Coma

by Robin Cook

  “It is rather gruesome.” Susan recalled the upsetting image of the cadavers hung in the freezer. “What is the strange lighting?”

  “Oh, yes, we should put on glasses if we stay in here much longer.” Michelle fetched several pairs of goggles from a table.

  “There is a low-level of ultraviolet light in here. It has been found useful in controlling bacteria as well as helping to maintain the integrity of the skin.” Michelle offered a set of goggles to Susan, and they both put them on.

  “The temperature in here is maintained at ninety-four point five Fahrenheit, plus or minus five hundredths of a degree. The humidity is held at eight-two percent with a one percent variance. That tends to reduce patient heat loss and hence reduces the patients’ caloric needs. The humidity has reduced the respiratory infection problem, which you know is critical for coma patients.”

  Susan was spellbound. She gingerly moved closer to one of the suspended patients. A profusion of wires perforated various long bones. The wires then passed horizontally through an aluminum frame around the patient before running up to a complicated trolley device on the ceiling. Susan looked up at the ceiling and saw that it was a maze of tracks for the trolleys. All the I.V. lines, suction tubes, and monitoring lines from the patient ascended to the trolley. Susan looked back at Michelle. “And there are no nurses?”

  “I happen to be a nurse, and there are two others on duty, plus one doctor. That’s quite a reasonable ratio for one hundred and thirty-one intensive care patients, wouldn’t you say? You see, everything is automated. The patient’s weight, blood gases, fluid balance, blood pressure, body temperature—in fact, an enormous list of variables—are being constantly scanned and compared to standards by the computer. The computer actuates solenoid valves to rectify any abnormalities or discrepancies it finds. It is far better than conventional care. A doctor tends to concern himself with isolated variables and in a static fashion. The computer is able to sample over time, hence it treats dynamically. But more important still is that the computer correlates all the variables at any given moment. It’s much more like the bodies’ own regulatory mechanisms.”

  “Modern medicine carried to the nth degree. It’s incredible, really it is. It’s like some science fiction setting. A machine taking care of a host of mindless people. It’s almost as if these patients aren’t people.”

  “They aren’t people.”

  “I beg your pardon?” Susan looked up from the patient toward Michelle.

  “They were people; now they’re brain stem preparations. Modern medicine and medical technology have advanced to the point where these organisms can be kept alive, sometimes indefinitely. The result was a cost-effectiveness crisis. The law decided they had to be maintained. Technology had to advance to deal with the problem realistically. And it has. This hospital has the potential to handle up to a thousand such cases at a time.”

  There was something about the basic philosophy Michelle elucidated that made Susan uncomfortable. She also had a feeling that her guide had herself been very carefully indoctrinated. Susan could tell that Michelle did not question what she was saying. Nevertheless Susan did not dwell on the institute’s philosophical foundations. She was overwhelmed by the place’s physical aspects. She wanted to see more. She looked around the room. It was more than a hundred feet long, with a fifteen- to twenty-foot ceiling. In the ceiling the maze of tracks was bewildering.

  There was another door at the far end of the room. It was closed. But it was a normal door with normal hardware. Susan decided that only the doors they had so far traversed were centrally controlled. After all, most visitors, the families, never came into the main ward.

  “How many operating rooms are there here in the Jefferson Institute?” asked Susan suddenly.

  “We don’t have operating rooms here. This is a chronic-care facility. If a patient needs acute care, he is transferred back to the referring institution.”

  The reply was so fast that it gave the impression of a reflex or trained response. Susan distinctly remembered seeing the ORs in the floor plans she had obtained at City Hall. They were on the second floor. Susan began to sense that Michelle was lying.

  “No operating rooms?” Susan deliberately acted very surprised. “Where do they do emergency procedures, like tracheotomies?”

  “Right here on the main ward or in the ICU visiting room next door. That can be set up as a minor OR if needed. But it rarely happens. As I said, this is a chronic-care hospital.”

  “I still would have thought that they would have included an OR.”

  At that moment almost directly in front of Susan, one of the patients was automatically tipped back so that his head was about six inches below his feet.

  “There is a good example of the computer working,” said Michelle. “The computer probably sensed a fall in the blood pressure. It put the patient into the Trendelenburg position prior to correcting the main cause for the blood pressure fall.”

  Susan was barely listening; she was trying to figure a way to do a little exploring on her own. She wanted to see those operating rooms indicated on the floor plans.

  “One of the reasons I asked to come here was to see a particular patient. The name is Berman, Sean Berman. Do you have any idea where he is located?”

  “No, not offhand. To tell you the truth, we don’t use names here for the patients. The patients are given numbers, sample 1, sample 2, etcetera. It’s infinitely easier to key into the computer. In order to find Berman’s number, I’ll have to match the name with the computer. It takes a minute or so, that’s all.”

  “Well, I would like to find out.”

  “I’ll use the information terminal at the control desk. Meanwhile, you could take a look here and see if you can see him. Or you can come with me and wait in the waiting room. No guests are permitted in the control room.”

  “I’ll wait here, thank you. There is enough of interest here to keep me occupied for a week.”

  “Suit yourself, but, needless to say, don’t touch any of the wires or the patients under any circumstances. The whole system is very carefully balanced. The electrical resistance of your body would be picked up by the computer and an alarm would sound.”

  “No need to worry. I’m not about to touch anything.”

  “Good. I’ll be right back.”

  Michelle removed her goggles. The door to the visiting room opened automatically and she was gone.

  Michelle walked through the visitors’ room and halfway down the corridor beyond it. The door to the control room opened for her. It was dimly illuminated like the control room on a nuclear submarine. A good portion of the light in the room came from the far wall, which was actually a two-way mirror permitting observation of the visitors’ hall from the control room.

  Two other people occupied the room when Michelle entered. Sitting in front of a large U-shaped bank of TV monitors was a guard. He was also dressed in white, and wore a wide white leather belt, a white-holstered automatic, and a two-way Sony receiver. He sat in front of a vast console with multiple switches and dials. A battery of TV monitors in front of him was scanning rooms, corridors, and doors throughout the hospital. Several screens had constant images, such as the monitors for the front door and the entry hall. Others changed as remote control video cameras scanned their areas. The guard looked up sleepily as Michelle entered.

  “You left her by herself in the ward? Do you think that was wise?”

  “She’ll be fine. I was told to let her see what she wanted on the first floor.”

  Michelle walked toward a large computer terminal where the other occupant of the room, a nurse dressed like Michelle, sat watching the data displayed on the forty or more screens in front of her. Intermittently the computer’s printer to her right would activate and print out information.

  Michelle plopped herself down in a chair.

  “Who the hell does she know to get invited here by herself?” asked the computer nurse, suppressing a yawn. “She looks lik
e a Goddamn LPN or something. She doesn’t even have a pin or a cap. And that uniform! It looks like she’s been wearing it for six months.”

  “I haven’t the slightest idea who she knows. I got a call from the director saying that she was coming and that we were to let her in and entertain her. I was to call Herr Direktor when she arrived. Do you think there’s some hankypanky going on?”

  The computer nurse laughed.

  “Do me a favor,” continued Michelle, “and punch in the name of Sean Berman. He was a Memorial referral. I need his patient number and location.”

  The computer nurse began to key in the information. “On our next shift, you can be the computer-sitter while I float. Playing with this machine is starting to drive me up the wall.”

  “Gladly. The only break in the routine of floater for the past week has been this visitor. A year ago, if someone told me I would be tending a hundred intensive care patients myself, I’d have laughed in his face.”

  One of the display screens flashed: Berman, Sean. Age 33, sex male, race caucasian. Diagnosis: cerebral brain death secondary to anesthetic complications. Sample number 323 B4. STOP.

  The nurse keyed Sample number 323 B4 back into the computer.

  The guard at the other end of the room slouched over, watching the monitors as usual, as he had been doing for two hours since his last break, as he had been doing for almost a year. The picture of the main ward appeared on screen number 15; moving as the video camera slowly panned from one end of the huge room to the other. The dangling nude patients held no interest for the guard. He was finally accustomed to the gruesome scene. Automatically screen number 15 shifted to the intensive care visitors’ ward as its camera started to scan.

  The guard sat up suddenly, looking at the screen of number 15. He reached for the manual mode switch and returned the scan to the main ward. The video camera scanned the enormous room again.

  “The visitor is no longer in the main ward!” said the guard.

  Michelle turned from the computer display screen and squinted to see screen number 15 of the monitor. “No? Well check the visitors’ ward and the corridor. Maybe she had enough. The main ward is usually a shock for first-time visitors.”

  Michelle turned and looked out through the glass to the waiting room, but Susan was not there either.

  The display screen on the computer flashed: Sample 323 B4 terminated. 0310 Feb. 26. Cause of death: cardiac arrest. STOP.

  “Well if she came here for Berman, she’s too late,” said Karen without feeling.

  “She’s not in the visitors’ ward,” said the guard, activating a series of switches. “And she’s not in the corridor. It’s not possible.”

  Michelle got up from the chair, her eyes staying on screen 15 until she was at the door. “Calm down. I’ll locate her.” Michelle turned to the nurse at the computer. “Maybe you should try to call the director again. I think we’d better get rid of this girl.”

  Thursday

  February 26

  5:20 P.M.

  As soon as Michelle left the main ward, Susan had removed the Xeroxed copies of the Jefferson Institute floor plans she had folded in her notebook. She oriented herself from the entrance, traced their route to the main ward, and then checked the routes for gaining access to the second floor. She saw two choices. There was a stairway from MG or an elevator from M Comp R. Susan glanced down at the key in the lower right hand corner. MG stood for morgue; M Comp R was the main computer room. Susan quickly decided that the stairs would be safer than the elevator; she thought that the computer room might well be occupied.

  She walked toward the far end of the ward, where there was a conventional door, and tried the knob. It turned and Susan opened the door into the corridor beyond. It seemed to be quite dark; then she remembered the goggles. She took them off and put them in her uniform pocket. The corridor was like the others she had seen, starkly white with the illumination coming through the floor. At either end of the corridor was a large mirror, and its multiple reflections made the corridor seem infinitely long.

  There were no sounds and no one in sight. Susan checked the floor plan, which indicated that the morgue and the stairs were to the right. She closed the door to the ward behind her. Moving quickly, she made her way down to a door at the end of the corridor. There were no markings on the door, but at least it too had normal hardware. Susan tried the knob; the door was unlocked.

  As silently as possible, she opened the door, just a few inches at a time. She could see the tiles of the near wall. Then she began to see the upper part of a stainless steel dissecting table. A corpse lay naked on it. Susan heard some voices and a laugh, followed by the sound of a scale.

  “So much for the lungs. How much should we say the heart weighed?” said one of the voices.

  “Your turn to guess,” laughed the other.

  Nudging the door an inch more, Susan could just glimpse the head of the corpse. She squinted, then felt weak. It was Berman.

  Letting the door close without a sound, Susan stood in the doorway for a few deep breaths. She felt slightly nauseated but it passed. She realized that she had very little time. The elevator.

  Susan’s pause in the doorway had been perfect timing. The TV scanner behind the one-way mirror finished its five-second scan as Susan stepped back into the corridor. It would resume its scan in ten seconds.

  She hurried back into the main ward and reached the doorway to the computer room. Hesitantly she tried it. It too was unlocked. She opened the door about ten inches and looked into the room. To her relief, it seemed unoccupied. As she pushed the door farther she could see a fantasy of computer consoles, input-output equipment, and tape storage systems.

  A movement in the far corner near to the ceiling caught Susan’s eye. She recognized it immediately. It was a TV monitor camera. As its unhurried pan brought its lens toward Susan, she ducked back and closed the door. When she guessed that the camera had panned past, she whipped open the door and began to run the length of the room, to the elevator. But her timing was off; she would be spotted by the TV camera on its return sweep. Susan dived behind a computer console only halfway to her destination.

  She had to work her way down the rest of the room, from console to console, trying to avoid the roving eye of the camera. Making a dash for the elevator, she pressed the button frantically. Susan could hear the machinery start up inside the shaft. The elevator was on another floor.

  The TV camera reached the end of its arc and started back. Susan pressed the elevator button several times in succession. The sound of the elevator machinery stopped, the doors quivered and then began to open. Susan glanced up at the TV camera before rolling around the edge of the elevator door, groping for the “close” button. The door closed but Susan had no idea if she had been observed or not.

  The elevator was cavernous and correspondingly slow. There were only three buttons. She pressed the button for floor two and felt the machine begin to ascend. The floor plan for the second floor showed that the ORs were at the extreme opposite end of the building from the elevators. A long hall stretched from the elevators back to the OR area. Both the eighth and ninth doors to the right led into the OR complex.

  When the elevator stopped and the doors opened, Susan stayed inside with her finger poised over the “door-close” button. No one in sight. The corridor was similiar to those of the first floor except that the doors were more deeply recessed. The ceilings carried tracks for the trolleys.

  As the elevator doors began to close Susan plunged down the corridor, mentally checking off the number of doorways she had passed. Suddenly, in the distance, Susan saw a man driving a miniature forklift loaded with units of whole blood. He appeared to emerge from an intersecting corridor. She half-skidded, half-ran into one of the recessed doorways, crashing up against the wall, her breath coming in gasps. She listened. The sound of the machine receded. She peered into the corridor. Empty. She pushed off and reached the ninth door.

  She waited until her
breath returned to a semblance of normal before cracking the door and checking the room. She slipped in quickly.

  She was in a dressing room. A partially smoked cigarette lay in an ashtray, its smoke curling up in the still air. An open doorway led to a bath area. Susan could hear the sound of a shower going.

  Michelle reentered the control room. Her sense of ennui had disappeared. Her mouth was set, but her eyes moved incessantly. Like the guard, she was now very nervous.

  “That girl has literally evaporated. She couldn’t have walked out, could she?” asked Michelle.

  “Impossible. There’s no way the front door, or any outside door for that matter, can be opened without me activating the door release.” The guard was still switching from scanner to scanner.

  “I think we’d better give direction another call. This affair could get serious,” said the nurse at the computer console.

  “I don’t understand it. We have these monitors placed in all the key areas. She’s got to be in some doorway,” said the guard.

  “She’s not in a doorway. I went all the way through to the main ward. What about the elevator?”

  “That’s a thought,” said the guard. “If she does get upstairs there could be big trouble. I’m going to secure the building and activate all the automatic locking mechanisms on all stairway doors and electrify the perimeter fence. I’ll hold the general alarm until direction is reached.”

  Michelle moved to a red telephone. “This is absurd, really! Totally unnecessary. Why was she allowed in by herself without a group?”