Coma

by Robin Cook

  There were advantages, though, to being bright and beautiful, and Susan was slowly beginning to realize that it was reasonable to exploit them to a degree. If she needed a further explanation regarding some complicated topic, she only had to ask once. Instructors and professors alike would hasten to help Susan understand a fine point of endocrinology or a subtle point of anatomy.

  Socially, Susan did not date as much as people imagined she would. The explanation for this paradox was severalfold. First, Susan preferred reading in her room to a boring date, and with her intelligence, Susan found quite a few men boring. Second, few men actually asked Susan out, just because Susan’s combination of beauty and brains was a bit intimidating. Susan spent many Saturday nights engrossed in novels, some literary, some otherwise.

  Starting February 23, Susan feared her comfortable world was going to be blown up. The familiar lecture routine was over. Susan Wheeler and one hundred and twenty-two of her classmates were being rudely weaned from the security of the inanimate and tossed into the arena of the clinical years. All the confidence in one’s abilities formed during the basic science years were hardly proof against the uncertainties of actual patient care.

  Susan Wheeler had no illusions concerning the fact that she knew nothing about actually being a doctor, about taking care of real live patients. Inwardly she doubted that she ever would. It wasn’t something she could read about and assimilate intellectually. The idea of trial by fire was diametrically opposed to her basic methodology. Yet on February 23 she was going to have to deal with patients some way, somehow. It was this crisis of confidence that made sleep difficult for her and filled the night with bizarre, disturbing dreams in which she found herself wandering through foreign mazes searching for horrible goals. Susan had no idea how closely her dreams would approximate her experience during the next few days.

  At 7:15 the mechanical click of the clock radio broke her dream’s feedback circuit and Susan’s brain awakened to full consciousness. She turned off the radio before the transistors had a chance to fill the room with raucous folk music. Normally she relied on the music to wake her. But on this particular morning she needed little assistance. She was too keyed up.

  Susan put her feet onto the floor and sat on the edge of the bed. The floor was cold and uninviting. Her hair descended from her head, haphazardly, leaving only a two-to-three-inch gap through which to regard her room. It wasn’t much of a room, about twelve by fourteen feet, with two multipaned windows at the end. The windows gave out onto another brick building and a parking lot so that Susan rarely looked out. The paint was reasonably fresh because she had painted the room herself about two years previously. The color was a pleasing pastel yellow which accented perfectly the Marimekko Printex fabric she had used to make the curtains. Their colors were several shades of electric green, separated by dark blue. On the walls hung a variety of colorful posters, framed with stainless steel, advertising past cultural events.

  The furniture was medical school issue. There was an old-fashioned single bed, which was too soft, and difficult for entertaining. There was a worn, overstuffed easy chair, which Susan never used save for depositing dirty laundry. Susan liked to read on the bed and study at the desk so that the easy chair really wasn’t “critical,” in her words. The desk was oak and ordinary except for the pattern of initials and scratches carved in the top. In its right corner, Susan had even found a few obscene words associated with the word biochem. A physical diagnosis book was open on the desk. During the last three days she had totally reread it, but the text had failed to buoy her sagging confidence.

  “Shit,” she said out loud, with little inflection. The remark was directed at no one and at nothing. It was a basal response as she comprehended that February 23 had indeed arrived. Susan liked to swear and she did it a lot, but mostly to herself. Since such language contrasted sharply with her wholesome image, the effect was truly remarkable. She had found it a useful and entertaining tool.

  Having pulled herself from the warmth of her covers with such dispatch, Susan realized that she had an extra fifteen minutes to spare. That was the usual duration of her ritual of repeatedly turning off her radio alarm before actually making it into the bathroom. Her ambivalence toward starting this day made her squander the time by just sitting and staring ahead, wishing that she had gone to law school or graduate school in literature . . . anything besides medical school.

  The coldness of the bare waxed floor worked its way into Susan’s feet. As she sat there, her circulatory system dissipated her body heat into the cold room, making her nipples rise up from the summits of her shapely breasts. Goose pimples appeared from nowhere along the insides of her naked thighs. She wore only a thin worn-out flannel nightgown she had gotten for Christmas when she was in the fifth grade. She still wore it to bed almost every night, at least when she was sleeping alone. Somehow she loved that nightgown. Amid the furious pace of change in her life, it seemed to afford a sanctuary of consistency. Besides, it had always been her father’s favorite.

  Susan had enjoyed pleasing her father from a very early age. Her first remembrance of him was his smell: a mixture of the outdoors and deodorant soap covering a distinctive odor she later realized was male. He had always been good to her, and she knew that she was his favorite. That secret she never shared with anyone, especially not with her two younger brothers. It had always been a source of confidence for her as she faced the usual hurdles of childhood and adolescence.

  Susan’s father was a strong-willed individual, a dominant but generous and gentle man who ran his family and his insurance business like an enlightened despot. A charming man whose brood acknowledged him as the last word on any subject. It wasn’t that Susan’s mother was a weak-willed individual. It was just that she had met more than her match in the man she married. For much of her life Susan accepted this situation as the invariable norm. Eventually, however, it began to cause her some inner confusion. Susan was very much like her father, and her father encouraged her development in that direction. Then Susan began to realize she could not be like her father and expect one day to have a home of her own like the one in which she was reared. For a time she wanted desperately to be like her mother, and consciously tried. But it was to no avail. Her personality showed more and more her father’s traits, and in high school she was literally forced into a leadership role. Susan was voted president of her graduating class at a time in her life when she thought that she would have preferred to be more in the background.

  Susan’s father was never particularly demanding, and certainly never pushy. He remained a source of confidence and encouragement for Susan to do whatever she wanted, without considering her sex. After Susan had entered medical school and became familiar with some of her female classmates, she realized that many of them had emerged from a similar paternalistic background. In fact when she met some of their parents, the fathers seemed to be vaguely familiar, as if she had actually known them in the past.

  A resonant thumping issued from the radiator beneath the window, heralding the coming of heat. A tiny bit of steam hissed from the overflow valve. The radiator’s stirring reminded Susan of the coldness of the room. Stiffly she stood up, stretched, and closed the window. It had been open only about a half-inch. Susan lifted the nightgown over her head and regarded her naked body in the mirror on the bathroom door. Mirrors held a strange attraction for her. It was almost impossible for her to pass a mirror without at least a quick reassuring look.

  “Maybe you should be a dancer, Susan Wheeler,” she said rising up onto her tiptoes and stretching her arms straight up, “and give up this idea of becoming a fucking doctor.” Like a balloon being deflated, she let herself sag until she was slumped over. She was still looking at herself in the mirror. “I wish I could do that,” she added more quietly. Susan was proud of her body. It was soft and supple, yet strong and well tuned. She could have been a dancer. She had good balance and she was filled with a sense of rhythm and movement. She envied Carla Curt
is, a friend from Radcliffe who had gone into dance after college and was somewhere in the New York world. But Susan knew she could not actually go into dance despite her fantasy about it. She needed a vocation which would constantly exercise her brain. Susan made a horrible grimace and stuck her tongue out at the girl in the mirror, who did the same. Then Susan went into the bathroom.

  In the bathroom she turned on the shower. It took four or five minutes to get hot. She looked at her face in the bathroom mirror, after shaking her hair from her line of sight. If only her nose had been made a little more narrow, she thought that she would be quite attractive. Then she started her bathroom routine with one lavender tablet of Ortho-Novum. Among her other characteristics, Susan Wheeler was a practical woman— strong-willed and practical.

  Monday

  February 23

  7:30 A.M.

  The Boston Memorial Hospital is certainly not an architectural landmark, despite the disproportionately large number of architects in the Boston area. The central building is attractive and interesting. It was constructed over a century ago with brownstone blocks carefully fitted together with skill and feeling. But the structure is inconveniently small and only two stories tall. Besides, it was designed with large, general wards, now outmoded. Hence its present-day practicality is minuscule. Only the ooze of medical history which permeates its halls keeps the wreckers and the planners at bay.

  The innumerable larger buildings are studies in American gothic. Extending off at obtuse angles, millions upon millions of bricks join together to hold up dirty windows and flat monotonous roofs. The buildings were added in spurts, responding to the purported need for beds or the availability of funds. There is no doubt that it is an ugly combination of buildings, except perhaps for a few smaller research buildings. Those had architects and money to burn.

  But very few people ever notice the appearance of the buildings. The whole is larger than the sum of its parts; perception is too clouded by innumerable layers of emotional response. The buildings are not buildings by themselves. They are the famed Boston Memorial Hospital, containing all the mystery and wizardry of modern medicine. Fear and excitement intermingle in an ambivalent dialogue as lay people approach the structure. And for the professional individual, it is the mecca: the pinnacle of academic medicine.

  The setting for the hospital adds very little. On one side a maze of railroad tracks leading to North Station and a bewildering array of elevated highways forms an enormous sculpture of rusting steel. On the other side is a modern housing project for low-income families. Somehow that goal got mixed up in the renowned corruptness of the Boston government. The apartment buildings look like housing for the underprivileged, because of their lack of outward design. But the rents are out of sight and only the rich and privileged live there. In front of the hospital is a stagnant corner of Boston Harbor with water like black coffee, sweetened with sewer gas. Separating the hospital and the water is a cement playground filled with discarded newspapers.

  By seven-thirty this Monday morning all the operating rooms at the Memorial hummed with activity. Within a five-minute interval, twenty-one scalpels sliced through unresisting human skin as the scheduled operations commenced. The fate of a sizable number of people depended on what was done or not done, what was found or not found in the twenty-one tiled rooms. A furious pace was set which would not slow down until two or three in the afternoon. By eight or nine o’clock in the evening only two rooms would still be functioning, and they often continued until the seven-thirty rush the following morning.

  In sharp contrast to the bustle in the OR area, the surgical lounge presented a luxuriant hush. Only two people were there, because the coffee break pattern did not begin until after nine. By the sink was a sickly-looking man appearing much older than his sixty-two years. He was busy trying to clean the sink without moving the twenty-odd coffee cups left there half-filled with water by their owners. Walters was his name, although few knew if it was his first or last name. His whole name was Chester P. Walters. No one at all knew what the P stood for, not even Walters himself. He’d been an employee of the Memorial OR since he was sixteen, and no one had the temerity to fire him despite the fact that he did almost nothing. He wasn’t well, he’d say, and, indeed, he did not look well. His skin was a pasty white and every few minutes he’d cough. His cough rattled with phlegm deep within his bronchial tubes, but he never coughed hard enough to get it up and out. It was as if he was content to merely keep his tubes grossly patent without disturbing the cigarette he had constantly in the right corner of his mouth. Half the time he had to have his head cocked over to the left so that the smoke would not burn his eyes.

  The other occupant of the surgical lounge was an intermediate surgical resident, Mark H. Bellows. The H stood for Halpern, his mother’s maiden name. Mark Bellows was busy writing on a yellow legal tablet. Walters’s coughing as well as Walters’s cigarette definitely bugged Bellows, and Bellows would look up each time Walters started yet another coughing sequence. To Bellows it was incomprehensible how an individual could do so much bodily damage to himself and still keep it up. Bellows did not smoke; Bellows had never smoked. It was equally incomprehensible to Bellows how Walters managed to stay around the OR despite his appearance, personality, and the fact that he didn’t do a damn thing. Surgery at the Memorial was the apogee, the zenith of the art of modern surgery, and being on its staff offered Nirvana, as far as Bellows was concerned. Bellows had striven hard and long for his appointment as a resident. Yet here, smack in the middle of all this excellence, was, as Bellows put it to his fellow residents, this ghoul. It seemed too ridiculously inconsistent.

  Under normal circumstances Mark Bellows would have been inside one of the twenty-one operating rooms contributing to or directing one of the acts of mayhem. But on February 23 he was adding five medical students to his burgeoning list of responsibilities. Bellows was currently assigned to Beard 5, meaning the fifth floor of the Beard Building. It was a good general surgical rotation, maybe the best. As the intermediate resident of Beard 5, Bellows was also in charge of the surgical intensive care unit physically adjacent to the ORs.

  Bellows reached for the table next to his chair and grasped a coffee mug without looking up from his work. He sipped the hot coffee loudly before abruptly replacing the cup with a minor clatter. He’d thought of another “attending” who would be good at lecturing to the students, and he quickly penciled the name onto the tablet. In front of him on a low table lay a piece of Surgical Department stationery. He picked it up and studied the names of the five students: George Niles, Harvey Goldberg, Susan Wheeler, Geoffrey Fairweather III, and Paul Carpin. Only two of the names made any impression. The Fairweather name made him smile and conjure up the image of a spoiled, slender fellow with glasses, Brooks Brothers shirts, and a long New England genealogy. The other name, Susan Wheeler, caught his eye purely because Bellows liked women in a general way. He also thought that women liked him in return; after all, he was athletic and a doctor. Bellows was not very subtle in his social concepts; he was rather naive, like most of his fellow doctors. Looking at the name Susan Wheeler, he reflected that having one female student might make the next month a little bit less of a pain in the ass. His mind didn’t struggle to find a mental image for the name Susan Wheeler. The part of his brain concerned with stereotypes told him it wasn’t worth it.

  Mark Bellows had been at the Memorial for two and one half years. Things had been going well, and he was reasonably sure of finishing the program. In fact, it had begun to look as if he might have a fighting chance for the chief resident position if everything went smoothly. Having been selected while he was an intermediate resident to get a group of medical students was certainly auspicious, although a bother. It had been an unexpected turn and was the immediate result of Hugh Casey coming down with hepatitis. Hugh Casey was one of the senior residents whose job included teaching two groups of medical students during the course of the year. The hepatitis came on only three weeks
earlier. Right after that Bellows had received the message to come to Dr. Howard Stark’s office. Bellows had never associated the message with Casey’s illness. In fact, with the usual paranoia following a request to come to the Chief of the Department of Surgery’s office, Bellows had mentally tried to relive all his latest blunders so as to be prepared for the tirade he expected. But contrary to his usual self, Stark had been very pleasant and had actually commended Bellows on his performance related to a recent Whipple procedure Bellows had done. After the unanticipated honeyed words, Stark had asked if Bellows would be interested in taking the medical students scheduled to be with Casey. Truthfully, Bellows would have preferred to pass up the chance while being on the Beard 5 rotation, except that one did not pass up a request by Stark even if it were carefully couched in the form of an offer. It would have been professional suicide for Bellows to have done so and he knew it. Bellows comprehended the vengeance of the affronted surgical personality, so he had agreed with the proper amount of alacrity.

  With a straightedge Bellows filled the front page of his yellow legal tablet with little squares about an inch on a side. He then proceeded to fill in the dates of the subsequent thirty or so days the medical students were scheduled to be under his tutelage. Within each square he blocked off morning and afternoon. Each morning he planned to give a lecture; each afternoon he was going to enlist one of the attendings to give a lecture. Bellows wanted to schedule all the topics in advance to avoid duplication.

  Bellows was twenty-nine years old, having just celebrated a birthday the week before. However, it was relatively hard to guess his age. His skin was smooth for a man and he was in excellent physical shape. Almost without fail he jogged two to three miles per day. The only outward evidence of the fact that he was almost thirty was the thinning area on the crown of his head and the slightly receding hairline at the temples. Bellows had blue eyes and an almost imperceptible salting of gray over his ears. He had a friendly face, and he was endowed with the enviable quality of making people feel comfortable. Most everyone liked Mark Bellows.