Coma

by Robin Cook

  “Understood,” said Susan looking squarely at Bellows. “I’ll do that, if you do something for me.”

  “What’s that?”

  “Pull out these articles and have them Xeroxed. I’ll pay you later.” Susan tossed her list of references to Bellows, jumped up from the table and breezed out of the room before Bellows could respond. He found himself looking at a list of thirty-seven journal articles. Since he knew the library like the bones of his hand, he located the volumes with ease, marking each article with a piece of paper. He took the first group over to the desk and told the girl to copy the indicated articles and put it on his library charge. Bellows knew that he had been manipulated again, but he didn’t mind. It had taken only ten minutes. He would get them back with interest.

  And he had been right; she had a dynamite figure.

  Monday

  February 23

  5:05 P.M.

  As she had been telling Bellows that the incidence of coma following anesthesia at the Memorial was one hundred times the national incidence, Susan had realized that she was basing her calculations on the six cases Harris had mentioned in his outburst. Susan had to check that figure. If it was actually higher, she would have more ammunition to base her commitment to the project. Besides, she needed the names of the coma victims so that she could obtain their charts. What she needed more than anything else, she recognized, was hard data.

  Susan knew that she had to get access to the central computer. Harris would be unwilling to supply the names of the patients. Susan was certain of that. Bellows might have been able to get them if he were sufficiently motivated. But that was a big if. Susan felt that the best route was for her to try to get the information herself. So she was thankful she had taken the introductory course in PL 1 computer programming as a junior in college. Already it had paid off in surprising ways, and her need for the information at hand was just another example.

  The computer center in the hospital was located in the Hardy wing, occupying the entire top floor. Many people joked about the symbolic aspects of the computer being above everything else in the hospital, and it had added a new meaning to the phrase “with a little help from above.”

  As the elevator door slid open on the foyer of the eighteenth floor, Susan knew she was going to have to improvise if she were to be successful. Beyond the foyer Susan could see through glass partitions into the main computer reception area. The place had the appearance of a bank. The only difference was that the medium of exchange here was information, not currency.

  Susan entered the reception room and walked directly to a countertop that ran the length of the room along the right wall. There were about eight other people in the room, most of them sitting in comfortable-looking blue corduroy chairs. A few were at the countertop bent over computer request forms. All looked up as Susan traversed the room, but they quickly returned to their own affairs. Without the slightest hint of uncertainty Susan took one of the computer request forms. Ostensibly concentrating on the form, Susan had her real attention on the room.

  In the back of the room, about twelve feet from Susan, was a large white Formica desk. Above it hung a sign: “Information.” It was so appropriate that it brought a smile to Susan’s face. The man at the desk sat motionlessly, a slight proud smile on his face. He was about sixty, pudgy but neat. Behind him, visible through another glass partition, were the gleaming input-output terminals of the computer itself. While Susan was pretending to be absorbed in the form in front of her, the man at the desk accepted several computer request forms. Each time he went over the form, converting the request to computer language and writing it on the lower portion of the form. He also checked the authorization by calling the department involved, unless he knew the requesting individual personally. Finally he placed the form—or several stapled together—in the “in” box on the corner of the desk. The requesting individual was told when to expect the information, depending on the priority assigned to the request.

  Having assessed the procedure, Susan gave full attention to the form before her. It was certainly simple enough. She filled in the date in the indicated box. She left blank the box for the authorizing department, and she also omitted the name of the requesting party or organization. Susan also left blank the box reserved for method of payment for computer time. She concentrated on the information desired. Susan was not sure how she should word the request for several reasons. One was the concern that the hospital might be uptight about leaking information on cases of coma resulting from anesthesia. Perhaps they might have programmed a subroutine into the computer so that any requests for information would be automatically canceled, or at least alert the computer that the information had been requested. Another point that occurred to Susan was that a disease or disease process might have several modes or degrees of expression. Prolonged coma after an anesthetic might be one of them, maybe the most severe. Susan wanted to obtain a wide range of information and in that way be able to select what she thought was significant.

  But requesting all cases of coma for the past year might yield a printout that was too extensive. Since coma was a symptom and not a disease itself, Susan could end with a list of every heart attack, stroke, and cancer victim who had succumbed to those diseases over the last year. Susan decided to call only for cases of coma occurring in people who had no known chronic or debilitating disease. Then she realized that she was already making assumptions. If she were on the track of a new disease, there was no reason why it couldn’t affect people who had other diseases. In fact, if it were infectious in nature, other disease processes would encourage its expression by lowering defenses.

  Susan changed her request to all cases of coma occurring to inpatients (in hospital) which were unrelated to the patient’s known disease processes. Susan next asked for a correlate between her sample and those having surgery during their stay at the Memorial prior to their coma, with a time correlation between surgery and the onset of the coma. With a certain amount of difficulty Susan translated her request into computer language. She had not used it for almost a year, and it took a few moments to get it right. This portion of the request was below two red lines and the admonishment “Do not write below this line.”

  Susan then waited for the next request to be turned in to the man at the desk. Luckily she did not have to wait long. About four minutes after she finished writing, the elevator arrived. Through the glass she saw a man squeeze past the elevator door before it had fully opened and approach the reception desk at a lope. About forty, slight of build, with flaxen hair parted from a deeply recessed hairline, the man waved a handful of the computer request forms nervously.

  “George,” said the man pulling up in front of the reception desk, “you gotta help me.”

  “Ah, my old friend Henry Schwartz,” said the man behind the desk. “We’re always ready to help the accounting department. After all, that’s where our checks come from. What can I do for you?”

  Susan carefully penciled in “Henry Schwartz” onto her own form in the box for the requesting party. In the area for authorizing department, Susan wrote “Accounting.”

  “I need a couple of things, but most of all I need a list of all the Blue Cross-Blue Shield subscribers who have had surgery in the last year,” said Schwartz in a rapid-fire fashion. “If you asked why I need it, you’d crack up, I swear you would. But I need it and fast. The day shift was supposed to have had it ready for me.”

  “We can run it in an hour or so. I’ll have it for you by seven,” said George, stapling Schwartz’s requests together and tossing them into the box.

  “George, you’re a lifesaver,” said Schwartz, running his hand through his hair over and over again. He then headed toward the elevator. “I’ll be back at seven sharp.”

  Susan watched Schwartz press the “down” button and then walk back and forth in the elevator foyer. It looked as if he was talking to himself. He hit the “down” button several more times. After the elevator picked him up, Susan watched the
floor indicator above the elevator. It stopped at six, then three, then one. Susan would have to look up which floor the accounting department was located on.

  Susan took another blank request form and, carefully placing it over her own, she headed for the desk.

  “Excuse me,” said Susan, marshaling a smile she hoped would be convincing. George looked up at her, over the tops of his black-rimmed glasses, which perched midway down his nose. “I’m a medical student,” continued Susan, making her voice as sweet as possible, “and I’m very interested in the computer here at the hospital.” She held up the request forms, the blank one hiding the one she had filled out.

  “You are, are you?” said George, sitting back with a smile broadening on his own face.

  “I am,” repeated Susan shaking her head in the affirmative. “I think that the potential of the computer in medicine is very great, and since it is obviously not a part of our formal orientation here, I thought I’d just come up and sort of get acquainted.”

  George looked at Susan, then over his shoulder through the glass partition at the gleaming IBM hardware. When he turned back to Susan his pride was effervescing.

  “It’s a marvelous set up, Miss . . .”

  “Susan Wheeler.”

  “It is a fantastic machine, Miss Wheeler,” said George, leaning forward in his seat and lowering his voice and emphasizing his words, suggesting that he was telling Susan a tremendous secret. “The hospital couldn’t do without it.”

  “In order to get an idea how it is used, I’ve been studying the request form here.” Susan held the request forms so that George would see only the blank one, but he had turned again to look into the terminal room.

  “I was interested to see a completed form,” continued Susan reaching over and taking the top group of stapled forms from the “in” box. “I was curious about how the requests were fed into the computer. Is it all right if I look at one of these?” She placed the forms Schwartz had delivered over her own.

  “Sure,” said George turning back to Susan. He stood up and leaned over toward Susan, placing his left hand on the desk. With his other hand he pointed to the space where the request was written in normal English.

  “Here the requesting party indicates what it is they want. Then down here . . .” George’s finger moved down below the red lines” . . . we have the area where the request is translated into a language that the computer will understand.”

  Susan slipped her blank form from under the pile of Schwartz’s forms, as if comparing them and she put it down on the desk beside them—leaving her own filled-out form beneath Schwartz’s.

  “So if someone wants several different kinds of information, they have to fill out separate forms?” asked Susan.

  “Exactly, and if . . .”

  Susan turned Schwartz’s first request form back from the rest of them rapidly, pulling it free of the staple in the upper left corner.

  “Oh, I’m terribly sorry,” said Susan putting the top sheet back in position. “Look what I’ve done. Let me staple it for you.”

  “No matter,” said George, fumbling for the staple machine himself. “One staple will fix it.” George pressed the staple machine as Susan held the completed forms, together with her own request on the underside.

  “Let me put these back before I destroy them completely,” said Susan contritely, replacing the forms in the “in” box.

  “No harm done,” reassured George.

  “Now once the request is in, what happens to it?” asked Susan looking into the terminal room and taking George’s attention from the “in” box.

  “Well, I take them inside to the key puncher, who prepares the cards for the card reader. Then . . .”

  Susan was not listening; she was thinking of how best to terminate her visit. About five minutes later she was down at the directory for the hospital, looking up Henry Schwartz of the accounting department.

  With a spare hour and a half, Susan left the Memorial for her dorm. Her stomach growled in opposition to her forgetfulness of basic needs. The tuna sandwich, as bad as it was, had long since disappeared into her metabolic mill, and Susan looked forward to dinner.

  Monday

  February 23

  6:55 P.M.

  It was a little before seven when Susan alighted from the MBTA at the North Station stop. Crossing the footbridge spanning the street, Susan was exposed to the rush of wind whipping up from the partially frozen harbor water. She bent against its force, clutching her sheepskin ski hat with her left hand and the lapels of her pea jacket with her right hand. She tried to keep the cold from her neck by snuggling her chin as far as possible into the recesses of her collar.

  When she rounded the edge of the building, the wind increased. An empty beer can tumbled past her into the street. The familiar rush hour sea of red taillights and wisps of exhaust fumes stretched as far as Susan could see. The windows on the cars were frosted, and they reflected the images about them with a silver sheen, giving the impression of the often white, unseeing pupils of the blind.

  Susan began to run at a slow jog with an exaggerated to and fro roll of her body since her arms were pressed against herself. The main entrance to the hospital yawned in front of her, and with relief she pushed through the revolving door.

  Susan stuffed her hat into the right sleeve of her coat and left it in the coatroom behind the main information desk. Then she used the hospital telephone directory and rang up the computer center.

  “Hello, this is the accounting department,” said Susan slightly out of breath and struggling to make her voice sound normal. “Has Mr. Schwartz picked up his material yet?”

  The answer was affirmative; he had collected it about five minutes earlier. The timing seemed perfect as far as Susan was concerned, and she left for the Hardy Building elevator and the third floor accounting offices.

  The evening accounting crew was a mere skeleton compared to the day shift. When Susan entered the room only three people were visible at the far end. Two men and one woman looked up in unison as Susan entered.

  “Excuse me,” called Susan, approaching the group. “Can you tell me where I can find Mr. Schwartz?”

  “Schwartz? Sure. He’s in the office in the corner,” said one of the men, pointing down the opposite side of the room.

  Susan’s eyes followed his finger. “Thanks,” she said, reversing her direction.

  Henry Schwartz was in the middle of the computer printout he had requested. The office was small but extraordinarily neat. The books in the bookcase were arranged so that their heights descended in an orderly fashion. The depth of the book backs in the shelves was one inch, no more, no less.

  “Mr. Schwartz?” asked Susan smiling and walking up to his desk.

  “Yes?” said Schwartz without removing his index finger from his place in the printout.

  “It seems that my printout got mixed up with yours, or at least that was the combined opinion upstairs. I was wondering if you had noticed any material you had not requested?”

  “No, but I haven’t looked through it all yet. What was it you’re missing?”

  “It’s some information on coma we need for a section presentation. Do you mind if I see if it’s included with your material?”

  “Not at all,” said Schwartz, lifting sections of the printout to find the break points.

  “If it’s there, it would be the last section,” offered Susan. “They said it was run right after yours.”

  Schwartz lifted the bulk of the material from the desk. Remaining was the information Susan needed. Attached to the top was her request form.

  “That’s it,” said Susan.

  “But the form indicates I requested it,” questioned Schwartz glancing at the request form.

  “No wonder they got it mixed up with your material,” said Susan, reaching for the material. “But I assure you, you wouldn’t be interested in this stuff. And it’s certainly not your fault, by any means.”

  “I’d better say som
ething to George . . . ,” said Schwartz replacing his own printout in front of him.

  “No need,” said Susan, exiting. “We already discussed it at length. Thanks a million.”

  “You’re welcome,” said Schwartz, but Susan had already left.

  “Susan, you are too much, really too much,” said Bellows between spoonfuls of custard he had taken from the tray of a patient who was too nauseated to eat. “You skip the lecture, afternoon rounds, and avoid your patients, and now you’re hanging around here until eight P.M. The only consistency about your performance so far is constant variation.” Bellows laughed as he scraped the bottom of the custard cup.

  Susan and Bellows were sitting in the lounge on Beard 5 where the hospital day had begun for Susan. She was sitting in the same seat she had occupied that morning. Spilling over onto the floor was the IBM printout sheet she had obtained. She was running down the list of names and marking appropriate ones with a yellow felt-tip pen.

  Bellows took a drink from his coffee.

  “Well, that proves it,” said Susan, putting the cap on the pen.

  “Proves what?” asked Bellows.

  “Proves that there haven’t been six cases of unexplained coma, excluding Berman, here at the Memorial this last year.”

  “Hurray,” cheered Bellows, toasting with his coffee mug. “Now I can stop worrying about anesthesia and have my hemorrhoids fixed.”

  “I would recommend that you stick to your suppositories,” said Susan, counting the names she’d marked. “There haven’t been six because there’ve been eleven. And if Berman continues on his present course, then there will have been twelve.”

  “Are you sure?” Bellows’s tone changed abruptly and he showed interest in the IBM printout sheet for the first time.