Robin Cook - Coma

Berman then tried another tactic; he switched to what the psychiatrists call reaction formation. He let himself think about his upcoming operation to the point where he seemingly made light of the idea.

“I’m one of the dieticians and I’d like to discuss your meal selection,” said an overweight woman with a clipboard who entered Berman’s room after a sharp knock. “You are here to have surgery, I presume.”

“Surgery?” Berman smiled. “Yeah, I have it about once a year. It’s a hobby.”

The dietician, the lab technician, anyone who would listen, became a victim of Berman’s offhand comment about his scheduled operation.

To an extent this method of defense was successful, at least until the actual morning of the operation. Berman had been awakened at six-thirty by the sound of some jangling cart in the corridor. Try as he might, he had been unable to fall back to sleep. Reading had been impossible. The time had dragged horribly, slowly yet inexorably toward 11, when his surgery was scheduled. His stomach had growled from its emptiness.

At 11:05 the door to his room burst open. Berman’s pulse fluttered. It was one of the harried nurses.

“Mr. Berman, there’s going to be a delay.”

“A delay? How long?” Berman forced himself to be civil. The agony of anticipation was taking its toll.

“Can’t say. Thirty minutes, an hour.” The nurse shrugged.

“But why? I’m starved.” Berman really wasn’t hungry; he was too nervous.

“The OR’s backed up. I’ll be back later to give you your pre-op meds. Just relax.” The nurse departed. Berman’s mouth was open, ready for another question, a hundred questions. Relax? Fat chance. In fact, until Susan’s appearance, Sean Berman had spent the entire morning in an uninterrupted cold sweat, dreading the passage of each moment, yet at the same time wishing time would hurry by. Several times he had felt a tinge of embarrassment at the depth of his anxiety, and he wondered if his feelings were relative to the seriousness of the anticipated surgery. If that were the case, he felt he could never undergo a truly serious operation. Berman was worried about feeling pain, worried that his leg might not be ninety-eight percent better, as his doctor had promised, worried about the cast he would have to wear on his leg for several weeks after the operation. He wasn’t worried about the anesthesia. If anything, he worried that they might not put him to sleep. He did not want local anesthesia; he wanted to be out cold.

Berman did not worry about possible complications, nor did he worry about his mortality. He was too young and healthy for that. If he had, he would have thought twice about having the operation. It had always been one of Berman’s faults, to miss the forest for the trees. Once he had designed an architecturally award-winning building only to have it turned down by the local city council just because it did not fit into the surroundings. Fortunately Berman was unaware of the stricken Nancy Greenly in the ICU.

For Berman, Susan Wheeler had been a star on a cloudy night. In his overly sensitized and anxiety-ridden state, she had seemed like an apparition coming to help him pass the time, to ease his mind. But she had done more. For the first few moments of the morning Berman had been able to think of something besides his knee and the knife. He had given every ounce of concentration to Susan’s comments and all too brief self-revelation. Whether it was Susan’s attractiveness or her obvious wit or just Berman’s own emotional vulnerability, he had been charmed and delighted and felt immeasurably more comfortable on his ride in the elevator down to the operating room. He also considered that the shot Ms. Sterns had given him might have contributed, because he began to get a little lightheaded and images began to be slightly discontinuous.

“Guess you see a lot of people on their way to surgery,” said Berman to the orderly, as the elevator approached floor two. Berman was on his back, his hands beneath his head.

“Yup,” said the orderly, uninterested, cleaning under his nails.

“Have you ever had surgery here?” asked Berman, enjoying a sensation of calmness and detachment spreading through his limbs.

“Nope. I’d never have an operation here,” said the orderly, looking up at the floor indicator as the car eased to a stop on two.

“Why not?” asked Berman.

“I’ve seen too much, I guess,” said the orderly, pushing Berman into the hall.

By the time his gurney was parked in the patient holding area, Berman was happily inebriated. The shot he had received on orders from the anesthesiologist, a Dr. Norman Goodman, was 1 cc of Innovar, a relatively new combination of extremely potent agents. Berman tried to talk to the woman next to him in the patient holding area, but his tongue seemed to have become unresponsive, and he laughed at his own ineffectual efforts. He tried to grab a nurse who walked by, but he missed, and he laughed. Time ceased to be a concern and Berman’s brain no longer recorded what happened.

Down in the OR things were progressing well. Penny O’Rilley was already scrubbed and gowned and had brought in the steaming tray of instruments to put out on the Mayo stand. Mary Abruzzi, the circulating nurse, had located one of the pneumatic tourniquets and had carried it into the room.

“One more to go, Dr. Goodman,” said Mary, activating the foot pedal to raise the operating table to gurney height.

“How right you are,” said Dr. Goodman cheerfully. He let I.V. fluid run through the tube onto the floor to remove the bubbles. “This should be a rapid case. Dr. Spallek is one of the fastest surgeons I know and the patient is a healthy young man. I bet we’re out of here by one.”

Doctor Norman Goodman had been on the staff at the Memorial for eight years and held a joint appointment at the medical school. He had a lab on the fourth floor of the Hilman Building with a large population of monkeys. His interests involved developing newer concepts of anesthesia by selectively controlling various brain areas. He felt that eventually drugs were going to be specific enough so that just the reticular formation itself would be altered, thereby reducing the amount of drugs necessary to control anesthesia. In fact, only a few weeks earlier he and his laboratory assistant, Dr. Clark Nelson, had stumbled onto a butyrophenone derivative which had slowed the electrical activity only in the reticular formation of a monkey. With great discipline he had kept himself from becoming overly encouraged at such an early time, especially when the results had been from a single animal. But then the results had become reproducible. So far he had tested eight monkeys and all had responded the same.

Dr. Norman Goodman would have preferred to give up all activities and devote twenty-four hours a day to his new discovery. He was eager to advance to more sophisticated experiments with his drug, especially a trial on a human. Dr. Nelson, if anything, was even more eager and optimistic. It had been with difficulty that Dr. Goodman had talked Dr. Nelson out of trying a small subpharmacological dose on himself.

But Dr. Goodman knew that true science rested on a foundation of painstaking methodology. One had to proceed slowly, objectively. Premature trials, claims, or disclosure could be disastrous for all concerned. Accordingly Dr. Goodman had to rein in his excitement and maintain his normal schedule and commitments unless he was willing to divulge his discovery; and that he was unwilling to do as yet. So on Monday morning he had to “pass gas,” as they called it in the vernacular… devote time to clinical anesthesia.

“Damn,” said Dr. Goodman straightening up. “Mary, I forgot to bring down an endotracheal tube. Would you run back to the anesthesia room and bring me a number eight.”