Robin Cook - Coma

“You meant to say ‘a nice shit,’ didn’t you?”

Bellows glanced at Susan. She looked up at him with a slight smile. “You don’t have to act differently on my account,” said Susan.

Bellows continued to study her face, which she carefully kept as neutral as possible. They walked in silence past the holding area for surgery.

“As I mentioned before, an arterial stick is just about the same as a venous stick,” said Bellows, changing the subject. He sensed the unnerving effect Susan had on him and he sought to regain the upper hand. “You isolate the artery, either the brachial, radial, or femoral, it really doesn’t matter which, with your middle and index fingers, like this…” Bellows held up his left hand and extended his middle and index fingers and pretended to palpate an artery in the air. “Once you have the artery between the fingers, you can feel the pulse. Then simply guide the needle in by feel. The best method is to let arterial pressure fill the syringe. In that way you can avoid air bubbles, which tend to distort the values.”

Bellows backed into the recovery room door, still gesturing the technique of the arterial stick. “Two important points: you have to use a heparinized syringe to keep the blood from clotting, and you have to keep pressure over the site for five minutes after the stick. The patient can get a frightful hematoma from an arterial stick if the pressure part is forgotten.”

To Susan the recovery room seemed superficially similar to the ICU except that it was brighter, noisier, and more crowded. There were about fifteen to twenty spaces designated for beds. Each space had a complement of equipment built into the wall, including monitors, gas lines, and suction lines. Most of the spaces were occupied by high beds with the side rails pulled up. In each bed was a patient with fresh bandages over some part of his body. Bottles of intravenous fluid were clustered on the tops of poles, like some hideous fruit on leafless trees.

New patients were arriving, others leaving, causing mini-traffic jams of moving beds. Conversation flowed freely from those who worked there and felt at home in the environment. There was even some occasional laughter. But there were also some groans, and a baby was wailing an unheeded lament in a crib by the nurses’ station. Some of the beds had groups of doctors and nurses busily engaged in adjusting the hundreds of lines, valves, and tubes. Some of the doctors were dressed in wrinkled scrub suits, stained with all sorts of secretions, although blood was the most prevalent. Others wore long white coats starched painfully stiff. It was a busy place, a crossroad filled with patients, charts, motion, and talk.

Bellows was anxious to dispense with the task ahead and approached the main desk, which was strategically placed in the center of the large room. In response to his inquiry he was handed a tray with a heparinized syringe and directed to one of the recovery room beds to the left, opposite the door through which they had entered.

“Why don’t I go ahead and do this one, and you do the next one,” said Bellows. Susan nodded in agreement as they approached the bed. They could not see the patient because of the people standing in the way. There were several nurses on the left, two doctors in scrub suits at the foot, and a tall black doctor in a long white coat on the right. As Bellows and Susan drew near, it was obvious that the latter individual had been talking although at that moment he was adjusting the pressure setting on the respirator. Susan sensed the emotional climate instantly. Both of the doctors in scrub suits were obviously intensely concerned. The smaller individual, Dr. Goodman, was visibly shaking. The other, Dr. Spallek, had his mouth angrily set with clenched teeth, audibly breathing through his nostrils as if he were about to attack the next person in his path.

“There’s got to be some sort of an explanation,” snarled the infuriated Spallek. He took hold of his face mask still tied around his neck and yanked it free, snapping the cord. He flung it to the floor. “That doesn’t seem too much to ask,” he hissed before abruptly turning away and leaving. He collided with Bellows, who miraculously managed to juggle the small tray he was carrying without dropping any of its contents. There were no words of apology from Dr. Spallek. He crossed the recovery room and blasted open the doors to the hall.

Bellows went directly to the left of the bed and put down the tray. Susan advanced warily, watching the expressions of the remaining people. The black doctor straightened up and his dark eyes followed the exit of the irate Dr. Spallek. Susan was immediately taken by the imposing image of the man. His tag gave his name: Dr. Robert Harris. He was tall, well over six feet, his dark hair textured into a restrained Afro. His blemishless tawny skin shone, and his face reflected a curious combination of culture and restrained violence. His movements were calm, almost to the point of deliberate slowness. As his eyes returned from watching Spallek’s exit they passed over Susan’s face before returning to the respirator at the side of the bed. If he had noticed Susan, he gave no hint whatsoever.

“What did you use for the pre-op, Norman?” asked Harris, pronouncing each word carefully. He had a cultured Texas accent—if that were possible.

“Innovar,” said Goodman. The pitch of his voice was abnormally high and cracking under the strain.

Susan moved up to the foot of the bed where Spallek had been standing. She studied the crumpled man next to her, Dr. Goodman. He looked pale and his hair was matted with perspiration to his forehead. He had a prominent nose, which Susan saw in perfect profile. His deep-set eyes were riveted to the patient. He did not blink.

Susan looked down at the patient, her eyes wandering to the wrist which Bellows was prepping for the arterial stick. With an exaggerated double-take, her eyes shot back to the face of the patient as recognition occurred. It was Berman!

In contrast to the tanned visage Susan recalled from their meeting in room 503 only ninety minutes ago, Berman’s face was a dusky gray color. The skin was pulled taut over his cheekbones. An endotracheal tube protruded from the left side of his mouth and some dried secretion was crusted along his lower lip. His eyes were closed but not completely. His right leg was in a huge plaster cast.

“Is he all right?” blurted Susan looking from Harris to Goodman. “What happened?” Susan spoke from emotion, without thinking; she sensed something was wrong and she reacted impulsively. Bellows was surprised at her sudden questions and looked up from his work, holding the syringe in his right hand. Harris straightened up slowly and turned toward Susan. Goodman’s eyes did not stray.

“Everything is absolutely perfect,” said Harris with a pronunciation suggesting an Oxford sojourn some time in his past. “Blood pressure, pulse, temperature all perfectly normal. However, he has apparently enjoyed his anesthetic slumber so much that he has decided not to wake up.”

“Not another one,” said Bellows, switching his attention to Harris and concerned that he was going to be saddled with another problem like Greenly. “What does the EEG look like?”

“You’ll be the first to know,” said Harris with a trace of sarcasm. “It’s been ordered.”

Comprehension for Susan was delayed by emotion, for hope was momentarily stronger than reason. But eventually it flooded over her.

“EEG?” asked Susan apprehensively. “You mean he’s like the patient down in the ICU?” Her eyes darted back and forth between Berman and Harris, then to Bellows.

“Which patient is that?” asked Harris, picking up the anesthesia record.

“The D&C mishap,” said Bellows. “You remember, about eight days ago, the twenty-three-year-old girl.”