Robin Cook - Coma

“That may be true, but these six cases represent only one type of possible complication, not surgical-anesthesia risk in general. Mark, it’s got to be too high. In fact, down in the ICU this morning you said that the particular complication Nancy Greenly represented occurred only about one in a hundred thousand. Now you’re trying to tell me that six in twenty-five thousand is OK. Bullshit. It’s too high whether you or Harris or anybody in the hospital accept it. I mean would you want to have some minor surgery tomorrow with that kind of risk? You know this whole thing really bothers me, the more I think about it.”

“Well then, don’t think about it. Come on, we’ve got to get moving.”

“Wait a minute. You know what I’m going to do?”

“I can’t guess and I’m not sure I want to know.”

“I’m going to look into this particular problem. Six cases. That should be enough for some reasonable conclusions. I do have a third-year paper to do and I think I owe that much to Sean here.”

“Oh for Christ sake, Susan, let’s not be melodramatic.”

“I’m not being melodramatic. I think I’m responding to a challenge. Sean challenged me earlier with my image of myself as a doctor. I failed. I wasn’t detached or professional. You might even say I acted like a schoolgirl. Now I’m challenged again. But this time intellectually with a problem, a serious problem. Maybe I can respond to this challenge in a more commendable fashion. Maybe these cases represent a new symptom complex or disease process. Maybe they represent a new complication of anesthesia because of some peculiar susceptibility these people had from some previous insult which they suffered in the past.”

“All the more power to you,” said Bellows getting the remains from the arterial stick together. “Frankly though, it sounds like a hell of a hard way to work out some emotional or psychological adjustment problem of your own. Besides, I think you’ll be wasting your time. I told you before that Dr. Billing, the anesthesiology resident on Greenly’s case, went over it with a fine-toothed comb. And believe me, he’s bright. He said that there was absolutely no explanation for what happened.”

“Your support is appreciated,” said Susan. “I’ll start with your patient in the ICU.”

“Just a minute, Susan dear. I want to make one point crystal clear.” Bellows held up his index and middle finger like Nixon’s victory sign. “With Harris on the rag, I don’t want to be involved, no how. Understood? If you’re crazy enough to want to get involved, it’s your bag from A to Z.”

“Mark, you sound like an invertebrate.”

“I just happen to be aware of hospital realities and I want to be a surgeon.”

Susan looked Mark directly in the eye. “That, Mark, in a nutshell, is probably your tragic flaw.”

Monday, February 23, 1:53 P.M.

The cafeteria at the Memorial could have been in any one of a thousand hospitals. The walls were a drab yellow that tended toward mustard. The ceiling was constructed of a low-grade acoustical tile. The steam table was a long L-shaped affair with brown, stained trays stacked at the beginning.

The excellence of the Memorial’s clinical services did not extend into the food service. The first food seen by an unlucky customer coming into the cafeteria was the salad, the lettuce invariably as crisp as wet Kleenex. To heighten the disagreeable effect, the salads were stacked one on top of the other.

The steam table itself presented the hot selections, which posed a baffling mystery. So many things tasted alike that they were indistinguishable. Only carrots and corn stood aside. The carrots had their own disagreeable taste; the corn had absolutely no taste at all.

By quarter to two in the afternoon, the cafeteria was almost empty. The few people who were sitting around were mostly kitchen employees, resting after the mad lunchtime rush. As bad as the food was, the cafeteria was still heavily patronized because it enjoyed a monopoly. Few people in the hospital complex took more than thirty minutes for lunch, and there simply was not enough time to go elsewhere.

Susan took a salad but after one look at the limp lettuce, she replaced it. Bellows went directly to the sandwich area and took one.

“There’s not much they can do to a tuna sandwich,” he called back to Susan.

Susan eyed the hot entrees and moved on. Following Bellows’s lead, she selected a tuna sandwich.

The woman who was supposed to be at the cash register was nowhere to be seen.

“Come on,” motioned Bellows, “we ain’t got much time.”

Feeling a bit like a shoplifter by not paying, Susan followed Bellows to a table and sat down. The sandwich was repellent. Somehow too much water had gotten into the tunafish and the tasteless white bread was soggy. But it was food and Susan was famished.

“We’ve got a lecture at two,” garbled Bellows through a huge bite of sandwich. “So eat hearty.”

“Mark?”

“Yeah?” said Bellows as he gulped half his milk in one swig. It was apparent that Bellows was a speed eater of Olympic caliber.

“Mark, you wouldn’t be hurt if I cut your first surgery lecture, would you?” Susan had a twinkle in her eye.

Bellows stopped the second half of his tuna sandwich midway to his mouth and regarded Susan. He had an idea that she was flirting with him, but he dismissed it.

“Hurt? No, why do you ask?” Bellows had a helpless feeling that he was being manipulated.

“Well I just don’t think I could sit through a lecture at this moment in time,” said Susan, opening her milk carton. “I’m a little spaced from this affair with Berman…. Affair is not the right word. Anyway I’m really uptight; I couldn’t handle a lecture. If I do something active I’ll be much better off. I was thinking that I’d go to the library and look up something about anesthesia complications. It will give me a chance to start my ‘little’ investigation as well as sort out this morning in my mind.”

“Would you like to talk about it?” asked Bellows.

“No, I’ll be OK, really.” Susan was surprised and touched by his sudden warmth.

“The lecture isn’t critical. It’s an introductory kind of thing by one of the emeritus professors. Afterwards I planned for you students to come on the ward to meet your patients.”

“Mark?”

“What?”

“Thanks.”

Susan stood up, smiled at Bellows, and left.

Bellows put the second half of his tuna sandwich into his mouth and chewed it on the right side, then he moved it over to the left cheek. He wasn’t even sure what Susan had thanked him for. He watched her cross the cafeteria and deposit her tray in the rack. She rescued her unfinished milk and sandwich before leaving. At the door she turned and waved. Bellows waved in return but by the time he got his hand up, she had already disappeared.

Bellows looked around self-consciously, wondering if anyone had noticed him with his hand in the air. Replacing his hand on the table, he thought about Susan. He had to admit that she attracted him in a refreshing, basic way, reminding him of the way he felt early in his social career: an excitement, an unsettling impatience. His imagination conjured up sudden romantic pursuits with Susan as the object. But as soon as he did so, he reprimanded himself for being juvenile.

Bellows polished off his milk with another gigantic gulp while carrying his tray to the dirty-dish cart. En route he wondered if he dared to ask Susan out. There were two problems. One was the residency and Stark. Bellows had no idea how the chief would react to one of his residents dating a student assigned to him. Bellows was not sure if such a worry was rational or not. He did know that Stark tended to favor married residents. The idea was that the married ones would be more dependable, which, as far as Bellows was concerned, was pure bunk. But there was little hope of keeping a relationship between himself and one of the students a secret. Stark would find out and it could be bad. The second problem was Susan herself. She was sharp; there was no question about that. But could she be warm? Bellows had no idea. Maybe she was just too busy, or too intellectualized, or too ambitious. The last thing that Bellows wanted to do was to squander his limited free time on some cold, castrating bitch.