Coma

Goodman felt a tenseness in the ventilating bag when he tried to breathe Berman. He sensed that Berman was trying to breathe on his own.

Concurrently the blood pressure rose to 110/80.

“He must be a little light,” said Dr. Colbert, trying to sort out the layers of tissue in the wound.

“I’ll give him a bit more of this love potion,” said Dr. Goodman. He injected another full cc of Innovar, since the syringe with the Innovar was still connected to the I.V. line. Later he admitted that this could have been a mistake. He should have used only the analgesic, fentanyl.

The blood pressure responded rapidly and fell as Berman’s anesthesia deepened again. The blood pressure leveled off at 90/60. The pulse increased to 80 per minute, then fell to a comfortable 72 per minute.

“He’s OK now,” said Dr. Goodman.

“Good. OK, Penny, feed me those chromic sutures and I’ll get this joint closed,” said Colbert.

The resident made fine headway, closing the joint capsule and then the subcutaneous tissues. There was no conversation. Mary Abruzzi sat down in the corner and turned on a small transistor radio. Very faint rock music trickled through the room. Dr. Goodman started the final notations on the anesthesia record.

“Skin sutures,” said Dr. Colbert, straightening up from his crouch over the knee.

There was the familiar slapping sound as the needle holder was thrust into his open hand. Mary Abruzzi changed her worn-out gum for a new stick by lifting the lower part of her mask.

At first it was only one premature ventricular contraction followed by a compensatory pause. Dr. Goodman’s eyes looked up at the monitor. The resident asked for more suture. Dr. Goodman increased the oxygen flow to wash out the nitrous oxide. Then there were two more abnormal ectopic heartbeats and the heart rate increased to about 90 per minute.

The change in the audible rhythm caught the attention of the scrub nurse, who looked at Dr. Goodman. Satisfied that he was aware, she went back to supplying the resident with skin sutures, slapping a loaded needle holder in his hand every time he reached up.

Dr. Goodman stopped the oxygen, thinking that maybe the myocardium or heart muscle was particularly sensitive to the high oxygen levels that were obviously in the blood. Later he admitted that this might have been a mistake as welt. He began to use compressed air for aerating Berman’s lungs. Berman was still not breathing on his own.

In quick succession there were several back-to-back runs of the strange premature-type heartbeats, which made Dr. Goodman’s own heart jump in his chest from fright. He knew all too well that such runs of premature ventricular contractions often were the immediate harbinger of cardiac arrest Dr. Goodman’s hands visibly trembled as he inflated the blood pressure cuff. Blood pressure was 80/55; it had fallen for no apparent reason. Dr. Goodman looked up at the monitor as the premature beats began to increase in frequency. The beeping sound became faster and faster, screaming its urgent information into Dr.

Goodman’s brain. His eyes swept over the anesthesia machine, the carbon dioxide canister. His mind raced for an answer. He could feel his bowels loosen and he had to clamp down voluntarily with the muscles of his anus.

Terror spread through him. Something was wrong. The premature beats were increasing to the point that normal beats were being crowded out as the electronic blip on the monitor began to trace a senseless pattern.

“What the hell’s going on?” yelled Dr. Colbert, looking up from his suturing job.

Dr. Goodman didn’t answer. His trembling hands searched for a syringe.

“Lidocaine,” he yelled to the circulating nurse. He tried to pull the plastic cap from the end of the needle but it would not come off. “Christ,” he yelled and flung the syringe against the wall in utter frustration. He tore the cellophane cover from another syringe and managed to get the cap off the needle. Mary Abruzzi tried to hold the lidocaine bottle for him but his trembling hands made it impossible. He snatched the bottle from her and thrust in the needle.

“Holy shit, this guy’s going to arrest,” said Dr. Colbert in disbelief. He was staring at the monitor. The needle holder was still in his right hand; a pair of fine-toothed forceps were in his left hand.

Dr. Goodman filled the syringe with the lidocaine, dropping the bottle in the process so that it shattered on the tile floor. Struggling with his trembling he tried to insert the needle into the I.V. line and succeeded only in jabbing his own index finger, bringing a drop of blood. Glen Campbell whined in the background from the transistor.