Coma

Dr. Goodman liked droperidol and fentanyl best of the agents cleared for use. After they were given, the patient was put to sleep with Pentothal and maintained asleep on nitrous oxide. Curare was used to paralyze the skeletal muscles for entubation and surgical relaxation. During the case aliquots of the neurolept and analgesic agents were used as needed to maintain the proper depth of anesthesia. The patient had to be watched very closely through all this, and Dr. Goodman liked that. For him the time passed more quickly when he was busy.

The OR door was opened by one of the orderlies helping to guide Berman’s gurney into room No. 8. Mary Abruzzi was pushing.

“Here’s your baby, Dr. Goodman. He’s sound asleep,” said Mary Abruzzi.

They put down the arm rails.

“OK, Mr. Berman. Time to move over onto the table.” Mary Abruzzi gently shook Berman’s shoulder. He opened his eyelids about halfway.

“You have to help us, Mr. Berman.”

With some difficulty they got Berman over onto the table. Smacking his lips, turning on his side, and drawing up the sheet around his neck, Berman gave the impression that he thought he was home in his own bed.

“OK, Rip Van Winkle, on your back.” Mary Abruzzi coaxed Berman onto his back and secured his right arm to his side. Berman slept, apparently unaware of the activity about him. The cuff of the pneumatic tourniquet was placed about his right thigh and tested. The heel of his right foot was placed in a sling and hung from a stainless steel rod at the foot of the operating table, lifting the entire right leg. Ted Colbert, the assisting resident, began the prep by scrubbing the right knee with pHisoHex.

Dr. Goodman went right to work. The time was 12:20. Blood pressure was 110/75; pulse was seventy-two and regular. He started an I.V. with deftness which belied the difficulties of handling a large-bore intravenous catheter. The whole process from skin puncture to tape took less than sixty seconds.

Mary Abruzzi attached the cardiac monitor leads, and the room echoed with the high-pitched but low-amplitude beeps.

With the anesthesia machine rigged and ready, Dr. Goodman attached a syringe to the I.V. line.

“OK, Mr. Berman, I want you to relax now,” kidded Dr. Goodman, smiling at Mary Abruzzi.

“If he relaxes any more, he’s going to pour off the table,” laughed Mary.

Dr. Goodman injected intravenously a 6 cc bolus of Innovar, the same droperidol and fentanyl combination that had been used as the pre-op medication. Then he tested the lid reflex and noted that Berman had already achieved a deep level of sleep. Consequently Dr. Goodman decided that the Pentothal was not needed. Instead he began the nitrous oxide/oxygen mixture by holding the black rubber mask over Berman’s face. Blood pressure was 105/75; pulse was sixty-two and regular. Dr.

Goodman injected 0.40 mg of d-tubocurarme, the drug which represents a debt modern society owes to the Amazon peoples. There were a few muscle twitches in Berman’s body, then relaxation followed; breathing stopped. The entubation was rapid and Dr. Goodman inflated Berman’s lungs with the ventilating bag while he listened to each side of the chest with his stethoscope. Both sides aerated evenly and fully.

Once the pneumatic tourniquet was cajoled into functioning, Dr. Spallek breezed into the room, and the case went rapidly. Dr. Spallek was into the joint in one dramatic slice.

“Voilà,” he said, holding the scalpel in the air and tilting his head to admire his handiwork. “And now for the Michelangelo touch.”

Penny O’Rilley’s eyes rolled up inside of her head in response to Dr.

Spallek’s theatrics. She handed him the meniscus knife with a trace of a smile on her lips.

“Anoint my blade,” said Dr. Spallek holding the knife out for the resident to squirt irrigation fluid over its tip.

The knife was then inserted into the joint and for a few moments Dr.

Spallek rooted around blindly, his face upturned toward the ceiling. He was cutting by feel alone. There was a faint grinding sound, then a snap.

“OK,” said Dr. Spallek tightening his teeth, “here comes the culprit.”

Out came the damaged cartilage. “Now I want everyone to see this. See this little tear on the inside edge. That’s what’s been causing this chap’s problems.”

Dr. Colbert looked from the specimen to Penny O’Rilley. They both nodded approval while both secretly wondered if the little tear hadn’t been caused by the blind cutting with the meniscus knife.

Dr. Spallek stepped back from the table, pleased with himself. He snapped off his gloves. “Dr. Colbert, why don’t you close up. 4-0 chromic, 5-0 plain, then 6-0 silk for the skin, I’ll be in the lounge.” Then he was gone.

Dr. Colbert dabbed ineffectually at the wound for a few moments.

“How much longer do you estimate?” questioned Dr. Goodman over the ether screen.

Dr. Colbert looked up. “Fifteen or twenty minutes, I guess.” He palmed a pair of toothed forceps and took the first suture from Penny O’Rilley. He took a bite with the suture and Berman moved. At the same time Dr.