Coma

Bellows took a sip from his drink, motioning for them to return to the living room. The dock over the fireplace chimed. It was two-thirty.

“Gas lines have valves,” said Bellows at length.

“The others didn’t have them.”

“You mean a type of valve which would allow gas to be introduced into the line?”

“I think so. I don’t know much about valves and the like.”

“Did you trace the others to each room to be sure?”

“No, but room eight was the only line with a valve at the main chase.”

“Simply having a valve doesn’t surprise me. Maybe they all have one someplace in their lines. I wouldn’t use that valve to draw my conclusions, at least not until I had traced all the lines.”

“It’s too much of a coincidence, Mark. All these cases apparently happened in room No. 8, and room No. 8 has an oxygen line that has a valve in it at a funny place, rather well concealed.”

“Susan, look. You’re forgetting that some twenty-five percent of your supposed victims weren’t even near the OR, much less room No. 8. Now, even under the best of circumstances, I find your crusade ridiculous and threatening. And when I’m exhausted, I find it numbing. Can’t we talk about something soothing, like socialized medicine?”

“Mark, I’m sure about this.” Susan could sense the exasperation in Bellows’s voice.

“I’m sure you’re sure, but I’m also sure I’m unsure.”

“Mark, the man who attacked me this afternoon warned me, and then he returned tonight, and I don’t think he wanted to talk. I think he wanted to kill me. In fact, he tried to kill me. He shot at me!”

Bellows rubbed his eyes, then the sides of his head. “Susan, I don’t know what to even think about that, much less have something intelligent to say. Why don’t you go to the police if you’re so sure?”

Susan did not hear Bellows’s last comment; her mind was racing ahead.

She started to speak out loud. “It has to be from lack of oxygen. If they were given too much succinylcholine or curare, must enough so that the people would have a hypoxic episode ...” Susan trailed off, thinking. “That could be why respiratory arrest occurred. The one they autopsied, Crawford.” Susan took out her notebook. Bellows took another drink.

“Here it is, Crawford. He had severe glaucoma in one eye and was on phospholine iodide. That’s an anticholinesterase and that means that his ability to break down the succinylcholine would have been impaired and a sublethal dose could be lethal.”

“Susan, I’ve already told you that succinylcholine would not work in the OR, not with the surgeon and the anesthesiologist right there. Besides you cannot give succinylcholine by gas ... at least, I’ve never heard of it.

Maybe you could, but anyway, they’d just keep respiring the patient until it was gone; there wouldn’t be any hypoxia.”

Susan took another slow sip from the bourbon.

“What you’re saving is that the hypoxia in the OR has to occur without the color of the blood changing so the surgeon stays nice and happy. How could that be done? ... You’d have to block the use of oxygen by the brain somehow ... maybe at the cellular level ... or block the release of oxygen to the brain cells. It seems to me there is a drug that can block oxygen utilization, but I can’t think of it offhand. If the valve on the oxygen line were significant, it would have to be a drug that comes in a gas form. But there’s another way to do it. You could use a drug that blocks the uptake of oxygen on the hemoglobin and yet still keeps the color. ... Mark, I’ve got it!” Susan sat bolt upright, her eyes wide open, her mouth forming a half-smile.

“Sure you do, Susan; sure you do,” soothed Mark sarcastically.

“Carbon monoxide! Carefully bled-in carbon monoxide, by way of the T-valve, titrated to cause just the right amount of hypoxia. The blood color would stay the same. In fact it would get even brighter red, cherry red.

Even a very small amount would cause the oxygen to be displaced from the hemoglobin. The brain is starved of oxygen and—coma. In the OR

everything has seemed absolutely normal. Then the patient’s brain dies; there is not a trace of the cause.”

There was a silence as the two people looked at each other. Susan expectantly, Bellows with tired resignation.

“You want me to say something? OK, it’s possible. Ridiculous but possible. I mean it’s theoretically possible for the OR cases to be caused by carbon monoxide. It’s an awful idea, maybe it’s even ingenious, but at any rate, it’s possible. The trouble is there are still twenty-five percent of the coma victims who didn’t even get close to the OR.”

“They’re the easy ones to explain. That was never hard. It was the OR

cases that were hard. It was also hard for me to break away from the idea in the diagnosis of disease in medicine that one should search for single causes. But in this case we’re not dealing with a disease. The cases on the medical floors were given sublethal doses of succinylcholine.

Something like that happened in a V.A. hospital in the Midwest, and even in New Jersey.”