Robin Cook - Coma

When Susan alighted from the cab she found herself in an area that seemed isolated from life. Straight ahead, the only streetlight she could see emitted a beam of light from a modern hooded fixture which illuminated the door of a building, a sign, and the walk leading up to the door. The sign was fabricated in block letters of a deep azure. The sign read: “The Jefferson Institute.” Below the blue letters was a brass plaque. It said: “Constructed with the Support of the Department of Health, Education and Welfare, US Government, 1974.”

The Jefferson Institute was surrounded by an eight-foot-high hurricane fence. The building was set back about fifteen feet from the street. It was a strikingly modern structure surfaced with a white terrazzo conglomerate polished to a high gloss. The walls slanted inward at an angle of eighty degrees, rising in a first story of some twenty-five feet. Then there was a narrow horizontal ledge before the wall soared another twenty-five feet at the same angle. Except for the front entrance, there were no windows or doors along the entire length of the facade on the ground floor. The second story had windows but they were recessed and could not be seen from the street. Only the sharply geometric embrasures were visible and the glow of lights from within.

The building occupied a city block. In a strange way, Susan found it beautiful, though she realized that its effect was enhanced by the surrounding squalor. Susan guessed that it was the centerpiece of some urban renewal scheme. It gave the impression of a two-storey ancient Egyptian mastaba, or the base of an Aztec pyramid.

Susan walked up to the front door. Made of bronzed steel, it had no knobs, no openings of any kind. To the right of the door was a recessed microphone. As Susan stepped onto the Astroturf immediately before the door, she activated a recording which told her to give her name and the purpose of her visit. The voice was deep, reassuring, and measured.

Susan complied, although she hesitated about the purpose of the visit. She was tempted to say tourism, but she changed her mind. She wasn’t feeling very jokey. So, finally, she said, “Academic purposes.”

There was no answer. A rectangular red light beneath the microphone came on. Printed on the glass was the word wait. The light flashed green and the word changed to proceed. Without a sound the bronzed door glided to the right, and Susan stepped over the threshold.

Susan found herself in a stark white hall. There were no windows, no pictures, no decorations at all. The only illumination seemed to be from the floor, which was made of a milky opaque plastic material. Susan found the effect curious and futuristic; she walked ahead.

At the end of the hall, a second silent door glided into the wall, and Susan entered what appeared to be a large, ultramodern waiting room. Its far and near walls were mirrored from floor to ceiling. The two side walls were spotlessly white and totally devoid of any interruptions or decoration. The sameness was somewhat disorienting. As Susan looked at the walls, her eyes began to focus on her own vitreous floaters. She had to blink and make an effort to focus at a distance. Looking into the mirror at the end of the room had the opposite effect Because of the opposing mirrors Susan saw the image of herself reflected to infinity.

The room was furnished with rows of molded white plastic chairs. The floor was the same as in the hall, the light from it casting strange shadows on the ceiling. Susan was about to sit down when another door slid open in the farthest mirrored wall. A tall woman entered and walked directly up to Susan. She had very short, medium brown hair. Her eyes were deeply set and the line of her nose merged imperceptibly with her forehead. Susan was reminded of the classic features of a cameo. The woman wore a white pants suit as devoid of decoration as the walls. A pocket dosimeter peeped from her jacket. Her expression was neutral.

“Welcome to the Jefferson Institute. My name is Michelle. I will show you our facilities.” Her voice was as noncommittal as her expression.

“Thank you,” said Susan, trying to see through the woman’s facade. “My name is Susan Wheeler. I believe you are expecting me.” Susan let her eyes sweep around the room once more. “It certainly is modern. I’ve never seen anything quite like this.”

“We have been expecting you. But before we begin I’d like to warn you that it is very warm inside. I suggest that you leave your coat here. And please leave your bag as well.”

Susan took off her coat, a bit embarrassed by the wrinkled and soiled nurse’s uniform she still had on. She took her notebook from her bag.

“Now then… I suppose that you know that the Jefferson Institute is an intensive-care hospital. In other words, we only take care of chronic intensive-care patients. Most of our patients are in some level of coma. This particular hospital was built as a pilot project with HEW funds, although the actual running of it has been delegated to the private sector. It has been very successful in freeing up beds in the acute intensive care units of the city’s hospitals. In fact, since the project has been so successful, an equivalent hospital is either being built or is in the planning stages in most of the large cities of the country. Research has shown that any city or population center with a population of a million or more can economically support a hospital of this sort…. Excuse me, but why don’t we sit down?” Michelle indicated two of the chairs.

“Thank you,” said Susan, taking one of the chairs.

“Visiting the Jefferson Institute is strictly regulated because of the methodology we use to care for the patients. We have developed very new techniques here, and if people are not prepared, some may react on an emotional level. Only immediate family may visit, and only once every two weeks on a preplanned basis.”

Michelle paused in her monologue, then she managed a half-smile. “I must say that your visit here is highly unusual. Normally we have a group of medical people on the second Tuesday of each month, and there is a planned program for them. But since you have come by yourself, I guess I can improvise a bit. But we do have a short film if you would like to see it.”

“By all means.”

“Good.”

Without any sign from Michelle, the room darkened and on the wall opposite from where they were sitting, a film began to roll. Susan was intrigued. She presumed that the film was being projected through a translucent section of the wall serving as a screen.

The film itself reminded Susan of old newsreels. Its outdated technique seemed an anachronism in the modern surroundings. The first section was devoted to the concept of the intensive care hospital. The Secretary of Health, Education and Welfare was shown discussing the problem with policy planners, economists, and health care specialists. The problem of spiraling hospital costs spearheaded by the cost of long-term intensive care was illustrated by graphs and charts. The men explaining the charts were dull and uninspiring, as commonplace as the suits they wore.

“This is a terrible film,” said Susan.

“I agree. Government films are all alike. You’d think that they’d try a little creativity.”

The movie moved on to ground-breaking ceremonies, at which politicians smiled and joked idiotically. More graphs and charts followed, attesting to the enormous savings that had been accrued by the hospital. There were several more scenes showing how the Jefferson Institute’s facilities freed the beds in the city’s hospitals for the care of acute cases. Then followed a comparison of the number of nurses and other personnel needed at the Jefferson facility to the number needed in a conventional hospital for the same number of intensive care patients. The people used to illustrate this point were photographed milling about aimlessly in a parking lot. Finally, the film showed the heart of the new hospital: the huge computer, both digital and analog. It concluded by pointing out that all the functions of homeostasis were monitored and maintained by the computer. The film ended with a burst of inspirational marching music, like the finale of a war movie. The lights under the floor came on as the last image disappeared.