Coma

Homeostasis is indeed extremely difficult to maintain over protracted periods of time when the brain ...”

A red light on the side wall suddenly sprang to life, blinking frantically.

All eyes in the conference room turned toward it. Silently a message flashed onto a TV screen below the red light: “Cardiac Arrest Intensive Care Unit Beard 2.”

“Shit,” muttered Bellows as he jumped up. Cartwright and Reid followed at his heels, and the three pushed their way to the aisle. Susan and the other four med students hesitated for a moment, looking at each other for encouragement. Then they followed en masse.

“As I was saying, homeostasis is difficult to maintain when the brain is damaged beyond repair. Next slide, please,” said Stark consulting his notes on the lectern, hardly paying heed to the group storming from the room.

Monday, February 23, 12:16 P.M.

There was no doubt that Sean Berman was very nervous about being in the hospital, facing imminent surgery. He knew very little about medicine, and although he wished that he were better informed, he had not bothered to inquire intelligently about his problem and its treatment.

He was frightened about medicine and disease. In fact he tended to equate the two rather than think of them as antagonists. Hence the thought of undergoing surgery offended his sensibility; there was no way for him to deal rationally with the idea that someone was going to cut his skin with a knife. The thought made his stomach sink and sweat appear on his forehead. So he tried not to think about it. In psychiatric terms this was called denial. He had been reasonably successful until he had come to the hospital the afternoon before his scheduled surgery.

“The name is Berman. Sean Berman.” Berman remembered the admission sequence all too well. What should have been a smooth affair got hopelessly caught in the bureaucratic tangle of the hospital.

“Berman? Are you sure you’re to come to the Memorial today?”

questioned the well-meaning, overly made-up receptionist, who wore black nail polish.

“Yes, I’m sure,” returned Berman, marveling at the black nail polish. It made him realize that hospitals were monopolies of sorts. In a competitive business someone would have the sense to keep the receptionist from wearing black nail polish.

“Well, I’m sorry but I don’t have a file for you. You’ll have to take a seat while I handle these other patients. Then I’ll call Admitting and I’ll be with you shortly.”

So commenced the first of several snafus which characterized Sean Berman’s admission. He sat down and waited. The big hand of the clock worked its way through an entire revolution before he was admitted.

“May I have your X-ray request, please?” asked a young and extremely thin X-ray technician. Berman had waited over forty minutes in X-ray before being called.

“I don’t have an X-ray request,” said Berman, glancing through the papers he’d been given.

“You must have one. All admissions have one.”

“But I don’t.”

“You must.”

“I tell you I don’t.”

Despite the obvious frustration, the ridiculous admission sequence had had one positive effect. It had totally occupied Berman’s consciousness, and he did not dwell upon his impending surgery. But once in his room, hearing the random moans through partially closed hospital doors, Sean Berman was forced to confront his imminent experience. Even more difficult to dismiss were the people with bandages or even tubes that issued forth mysteriously from areas of the human body without natural orifices. Once in the hospital environment, denial was no longer an effective means of psychological defense.

Berman then tried another tactic; he switched to what the psychiatrists call reaction formation. He let himself think about his upcoming operation to the point where he seemingly made light of the idea.

“I’m one of the dieticians and I’d like to discuss your meal selection,”

said an overweight woman with a clipboard who entered Berman’s room after a sharp knock. “You are here to have surgery, I presume.”

“Surgery?” Berman smiled. “Yeah, I have it about once a year. It’s a hobby.”

The dietician, the lab technician, anyone who would listen, became a victim of Berman’s offhand comment about his scheduled operation.

To an extent this method of defense was successful, at least until the actual morning of the operation. Berman had been awakened at six-thirty by the sound of some jangling cart in the corridor. Try as he might, he had been unable to fall back to sleep. Reading had been impossible. The time had dragged horribly, slowly yet inexorably toward 11, when his surgery was scheduled. His stomach had growled from its emptiness.

At 11:05 the door to his room burst open. Berman’s pulse fluttered. It was one of the harried nurses.

“Mr. Berman, there’s going to be a delay.”

“A delay? How long?” Berman forced himself to be civil. The agony of anticipation was taking its toll.

“Can’t say. Thirty minutes, an hour.” The nurse shrugged.

“But why? I’m starved.” Berman really wasn’t hungry; he was too nervous.