Coma (9 page)

February 23

11:40 A.M.

It gave Susan a feeling of unreality to answer a page for “Dr. Wheeler.” She felt transparent as if she were an actress playing the role of a doctor. She had on the white coat and the scene was melodramatic and appropriate. Yet on the inside she just didn’t feel like the part, and there was the thought that she would be exposed at any moment as a charlatan.

At the other end of the phone line, the nurse was matter-of-fact and to the point.

“We need an I.V. started on a pre-op. The case has been delayed and anesthesia wants some fluid in him.”

“When would you like me to start it?” asked Susan twisting the phone cord.

“NOW!” answered the nurse before hanging up.

The other members of Susan’s group had moved on to another patient and were again huddled about the desk, straining to see the chart Bellows had pulled from the rack and had in front of him. No one looked up as Susan traversed the half-light of the ICU. She reached the door and her left hand wrapped around the upturned stainless steel handle. Turning her head slowly to the right she chanced another glance at the immobile and lifeless-appearing Nancy Greenly. Once again Susan’s mind stumbled through a painful
identification. She left the ICU with difficulty but also with a sense of relief.

The sense of relief was short-lived. Hurrying along the crowded corridor, Susan began to prepare herself for the next mini-hurdle. Susan had never started an I.V. before. She had drawn blood from several patients, including her lab partner, but she never had started an I.V. Intellectually she knew what was required and she knew that she could do it. After all, it only involved punching a razor-sharp needle through some thin skin and impaling a vein without going all the way through the vessel. The difficulties arose from the fact that frequently the vein was only the size of thin spaghetti with a corresponding smaller lumen. In addition, sometimes the vein could not be seen from the surface of the skin and had to be attacked blindly with only the help of the sense of touch.

With these difficulties in mind Susan knew that even something as mundane as starting an I.V. was going to be a challenge of sorts. Her biggest concern was that it was going to be very apparent that she was new at the game, and perhaps the patient might rebel and demand a real doctor. Besides, she was in no frame of mind to have to put up with any exasperated ridicule from any of those bitchy nurses.

When Susan arrived at Beard 5, the scene was unchanged. The bustle of activity was as hectic as ever. Terry Linquivist gave a fleeting look at Susan before disappearing into the treatment room. One of the other nurses, whose cap had a bright orange stripe and whose name tag read “Sarah Sterns,” responded to Susan’s arrival by handing her the I.V. tray and a bottle of I.V. fluid.

“The name’s Berman. He’s in 503,” said Sarah Sterns. “Don’t worry about the rate. I’ll be down there in a few minutes to regulate it.”

Susan nodded and headed for 503. En route she examined the I.V. tray. There were all sorts of needles: scalp needles, long-dwelling catheters, CVP lines, and traditional disposable needles. There were packets of alcohol sponges, a few-lengths of flat rubber tubing to be used as the tourniquets, and a flashlight. Eyeing the flashlight, Susan wondered how many times she would repeat the scene of trudging off in the middle of the night to start an I.V.

Susan passed 507, then 505. As 503 loomed she rummaged in the I.V. tray among the scalp needles until she located a #21 in a bright yellow packet. That was the needle she had seen an I.V. started with in the
past. She was tempted to try one of the impressive-looking long-dwells but she decided to keep the experimenting to a minimum, at least on her first I.V.

“Room 503” was stenciled plainly on the door. It stood slightly ajar. Susan didn’t know whether she should knock or just walk in. With a self-conscious glance over her shoulder to make sure she was not being watched, she knocked.

“Come in,” said a voice from within.

Susan pushed open the door with her foot, clutching the I.V. tray in her right hand and the D5W bottle in her left. Expecting to see an elderly ill individual, Susan moved into the room. It was a typical private room at the Memorial: small, old, the floor tiled with vinyl squares. The window was curtainless and dirty. An old radiator stood in the corner covered with a dozen layers of paint.

Contrary to Susan’s expectations, the patient was neither old nor infirm. Propped up in the hospital bed was a youngish man, seemingly in perfect health. Susan quickly estimated that he was about thirty. He was wearing the usual hospital garb with the sheet pulled up to his waist. His hair was dark and very thick, and it was brushed back on both sides of his temples so that it covered the top part of each ear. His face was narrow, intelligent, and tanned despite the winter season. He had a sharp nose with flared nostrils, making him appear as if he were constantly breathing in. He looked athletic and in good physical condition. His muscular arms encircled his updrawn knees. His hands worked at each other nervously as if they were cold. Susan sensed immediately the man’s anxiety through a patina of contrived calmness.

“Don’t be bashful, come right in. It’s like Grand Central here,” smiled Berman. The smile wavered. It was apparent that the man welcomed an interruption in the tenseness of waiting to be called for surgery.

Susan entered and allowed herself only a short look at Berman while she returned the smile. She then pushed the door to its original position. She put the tray on the foot of the bed and hung the I.V. bottle from the stand at the head of the bed. She consciously avoided Berman’s eyes while she wondered why in God’s name did Berman have to be so young, healthy, and obviously in charge of all his faculties. Susan certainly would have preferred an unconscious centenarian.

“Not another needle!” said Berman with partially feigned overconcern.

“I’m afraid so,” said Susan opening a package of I.V. tubing, which she inserted into the bottle of D5W on the stand, allowing some of the fluid to run through the tube before securing it with a stopcock. With that accomplished, Susan looked up at Berman, to find that he was staring intently at her.

“Are you a doctor?” asked Berman with a tone of disbelief.

Susan didn’t respond immediately. She continued to look directly into Berman’s deep brown eyes. In her mind she weighed the possibilities of her response. She wasn’t a doctor, that was obvious. What did she want to say? She wanted to say that she was a doctor. But Susan was a realist and she wondered if she would ever be able to say she was a doctor and believe it herself.

“No,” said Susan with finality while returning her gaze to the #21 scalp needle. The reality disappointed her and she thought that it would add to Berman’s anxiety. “I’m just a medical student,” she added.

Berman’s hands stopped their nervous activity. “There’s no need to be defensive about that,” he said with sincerity. “You just don’t look like a doctor or a doctor-to-be.”

Berman’s innocent comment struck a tender chord in Susan’s mind. Her embryonic professionalism made her rather paranoid and she immediately misconstrued Berman’s comment, which was meant as a backhanded compliment.

“What is your name?” continued Berman, totally unaware of the effect of his previous comment. He shielded his eyes from the glare of the overhead fluorescent lights and motioned for Susan to turn slightly to the left so he could see her name tag on her lapel. “Susan Wheeler . . . Dr. Susan Wheeler. It has a natural sound to it.”

Susan quickly realized that Berman was not challenging her as a doctor after all. Still she did not respond. Something about Berman was distantly but comfortably familiar to her but she could not characterize it. Her mind tried but it was too subtly hidden in the immediacy of their encounter. It had something to do with Berman’s charming authoritarian manner.

Partially as a method to concentrate her own thoughts and partially to control the conversation, Susan plunged into the I.V. affair. In a businesslike manner she placed the tourniquet about Berman’s left wrist and pulled it tight. She tore open the packets containing the scalp needle and the alcohol sponge. Berman’s eyes
followed these preparations with great interest.

“Gotta admit from the start, I’m not crazy about needles,” said Berman, trying to maintain a degree of aplomb. He looked back and forth from his hand to Susan.

Susan sensed Berman’s mounting concern and she wondered what he’d say if she told him that it was her first attempt at starting an I.V. She was quite certain that he would simply become unhinged. She felt certain because she realized that if the roles were reversed, that would be how she would react.

The tourniquet combined forces with Berman’s ectomorphic body to make the veins on the back of his hand stand out like garden hoses. Susan took a deep breath and held it. Berman did the same. After a swipe with the alcohol pledget, Susan tried to jam the needle into the back of Berman’s hand. But the skin advanced, resisting penetration.

“Ahhh,” cried Berman gripping the sheet with his free right hand. He was purposely overdoing the theatrics as a self-preservation maneuver. However, its effect was to unnerve Susan, who desisted in her attempt to break the skin.

“If it’s any consolation, you feel just like a doctor,” said Berman looking at the back of his left hand. The tourniquet was still in place and the hand had an overall bluish discoloration.

“Mr. Berman, you’re going to have to be a little more cooperative,” said Susan, mustering her forces for a renewed attempt and wishing to spread the responsibility for any failure.

“Cooperate, she says,” echoed Berman while rolling his eyes up inside of his head. “I’ve been as quiet as a sacrificial lamb.”

Susan replaced Berman’s left hand flat on the bed. With her own left hand she effected countertraction on Berman’s skin. With the same amount of effort the needle entered the scanty tissue.

“I give up,” pleaded Berman with a tinge of humor.

Susan concentrated on the submerged needle point. At first it tended to push the vein in front of itself. She tried the countertraction trick: same problem. She tried the countertraction combined with a decisive lunge with the needle. She could feel the pop as the needle burst into the vein. Blood flowed back through the needle, filling the attached plastic tubing. Quickly she hooked up the I.V. line, opened the stopcock, and
removed the tourniquet. The I.V. flowed smoothly.

Both parties felt definite relief.

Having actually accomplished something, something medical for a patient, Susan felt a tinge of euphoria. It was a small affair, a mere I.V., but nonetheless a definite service. Maybe there was a future for her after all. The euphoria brought a feeling of expansiveness to Susan which included a heightened sense of warmth with a shade of condescension toward Berman in spite of the hospital environment.

“You said before that I don’t look like a doctor,” said Susan, getting the tape out to secure the I.V. line to the back of Berman’s hand. “What does it mean, to look like a doctor?” There was a slight tease to her voice as if she were more interested in hearing Berman speak than in actually listening to what he had to say.

“Maybe it was a silly comment,” said Berman, watching every move Susan made while taping the I.V. line. “But I do know a few girls who went into medicine from my graduating class in college. Several of them were OK; all of them were bright; there was no doubt about that, but they were hardly feminine.”

“They probably weren’t feminine to you because they went into medicine rather than vice versa,” said Susan, slowing the I.V. to a steady drip.

“Possible . . . possible . . . ,” said Berman thoughtfully. He recognized that Susan’s interpretation represented a new perspective. “But I don’t think so. Two of them I happen to know quite well. In fact I knew them all the way through college. They really didn’t decide on medicine until the last year. They were just as nonfeminine before as after their decision. Whereas you, Dr. Wheeler-to-be, have a distinct aura of femininity that envelops you like a cloud.”

Susan, eager to take exception to Berman’s comment regarding his friends’ femininity, was caught off guard by Berman’s reference to her own femininity. On the one hand she was tempted to respond, “Are you for real, buddy?” while on the other hand she thought that Berman might be serious and actually paying her a compliment. Berman himself decided which way Susan’s mind would turn.

“If I had to pick what your vocation was,” continued Berman, “I’d have to say you were a dancer.”

Having stumbled on to Susan’s own fantasy concerning her alter ego, Berman opened the door on Susan’s personality. To her, appearing like a dancer was definitely a compliment, and therefore she was more
than willing to accept Berman’s comment about her femininity as a compliment as well.

“Thank you, Mr. Berman,” said Susan with sincerity.

“Please call me Sean,” said Berman.

“Thank you, Sean,” repeated Susan. She stopped her activity of gathering up the debris from the I.V. paraphernalia and looked out the dirty window. She didn’t notice the dirt, the brick, the dark clouds, nor the lifeless trees. She looked back at Berman. “You know, I wouldn’t be able to tell you how much I appreciate your compliment. It might sound rather strange to you, but to be quite honest I haven’t felt feminine over the last year or so. To hear someone like yourself say so is enormously reassuring. It’s not that I have dwelt on it, but just the same I have begun to think of myself as . . .” Susan paused, thinking of the right word. “Neutral, or neuter. Yes that’s the right word, neuter. It has happened slowly, in degrees, and I guess I’m really only aware of it by comparison when I get together with some of my former college classmates, especially my former roommate.”

Susan suddenly stopped in the middle of her thought and straightened up. She was slightly embarrassed and surprised at her own unexpected candor. “What am I talking about? Sometimes I can’t believe myself.” She smiled and then laughed at herself. “I can’t even act like a doctor, much less look like one. I’m sure that the last thing you want to hear about is my professional adjustment difficulties!”