Coma (25 page)

“You’re Dr. Bellows?”

“None other.”

“Well, you have been taken off that case.”

“Taken off? By whom?” Bellows was perplexed.

“By Dr. Chandler, and he left word for you to meet him in his office when you appeared.”

To be taken off one of his own cases was very strange for Bellows. Certainly it was within George Chandler’s prerogative since he was the chief resident. But it was highly irregular. Occasionally Bellows had been removed from a scrub on which he was to assist, usually to help on some other case, and usually for purely logistic reasons. But to be removed from one of his own cases where the patient had been assigned to Beard 5 was a totally new experience.

Bellows thanked the OR clerk without bothering to hide his surprise and irritation. He turned and headed for George Chandler’s office.

The chief resident’s office was a windowless cubicle on 2. From this tiny area came the tactical edicts that ran the surgical department from day to day. Chandler was in charge of all the schedules for all the residents, including the on-call and weekend duty assignments. Chandler was also in charge of the operating room schedule, assigning the staff and clinic cases as well as the assists for the attending surgeons who asked for them.

Bellows knocked on the closed door, entering after hearing a muffled “Come in.” George Chandler was sitting at his desk, which nearly filled the tiny room. The desk faced the door, and Chandler had to squeeze past to gain access to the seat. Behind him was a file cabinet. In front of the desk was a single wooden chair. The room was bare; only a bulletin board adorned the walls. Blank but neat, the room was somewhat like Chandler himself.

The chief resident had successfully risen up the competitive pyramidal power structure of the lower world of students and residents. Now he was the liaison between the upper world, the full-fledged surgeons certified by specialty boards, and the lower world. As such he was a member of neither class. This fact was the source of his power as well as his weakness and isolation. The years of competition had taken their inexorable toll. Chandler was still young by most standards: thirty-three years old. He was not tall: about
five-eight. His hair was half-heartedly combed in some sort of modern Caesar look. His face had a gentle pudginess that belied his easily aroused temper. In many ways Chandler represented the young boy who had been bullied too much.

Bellows took the wooden chair opposite Chandler. At first no words were spoken. Chandler regarded a pencil he had in his fingers. His elbows were resting on the arms of his chair. He had rocked back from what he had been working on when Bellows knocked.

“Sorry about taking you off your case, Mark,” said Chandler without looking up.

“I can manage without another hemorrhoid,” said Bellows, maintaining a neutral tone.

There was another pause. Chandler tipped his chair forward to the level position and looked directly at Bellows. Bellows thought that he’d be a perfect individual to play Napoleon in a play.

“Mark, I’m going to assume you’re serious about surgery, surgery here at the Memorial, to be exact.”

“I think that’s a fair assumption.”

“Your record has been reasonable. In fact I’ve heard your name on several occasions in relation to possibly being considered for the chief residency. That leads me to one of the reasons I wanted to talk with you. Harris gave me a call not too long ago and he was completely strung out. I wasn’t even sure what he was talking about for a few minutes. Apparently one of your students has been nosing around about these coma cases, and it’s got Harris bullshit. Now, I have no idea what’s going on, but he thinks that you might be behind getting the student interested and helping him.”

“It’s a her.”

“Him, her, I don’t give a damn.”

“Well, it might be significant. She happens to be a very well put-together specimen. As for my role in the matter, it’s a big fat zero! If anything, I have constantly tried to talk her out of the whole affair.”

“I’m not about to argue with you, Mark. All I wanted to do is warn you of the situation. I’d hate to have you gamble your chances on the chief residency because of some student’s activities.”

Mark looked at Chandler and wondered what Chandler would say if he told Chandler that he was going to see Susan that night on a social basis.

“I have no idea if Harris has said anything to Stark about all this, Mark, and I can assure you that I won’t unless it gets to the point where I have to cover my own tracks. But let me emphasize that Harris was livid, so you’d better tone your student down and tell him . . .”

“Her!”

“OK, tell her to find something else to get interested in. After all there must be ten people who are working on the problem already. In fact most of Harris’s department has been doing nothing else since the present run of anesthetic coma catastrophes.”

“I’ll try to tell her again, but it’s not as easy as it may sound. This girl has a mind of her own, with a rather fertile imagination.” Bellows wondered why he chose that way to describe Susan’s imagination. “She’s gotten into this thing because the first two patients she came in contact with are victims of the problem.”

“Anyway, let’s just say you have been warned. What she does is going to reflect on you, especially if you aid her in any way at all. But that was only one of the reasons I wanted to talk with you. There is another problem, more serious, to be sure. Tell me, Mark, what is your locker number up in the OR?”

“Eight.”

“What about number 338?”

“That was my temporary locker. I used it for about one week before number eight became available.”

“Why didn’t you stay with 338?”

“I guess it actually belonged to someone else, and I got to use it until I could get one of my own.”

“Do you know the combination of 338?”

“Maybe, if I thought long enough. Why do you ask?”

“Because of a strange finding by Dr. Cowley. He claims that 338 opened by magic when he was changing his clothes and the whole Goddamn thing was filled with drugs. We checked it out and he was right. Every kind of drug that you could imagine and a few more, including narcotics. The locker list I have has you down for 338, not eight.”

“Who’s down for eight?”

“Dr. Eastman.”

“He hasn’t done a case in years.”

“Exactly. Tell me, Mark, who gave you number eight? Walters?”

“Yup. Walters first told me to use 338, and then he gave me number eight.”

“OK, don’t say anything to anybody about this, least of all to Walters. Finding a hoard of drugs like this is a pretty serious business, considering all the rigmarole you have to go through to get a narcotic in the first place. Because of my locker list, you will probably be contacted by the hospital administration. For obvious reasons they are not excited about letting this information out, especially with the recertification deal coming up. So keep it under your hat. And for God’s sake, get your student interested in something else besides anesthesia complications.”

Bellows emerged from Chandler’s cubicle with a strange feeling. He wasn’t surprised about hearing that he was being associated with Susan’s activities. He was already afraid of that. But the news about the drugs found in a locker to which he was assigned, that was a different story. His mind conjured up an image of Walters oozing around the OR area. He questioned why anyone would hoard drugs like that. Then there was the suggestion of association. Susan had used the words
supernatural
and
sinister.
Bellows wondered exactly what kind of drugs were stored in locker 338. He also wondered if he should tell Susan about the discovery.

February 24

2:30 P.M.

Susan allowed her eyes to wander around the Chief of Surgery’s office. It was spacious and exquisitely decorated. Large windows occupying most of two walls afforded a splendid view of Charlestown in one direction and a corner of Boston and the North End in the other. The Mystic River Bridge was partially concealed by gray snow clouds. The wind had shifted from the sea and was now blowing in from the northwest with arctic air.

Stark’s teak desk, with its white marble top, was situated catercorner in the northwest section of the office. The wall behind and to the right of the desk was mirrored from floor to ceiling. The fourth wall contained the door from the reception room and carefully constructed, recessed bookshelves. A section of the shelves was hinged; partly ajar, it revealed gleaming glasses, bottles, and a small refrigerator.

In the southeast corner, where the huge expanse of windows met the bookshelves, there was a low, glass-topped table surrounded by molded fiberglass chairs. Their leather cushions were made of bright colors ranging through the oranges and greens.

Stark himself was seated behind his massive desk. His image was recreated a hundred times in the mirror to the right thanks to the reflection from the tinted window glass to his left. The Chief of Surgery had
his feet propped up on the corner of his desk so that daylight fell over his shoulder onto the paper he was reading.

He was impeccably dressed in a beige suit tailored to fit close to his lean body, accented by an orange silk scarf in his left breast pocket. His graying hair was moderately long and brushed back from his high forehead, just covering the tops of his ears. His face was aristocratic, with sharp features and a thin nose. He wore executive half-glasses framed in delicate reddish tortoiseshell. His green eyes rapidly scanned back and forth across the sheet of paper in his hand.

Susan would have been greatly intimidated by a combination of the impressive surroundings and Stark’s awe-inspiring reputation as a surgical genius had it not been for his initial smile and his seemingly incongruous posture. The fact that he had his feet up on the corner of the desk made Susan feel more comfortable, as if Stark really didn’t take his power position within the hospital too seriously. Susan correctly surmised that his skill as a surgeon and his ability as a medical administrator-businessman made it possible for Stark to ignore conventional executive posturing. Stark finished the paper and looked up at Susan sitting in front of him.

“That, young lady, is very interesting. Obviously I am totally aware of the surgical cases, but I had no idea a similar problem was occurring on the medical floors. Whether they are indeed related is uncertain but I must give you credit for coming up with the idea that they may be related. And these two recent respiratory arrests and deaths; associating them is . . . well, both far-out and brilliant at the same time. It gives food for thought. You have related them because you feel that depression of respiration is the common ground for all the cases. My first reaction to that—now, this is just my first reaction—is that it does not explain the anesthesia cases because in that circumstance, the respiratory pattern is being artificially maintained. You suggest some previous encephalitis or brain infection making people more susceptible to complications during anesthesia . . . let me see.”

Stark swung his feet from his desk and turned toward the window. Unconsciously he took his reading glasses from his nose and lightly chewed one of the earpieces. His eyes narrowed in concentration.

“Parkinsonism has now been related to previous unsuspected viral insult, so I suppose your theory is
possible. But how could it be proved?”

Stark rotated around, facing Susan.

“And you must be assured that we investigated the anesthesia complication cases ad nauseam. Everything—and I mean everything—was studied with a fine-tooth comb by a host of people, anesthesiologists, epidemiologists, internists, surgeons . . . everybody we could think of. Except, of course, a medical student.”

Stark smiled warmly and Susan found herself responding to the man’s renowned charisma.

“I believe,” said Susan, her confidence rallying, “the study should start with the central computer bank. The computer information I obtained was only for the past year and called up by an indirect method. I have no idea what data would emerge if the computer was asked directly for all cases over, say, the last five years of respiratory depression, coma, and unexplained death.

“Then with a complete list of the potentially related cases, the charts would have to be painstakingly reviewed to try to elicit any common denominators. The families of the involved patients would have to be interviewed to obtain the best possible record of previous viral illness and patterns of illnesses. The other task would be to obtain serum from all existing cases for antibody screens.”

Susan watched Stark’s face, intently preparing herself for an untoward response like that she had experienced with Nelson and then more dramatically with Harris. In contrast, Stark maintained an even expression, obviously in thought over Susan’s suggestions. It was apparent that he had an open, innovative mind. Finally he spoke.

“Shotgun-style antibody screening is not very productive; it is time-consuming and it is horribly expensive.”

“Counter-immunoelectrophoresis techniques have relieved some of these disadvantages,” offered Susan, encouraged by Stark’s response.

“Perhaps, but it still would represent an enormous outlay of capital with a very low probability of positive results. I’d have to have some specific evidence before I could justify that type of resource commitment. But maybe you should suggest this to Dr. Nelson, down in Medicine. Immunology is his
special field.”

“I don’t think Dr. Nelson would be interested,” said Susan.

“Why is that?”

“I haven’t the faintest idea. To tell the truth, I already spoke with Dr. Nelson. So I already know he’s not interested. And he wasn’t the only one. I mentioned my ideas to another department head and I thought I was going to get swatted like some naughty child that needed chastising. Trying to incorporate that episode into the whole picture, I get a feeling that something else could be operating here.”

“And what is that?” asked Stark, glancing over the figures Susan had provided.

“Well, I don’t know what word to use . . . foul play . . . or something sinister.”