Coma

by Robin Cook

  Susan paused, hoping for some sign of acknowledgment from the faceless figure in front of her. There was none. There was no movement whatsoever. Susan continued.

  “The fact of the matter was that my conversation with the patient had not remained on an entirely professional level; in fact, we had tentatively agreed to meet sometime on a social basis.”

  Susan paused again but silence continued from Dr. Harris.

  “I’m offering this information more as an explanation than an excuse for my reaction in the recovery room. Needless to say, when I was confronted with the reality of the patient’s condition, I became quite upset.”

  “So you reverted to the vestiges of your sex,” said Harris condescendingly.

  “Excuse me?” Susan had heard his comment, but by reflex she questioned whether she had heard him correctly.

  “I said, so you reverted to the vestiges of your sex.”

  Susan felt a flush spread across her cheeks. “I’m not sure how to take that.”

  “Take it at face value.”

  There was an awkward pause. Susan fidgeted, then spoke. “If that is your opinion of being a woman, then I plead guilty; emotionalism under such circumstances is understandable from any human being. I admit the fact that I was not the archetypical professional at the first meeting with the patient, but I think that if the roles had been reversed, I being the patient and the patient being the doctor, it probably would have come out the same. I hardly think that susceptibility to human responses is a frailty reserved for female medical students, especially when I have to put up with the patronizing attitudes of my male counterparts with the female nurses. But I did not come here to discuss such matters. I came here to apologize for impertinence to you and that is all. I’m not apologizing for being a woman.”

  Susan paused again, expecting some sort of reply. None was forthcoming. Susan felt a definite feeling of irritation spread through her.

  “If my being a woman bothers you, then that’s your problem,” said Susan with emphasis.

  “You’re being impertinent again, my dear,” said Harris.

  Susan stood up. Gazing down, she looked at Harris’s face, his narrowed eyes, his full cheeks and broad chin. Light played through the edge of his hair, making it appear like silver filigree.

  “I can see this is getting us nowhere. I’m sorry I came. Goodbye, Dr. Harris.”

  Susan turned and opened the door to the corridor.

  “Why did you come?” said Harris after her.

  With her hand on the door, Susan looked out into the corridor and considered Harris’s question. Obviously debating with herself whether to leave or not, she finally turned and faced the Chief of Anesthesiology again.

  “I thought I’d apologize so that we could let bygones be bygones. I had the irrational hope that you might be willing to lend me some assistance.”

  “In what regard?” said Harris, his voice relaxing its aloofness by a degree.

  Susan hesitated again, debating, then let the door shut. She walked up to the chair she had been sitting in but she did not sit down. She eyed Harris and thought that she had nothing to lose and should say what she had originally come to say despite his coldness.

  “Since you said that there have been six cases of prolonged coma following anesthesia during the last year, I decided to look into the problem as a potential subject for my third-year paper. Well, I found out that you were absolutely correct. There have been six cases following anesthesia during the last year. But there also have been five cases of sudden unexplained coma occurring in patients on the medical floors during the past year. Yesterday there were two deaths for apparent respiratory arrest. These patients gave no history to suggest that such an event might take place. They were in the hospital for essentially peripheral problems; one had a minor foot operation followed by phlebitis, the other had Bell’s palsy. Both were essentially well individuals, except one of them had glaucoma. There was no explanation for their respiratory arrest and I have a feeling that they are possibly related to the other coma cases. In other words, I think I have twelve cases representing gradations of the same problem. And if Berman turns out to be in the same boat as the others, then there are thirteen people suffering from some unexplained phenomenon. Perhaps worst of all, the incidence seems to be on the upswing, especially for the cases occurring during anesthesia. The interval between cases seems to be getting shorter and shorter. Anyway, I have decided to try to look into the problem. In order for me to continue my investigation I need some help from someone like yourself. I need authorization to search the data bank and see how many cases the computer could find if it’s asked directly. Also I need the charts of the previous victims.”

  Harris leaned forward and slowly placed his arms on his desk.

  “So the Medical Department has had some trouble too,” he murmured. “Jerry Nelson didn’t mention that.”

  Looking up at Susan, he spoke louder.

  “Miss Wheeler, you are dabbling in troubled waters. It’s refreshing to hear someone, fresh from the basic science years of medical school, interested in clinical research. But this is not the proper subject for you. There are many reasons for my saying this. First of all, the problem of coma is far more complex than might be apparent to you. It is a wastepaper-basket term, a mere description. And for someone to immediately assume all cases of coma are related simply because the causative agent is not precisely known is intellectually absurd. Miss Wheeler, I advise you to stick to something more specific, less speculative, for your so-called third-year paper. As far as helping you is concerned, I must admit I do not have the time. And let me admit something else that might be rather apparent to you. I don’t try to hide it. I’m not keen on women in medicine.”

  Harris pointed his finger at Susan and aimed it across, almost as if it were a gun.

  “They treat it like a game, something to do for now . . . something chic . . . later, who knows. It’s a fad. And on top of that, they are invariably, impossibly emotional and . . .”

  “Dr. Harris, cut the bullshit,” interrupted Susan, lifting up the back of the chair and letting it fall a few inches. She was furious. “I didn’t come here to listen to this type of nonsense. In fact it’s people like you who keep medicine in the old rut, unable to respond to the challenge of relevancy and change.”

  Harris pounded the top of the desk with his open hand causing a few papers and pencils to flee for safety. Almost in one step he came from behind his desk with a speed that caught Susan off guard. His movement brought his face only inches from Susan’s. She froze before the unexpected fury she had unleashed.

  “Miss Wheeler, you do not know your place here,” hissed Harris, holding himself in check with great difficulty. “You are not to be the Messiah who is going to miraculously deliver us from a problem which has already been under the scrutiny of the best minds in this hospital. In fact, I see you as a very destructive influence and I can promise you this: you’ll be out of this hospital in twenty-four hours. Now get out of my office.”

  Susan backed up, afraid to expose her unguarded back to this man who seemed about to explode with hatred. She opened the door and ran down the corridor, feeling the tears well up from her mixture of fear and anger.

  Behind her, Harris kicked the door shut and snatched the phone off the hook. He told his secretary to get him the director of the hospital without delay.

  Tuesday

  February 24

  11:00 A.M.

  Susan slowed to a deliberate walk, avoiding the questioning expressions of the people using the corridor. Her emotions, she was afraid, could be read from her face like an open book. Usually when she cried or was about to cry, her cheeks and eyelids turned bright crimson. Although she knew she wasn’t going to cry now, the proper neural connections had been made. If someone she knew stopped her and said something innocuous, like “What’s the matter, Susan?” she probably would have cried. So Susan wanted to be alone for a few moments. As it was, she was more angry an
d frustrated than anything else as the fear generated by her encounter with Harris evaporated. Fear seemed so out of place in the context of a meeting with a professional superior that she wondered if she was becoming delusional. Had she really crossed Harris to the extent that he had had to keep himself in check to avoid some sort of physical encounter? Was he just about to strike her, as she had feared, when he came bounding out from behind his desk? The idea seemed ludicrous and it was difficult for her to believe that the situation had been so precipitous. She knew that she could never make someone else believe what she had felt. It reminded her of the situation with Captain Queeg in The Caine Mutiny.

  The stairwell was the only haven she could think of, and she pushed through the metal door. It closed behind her rapidly, cutting off the raw fluorescent lights and the voices. The single bare incandescent bulb above her had a warmer glow and the stairway offered a soothing silence.

  Susan was still clutching her notebook and a ballpoint pen. Gritting her teeth, and swearing loudly enough to hear an echo, she threw the notebook and the pen down the course of stairs to the landing below. The notebook bounced on the edge of a stair, then fell flat, cover down, onto the floor. It skidded across the landing and struck the wall, coming to a rest unhurt and open. The pen flipped over the edge of the stairs and a few telltale sounds suggested that it had descended to the bowels of the hospital.

  Uninviting as it was, Susan sat down on the top stair, her feet on the very next step, bringing her knees up at acute angles. Her elbows rested on the tops of her knees. She closed her eyes tightly. So much of her experience in medicine with relationships had been reemphasized in the short time she had been at the Memorial. Professional superiors, instructors to professors, reacted to her in a manner that unpredictably varied from warm acceptance to overt hostility. Usually the hostility was more passive-aggressive than Harris’s had been; Nelson’s reaction was more typical. Nelson had been friendly at first, then later had slipped into an obstructive stance. Susan felt an old familiar feeling, a feeling which had developed ever since she had chosen medicine as a career: it was a paradoxical loneliness. Although constantly surrounded by people who reacted to her, she felt apart. The day and a half at the Memorial had not been an auspicious beginning for her clinical years. Even more than during her first days at medical school, she felt that she was entering a male club; she was an outsider forced to adapt, to compromise.

  Susan opened her eyes and looked down at her notebook sprawled on the landing below. Throwing the book had given some vent to her frustrations, and she felt a degree more relaxed. Control was returning. At the same time the childish aspect of the gesture surprised her. It was not like her to do such a thing. Perhaps Nelson and Harris were, in the final analysis, right. Perhaps being a medical student so early in training, she was not the right person to investigate such a serious clinical problem. And perhaps her emotionalism was a built-in handicap. Would a male have responded in the same way to Harris’s reaction? Was she more emotional than her male counterparts? Susan thought about Bellows and his cool detached manner, how he could concentrate on the sodium ions while confronting a tragedy. Susan had found fault with his behavior the day before, but now, daydreaming in the stairwell, she was no longer so sure. She wondered if she could achieve that type of detachment if it were necessary.

  A door opening somewhere far above brought Susan to her feet. There were some hushed and hurried footsteps on the metal stairs, then the sound of another door, then silence returned. The crude cement walls of the stairwell combined with the curious longitudinal rust-colored stains enhanced Susan’s sense of isolation. In slow motion she descended to where her notebook lay. By chance it had opened to the page copied from Nancy Greenly’s chart. Reaching for the book, Susan read her own handwriting. “Age 23, Caucasian, previous medical history negative except for mononucleosis at age 18.” Quickly Susan’s mind conjured up the image of Nancy Greenly, her ghostly pallor, lying in the ICU. “Age twenty-three,” Susan said aloud. In a rush she reexperienced the intensity of her feelings of transference. Susan felt a rekindling of her commitment to investigating the coma problem to the limit of her abilities despite Harris, despite Nelson. Without questioning why, she felt a strong urge to find Bellows. Within a single day her feeling toward Bellows had taken a one-hundred-and-eighty-degree turn.

  “Susan, for Christ’s sake, haven’t you had enough yet?” With his elbows on the table, Bellows placed his palms against his face so that his fingers could lightly massage his closed eyes. His hands rotated, bringing his fingers below his ears. With his face cradled in his hands, he looked at Susan sitting across from him in the hospital coffee shop. The place had a relatively clean appearance with indeterminate modern furnishings. It was primarily meant for visitors to the hospital, although the staff frequented it on occasion. The prices were higher than the cafeteria’s but the quality was equivalently better. At eleven-thirty it was crowded but Susan had found a table in the corner and had paged Bellows. She was pleased when he agreed to see her immediately.

  “Susan,” continued Bellows after a pause, “you’ve got to give up this self-destructive crusade. I mean it’s absolutely sure suicide. Susan, there’s one thing about medicine, you’ve got to flow with the river or you’ll drown. I’ve learned that. God, whatever could have possessed you to go to Harris, especially after that little episode yesterday?”

  Susan sipped her coffee in silence, keeping her eyes on Bellows. She wanted him to talk because it sounded good; he seemed to care. But also she wanted him to get involved, if that were at all possible. Bellows shook his head as he took a drink of his coffee.

  “Harris is powerful, but he’s not omnipotent around here,” added Bellows. “Stark can reverse anything Harris does if he has reason to do so. Stark has raised most of the money for construction around here, millions. So people listen to what he says. So why not give him a reason; why not pretend to be a normal medical student for a few days? Christ, I need it myself. Guess who was on rounds this morning to welcome you medical students? Stark. And the first thing he wanted to know was why there were only three students out of five. Well I told him that, foolishly enough, I had taken you all in to see a case on the first day, and one of you had fainted and smashed his head on the floor. You can guess how that went over. And then I couldn’t think of anything appropriate to say about you. So I said you were doing a literature search on coma following anesthesia. I decided that since I couldn’t think of a good lie I might as well tell the truth. Well he immediately assumed that it had been my idea to put you on the project. I cannot repeat what he said to me in response. It should be enough for me to say that I need you to behave like a normal medical student. I’ve covered for you to the extent that I’m already overdrawn.”

  Susan felt an urge to touch Bellows, kind of a reassuring people-to-people hug. But she didn’t; instead she played with her coffee spoon with her head down. Then she looked at Bellows.

  “I’m really sorry if I’ve caused you some difficulties, Mark, really I am. Needless to say, it was unintentional. I’m the first to admit this thing has gotten out of hand so rapidly that it’s uncanny. I started because of an emotional crisis of sorts. Nancy Greenly is the same age as I, and I’ve had some occasional irregularities with my periods, probably just like Nancy Greenly. I cannot help but feel some . . . some kinship with her. And then Berman . . . what a Goddamned coincidence. By the way, did Berman have an EEG?”

  “Yeah, it was completely flat. The brain is gone.”

  Susan searched Bellows’s face for some response, some sign of emotion. Bellows lifted the coffee cup to his lips and took a sip.

  “The brain is gone?”

  “Gone.”

  Susan bit her lower lip and looked down into her coffee cup. A small amount of oil opalesced on the surface in colorful swirls. Somehow she had expected the news, but it still cut into her and she fought with her mind, suppressing emotion as best she could.

  “Are you OK?” ask
ed Bellows, reaching across and gently lifting her chin with his hands.

  “Don’t say anything for a second,” said Susan, not daring to look at him. The last thing she wanted to do was cry and if Bellows persisted, it would happen. Bellows cooperated and returned to his coffee while keeping his eyes on Susan.

  After a few moments Susan looked up; her eyelids were slightly reddened.

  “Anyway,” continued Susan, avoiding eye contact with Bellows, “I started with an emotional sort of commitment, but that quickly mixed with intellectual commitment. I really thought I had stumbled onto something . . . a new disease or a new complication of anesthesia or a new syndrome . . . something, I don’t know what. But then there was another change. The problem loomed bigger than I had imagined initially. They’ve had coma cases on the medical floors as well as in surgery. On top of that, there were those deaths you told me about. I know you think it’s crazy, but I think they are related, and the pathologist intimated they have had a number of such cases. My intuition tells me there is something else in all this, something . . . I don’t know how to explain it . . . call it supernatural or call it sinister . . .”

  “Ah, now paranoia,” said Bellows, nodding his head in mock understanding.

  “I can’t help it, Mark. There was something very strange about the reaction of Nelson and Harris. You have to admit that Harris’s reaction was totally inappropriate.”

  Bellows tapped his forehead in succession with the heel of his hand. “Susan, you’ve been staying up watching old horror movies. Admit it, Susan . . . admit it or I’ll think you’re having a psychotic break. This is absurd. What do you suspect, some sort of sinister inversion layer spreading evil forces, or is it a crazed killer who hates people with minor ailments? Susan, if you hypothesize so extravagantly and with such creativity, then come up with some ideas of motive. I mean, a demented killer was OK for Hollywood and George C. Scott in Hospital just to create an artificial mystery . . . but it’s a little too farfetched for reality. I admit Harris’s performance sounds a bit weird, there’s no doubt about that. But at the same time I think I could come up with some reasonable explanation for his unreasonable behavior.”