Coma

In the back of the room, about twelve feet from Susan, was a large white Formica desk. Above it hung a sign: “Information.” It was so appropriate that it brought a smile to Susan’s face. The man at the desk sat motionlessly, a slight proud smile on his face. He was about sixty, pudgy but neat. Behind him, visible through another glass partition, were the gleaming input-output terminals of the computer itself. While Susan was pretending to be absorbed in the form in front of her, the man at the desk accepted several computer request forms. Each time he went over the form, converting the request to computer language and writing it on the lower portion of the form. He also checked the authorization by calling the department involved, unless he knew the requesting individual personally. Finally he placed the form—or several stapled together—in the “in” box on the corner of the desk. The requesting individual was told when to expect the information, depending on the priority assigned to the request.

Having assessed the procedure, Susan gave full attention to the form before her. It was certainly simple enough. She filled in the date in the indicated box. She left blank the box for the authorizing department, and she also omitted the name of the requesting party or organization.

Susan also left blank the box reserved for method of payment for computer time. She concentrated on the information desired. Susan was not sure how she should word the request for several reasons. One was the concern that the hospital might be uptight about leaking information on cases of coma resulting from anesthesia. Perhaps they might have programmed a subroutine into the computer so that any requests for information would be automatically canceled, or at least alert the computer that the information had been requested. Another point that occurred to Susan was that a disease or disease process might have several modes or degrees of expression. Prolonged coma after an anesthetic might be one of them, maybe the most severe. Susan wanted to obtain a wide range of information and in that way be able to select what she thought was significant.

But requesting all cases of coma for the past year might yield a printout that was too extensive. Since coma was a symptom and not a disease itself, Susan could end with a list of every heart attack, stroke, and cancer victim who had succumbed to those diseases over the last year. Susan decided to call only for cases of coma occurring in people who had no known chronic or debilitating disease. Then she realized that she was already making assumptions. If she were on the track of a new disease, there was no reason why it couldn’t affect people who had other diseases. In fact, if it were infectious in nature, other disease processes would encourage its expression by lowering defenses.

Susan changed her request to all cases of coma occurring to inpatients (in hospital) which were unrelated to the patient’s known disease processes. Susan next asked for a correlate between her sample and those having surgery during their stay at the Memorial prior to their coma, with a time correlation between surgery and the onset of the coma. With a certain amount of difficulty Susan translated her request into computer language. She had not used it for almost a year, and it took a few moments to get it right. This portion of the request was below two red lines and the admonishment “Do not write below this line.”

Susan then waited for the next request to be turned in to the man at the desk. Luckily she did not have to wait long. About four minutes after she finished writing, the elevator arrived. Through the glass she saw a man squeeze past the elevator door before it had fully opened and approach the reception desk at a lope. About forty, slight of build, with flaxen hair parted from a deeply recessed hairline, the man waved a handful of the computer request forms nervously.

“George,” said the man pulling up in front of the reception desk, “you gotta help me.”

“Ah, my old friend Henry Schwartz,” said the man behind the desk.

“We’re always ready to help the accounting department. After all, that’s where our checks come from. What can I do for you?”

Susan carefully penciled in “Henry Schwartz” onto her own form in the box for the requesting party. In the area for authorizing department, Susan wrote “Accounting.”

“I need a couple of things, but most of all I need a list of all the Blue Cross-Blue Shield subscribers who have had surgery in the last year,”

said Schwartz in a rapid-fire fashion. “If you asked why I need it, you’d crack up, I swear you would. But I need it and fast. The day shift was supposed to have had it ready for me.”

“We can run it in an hour or so. I’ll have it for you by seven,” said George, stapling Schwartz’s requests together and tossing them into the box.