Coma

It wasn’t that Bellows didn’t care about the human element, it was just that he didn’t have time for it. Besides the sheer number of cases he had been and was involved with provided a, cushion or a numbness associated with anything done repeatedly. Bellows did not make the association between Susan’s and Nancy Greenly’s ages, nor did he remember the emotional susceptibility associated with an individual’s initial clinical experiences in the hospital environment.

“Now for the hundredth time, let’s get back to work,” said Bellows, pulling his chair in closer to the desk and running his hand nervously through his hair. “He looked at his watch before going back to his calculations. “OK, if we use 1/4 normal saline, let’s see how many milliequivalents well get in 2500 cc.”

Susan was totally detached from the conversation, almost in a fugue.

Following some inner curiosity, she moved around the desk and approached Nancy Greenly. She moved slowly, warily, as if she were approaching something dangerous, and absorbing all the details of the scene as they came available. Nancy Greenly’s eyes were only half closed and the lower edges of her blue irises were visible. Her face was a marble white, which contrasted sharply with the sable brown of her hair.

Her lips were dried and cracked, her mourn held open with a plastic mouthpiece so she wouldn’t bite the endo-tracheal tube. Brownish material had crusted and hardened on her front teeth; it was old blood.

Feeling slightly giddy, Susan looked away for a moment and then back.

The harshness of the image of the previously normal young woman made her tremble with undirected emotion. It wasn’t sadness per se. It was another kind of inner pain, a sense of mortality, a sense of the meaningless of life which could be so easily disrupted, a sense of hopelessness, and a sense of helplessness. All these thoughts cascaded into the center of Susan’s mind, bringing unaccustomed moisture to the palms of her hands.

As if reaching for a delicate piece of porcelain, Susan lifted one of Nancy Greenly’s hands. It was surprisingly cold and totally limp. Was she alive or dead? The thought crossed Susan’s mind. But there directly above was the cardiac monitor with its reassuring electronic blip tracing excitedly its pattern.

“I shall assume you are a whiz at fluid balance, Miss Wheeler,” said Bellows at Susan’s side. His voice broke the semitrance Susan had assumed and she replaced carefully Nancy Greenly’s hand. To Susan’s surprise the whole group had moved over to the bedside.

“This, everybody, is the CVP line, the central venous pressure,” said Bellows holding up the plastic tube whose tip snaked into Nancy Greenly’s neck. “We just keep that open for now. The I.V. goes in the other side, and that’s where we’ll hang our 1/4 normal saline with the 25

milliequivalents of potassium to run at 125 cc per hour.”

“Now then,” continued Bellows after a slight pause, obviously thinking while looking vacantly at Nancy Greenly, “Cartwright, be sure to order electrolytes on her urine today but leave the standing order for daily serum electrolytes. Oh yeah, include magnesium levels too, OK.”

Cartwright was madly writing these orders down on the index card he had for Nancy Greenly. Bellows took his reflex hammer and absently tried for deep tendon reflexes on Nancy Greenly’s legs. There were none.

“Why didn’t you do a tracheostomy?” asked Fairweather.

Bellows looked up at Fairweather and paused. “That’s a very good question, Mr. Fairweather.” Bellows turned to Cartwright, “Why didn’t we do a tracheostomy, Daniel?”

Cartwright looked from the patient to Bellows, then back to the patient He became visibly flustered and consulted his index card despite the fact that he knew the information was not there.

Bellows looked back at Fairweather. “That’s a very good question, Mr.

Fairweather. And if I remember correctly I did tell Dr. Cartwright to get the ENT boys over here to do a trach. Isn’t that right, Dr.

Cartwright?”

“Yeah, that’s right,” enjoined Cartwright “I put in the call but they never called back.”

“And you never followed up on it,” added Bellows with uncamouflaged irritation.

“No, I got involved ...,” began Cartwright.

“Cut the bullshit, Dr. Cartwright,” interrupted Bellows. “Just get the ENT boys up here stat. It doesn’t look like this one is going to come to, and for long-term respiratory care we need a trach. You see, Mr.

Fairweather, the cuffed endo-tracheal tube will eventually cause necrosis of the walls of the trachea. It is a good point.”

Harvey Goldberg fidgeted, wishing he had asked Fairweather’s question.

Susan revived from the depths of her daydream as a result of me verbal exchange between Bellows and Cartwright.

“Does anybody have any idea why this horrible thing has happened to this patient?” asked Susan.

“What horrible thing?” asked Bellows nervously while he mentally checked the I.V., the respirator, and the monitor. “Oh, you mean the fact that she never woke up. Well ...” Bellows paused. “That reminds me.