Coma by Robin Cook
“Try.”
“OK, I’m sure Harris is already completely uptight about this problem of coma. After all, it’s his department which essentially has to shoulder the responsibility. And here comes a young medical student to drive in the painful spikes a little more. I think it’s understandable for an individual to overreact under that kind of stress.”
“Harris did a little more than overreact. This nut came from behind his desk with the intent of knocking me around the room.”
“Maybe you turned him on.”
“What?”
“On top of everything else maybe he was reacting to you sexually.”
“Come on, Mark.”
“I’m serious.”
“Mark, this guy’s a doctor, a professor, a chief of a department.”
“That does not rule out sexuality.”
“Now you’re the one being absurd.”
“A lot of doctors spend so much time with the nuts and bolts of their profession that they fail to ever really adequately resolve the usual social crises of life. Socially speaking, doctors are not very accomplished, to say the least.”
“Are you speaking for yourself?”
“Possibly. Susan, you have to realize you are a very seductive girl.”
“Fuck you.”
Bellows looked at Susan, stunned. Then he glanced around to see if anyone was listening to their conversation. He had not forgotten they were in the coffee shop. He took a sip of coffee and then regarded Susan for several minutes. She returned his stare.
“Why did you say that?” said Bellows with a lowered voice.
“Because you deserved it. I get a little tired of that kind of stereotyping. When you say I’m seductive you imply to me that I am actively trying to seduce. Believe me, I am not. If medicine has done anything to me, it certainly has cut into my image of myself as conventionally female.”
“All right, maybe it was a bad word. I didn’t mean to imply it was your fault. You’re an attractive girl . . .”
“Well there’s a helluva difference between saying someone’s attractive and saying someone’s seductive.”
“OK, I meant attractive. Sexually attractive. And there are people who may find that hard to deal with. Anyway, Susan, I didn’t mean to get into an argument. Besides, I’ve got to go. I’ve got a case in fifteen minutes. If you want, we can talk about it tonight over dinner. That is, if you still want to have dinner?” Bellows started to get up, taking his tray.
“Sure, dinner’s fine.”
“Meanwhile, couldn’t you try to be normal for a little while?”
“Well, I have one more stone to turn over.”
“What’s that?”
“Stark. If he doesn’t help me, I’ll have to give up. Without some support I’m doomed to failure, unless of course you want to get the computer information for me.”
Bellows let his tray drop back onto the table. “Susan, don’t ask me to do anything like that, because I can’t. As for Stark, Susan, you’re crazy. He’ll eat you alive. Harris is a jewel in comparison to Stark.”
“That’s a risk I have to take. It’s probably safer than undergoing minor surgery here at the Memorial.”
“That’s not fair.”
“Fair? What a choice word. Why don’t you ask Berman if he thinks it’s fair?”
“I can’t”
“You can’t?” Susan paused, waiting for Bellows to explain himself. Susan did not want to think of the worst but it came to her automatically. Bellows started toward the tray rack without explaining himself.
“He’s still alive, isn’t he?” asked Susan with a tingle of desperation in her voice. She got up and walked behind Bellows.
“If you call that heart beating being alive, he’s alive.”
“Is he in the recovery room?”
“No.”
“The ICU?”
“No.”
“OK, I give up, where is he?”
Bellows and Susan put their trays into the rack and walked from the coffee shop. They were immediately engulfed by the mob in the hall and forced to quicken their steps.
“He was transferred to the Jefferson Institute in South Boston.”
“What the hell is the Jefferson Institute?”
“It’s an intensive care facility built as part of the area’s Health Maintenance Organization design. Supposedly it’s been designed to curtail costs by applying economics of scale in relation to intensive care. It’s privately run but the government financed construction. The concept and plans came out of the Harvard-MIT health practices report.”
“I’ve never even heard about it. Have you visited it?”
“No, but I’d like to. I saw it from the outside once. It’s very modern . . . massive and rectilinear. The thing that caught my eye was that there were no windows on the first floor. God only knows why that caught my eye.” Bellows shook his head.
Susan smiled.
“There’s a tour organized for the medical community,” continued Bellows, “to visit the place on the second Tuesday of each month. Those that have gone have been really impressed. Apparently the program is a big success. All chronic-care ICU patients who are comatose or nearly so can be admitted. The idea is to keep the ICU beds in the acute-care hospitals available for acute cases. I think it’s a good idea.”
“But Berman just became comatose. Why would they transfer him so quickly?”
“The time factor is less important than stability. Obviously he’s going to be a long-term-care problem and I guess he was very stable, not like our friend Greenly. God, she’s been a pain in the ass. Just about every complication known, she’s had it.”
Susan thought about emotional detachment. It was difficult for her to understand how Bellows could be so out of touch emotionally with the problem Nancy Greenly represented.
“If she were stable,” continued Bellows, “even threatened stability, I’d transfer her to the Jefferson in a flash. Her case demands an inordinate amount of time with thin rewards. Actually, I have nothing to gain by her. If I keep her alive until the services switch, then at least I’ve suffered no professional harm. It’s like all those Presidents keeping Vietnam alive. They couldn’t win, but they didn’t want to lose either. They had nothing to gain but a lot to lose.”
They reached the main elevators and Bellows made sure one of the silently waiting crowd had pushed the “up” button.
“Where was I?” Bellows scratched his head, obviously preoccupied.
“You were talking about Berman and the ICU.”
“Oh, yeah. Well, I guess he was stable.” Bellows looked at his watch, then eyed the closed doors with hatred. “Goddamn elevators.
“Susan, I’m not one to give advice usually, but I can’t help myself. See Stark if you must, but remember I’ve gone out on a limb for you, so act accordingly. Then after you see Stark, give this crusade up. You’ll ruin your career before you begin.”
“Are you worried about my career or your own?”
“Both, I guess,” said Bellows standing aside for the disembarking elevator passengers.
“At least you’re honest.”
Bellows squeezed into the elevator and waved to Susan, saying something about seven-thirty. Susan presumed he meant their dinner date. At that moment her watch said eleven-forty-five.
Tuesday
February 24
11:45 A.M.
Bellows looked up at the floor indicator above the door. He had to cock his head way back, as he was almost directly under it. He knew that he had to hustle in order to be on time for his case, a hemorrhoid operation on a sixty-two-year-old man. It wasn’t his idea of a fascinating case but he loved to operate. Once he got going and felt the strange sense of responsibility which the knife afforded, he didn’t really care where he was working, stomach or hand, mouth or asshole.
Bellows thought about seeing Susan that night, and he felt a sense of pleasurable anticipation. Everything would be fresh and unspoiled. Their conversation c
A smile crept over his face as he imagined himself kissing Susan impulsively. It made him remember those awkward adolescent moments in his early youth when he would continue some banal conversation with his pimpled date right up to her doorstep. Then without warning he would kiss the girl, hard and sloppy. Then he’d step back to see what happened, hoping for acceptance but fearing rejection. It had never ceased to amaze him when he found acceptance, because in many ways he didn’t know why he was kissing the girl in the first place.
The concept of seeing Susan socially reminded Bellows of those early years of dating because he felt an inner urge for physical contact yet did not expect it. Susan was obviously palpable and luscious, yet she was going to be a doctor, as he was. Hence she would have little appreciation for the trump card Bellows always felt in a social situation—most everyone was impressed when he said he was a doctor, a surgeon! It didn’t matter that Bellows himself knew that being a doctor did not assure any special attributes, contrary to popular mythology. In fact, if he used many of the attending surgeons at the Memorial as examples, the effect of admitting such an association should have been a handicap. But what really bothered Bellows was the knowledge that a penis would hold little fascination for Susan; in all probability she had dissected one.
Bellows did not reduce his own sexual urges and fantasies to anatomical and physiological realities, but what about Susan? She looked so normal with her smile, her soft skin, the hint of her breast gently rising with her breathing. But she had studied the parasympathetic reflexes, and the endocrine alterations that make sex possible, even enjoyable. Maybe she had studied too much, too much of the wrong thing. Maybe even if the occasion was auspicious, Bellows would find his penis limp, impotent. The thought made Bellows doubtful about seeing Susan. After all, once away from the hospital, Bellows wanted to escape, and mindless sex was a superb method. With Susan, if it happened at all, it wasn’t going to be mindless. It couldn’t be. Finally there was the sticky question about the wisdom of dating a student currently under his supervision on the surgery rotation. Bellows was undoubtedly going to be called upon to evaluate Susan’s performance as a student. Dating her represented a ridiculous conflict of interest.
The elevator door opened on the OR floor and Bellows quickly crossed to the main OR desk. The clerk was preparing the OR schedule of the following day.
“What room is my case in? It’s a Mr. Barron, a hemorrhoid.”
The clerk looked up to see who it was, then down at the current schedule.
“You’re Dr. Bellows?”
“None other.”
“Well, you have been taken off that case.”
“Taken off? By whom?” Bellows was perplexed.
“By Dr. Chandler, and he left word for you to meet him in his office when you appeared.”
To be taken off one of his own cases was very strange for Bellows. Certainly it was within George Chandler’s prerogative since he was the chief resident. But it was highly irregular. Occasionally Bellows had been removed from a scrub on which he was to assist, usually to help on some other case, and usually for purely logistic reasons. But to be removed from one of his own cases where the patient had been assigned to Beard 5 was a totally new experience.
Bellows thanked the OR clerk without bothering to hide his surprise and irritation. He turned and headed for George Chandler’s office.
The chief resident’s office was a windowless cubicle on 2. From this tiny area came the tactical edicts that ran the surgical department from day to day. Chandler was in charge of all the schedules for all the residents, including the on-call and weekend duty assignments. Chandler was also in charge of the operating room schedule, assigning the staff and clinic cases as well as the assists for the attending surgeons who asked for them.
Bellows knocked on the closed door, entering after hearing a muffled “Come in.” George Chandler was sitting at his desk, which nearly filled the tiny room. The desk faced the door, and Chandler had to squeeze past to gain access to the seat. Behind him was a file cabinet. In front of the desk was a single wooden chair. The room was bare; only a bulletin board adorned the walls. Blank but neat, the room was somewhat like Chandler himself.
The chief resident had successfully risen up the competitive pyramidal power structure of the lower world of students and residents. Now he was the liaison between the upper world, the full-fledged surgeons certified by specialty boards, and the lower world. As such he was a member of neither class. This fact was the source of his power as well as his weakness and isolation. The years of competition had taken their inexorable toll. Chandler was still young by most standards: thirty-three years old. He was not tall: about five-eight. His hair was half-heartedly combed in some sort of modern Caesar look. His face had a gentle pudginess that belied his easily aroused temper. In many ways Chandler represented the young boy who had been bullied too much.
Bellows took the wooden chair opposite Chandler. At first no words were spoken. Chandler regarded a pencil he had in his fingers. His elbows were resting on the arms of his chair. He had rocked back from what he had been working on when Bellows knocked.
“Sorry about taking you off your case, Mark,” said Chandler without looking up.
“I can manage without another hemorrhoid,” said Bellows, maintaining a neutral tone.
There was another pause. Chandler tipped his chair forward to the level position and looked directly at Bellows. Bellows thought that he’d be a perfect individual to play Napoleon in a play.
“Mark, I’m going to assume you’re serious about surgery, surgery here at the Memorial, to be exact.”
“I think that’s a fair assumption.”
“Your record has been reasonable. In fact I’ve heard your name on several occasions in relation to possibly being considered for the chief residency. That leads me to one of the reasons I wanted to talk with you. Harris gave me a call not too long ago and he was completely strung out. I wasn’t even sure what he was talking about for a few minutes. Apparently one of your students has been nosing around about these coma cases, and it’s got Harris bullshit. Now, I have no idea what’s going on, but he thinks that you might be behind getting the student interested and helping him.”
“It’s a her.”
“Him, her, I don’t give a damn.”
“Well, it might be significant. She happens to be a very well put-together specimen. As for my role in the matter, it’s a big fat zero! If anything, I have constantly tried to talk her out of the whole affair.”
“I’m not about to argue with you, Mark. All I wanted to do is warn you of the situation. I’d hate to have you gamble your chances on the chief residency because of some student’s activities.”
Mark looked at Chandler and wondered what Chandler would say if he told Chandler that he was going to see Susan that night on a social basis.
“I have no idea if Harris has said anything to Stark about all this, Mark, and I can assure you that I won’t unless it gets to the point where I have to cover my own tracks. But let me emphasize that Harris was livid, so you’d better tone your student down and tell him . . .”
“Her!”
“OK, tell her to find something else to get interested in. After all there must be ten people who are working on the problem already. In fact most of Harris’s department has been doing nothing else since the present run of anesthetic coma catastrophes.”
“I’ll try to tell her again, but it’s not as easy as it may sound. This girl has a mind of her own, with a rather fertile imagination.” Bellows wondered why he chose that way to describe Susan’s imagination. “She’s go
“Anyway, let’s just say you have been warned. What she does is going to reflect on you, especially if you aid her in any way at all. But that was only one of the reasons I wanted to talk with you. There is another problem, more serious, to be sure. Tell me, Mark, what is your locker number up in the OR?”
“Eight.”
“What about number 338?”
“That was my temporary locker. I used it for about one week before number eight became available.”
“Why didn’t you stay with 338?”
“I guess it actually belonged to someone else, and I got to use it until I could get one of my own.”
“Do you know the combination of 338?”
“Maybe, if I thought long enough. Why do you ask?”
“Because of a strange finding by Dr. Cowley. He claims that 338 opened by magic when he was changing his clothes and the whole Goddamn thing was filled with drugs. We checked it out and he was right. Every kind of drug that you could imagine and a few more, including narcotics. The locker list I have has you down for 338, not eight.”
“Who’s down for eight?”
“Dr. Eastman.”
“He hasn’t done a case in years.”
“Exactly. Tell me, Mark, who gave you number eight? Walters?”
“Yup. Walters first told me to use 338, and then he gave me number eight.”
“OK, don’t say anything to anybody about this, least of all to Walters. Finding a hoard of drugs like this is a pretty serious business, considering all the rigmarole you have to go through to get a narcotic in the first place. Because of my locker list, you will probably be contacted by the hospital administration. For obvious reasons they are not excited about letting this information out, especially with the recertification deal coming up. So keep it under your hat. And for God’s sake, get your student interested in something else besides anesthesia complications.”