very interesting information. The complication of prolonged coma after anesthesia is about one hundred times more prevalent here at Memorial than the incidence given for the rest of the country over the past year. Mark, I think I’m onto something.
When I started, it was more of an emotional thing which I thought I could work out in a day or two here in the library. But one hundred times!
God, I could be on the track of something big, like a new disease, or a lethal combination of normally safe drugs. What if this is some sort of viral encephalitis, or even the result of a previous infection which makes the brain somehow more susceptible to certain drugs or mild lack of oxygen?”
Susan had been part of the medical world for only two years, and yet she was already cognizant of the potential benefits which would accrue to someone who discovered a new disease or syndrome. She thought this one might become known as the Wheeler syndrome, and Susan’s success within the medical community would be guaranteed. More often than not, the discoverer of the new disease became far more famous than the discoverer of the cure for the same disease. Eponyms abound in medicine like the tetralogy of Fallot, Cogan’s disease, the Tolpin syndrome, or Depperman’s degeneration. Whereas names like the Salk vaccine are an anomaly. Penicillin is called penicillin, not Fleming’s agent.
“We could call it the Free Wheeler Syndrome,” said Susan, allowing herself to laugh at her own enthusiasm.
“Christ,” said Bellows, cradling his head in his hands. “What an imagination. But that’s OK. Naivete has a certain license. But, Susan, you are in a real world situation with certain specific responsibilities. You are still a medical student, low man—or woman—on the totem pole. You’d better get your tail in gear and honor your surgery rotation obligations or, believe me, your ass will be grass. I’ll give you one more day for this project, provided you show up for rounds in the morning. After that you work on it in your free time. Now, if I need you I’ll page Dr. Wheels instead of Wheeler, so answer it, understand?”
“Understood,” said Susan looking squarely at Bellows. “I’ll do that, if you do something for me.”
“What’s that?”
“Pull out these articles and have them Xeroxed. I’ll pay you later.”
Susan tossed her list of references to Bellows, jumped up from the table and breezed out of the room before Bellows could respond. He found himself looking at a list of thirty-seven journal articles. Since he knew the library like the bones of his hand, he located the volumes with ease, marking each article with a piece of paper. He took the first group over to the desk and told the girl to copy the indicated articles and put it on his library charge. Bellows knew that he had been manipulated again, but he didn’t mind. It had taken only ten minutes. He would get them back with interest.
And he had been right; she had a dynamite figure.
Monday, February 23, 5:05 P.M.
As she had been telling Bellows that the incidence of coma following anesthesia at the Memorial was one hundred times the national incidence, Susan had realized that she was basing her calculations on the six cases Harris had mentioned in his outburst. Susan had to check that figure. If it was actually higher, she would have more ammunition to base her commitment to the project. Besides, she needed the names of the coma victims so that she could obtain then” charts. What she needed more than anything else, she recognized, was hard data.
Susan knew that she had to get access to the central computer. Harris would be unwilling to supply the names of the patients. Susan was certain of that. Bellows might have been able to get them if he were sufficiently motivated. But that was a big if. Susan felt that the best route was for her to try to get the information herself. So she was thankful she had taken the introductory course in PL 1 computer programming as a junior in college. Already it had paid off in surprising ways, and her need for the information at hand was just another example.
The computer center in the hospital was located in the Hardy wing, occupying the entire top floor. Many people joked about the symbolic aspects of the computer being above everything else in the hospital, and it had added a new meaning to the phrase “with a little help from above.”
As the elevator door slid open on the foyer of the eighteenth floor, Susan knew she was going to have to improvise if she were to be successful. Beyond the foyer Susan could see through glass partitions into the main computer reception area. The place had the appearance of a bank. The only difference was that the medium of exchange here was information, not currency.
Susan entered the reception room and walked directly to a counter top that ran the length of the room along the right wall. There were about eight other people in the room, most of them sitting in comfortable-looking blue corduroy chairs. A few were at the counter top bent over computer request forms. All looked up as Susan traversed the room, but they quickly returned to their own affairs. Without the slightest hint of uncertainty Susan took one of the computer request forms. Ostensibly concentrating on the form, Susan had her real attention on the room.
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.
