Stark too was nervous. That was obvious to the resident, who thought he himself must be the cause. But Stark was nervous because he knew that something was not right.

The oxygen non-return valve should not have failed. That meant that the oxygen pressure had fallen to zero in the main line. Of the operating team, only Stark knew that the patient’s cardiac irregularities meant that she had received carbon monoxide with the mainline oxygen. But when that oxygen source failed, he couldn’t be sure whether Susan had received enough of the deadly gas for his purposes.

And then there had been the muffled shouts which had caused the circulating nurses to check the corridor. But Stark knew that the noises came from above, from the ceiling space.

But that wasn’t all. As Stark was making the next to last skin suture, his eyes caught a surge of movement in the corridor through the window of the OR door. The corridor seemed to be filled with people, and at 12:35 A.M. that was inappropriate, to say the least.

Stark placed the last skin suture and dropped the needle bolder onto the instrument tray. As he picked up the ends to tie the knot, the OR door swung open, and Stark saw at least four people advance into the room. Mark Bellows was among them.

The sudden visitors wore surgical gowns, and Stark’s pulse began to race as he realized that most of them had thrown their gowns over blue uniforms. A deadly silence hung in the OR. But as Stark straightened up from the operating table, he knew now that something was wrong. Something was very Wrong.