Robin Cook - Coma

“Well I hope not,” said Harris, “but it’s beginning to look that way.”

“What was the anesthesia?” asked Bellows lifting Berman’s right eyelid and glancing down into the widely dilated pupil.

“Neurolept anesthesia with nitrous,” said Harris. “The girl’s was halothane. If the problem is the same clinically, it wasn’t the anesthetic agent.” Harris looked up from the anesthesia record toward Goodman. “Why did you give this extra cc of Innovar toward the end of the case, Norman?”

Dr. Goodman did not respond immediately. Dr. Harris called his name again.

“The patient seemed to be getting too light,” said Goodman, suddenly breaking his trance.

“But why Innovar so late in the case? Wouldn’t fentanyl alone have been more prudent?”

“Probably. I should have used the fentanyl alone. The Innovar was just handy and I knew that I’d only use an additional cc.”

“Can’t something be done?” asked Susan with a hint of desperation. Images of Nancy Greenly streamed back with bits and pieces of the recent conversation with Berman. She could distinctly remember his vitality, which was in sharp contrast to the waxy, lifeless-appearing figure before her.

“It’s been done, whatever it was,” said Harris with finality, returning the anesthesia record to Goodman. “All we can do now is watch and see what kind of cerebral function returns, if any. The pupils are widely dilated and they do not react to light. That is not a good sign, to say the least. It probably means that there was extensive brain death.”

Susan experienced a sickening feeling rise up within herself. She shuddered and the feeling passed but she felt lightheaded. Above all, she felt helplessly desperate.

“This is too much,” said Susan suddenly and with obvious emotion. Her voice quivered. “A normal healthy man with a minor peripheral problem ends up like a… like a vegetable. My God, this can’t go on. Two young people within just a couple of weeks. I mean, it’s an unacceptable risk. Why doesn’t the Chief of Anesthesia close the department? Something’s got to be wrong. It’s absurd to allow…”

Robert Harris’s eyes began to narrow as Susan began her tirade. Then he interrupted her with an obvious edge to his. voice. Bellows’s mouth had dropped open in total dismay.

“I happen to be the Chief of Anesthesia, young lady. And who, may I ask, are you?”

Susan started to speak, but Bellows cut in nervously. “This is Susan Wheeler, Dr. Harris, a third-year medical student who is rotating on surgery, and, ah… we just wanted to get this blood drawn here, then we’ll be off.” Bellows recommenced his prep on Berman’s right wrist, stroking rapidly with the Betadine sponge.

“Miss Wheeler,” continued Harris in a condescending tone, “your emotionalism is out of place and frankly will not serve constructive purposes. What one needs in those cases is to establish a causal factor. I’ve just mentioned to Dr. Bellows that the anesthetic agent was different in these two cases. The anesthetic care was unimpeachable save for a few minor debatable points. In short, both these cases were obviously unavoidable idiosyncratic reactions to the combination of anesthesia and surgery. One needs to try to determine from these people if there is a way in order to forecast this kind of disastrous sequelae. To condemn anesthesia across the board and deprive the populace of needed surgery would be far worse than to accept a certain minimal risk involved in anesthesia. What…”

“Two cases in eight days is hardly a minimal risk,” interrupted Susan contentiously.

Bellows tried to catch Susan’s eye to get her to break off with Harris, but Susan was staring directly at Harris, converting her emotionalism to defiance.

“How many such cases have there been in the last year?” asked Susan.

Harris’s eyes scanned Susan’s face for several seconds before he responded. “I suddenly find this conversation somewhat akin to being cross-examined, and in that sense intolerable and unnecessary.” Without waiting for a response, Harris walked past Susan toward the recovery room door.

Susan turned to face him. Bellows reached for her right arm to try and shut her up. Susan fended him off. She called after Harris, “Without wishing to sound impertinent, it does seem to me that some questions need to be asked by someone, and something done.”

Harris stopped abruptly about ten feet from Susan and turned very slowly. Bellows shut his eyes tightly, as if he expected to receive a blow to the head.

“And I suppose that someone should be a medical student! For your information, in case you are planning to be our Socratic gadfly, there have been six cases prior to this present problem in the last few years. Now if I may have your permission, I will get back to work.”

Harris turned again and started for the door.

“I suppose your emotionalism serves constructive purposes,” called Susan. Bellows supported himself by leaning onto the bed. Harris stopped for the second time, but he did not turn around. Then he continued, and he too blasted open the door to the hall.

Bellows put his left hand up to his forehead. “Holy fuck, Susan, what are you trying to do, commit medical suicide?” Bellows reached out and turned Susan around to face him. “That was Robert Harris, Chief of Anesthesia. Christ!”

Bellows commenced the prep for the third time, rapidly, nervously. “You know, just being here with you when you act like that makes me look bad. Shit, Susan, why did you want to get him pissed?” Bellows palpated the radial artery and then jammed the needle of the heparinized syringe into the skin on the thumb side of Berman’s wrist. “I’m going to have to say something to Stark before he hears about it through the grapevine. Susan, I mean, what’s the point of getting him mad? You obviously don’t have any idea what hospital politics are like.”

Susan watched Bellows performing the arterial stick. She consciously avoided looking at Berman’s sickly face. The syringe began to fill with blood spontaneously. The blood was a very bright crimson.

“He got mad because he wanted to get mad. I don’t think I was impertinent until that last question, and he deserved that.”

Bellows didn’t answer.

“Anyway I really didn’t want to make him angry… well, maybe I did in a way.” Susan thought for a few moments. “You see, I talked with this patient only an hour or so ago. He was the patient I had to leave the ICU for. It’s just so unbelievable; he was a functioning, normal human being. And… I… we had a conversation and I felt like I knew something about him. I even took a liking to him in a way. That’s what makes me mad or sad or both. And Harris, his attitude made it worse.”

Bellows didn’t respond immediately. He searched in the tray for a syringe cap. “Don’t tell me anymore,” he said at length. “I don’t want to hear about it. Here, hold the syringe for me.” Bellows gave Susan the syringe while he prepared the ice bed. “Susan, I’m afraid you’re going to be poison for me around here. You have no idea how miserable someone like Harris can make it. Here, put pressure on the puncture site.”

“Mark?” said Susan pressing on Berman’s wrist but looking at Bellows directly. “You don’t mind if I call you Mark, do you?”

Bellows took the syringe and placed it into the ice bath. “I’m not sure, to be perfectly honest.”

“Well, anyway, Mark, you have to admit that six, and maybe seven, cases, if Berman proves to be like Greenly, represents a lot of cases of brain death, or vegetables, as you call them.”

“But a lot of surgery goes on here, Susan. It’s often more than a hundred cases a day, some twenty-five thousand per year. That drops the six cases below some two hundredths of one percent in incidence. That’s still within the surgical anesthesia risk.”