Coma

“Susan, the anesthesiologist gives succinylcholine and then monitors the patient like a hawk; he even breathes for the patient. If there is too much succinylcholine, it just means the anesthesiologist has to breathe the patient for a longer time until the patient metabolizes the drug. The paralyzing effect is completely reversible. Besides, if something like that were being done maliciously, all the anesthesiologists in the hospital would have to be involved, and that’s hardly likely. And maybe even more important is the fact that under the combined eye of the anesthesiologist and the surgeon, who can actually see how red the blood is and how well it is oxygenated, it would be absolutely impossible to alter the patient’s physiologic state without one or both knowing it. When blood is oxygenated, it is bright red. When oxygen gets low, the blood becomes dark brownish-bluish-maroon. The anesthesiologist meanwhile is breathing the patient, constantly checking the pulse and blood pressure, and watching the cardiac monitor. Susan, you are hypothesizing some sort of foul play, and you don’t have a why or a who or a how. You’re not even sure you have a victim.”

“I’m sure I have a victim, Mark. It might not be a new disease but it’s something. One more question. Where do the anesthetic gases come from that the anesthesiologists use?”

“It varies. Halothane comes in cans like ether. It’s a liquid and it’s vaporized as needed in the OR. Nitrous, oxygen, and air come from central sources and are piped into the OR’s. There are standby cylinders of oxygen and nitrous oxide in the OR for emergency use. ... Look, Susan, I’ve got a little more work to do, then I’m free. How about coming over to the apartment for a drink?”

“Not tonight, Mark. I want to get a good night’s sleep and I’ve got a few more things to do. But thanks. Also, I’ve got to get these charts back to their hiding place. After that I intend to look around in OR room number eight.”

“Susan, I personally think you should get your ass out of this hospital before you really get yourself in hot water.”

“You’re entitled to your opinion, doctor. It’s just that this patient doesn’t feel like following orders.”

“I think you’re carrying all of this too far.”

“You do, do you? Well, I might not have a who, but I’ve got a number of suspects. ...”

“Sure you do. ...” Bellows fidgeted. “Are you going to make me guess or are you going to tell me?”

“Harris, Nelson, McLeary, and Oren.”

“You’re out of your squash!”

“They all act as guilty as hell and want me out of here.”

“Don’t confuse defensive behavior with guilt, Susan. After all, complications are hard to live with in medicine, no matter from what cause.”

Wednesday, February 25, 11:25 P.M.

Susan felt a definite sense of relief when she had returned the charts to their hiding place in McLeary’s closet. At the same time, she was very disappointed. Having finally inspected them was an anticlimax of sorts.

She had placed a great deal of emphasis on the importance of the charts, but after she had finished studying them, she felt no further in her mission. She had a lot more data but no correlates, no intercepts.

The cases still seemed to be random and unassociated.

The elevator slowed and stopped, the door quivered, then opened. Susan stepped out into the OR area. There was still a case going on in room No.

20, a ruptured abdominal aneurysm that had been admitted through the emergency room. The operation had been in progress for over eight hours; that didn’t look so good. Otherwise the OR area was in its nightly repose. There were a few people busy cleaning the floor and restocking the supply room with freshly laundered linen. A girl in a scrub dress was behind the main desk, trying to fit the last few cases into the following day’s master schedule.

The nurse’s uniform ruse was still working well for Susan and the few people in the hall did not seem to notice her passing. She went directly to the nurses’ locker rooms and changed into a scrub dress, hanging the nurse’s uniform in an open locker.

Reentering the main hall, Susan eyed the swinging doors into the area of the operating rooms. A large sign on the right door said “Operating Rooms: Unauthorized Entry Forbidden.” The main desk was just to the side of these doors. The nurse sitting behind the desk was still hard at work. Susan had no idea if she would be challenged if she tried to enter.

In order to survey the scene in its totality, Susan walked the length of the hall several times, half-hoping the girl at the main desk would take a break and leave. But she didn’t budge, nor even look up. Susan tried to think of some appropriate explanation in case the girl questioned her. But she couldn’t think of any. It was almost midnight and she knew she’d have to have some reasonably convincing story to explain her presence.