Coma (6 page)

“You’ll be assigned to Beard 5 for only one month of your three month surgical rotation here at the Memorial,” said Bellows, shifting into a familiar monotone associated with medical pedagogy. “In some ways this is an advantage and in others a disadvantage, like so many things in life.”

Carpin chuckled at this feeble attempt at philosophy, but noticing that he was alone, he shut up quickly.

Bellows fixed his gaze on Carpin and continued, “Beard 5 rotation includes the surgical intensive care unit. Hence you will be subjected to an intensive teaching experience. That’s the good part. The disadvantage is that it occurs so early in your clinical exposure. I understand this is your first clinical rotation. Is that correct?”

Carpin looked from side to side to make sure that this last question was directed at him. “We . . .” His voice faltered, and he cleared his throat. “That’s right,” he managed to say with some difficulty.

“The intensive care unit,” continued Bellows, “is an area where you all have the most to learn, but it represents the most critical area for patient care. All the orders that you write on any patient must be countersigned by myself or one of the two interns on the service, whom you will meet presently. If you write orders in the ICU they have to be countersigned the moment you write them. Orders for patients on the ward can be countersigned en masse at various times during the day. Is that clear?”

Bellows looked at each student, including Susan, who returned his gaze without altering her neutral expression. Susan’s immediate impression of Bellows was not particularly favorable. His manner seemed artificial and his opening mini-lecture on punctuality seemed a little unnecessary so early in the course of events. The monotone of his remarks combined with the pitiful stab at philosophy tended to support the image Susan had begun to construct of the surgical personality from previous conversations and her reading . . . unstable, egotistical, sensitive to criticism, and above all, dull. Susan did not notice that Mark Bellows was male. Such a thought did not even register in her mind.

“Now,” said Bellows in his artificial monotone, “I’ll have some schedules Xeroxed for you which will outline the basic calendar we’ll follow while you are assigned to Beard 5. The patients on the ward and in the ICU will be divided among you, and you are to work directly with the intern on the case. As for admissions, I want you to set up your own schedule for equitably dividing them. One of you will do a full workup on each admission. As for night call, I want at least one of you to stay here. That means you’ll be on only one in five nights and that’s not overburdening you. In fact, that is less than usual. If others want to stay in the evenings, that’s fine, but at least one of you stays here all night. Get together some time today and give me a schedule of who will be on when.

“Rounds will begin each morning in the ICU at six-thirty. Before then I want you to have seen your patients, collated all the necessary information to present during the rounds. Is that clear?”

Fairweather looked at Carpin in dismay. He leaned over and whispered in Carpin’s ear, “Christ, I’ll have to get up before I go to bed!”

“Do you have a question, Mr. Fairweather?” demanded Bellows.

“No,” answered Fairweather rapidly. He was intimidated by the fact that Bellows knew his name.

“As for the rest of the morning,” said Bellows, eyeing his watch again. “First I will take you to the ward and introduce you to the nursing staff, who will be thrilled to meet you all, I’m sure,” said Bellows with a wry smile.

“We have experienced their joy already,” said Susan, speaking for the first time. Her voice brought Bellows’s eyes around and held them. “We didn’t expect a brass band for our arrival but at the same time we didn’t expect a cold shoulder.”

Susan’s appearance had already somewhat unnerved Bellows. With the animation that the sound of her voice provided, Bellows’s pulse quickened slightly. There was a certain surge within his body which reminded him of watching cheerleaders in high school and wishing that they were naked. Bellows searched for words.

“Miss Wheeler, you’ll have to understand that the nurses here are primarily interested in one thing.”

Niles winked in agreement to Goldberg, who didn’t understand what Niles was implying.

“And that is patient care, damn good patient care. And when new medical students and/or new interns arrive that becomes a rather difficult goal. From actual experience they have all learned that new house staff is probably more deadly than bacteria and virus put together. So don’t expect to be greeted as saviors here, least of all from the nurses.”

Bellows paused but Susan did not respond. She was thinking about Bellows. At least he was a realist and that was a glimmer of hope in the otherwise poor impression he had made on her.

“At any rate, after showing you the ward, we’ll head up to surgery. There’s a staff gallbladder at ten-thirty and it will give you all a chance to get into a scrub suit and see the inside of an OR.”

“And the handle of a retractor,” added Fairweather. For the first time the atmosphere lightened and everyone laughed.

Down in the OR area Dr. David Cowley was absolutely pissed and he spared no one. The circulating nurse had broken into tears before the case was over and had to be replaced. The anesthesiology resident had had to weather one of the worst bombardments of foul words and captious epithets that had ever been hurled over an anesthesia screen. The surgical resident first assisting had a small cut in his right index finger from Cowley’s scalpel.

Cowley was one of the more prosperous of the general surgeons at the Memorial with a spacious private office on Beard 10. He had been spawned, trained, and now nurtured by the Memorial. When things went well, he was a most pleasant chap, full of jokes and ribald stories, always eager to offer an opinion, to bet on a game, to laugh. But when things went contrary to his wishes, he was a firebrand of the most vicious nature, a seething cauldron of invective. In short, he was a juvenile in adult clothing.

His only case that day had gone poorly. To start with, the circulating nurse had put out the wrong surgical instruments. She had set up the Mayo stand with the gallbladder instruments used by the residents. Dr. Cowley had responded by picking up the whole tray and dashing it to the floor. Next the patient quivered a little as he made the initial incision. It was only with great self-discipline that Cowley had curbed his inclination to hurl the scalpel at the anesthesiology resident. Then there was X-ray, who failed to show up at exactly the moment he called. Cowley’s viciousness had so unnerved the poor technician that the first couple of films were totally black.

Somehow Cowley forgot the real reason the case went poorly. Cowley himself had accidentally pulled off the proximal tie on the artery to the gallbladder, causing the wound to fill up with blood in seconds. It had been a struggle to reisolate the vessel and get a tie around it without disturbing the integrity of the hepatic artery. Even after the bleeding had been controlled, Cowley still was not positive that he had not compromised the blood supply to the liver.

Coming into the deserted doctors’ lounge, Cowley was raging. He was mumbling inaudibly as he
passed down the row of lockers to his own. With emphasis he flung his scrub hat and mask onto the floor. Then he kicked his locker with jarring force.

“Fucking incompetent assholes. This Goddamned place is going to the dogs.”

The fury of his kick followed by an overhead fist which he brought against the door of the locker did several things. First, it raised a cloud of previously undisturbed dust which had settled on top of the locker over some five years. Second, it dislodged a single scrub shoe, which fell, just missing Cowley’s head. Third, it jarred open the locker next to Cowley’s, causing some of the contents to spill out onto the floor.

Cowley dealt with the shoe first. He threw it as hard as he could against the far wall. Then he kicked open the locker next to his in preparation to replace the objects which had fallen out. One glance into the locker, however, made him pause.

Looking closer, Cowley was astonished to see that the locker contained an enormous collection of medications. Many were open, half-used containers and vials, but there were also many unopened. There were ampules, bottles, and pills in a bewildering assortment. Of the drugs that had fallen out, Cowley noted Demerol, succinylcholine, Innovar, Barocca-C, and curare. Within the locker were many more varieties, including an entire carton of unopened morphine bottles, syringes, plastic tubing, and tape.

Quickly Cowley replaced the medicines that had fallen to the floor. Then he locked the locker once again. In his calendar book he wrote the number 338. Cowley was going to check on that locker and see to whom it was assigned. Despite his anger, he had the presence of mind to realize that such a cache was important and had serious implications for the entire hospital. And with things that bothered him, Cowley had the memory of a sage.

February 23

10:15 A.M.

Susan Wheeler could not go into the doctors’ lounge to change into a scrub suit because the doctors’ lounge was synonymous with the men’s lounge. Susan had to go into the nurses’ locker room, which was synonymous with women’s lounge. So creeps society from day to day, thought Susan angrily. To her it was just another blatant example of male chauvinism and it gave her a momentary lift to think that she was upsetting this unfair identification. The locker room was at that moment deserted and Susan located an empty locker with ease and began to change by hanging up her white coat. Nearby the shower entrance she found the scrub suits. They were one-piece pale blue dresses made from plain cotton fabric. They were actually for the scrub nurses. She held it up and then against herself. Looking into the mirror, she felt suddenly rebellious despite the intimidating surroundings.

“Screw the dress,” said Susan to the mirror. The scrub dress arched in a tumble into the canvas hamper while Susan retraced her steps into the hall. She paused before the doctors’ lounge, and she almost lost her nerve. Impulsively she pushed open the door.

Bellows was at that very instant next to the door that Susan opened. He was reaching into one of the cabinets at the entrance for a scrub suit. He was clothed in his James Bond-style skivvies (that’s what he
called them) and black socks. He looked as if he belonged in the beginning of a grade C porno movie. Horror spread across his face as he caught sight of Susan. In a flash, he fled into the safety of the depths of the dressing room. As in the nurses’ locker room, one could not see into the dressing room from the door. Spurred by her rebelliousness despite the unexpected encounter, Susan advanced to the cabinet and selected a small scrub top and pants; then she left as quickly as she had entered. She could hear a tangle of excited voices in the interior of the doctors’ lounge.

Back in the nurses’ locker room, she completed changing rapidly. The pale green shirt was too large, as were the pants. Because of her narrow waist she had to cinch up the pants to their absolute maximum before tying the cord. Mentally she began to prepare for the inevitable diatribe from Bellows, the mighty surgeon-to-be, by deciding how she would counter. During their brief introductions on the ward, Susan had been very aware of the condescending attitude Bellows had directed toward the nurses. This attitude was ironical coming so soon after the commendable defense of the nurses he had made to explain their lack of enthusiasm toward new medical students. It was pretty obvious to Susan that Bellows was, among other things, a typical chauvinist. Susan decided that she would challenge that aspect of Bellows’s personality. Maybe it would make the surgical rotation at the Memorial a bit more bearable. Of course she had not planned to see Bellows in his underwear in the dressing room, but the image and symbolic aspects made Susan laugh out loud before she passed through the door into the OR area.

“Miss Wheeler, I presume,” said Bellows as Susan emerged. Bellows was leaning casually against the wall to the left of the doorway, obviously waiting for Susan to appear. His right elbow was on the wall, with the hand supporting his head. Susan literally jumped at the sound of his voice since she hardly expected him to be waiting there for her.

“I must admit,” continued Bellows, “you really caught me with my pants down.” A broad smile spread across his face, changing him in Susan’s eyes to a rather human individual. “That was one of the funniest things that has happened to me in a long time.”

Susan smiled in return but it was a half-smile. She was expecting the tirade to commence immediately.

“After I recovered and realized what you were after,” continued Bellows, “I started to think that it was a
pretty ridiculous response on my part to bolt. If I had had any sense I would have stood there and faced you despite my dress . . . or the lack of it. At any rate, it made me think that I might have been relying on appearances a bit too much this morning. I’m a second-year resident, that’s all. You and your friends are my first group of students. What I really want to do is to make this time here as profitable as possible for you all, and in the process, profitable for me as well. Last of all, we should enjoy ourselves.”

With a final smile and slight nod of the head, Bellows walked away from the stunned Susan to check which room the staff gallbladder was in. It was Susan’s turn to feel a sense of confusion as she looked after him. The resolve her feelings of anger and rebelliousness had evoked had been undermined by Bellows’s sudden insight into himself. In fact it made her rebelliousness seem a trifle foolish and out of place. The fact that Susan had stimulated the insight fortuitously made it obvious that she couldn’t take credit for it and that she would have to revise some of her impressions about Mark Bellows. She watched Bellows walk all the way over to the main OR desk; he was obviously at home in the alien environment. For the first time Susan was a little impressed. In fact, she thought that he really wasn’t that bad looking either.