Coma

4

Monday, February 23, 10:15 A.M.

Susan Wheeler could not go into the doctors’ lounge to change into a scrub suit because the doctors’ lounge was synonymous with the men’s lounge. Susan had to go into the nurses’ locker, which was synonymous with women’s lounge. So creeps society from day to day, thought Susan angrily. To her it was just another blatant example of male chauvinism and it gave her a momentary lift to think that she was upsetting this unfair identification. The locker room was at that moment deserted and Susan located an empty locker with ease and began to change by hanging up her white coat. Nearby the shower entrance she found the scrub suits. They were one-piece pale blue dresses made from plain cotton fabric. They were actually for the scrub nurses. She held it up and then against herself. Looking into the mirror, she felt suddenly rebellious despite the intimidating surroundings.

“Screw the dress,” said Susan to the mirror. The scrub dress arched in a tumble into the canvas hamper while Susan retraced her steps into the hall. She paused before the doctors’ lounge, and she almost lost her nerve. Impulsively she pushed open the door.

Bellows was at that very instant next to the door that Susan opened. He was reaching into one of the cabinets at the entrance for a scrub suit. He was clothed in his James Bond-style skivvies (that’s what he called them) and black socks. He looked as if he belonged in the beginning of a grade C porno movie. Horror spread across his face as he caught sight of Susan. In a flash, he fled into the safety of the depths of the dressing room. As in the nurses’ locker room, one could not see into the dressing room from the door. Spurred by her rebelliousness despite the unexpected encounter, Susan advanced to the cabinet and selected a small scrub top and pants; then she left as quickly as she had entered. She could hear a tangle of excited voices in the interior of the doctors’ lounge.

Back in the nurses’ locker, she completed changing rapidly. The pale green shirt was too large, as were the pants. Because of her narrow waist she had to cinch up the pants to their absolute maximum before tying the cord. Mentally she began to prepare for the inevitable diatribe from Bellows, the mighty surgeon-to-be, by deciding how she would counter. During their brief introductions on the ward, Susan had been very aware of the condescending attitude Bellows had directed toward the nurses. This attitude was ironical coming so soon after the commendable defense of the nurses he had made to explain their lack of enthusiasm toward new medical students. It was pretty obvious to Susan that Bellows was, among other things, a typical chauvinist. Susan decided that she would challenge that aspect of Bellows’s personality. Maybe it would make the surgical rotation at the Memorial a bit more bearable. Of course she had not planned to see Bellows in his underwear in the dressing room, but the image and symbolic aspects made Susan laugh out loud before she passed through the door into the OR area.

“Miss Wheeler, I presume,” said Bellows as Susan emerged. Bellows was leaning casually against the wall to the left of the doorway, obviously waiting for Susan to appear. His right elbow was on the wall, with the hand supporting his head. Susan literally jumped at the sound of his voice since she hardly expected him to be waiting there for her.

“I must admit,” continued Bellows, “you really caught me with my pants down.” A broad smile spread across his face, changing him in Susan’s eyes to a rather human individual. “That was one of the funniest things that has happened to me in a long time.”

Susan smiled in return but it was a half-smile. She was expecting the tirade to commence immediately,

“After I recovered and realized what you were after,” continued Bellows, “I started to think that it was a pretty ridiculous response on my part to bolt. If I had had any sense I would have stood there and faced you despite my dress… or the lack of it. At any rate, it made me think that I might have been relying on appearances a bit too much this morning. I’m a second-year resident, that’s all. You and your friends are my first group of students. What I really want to do is to make this time here as profitable as possible for you all, and in the process, profitable for me as well. Least of all, we should enjoy ourselves.”

With a final smile and slight nod of the head, Bellows walked away from the stunned Susan to check which room the staff gallbladder was in. It was Susan’s turn to feel a sense of confusion as she looked after him. The resolve her feelings of anger and rebelliousness had evoked had been undermined by Bellows’s sudden insight into himself. In fact it made her rebelliousness seem a trifle foolish and out of place. The fact that Susan had stimulated the insight fortuitously made it obvious that she couldn’t take credit for it and that she would have to revise some of her impressions about Mark Bellows. She watched Bellows walk all the way over to the main OR desk; he was obviously at home in the alien environment. For the first time Susan was a little impressed. In fact, she thought that he really wasn’t that bad looking either.

The others were already prepared to go down to the OR. George Miles showed Susan how to put on the paper booties over her shoes and tuck in the conductive tape. Next she put on the hood and finally the mask. Once everyone was so attired, they passed the main OR desk and pushed through the swinging doors into the “clean” area of the ORs themselves.

Susan had never been in an OR before. She had seen a couple of operations through the gallery windows but such an experience was akin to watching it on TV. The glass partition effectively isolated the drama. One did not feel a part of it. While walking down the long corridor Susan felt a certain excitement mixed with fear of the mortality of people. As they passed OR after OR, Susan could see clusters of figures bent over what she knew were sleeping patients with their fragile insides open to the elements. A hospital gurney approached them with a scrub nurse pulling and an anesthesiologist pushing. As the group came abreast Susan could see that the anesthesiologist was matter-of-factly holding the patient’s chin back while the patient retched violently. “I hear there’s almost forty inches of packed powder at Waterville Valley,” said the anesthesiologist to the scrub nurse. “I’m going Friday right after work,” returned the scrub nurse as the pair passed by Susan toward the recovery room. The image of the tortured face of the patient so recently operated on imprinted itself in Susan’s susceptible consciousness and she shuddered involuntarily.

The group pulled up in front of room 18.

“Try to keep the chatter to a minimum,” said Bellows, looking through the window in the door. “The patient is already asleep. Too bad, I wanted you to see that. Well, no matter. There will be a lot of moving around during the draping procedure, etcetera, so stay back against the right wall. Once they get underway, move around so that you can see something. If you have questions, save them until later, OK?” Bellows looked at each student He smiled anew when he met Susan’s gaze, then pushed open the OR door.

“Ah, Professor Bellows, welcome,” boomed a large, gowned, gloved, and sterile figure hovering in the background near some X-rays. “Professor Bellows has brought his brood of students to watch the fastest hands in the East,” he said laughing. He held up his arms in an exaggerated Hollywood surgical fashion with the hands up and bent outward as far as they would go. “I hope you have told the impressionable youths that the spectacle they are about to see is a rare treat.”

“That hulk,” said Bellows to the students while motioning toward the laughing character by the X-rays and loud enough for all in the OR to hear, “is the result of staying in the program too long. That’s Stuart Johnston, one of the three senior residents. We only have to put up with him for four more months. He had promised me he’d be civil, but I cannot be sure of that.”

“You’re just a poor sport, Bellows, because I stole this case from you,” said Johnston, still laughing. Then to his two assistants he said without laughing, “Let’s get the patient draped, you guys. What are you trying to do, make this your life’s work?”

The draping proceeded rapidly. A small piece of tubular metal arched over the top of the patient’s head and separated the anesthesiologist from the surgical area. By the time the draping was completed, only a small portion of the patient’s right upper abdomen was exposed. Johnston moved to the patient’s right side; one of the assistants went over to the left side. The scrub nurse moved over the draped Mayo stand, straining with a full compliment of surgical instruments. A profusion of hemostats was lined up in a perfect array along the back of the tray. The scalpel had a new razor-sharp blade snapped into its jaws.

“Knife,” said Johnston. The scalpel slapped into his gloved right hand. With his left hand he pulled the abdominal skin away from him to provide countertraction. The medical students all moved forward silently and strained to see with a foreboding curiosity. It was like watching an execution. Their minds tried to prepare themselves for the image that was going to be imminently transmitted to their brains.

Johnston held the scalpel about two inches above the pale skin while he looked over the screen at the anesthesiologist The anesthesiologist was slowly letting the air out of the blood pressure cuff and watching the gauge, 120/80. He looked up at Johnston and gave an imperceptible nod, tripping the poised guillotine. The scalpel dived deep into the tissues, and then with a smooth soundless slice, slid down the skin at an angle of approximately 45 degrees. The wound fell open and little jets of pulsating arterial blood sprayed the area, then ebbed and died.

Meanwhile curious phenomena occurred in George Niles’s brain. The image of the knife plunging into the skin of the patient was displayed instantly in his occipital cortex. Association fibers picked up the message and transported the information to his parietal lobe, where it was associated. The association spread so rapidly and so widely that it activated an area of his hypothalamus, causing widespread dilation of his blood vessels in his muscles. The blood literally drained from his brain to fill all the dilated vessels, causing George Niles to lose consciousness. In a dead faint he fell straight backward. His flaccid neck snapped his head against the vinyl floor with a resonant thump.

Johnston spun around in response to the sound of George’s head smashing against the floor. His surprise quickly metamorphosed into typically labile surgical anger.

“For Christ sake, Bellows, get these kids outa here until they can stand the sight of a few red cells.” Shaking his head, he went back to catching bleeders with his hemostats.

The circulating nurse broke a capsule under George’s nose and the acrid smell of the ammonia shocked him back to consciousness. Bellows bent down and felt along his neck and the back of his head. As soon as George was fully conscious, he sat up, somewhat confused about his whereabouts. Realizing what had happened, he felt immediately embarrassed.

Johnston meanwhile wouldn’t let the matter rest.

“Holy shit, Bellows, why didn’t you tell me these students were absolute greenhorns? I mean, what would have happened if the kid fell into my wound here?”

Bellows didn’t say anything. He helped George to his feet by degrees until he was satisfied George was really OK. Then he motioned for the group to leave OR No. 18.

Just before the OR door shut, Johnston could be heard angrily yelling at one of his junior residents, “Are you here to help me or hinder me…?”