Robin Cook - Coma

“Through those doors opposite the main desk,” said Terry Linquivist, mellowing slightly.

As Susan turned and moved toward her group, Terry Linquivist called out to one of the other nurses. “You’re not going to believe it, Nance, but today is going to be one of those days. Guess what we just got?… We got ourselves a new group of green med students.”

Susan’s ears, sensitized as they were, could pick out a few sighs and groans from the Beard 5 team.

Susan moved around the clerk’s desk. He was still on the phone and still writing. She walked toward the two plain white doors opposite the desk. The others fell in beside her.

“Some welcoming committee,” said Carpin.

“Yeah, real red carpet treatment,” said Fairweather. Despite problems of confidence, medical students still thought of themselves as very important people.

“Ah… a couple of days and the nurses will be eating out of your hand,” said Goldberg smugly. Susan turned and flashed a disdainful glare at Goldberg, who missed it altogether. Goldberg missed most subtle social interpersonal communications. Even some that weren’t very subtle.

Susan pushed through the swinging doors. The room was a jumble of old books, mostly outdated PDR’s (Physician’s Desk Reference), scratch paper, dirty coffee cups, and an assortment of disposable needles and I.V. paraphernalia. There was a counter, desk height, that ran along the length of the wall on the left. A large commercial-type coffee maker was in the middle. At the far end was a curtainless window covered on the outside with Boston grime. Only a meager amount of February morning light penetrated the glass and fell in a pale patch on the aging linoleum floor. The illumination in the room depended entirely on an ample bank of fluorescent lights in the ceiling. The right wall had a bulletin board filled with messages, reminders, and announcements. Next was a blackboard, which had a fine covering of chalk dust In the center of the room was a group of classroom chairs with a small desk piece on each right arm. One of them was pulled in front of the blackboard for Bellows. He was sitting with his yellow legal tablet in front of him. As the medical students filed in, he lifted his left hand and studied his watch. The maneuver was for the benefit of the students, and they recognized the gesture immediately. Especially Goldberg, who was extremely sensitive about nuances which might have an effect on his grade average.

No one said anything for several minutes. Bellows was silent for effect. He’d had no experience with medical students but from his own background he felt obliged to be authoritarian. The medical students were silent because they already felt ill at ease and a bit paranoid.

“It is nine-twenty,” said Bellows eyeing each student in turn. “This meeting was supposed to take place at nine, not nine-twenty.” No one contracted a single facial muscle lest Bellows’s attention be drawn to him. “I think we’d better start out on the right foot,” continued Bellows with authority. He got up laboriously and picked up a piece of chalk. “There’s one thing about surgery, especially here at the Memorial. Things happen on time. You people better take that to heart, or, believe me, your experience here is going to be…” Bellows searched for the proper word while he tapped the chalk on the blackboard. He looked at Susan Wheeler, whose appearance added to his momentary confusion. He glanced out of the window, “…a long cold winter.”

Bellows looked back at the students and began a semiprepared introductory talk. He examined the faces of the students as he talked. He was sure he recognized Fairweather. The very narrow amber-colored horn-rimmed glasses fit into Bellows’s preconception. And Goldberg: Bellows was reasonably confident he could pick him out. The other two males were nondescript entities at that point to Bellows. He hazarded another glance at Susan and felt the same instantaneous confusion. He had not been prepared for the attractiveness of the girl. She was wearing dark blue slacks which seemed to cling disturbingly snugly about her thighs. Above, she had on a lighter blue Oxford cloth shirt, accented by a darker blue and red silk scarf tied around her neck. Her medical student white coat was casually opened. Her ample breasts defiantly advertised her sex, and Bellows was not at all ready to deal with this concept in light of the plans he had formulated for dealing with the students. With some effort he avoided looking at Susan for the time being.

“You’ll be assigned to Beard 5 for only one month of your three month surgical rotation here at the Memorial,” said Bellows, shifting into a familiar monotone associated with medical pedagogy. “In some ways this is an advantage and in others a disadvantage, like so many things in life.”

Carpin chuckled at this feeble attempt at philosophy, but noticing that he was alone, he shut up quickly.

Bellows fixed his gaze on Carpin and continued, “Beard 5 rotation includes the surgical intensive care unit. Hence you will be subjected to an intensive teaching experience. That’s the good part. The disadvantage is that it occurs so early in your clinical exposure. I understand this is your first clinical rotation. Is that correct?”

Carpin looked from side to side to make sure that this last question was directed at him. “We…” His voice faltered, and he cleared his throat. “That’s right,” he managed to say with some difficulty.

“The intensive care unit,” continued Bellows, “is an area where you all have the most to learn, but it represents the most critical area for patient care. All the orders that you write on any patient must be countersigned by myself or one of the two interns on the service, whom you will meet presently. If you write orders in the ICU they have to be countersigned the moment you write them. Orders for patients on the ward can be countersigned en masse at various times during the day. Is that clear?”

Bellows looked at each student, including Susan, who returned his gaze without altering her neutral expression. Susan’s immediate impression of Bellows was not particularly favorable. His manner seemed artificial and his opening mini-lecture on punctuality seemed a little unnecessary so early in the course of events. The monotone of his remarks combined with the pitiful stab at philosophy tended to support the image Susan had begun to construct of the surgical personality from previous conversations and her reading… unstable, egotistical, sensitive to criticism, and above all, dull. Susan did not notice that Mark Bellows was male. Such a thought did not even register in her mind.

“Now,” said Bellows in his artificial monotone, “I’ll have some schedules Xeroxed for you which will outline the basic calendar we’ll follow while you are assigned to Beard 5. The patients on the ward and in the ICU will be divided among you, and you are to work directly with the intern on the case. As for admissions, I want you to set up your own schedule for equitably dividing them. One of you will do a full workup on each admission. As for night call, I want at least one of you to stay here. That means you’ll be on only one in five nights and that’s not overburdening you. In fact, that is less than usual. If others want to stay in the evenings, that’s fine, but at least one of you stays here all night. Get together some time today and give me a schedule of who will be on when.”

“Rounds will begin each morning in the ICU at six-thirty. Before then I want you to have seen your patients, collated all the necessary information to present during the rounds. Is that clear?”

Fairweather looked at Carpin in dismay. He leaned over and whispered in Carpin’s ear, “Christ, I’ll have to get up before I go to bed!”