behind the main boilers. He returned to his papers but found himself staring ahead, trying to understand what could have caused the kind of sound he had heard. It had a sharp, brief metallic resonance foreign to the indigenous sounds of the area. Finally curiosity got the best of him and he wandered over to the main boiler. To get near to the electrical panel situated next to the main chase, which contained all the piping rising up in the building, he had to go around the boiler in either direction. He chose to go right, which gave him an opportunity to check the gauges on the boiler. This was an unnecessary maneuver because the system had been fully automated with backup safety devices and automatic cutoff switches. But it was an instinctive move for Kelley, having originated in the days when the boiler had to be watched minute by minute. So as he rounded the boiler his eyes were on the system, his mind appreciating its marvelous compactness compared to the system when he had started at the Memorial. When he looked ahead toward the electrical panel, he froze in his tracks, his right arm lifted involuntarily in self- defense.
“God, you scared the life out of me,” said Kelley, catching his breath and allowing his arm to come back to his side.
“I could say the same,” said a slim man dressed in a khaki uniform. The shirt was open at the neck, and the man wore a white crew neck t-shirt which reminded Kelley of navy chiefs during his wartime duty. The man’s left breast pocket bulged with pens, small screwdrivers, and a ruler.
Above the pocket was embroidered “Liquid Oxygen, Inc.”
“I had no idea anyone else was in here,” said Kelley.
“Same with me,” said the man in khaki.
The two men looked at each other for a moment. The man in khaki was carrying a small green cylinder of compressed gas. A flow meter was attached to the cylinder head. “Oxygen” was stenciled plainly on the side.
“My name is Darell,” said the man in khaki. “John Darell. Sorry to have scared you. I’ve been checking the oxygen lines out to the central storage tank. Everything seems fine. In fact, I’m on my way out Could you tell me the shortest route?”
“Sure. Through those swinging doors, up the stairway to the main hall.
Then you have a choice. Nashua Street is to the right, Causeway Street to the left.”
“Thanks a million,” said Darell, heading for the door.
Kelley watched him leave, and then looked around in disbelief. He couldn’t figure how Darell had managed to get where he had been without being noticed. Kelley had no idea he could get so absorbed in his Goddamn paperwork.
Kelley walked back to his desk and returned to work. After a few minutes he thought of something else that bothered him. There were no oxygen lines in the boiler room. Kelley made a mental note to ask Peter Barker; assistant administrator, about oxygen line checks. The trouble was that Kelley had a poor memory for everything except mechanical details.
Monday, February 23, 3:36 P.M.
With the cloud cover Boston had enjoyed little daylight that day, and by 3:30 dusk settled over the city. It took a bit of imagination to comprehend that above the clouds shone the same six-thousand-degree fiery star which in summer turned the macadam on Boylston Street molten. The temperature had responded to the surrendering sun by precipitously falling to nineteen degrees. Another flurry of minute crystalline bodies wafted over the city. The outside lights along the hospital walkways had been on for almost a half-hour.
From within the illuminated library, it already appeared pitch black outside. The two-story window at the end of the room responded to the dropping temperature by starting an active convection current of cold air across its face. The weighted colder air fell to the floor at the foot of the window and then swept the length of the room under the tables toward the hissing radiators in the back. It was the cold current which first began “to nudge Susan from the depths of her intense concentration.
As with so many academic subjects, Susan began to perceive that the more she read about coma, the less she felt she knew. To her surprise, it was an enormous subject, spanning many disciplines of medical specialization. And perhaps the most frustrating of all was Susan’s realization that it was not known what determined consciousness, other than saying that the individual was not unconscious. The definition of one consisted of being the opposite of the other. Such a tautologous circle was a travesty of logic until Susan accepted the fact that medical science had not advanced enough to define consciousness precisely. In fact, being fully conscious and being totally unconscious (coma) seemed to represent opposite ends of a continuous spectrum which included partway states like confusion and stupor. Hence the inexact, unscientific terms were more an admission of ignorance than poorly conceived definitions.
Despite the semantics Susan was well aware of the stark difference between normal consciousness and coma. She had observed both states that very day in a patient ... Berman. And despite the lack of precision in definition, there was no lack of information regarding coma. Under the heading of “acute coma,” Susan began to fill page after page in her notebook with her characteristically small handwriting.
Her particular interest was in causation. Since science had not decided on what particular aspect of brain function had to be disrupted, Susan had to be content with precipitating factors. Being interested in acute coma, or coma of sudden onset, also helped to narrow the field but still was impressive and growing. Susan looked back over the list of causes that she had noted so far:
Trauma = concussion, contusion, or any type of stroke Hypoxia = low oxygen:
(1) mechanical
—strangulation
—blocked airway
—insufficient ventilation
(2) lung abnormality
—alveolar block
(3) vascular block
—blood cannot get to brain
(4) cellular block of oxygen use High Carbon Dioxide Hyper (hypo) Glycemia = high (low) blood sugar Acidosis = high acid in the blood
Uremia = kidney failure with high uric acid in the blood Hyper (hypo) Kalemia = high (low) potassium
Hyper (hypo) Natremia = high (low) sodium
Hepatic Failure = increase of toxins which would normally be detoxified by the liver
Addison’s Disease = severe endocrine or glandular abnormality Chemicals or Drugs ...
Susan took an extra couple of pages for the chemicals and drugs associated with acute coma and listed them alphabetically, each with a separate line to make it possible to add information as she got it: Alcohol
Insulin
Amphetamines
Iodine
Anesthetics Mercurial
diuretics
Anticonvulsants
Metaldehyde
Antihistamines
Methyl bromide
Aromatic hydrocarbons
Methyl chloride
Arsenic
Naphazoline
Barbiturates Naphthaline
Bromides
Opium
derivatives
