Coma

“And you must be assured that we investigated the anesthesia complication cases ad nauseam. Everything—and I mean everything—was studied with a fine-tooth comb by a host of people, anesthesiologists, epidemiologists, internists, surgeons ... everybody we could think of.

Except, of course, a medical student.”

Stark smiled warmly and Susan found herself responding to the man’s renowned charisma.

“I believe,” said Susan, her confidence rallying, “the study should start with the central computer bank. The computer information I obtained was only for the past year and called up by an indirect method. I have no idea what data would emerge if the computer was asked directly for all cases over, say, the last five years of respiratory depression, coma, and unexplained death.

“Then with a complete list of the potentially related cases, the charts would have to be painstakingly reviewed to try to elicit any common denominators. The families of the involved patients would have to be interviewed to obtain the best possible record of previous viral illness and patterns of illnesses. The other task would be to obtain serum from all existing cases for antibody screens.”

Susan watched Stark’s face, intently preparing herself for an untoward response like that she had experienced with Nelson and then more dramatically with Harris. In contrast, Stark maintained an even expression, obviously in thought over Susan’s suggestions. It was apparent that he had an open, innovative mind. Finally he spoke.

“Shotgun-style antibody screening is not very productive; it is time-consuming and it is horribly expensive.”

“Counter-immunoelectrophoresis techniques have relieved some of these disadvantages,” offered Susan, encouraged by Stark’s response.

“Perhaps, but it still would represent an enormous outlay of capital with a very low probability of positive results. I’d have to have some specific evidence before I could justify that type of resource commitment. But maybe you should suggest this to Dr. Nelson, down in Medicine.

Immunology is his special field.”

“I don’t think Dr. Nelson would be interested,” said Susan.

“Why is that?”

“I haven’t the faintest idea. To tell the truth, I already spoke with Dr.

Nelson. So I already know he’s not interested. And he wasn’t the only one. I mentioned my ideas to another department head and I thought I was going to get swatted like some naughty child that needed chastising.

Trying to incorporate that episode into the whole picture, I get a feeling that something else could be operating here.”

“And what is that?” asked Stark, glancing over the figures Susan had provided.

“Well, I don’t know what word to use ... foul play ... or something sinister.”

Susan stopped talking quite suddenly, expecting either laughter or anger. But Stark merely rotated in his chair, looking out over the city again.

“Foul play. You do have an imagination, Dr. Wheeler, no doubt about that.”

Stark turned back toward the room, rising up and walking around his desk.

“Foul play,” he repeated. “I must admit I’d never even considered that.”

Stark had been briefed only that morning about Cowley’s discovery of the drugs in locker 338; that information had disturbed him. He leaned against his desk and looked down at Susan.

“If you think about foul play, motive becomes of paramount importance.

And there just isn’t any motive for such a series of heartbreaking episodes. They are too dissimilar. And coma? You’d have to implicate some very clever psychopath operating on a premise that’s beyond rationality. But the biggest problem with the idea of foul play is that it would be impossible in the OR. There are too many people involved who are watching the patient too closely.

“Certainly investigative activities should be carried out with an open mind, but I don’t think foul play is possible in this instance. But, I must admit, I had not thought of it.”

“Actually,” said Susan, “I hadn’t planned on suggesting foul play to you, but I’m glad that I did so that I can forget it. But back to the problem itself. If antibody screening is too expensive, the chart review and interviews would, be comparatively cheap. I could take that on myself, except I’d need a little help from you.”

“What kind of help?”

“First of all, I’d need to have authorization to use the computer. That’s number one. Secondly, I’d need authorization to get the charts. Thirdly, I may have run into a problem downstairs.”

“What kind of a problem?”

“Dr. Harris. He’s the one who blew his cool. I think he intends to have my surgical rotation here at the Memorial cut short. It seems that he is not fond of women in medicine, and perhaps I have served to underline that prejudice.”

“Dr. Harris can be difficult to get along with. He’s an emotional type.