Coma

“As you can see, the patients are all suspended by wires under tension.

Some visitors react strongly to this, but it has proven to be the best method of long-term care, totally preserving the skin and minimizing nursing care. Its origin was in orthopedics, where wires are passed through bones to provide traction. Burn treatment research showed the benefits to be obtained when the skin does not rest on any kind of surface. It was a natural progression to apply the concept to the care of the comatose patient.”

“It is rather gruesome.” Susan recalled the upsetting image of the cadavers hung in the freezer. “What is the strange lighting?”

“Oh, yes, we should put on glasses if we stay in here much longer.”

Michelle fetched several pairs of goggles from a. table.

“There is a low-level of ultraviolet light in here. It has been found useful in controlling bacteria as well as helping to maintain the integrity of the skin.” Michelle offered a set of goggles to Susan, and they both put them on.

“The temperature in here is maintained at ninety-four point five Fahrenheit, plus or minus five hundredths of a degree. The humidity is held at eight-two percent with a one percent variance. That tends to reduce patient heat loss and hence reduces the patients’ caloric needs.

The humidity has reduced the respiratory infection problem, which you know is critical for coma patients.”

Susan was spellbound. She gingerly moved closer to one of the suspended patients. A profusion of wires perforated various long bones.

The wires then passed horizontally through an aluminum frame around the patient before running up to a complicated trolley device on the ceiling. Susan looked up at the ceiling and saw that it was a maze of tracks for the trolleys. All the I.V. lines, suction tubes, and monitoring lines from the patient ascended to the trolley. Susan looked back at Michelle. “And there are no nurses?”

“I happen to be a nurse, and there are two others on duty, plus one doctor. That’s quite a reasonable ratio for one hundred and thirty-one intensive care patients, wouldn’t you say? You see, everything is automated. The patient’s weight, blood gases, fluid balance, blood pressure, body temperature—in fact, an enormous list of variables—are being constantly scanned and compared to standards by the computer.

The computer actuates solenoid valves to rectify any abnormalities or discrepancies it finds. It is far better than conventional care. A doctor tends to concern himself with isolated variables and in a static fashion.

The computer is able to sample over time, hence it treats dynamically.

But more important still is that the computer correlates all the variables at any given moment. It’s much more like the bodies’ own regulatory mechanisms.”

“Modern medicine carried to the nth degree. It’s incredible, really it is.

It’s like some science fiction setting. A machine taking care of a host of mindless people. It’s almost as if these patients aren’t people.”

“They aren’t people.”

“I beg your pardon?” Susan looked up from the patient toward Michelle.

“They were people; now they’re brain stem preparations. Modern medicine and medical-technology have advanced to the point where these organisms can be kept alive, sometimes indefinitely. The result was a cost-effectiveness crisis. The law decided they had to be maintained.

Technology had to advance to deal with the problem realistically. And it has. This hospital has the potential to handle up to a thousand such cases at a time.”

There was something about the basic philosophy Michelle elucidated that made Susan uncomfortable. She also had a feeling that her guide had herself been very carefully indoctrinated. Susan could tell that Michelle did not question what she was saying. Nevertheless Susan did not dwell on the institute’s philosophical foundations. She was overwhelmed by the place’s physical aspects. She wanted to see more.

She looked around the room. It was more than a hundred feet long, with a fifteen- to twenty-foot ceiling. In the ceiling the maze of tracks was bewildering.

There was another door at the far end of the room. It was closed. But it was a normal door with normal hardware. Susan decided that only the doors they had so far traversed were centrally controlled. After all, most visitors, the families, never came into the main ward.

“How many operating rooms are there here in the Jefferson Institute?”

asked Susan suddenly.

“We don’t have operating rooms here. This is a chronic care facility. If a patient needs acute care, he is transferred back to the referring institution.”

The reply was so fast that it gave the impression of a reflex or trained response. Susan distinctly remembered seeing the ORs in the floor plans she had obtained at City Hall. They were on the second floor. Susan began to sense that Michelle was lying.

“No operating rooms?” Susan deliberately acted very surprised. “Where do they do emergency procedures, like tracheotomies?”