Coma

by Robin Cook

  On the other hand, the sweetness of the evening before last was still very much in Bellows’s mind. He had responded to Susan in a way that had been so natural, so fresh. He had made love with her in such a manner that orgasm had been a mere part, not a goal. There had felt something so wonderfully equal, a communion of sorts. Bellows realized that he cared for Susan very much, despite the fact that he knew so little about her, and despite the fact that she was so blasted stubborn.

  Bellows dictated his operative note on the gastrectomy case into a tape recorder with the usual medical monotone, ending each sentence with a vocalized “period.” Then he went into the dressing room and began to change back to his street clothes.

  Acknowledging affection for Susan put Bellows on guard. His rationality persuaded him that such feelings would diminish his objectivity and sense of perspective. He could not afford that, not now, when his career opportunities were in the balance. Since Susan had been transferred to the V.A., things had already quieted down. Stark had been civil on rounds, even to the extent of semiapologizing for his ungrounded implications concerning Bellows’s association with the drugs found in locker 338.

  Bellows completed dressing and walked over to the recovery room to check the post-op orders on his gastrectomy patient.

  “Hey, Mark,” called a loud voice from the recovery room desk. Bellows turned to see Johnston coming toward him.

  “How the hell are those students of yours? I understand that the girl’s a piece of ass.”

  Bellows didn’t answer. He waved his hand in a questioning fashion. The last thing he wanted to do was get into some idiotic conversation with Johnston about Susan.

  “Did your students tell you what happened at the med school this morning? It’s one of the funniest stories I’ve heard in a long time. Some guy broke into the Anatomy Building last night. He must have been some kind of a nut because he discharged a fire extinguisher, unveiled all the first-year students’ cadavers, shot up the place, got himself locked in the freezer, and then had a brawl with the bodies. He knocked a bunch of the corpses down and shot up some of them. Can you imagine?” Johnston erupted in gusts of laughter.

  The effect was just the opposite on Bellows. He looked at Johnston but thought about Susan. She had told him that she had been chased again, that someone had tried to kill her. Could that have been the same man? The freezer? Susan was rapidly becoming a total mystery. Why hadn’t she told him more?

  “Did the guy freeze?” asked Bellows.

  Johnston had to pull himself together in order to talk.

  “No, at least not all of him. The police had been tipped off by an anonymous phone call in the middle of the night. They thought it was a med school prank so they didn’t check it out until the morning shift came in. By the time they got there the guy was unconscious, sitting in the corner. His body temperature was ninety-two degrees, but the medical boys succeeded in thawing him out without any trouble with acidosis. I think that’s pretty commendable for those assholes. The only trouble was that they waited for two hours before calling me on consult. Hey, you know what the nurses in the ICU call him?”

  “I can’t guess.” Bellows was only half-listening.

  “Ice Balls.” Johnston broke down in laughter again. “I thought that was pretty clever. It’s a takeoff on Hot Lips from M*A*S*H. What a pair, Hot Lips and Ice Balls.”

  “Is he going to make it?”

  “Sure. I’m going to have to amputate some. At the very least he’s going to lose part of his legs. How much will be determined over the next day or so. The poor bastard might even lose those ice balls.”

  “Did they find out anything about him?”

  “What do you mean?”

  “Well, his name, where he was from, you know.”

  “Nothing. It turned out he had some I.D. which proved to be fake. So the police are very interested. He mumbled something about Chicago. Weird!” Johnston mouthed the last word as if it were some important secret message, as he went back to the recovery room desk.

  Bellows went over and checked his gastrectomy patient. Vital signs were stable. Then he checked the chart. The orders had been written by Reid, and they were fine. He thought about the man in the freezer. The story seemed so bizarre. He wondered again if it really was the man that had been chasing Susan. But how could she have locked him in the freezer? Why the hell hadn’t she mentioned it? Maybe he had never given her the chance. If she had locked the man in the freezer, she was now definitely in trouble legally. Could she have been the anonymous phone caller?

  Bellows examined the dressing on the patient. It was still in place and not blood-soaked. The I.V. was running well.

  Then he thought about Susan again and decided that the nut in the freezer must have been the man who chased her. And if he was, then it would be important for her to know that he was hospitalized and in critical condition.

  Bellows dialed the medical school and asked to be connected to the dorm. He let Susan’s phone ring twelve times before giving up. Then he called back the dorm switchboard and left a message for her to call when she came back to her room.

  After that, Bellows went to lunch.

  Thursday

  February 26

  4:23 P.M.

  Thirty-six dollars plus tax seemed to Susan an awfully high price for the tasteless room at the Boston Motor Lodge. But at the same time it was worth it. Susan felt refreshed and rested—and safe. She had spent the time during the day rereading her notebook. All the information she had about the OR cases fit the idea of carbon monoxide poisoning. The information about the medical cases fit with the idea of succinylcholine poisoning. But still she had no motive, no rhyme or reason. The cases were too disparate.

  Susan made a number of calls to the Memorial to try to learn Walters’s home address, but she was unsuccessful. At one point she had called the Memorial and had Bellows paged, but she hung up before he could answer. Slowly but inexorably, Susan began to comprehend that she was at a dead end. She thought that it was probably time to go to the authorities, tell what she had learned, then take a vacation. She had a month’s vacation coming to her as part of her third year and she was sure that she would be able to get permission to take the time immediately. She’d leave, get away, forget. She thought about Martinique. She liked things French, and she longed for the sun.

  The doorman of the motel whistled a cab for her and she got in. She told the driver the address: 1800 South Weymouth Street, South Boston. Then she settled back.

  It was stop and go down Cambridge Street, a little better on Storrow Drive, but worse on Berkeley. The cab driver took her through the nicer sections of the South End to avoid traffic. At Mass. Ave. he turned left and the surroundings deteriorated. Once into South Boston, Susan knew she was lost. The housing became monotonous, the streets badly littered. Soon the cab entered an area of warehouses, deserted factories, and dark streets. Nearly every streetlamp had a broken bulb.

  When Susan alighted from the cab she found herself in an area that seemed isolated from life. Straight ahead, the only streetlight she could see emitted a beam of light from a modern hooded fixture which illuminated the door of a building, a sign, and the walk leading up to the door. The sign was fabricated in block letters of a deep azure. The sign read: “The Jefferson Institute.” Below the blue letters was a brass plaque. It said: “Constructed with the Support of the Department of Health, Education and Welfare, US Government, 1974.”

  The Jefferson Institute was surrounded by an eight-foot-high hurricane fence. The building was set back about fifteen feet from the street. It was a strikingly modern structure surfaced with a white terrazzo conglomerate polished to a high gloss. The walls slanted inward at an angle of eighty degrees, rising in a first story of some twenty-five feet. Then there was a narrow horizontal ledge before the wall soared another twenty-five feet at the same angle. Except for the front entrance, there were no windows or doors along the entire length of the facade on the ground floor. The second story
had windows but they were recessed and could not be seen from the street. Only the sharply geometric embrasures were visible and the glow of lights from within.

  The building occupied a city block. In a strange way, Susan found it beautiful, though she realized that its effect was enhanced by the surrounding squalor. Susan guessed that it was the centerpiece of some urban renewal scheme. It gave the impression of a two-story ancient Egyptian mastaba, or the base of an Aztec pyramid.

  Susan walked up to the front door. Made of bronzed steel, it had no knobs, no openings of any kind. To the right of the door was a recessed microphone. As Susan stepped onto the Astroturf immediately before the door, she activated a recording which told her to give her name and the purpose of her visit. The voice was deep, reassuring, and measured.

  Susan complied, although she hesitated about the purpose of the visit. She was tempted to say tourism, but she changed her mind. She wasn’t feeling very jokey. So, finally, she said, “Academic purposes.”

  There was no answer. A rectangular red light beneath the microphone came on. Printed on the glass was the word wait. The light flashed green and the word changed to proceed. Without a sound the bronzed door glided to the right, and Susan stepped over the threshold.

  Susan found herself in a stark white hall. There were no windows, no pictures, no decorations at all. The only illumination seemed to be from the floor, which was made of a milky opaque plastic material. Susan found the effect curious and futuristic; she walked ahead.

  At the end of the hall, a second silent door glided into the wall, and Susan entered what appeared to be a large, ultramodern waiting room. Its far and near walls were mirrored from floor to ceiling. The two side walls were spotlessly white and totally devoid of any interruptions or decoration. The sameness was somewhat disorienting. As Susan looked at the walls, her eyes began to focus on her own vitreous floaters. She had to blink and make an effort to focus at a distance. Looking into the mirror at the end of the room had the opposite effect. Because of the opposing mirrors Susan saw the image of herself reflected to infinity.

  The room was furnished with rows of molded white plastic chairs. The floor was the same as in the hall, the light from it casting strange shadows on the ceiling. Susan was about to sit down when another door slid open in the farthest mirrored wall. A tall woman entered and walked directly up to Susan. She had very short, medium-brown hair. Her eyes were deeply set, and the line of her nose merged imperceptibly with her forehead. Susan was reminded of the classic features of a cameo. The woman wore a white pants suit as devoid of decoration as the walls. A pocket dosimeter peeped from her jacket. Her expression was neutral.

  “Welcome to the Jefferson Institute. My name is Michelle. I will show you our facilities.” Her voice was as noncommittal as her expression.

  “Thank you,” said Susan, trying to see through the woman’s facade. “My name is Susan Wheeler. I believe you are expecting me.” Susan let her eyes sweep around the room once more. “It certainly is modern. I’ve never seen anything quite like this.”

  “We have been expecting you. But before we begin I’d like to warn you that it is very warm inside. I suggest that you leave your coat here. And please leave your bag as well.”

  Susan took off her coat, a bit embarrassed by the wrinkled and soiled nurse’s uniform she still had on. She took her notebook from her bag.

  “Now then . . . I suppose that you know that the Jefferson Institute is an intensive care hospital. In other words, we only take care of chronic intensive-care patients. Most of our patients are in some level of coma. This particular hospital was built as a pilot project with HEW funds, although the actual running of it has been delegated to the private sector. It has been very successful in freeing up beds in the acute intensive care units of the city’s hospitals. In fact, since the project has been so successful, an equivalent hospital is either being built or is in the planning stages in most of the large cities of the country. Research has shown that any city or population center with a population of a million or more can economically support a hospital of this sort. . . . Excuse me, but why don’t we sit down?” Michelle indicated two of the chairs.

  “Thank you,” said Susan, taking one of the chairs.

  “Visiting the Jefferson Institute is strictly regulated because of the methodology we use to care for the patients. We have developed very new techniques here, and if people are not prepared, some may react on an emotional level. Only immediate family may visit, and only once every two weeks on a preplanned basis.”

  Michelle paused in her monologue, then she managed a half-smile. “I must say that your visit here is highly unusual. Normally we have a group of medical people on the second Tuesday of each month, and there is a planned program for them. But since you have come by yourself, I guess I can improvise a bit. But we do have a short film if you would like to see it.”

  “By all means.”

  “Good.”

  Without any sign from Michelle, the room darkened and on the wall opposite from where they were sitting, a film began to roll. Susan was intrigued. She presumed that the film was being projected through a translucent section of the wall serving as a screen.

  The film itself reminded Susan of old newsreels. Its outdated technique seemed an anachronism in the modern surroundings. The first section was devoted to the concept of the intensive care hospital. The Secretary of Health, Education and Welfare was shown discussing the problem with policy planners, economists, and health care specialists. The problem of spiraling hospital costs spearheaded by the cost of long-term intensive care was illustrated by graphs and charts. The men explaining the charts were dull and uninspiring, as commonplace as the suits they wore.

  “This is a terrible film,” said Susan.

  “I agree. Government films are all alike. You’d think that they’d try a little creativity.”

  The movie moved on to ground-breaking ceremonies, at which politicians smiled and joked idiotically. More graphs and charts followed, attesting to the enormous savings that had been accrued by the hospital. There were several more scenes showing how the Jefferson Institute’s facilities freed the beds in the city’s hospitals for the care of acute cases. Then followed a comparison of the number of nurses and other personnel needed at the Jefferson facility to the number needed in a conventional hospital for the same number of intensive care patients. The people used to illustrate this point were photographed milling about aimlessly in a parking lot. Finally, the film showed the heart of the new hospital: the huge computer, both digital and analog. It concluded by pointing out that all the functions of homeostasis were monitored and maintained by the computer. The film ended with a burst of inspirational marching music, like the finale of a war movie. The lights under the floor came on as the last image disappeared.

  “I could have done without that,” said Susan, smiling.

  “Well, at least it emphasizes the point about the economy. That’s the central concept of the institute. Now, if you’ll follow me, I’ll show you the principal features of the hospital.”

  Michelle stood up and walked toward the mirrored wall from which she had appeared. A door glided open. It shut behind them as they entered another corridor about fifty feet long. The far end of the corridor was also mirrored from floor to ceiling. As Susan passed down the hallway she noted other doors but they were all closed. None of the doors had any exposed hardware. Apparently they were automatically activated.

  When they reached the far end of the corridor, a door slid open and Susan entered a familiar-looking room. It was about forty by twenty feet and looked exactly like an intensive care unit in any hospital. There were five beds and the usual assortment of gadgets, EKG screens, gas lines, etcetera. But four of the beds appeared different: each was constructed with a gap of some two feet running lengthwise. It was as if each bed were constructed of two very narrow beds with a fixed two-foot span between them. In the ceiling above the beds there were complicated tracklike mechanisms. The fifth bed
, which seemed conventional, was occupied. A patient was being breathed by a small respirator. Susan was reminded of Nancy Greenly.

  “This is the visiting area for the immediate families,” explained Michelle. “When a family is scheduled to visit, the patient is transferred here automatically. When he is placed in one of these special beds and it is made up, the bed appears like a normal one. This patient was visited this afternoon.” Michelle pointed toward the patient in the fifth bed. “We purposely did not return him to the main ward for your benefit.”

  Susan was confused. “You mean that bed the patient is in is the same as these other beds?”

  “Exactly. And when family visits, these other beds are filled with other patients so that the area looks like a normal intensive care unit. Follow me, please.”

  Michelle walked the length of the room, past the patient in the bed. At the end of the room was a door, which opened silently and automatically.

  Susan was amazed when she passed the fifth bed with the patient. The bed appeared exactly like a regular hospital bed. There was no evidence that its central section, its basic support, was missing. But Susan had no time to examine the bed more closely as she followed Michelle into the next room.

  The first thing Susan became aware of was the light; there was something strange about it. Then she felt the warmth and the humidity. Finally she saw the patients, and she stopped in utter astonishment. There were more than a hundred patients in the room, and all of them were completely suspended in midair about four feet from the floor. All of them were naked. Looking closely, Susan could see the wires piercing multiple points on the patients’ long bones. The wires were connected to complicated metal frames and pulled taut. The patients’ heads were supported by other wires from the ceiling which were attached to screw eyes in the patients’ skulls. Susan had an impression of grotesque, horizontal, sleeping marionettes.

  “As you can see, the patients are all suspended by wires under tension. Some visitors react strongly to this, but it has proven to be the best method of long-term care, totally preserving the skin and minimizing nursing care. Its origin was in orthopedics, where wires are passed through bones to provide traction. Burn treatment research showed the benefits to be obtained when the skin does not rest on any kind of surface. It was a natural progression to apply the concept to the care of the comatose patient.”