is the cause of the coma that is important. What is the cause of the coma you have become interested in?”
“I don’t know. In short, that’s why I’m interested in it I’m interested in the kind, of coma that just seems to happen and no cause is found.”
“Are you concerned with emergency room patients or in-hospital patients?” asked Dr. Nelson, whose voice changed slightly.
“Inpatients.”
“Are you referring to the few cases that have occurred during surgery?”
“If you call seven few.”
“Seven,” said Dr. Nelson taking several long pulls from his pipe, “I believe is a rather high estimate.”
“It’s not an estimate. Six previous cases occurred during surgery.
Presently there is another case upstairs, operated on yesterday, that appears to fit into the same category. In addition, there have been at least five cases on the medical floor occurring in patients admitted for some seemingly unrelated complaint.”
“How did you get this information, Miss Wheeler?” asked Dr. Nelson with an altogether different tone of voice. The previous warmth was gone. His eyes regarded Susan without blinking. Susan was unaware of this change in apparent mood.
“I got the information from this computer printout right here.” Susan leaned forward with the printout and handed it across the desk to Dr.
Nelson. “The cases I’ve mentioned have been indicated with yellow ink.
You’ll see that there is no mistake. Besides, this represents only coma cases for the last year. I don’t know what the incidence was before then, and I think it would be essential to get a year-by-year printout. In that way one could have a better idea if this problem is static or on a dynamic upswing. And perhaps even more important, or at least equally important, I have a feeling that a number of sudden deaths here at the Memorial could be ascribed to the same unknown category. I believe the computer could help on that as well. Anyway, it is for these reasons that I wanted to speak with you. I was wondering if you would support me on this endeavor. What I need is full clearance to use the computer and the opportunity to get the hospital charts on these patients. I came to you because I have an intuitive feeling that it represents some sort of unknown medical problem.”
With her case presented, Susan allowed herself to sit back into the chair. She felt she had put the matter fairly and completely; if Dr.
Nelson was going to be interested, he certainly had enough to go on to make up his mind.
Dr. Nelson did not speak right away. Instead he continued to regard Susan; then he studied the printout, taking short, quick puffs on his pipe.
“This is all very interesting information, young lady. Of course I have been aware of the problem. However, there are other implications in these statistics and I can assure you that this apparent high incidence is occurring because ... well, frankly ... we have been lucky over the last five or six years that we haven’t had any such cases. Statistics have a way of catching up with you, though ... and indeed that seems to be the case at present. As to your request, I’m afraid I’m not in a position to grant it.
You undoubtedly understand one of the major impediments to our establishing our central computer information bank was the creation of adequate safeguards concerning the confidentiality of most of the information stored. It is impossible for me to give blanket authorization.
In fact, this type of endeavor is really ... what should I say ... hmm ...
beyond ... or above that which a medical student of your level is equipped to deal with. I think it would be in everyone’s best interest, yours included, if you would limit your research interests to more scientific projects. I’m certain I could find room for you in our liver lab, if you were interested.”
Susan was so accustomed to academic encouragement that she was totally caught off guard by Dr. Nelson’s negative response to her investigation. Not only was he not interested, but he was obviously trying to talk Susan out of the project as well.
Susan hesitated, then stood up.
“Thank you very much for the offer. But I’ve just gotten so involved with this study that I think I’ll follow it up for a while.”
“Suit yourself, Miss Wheeler. But I’m sorry; I cannot help you.”
“Thank you for your time,” said Susan, reaching out for her computer printout.
“I’m afraid this information cannot be made available for you any longer,” said Dr. Nelson interposing his hand between Susan’s and the IBM sheet.
Susan kept her hand extended for a second of indecision. Once again Dr. Nelson had caught her off guard with an unexpected response. It seemed absurd that he would actually have the gall to confiscate material she already had.
Susan did not say another word and she avoided looking at Dr. Nelson.
She got her things together and left. Dr. Nelson instantly picked up the telephone and placed a call.
Tuesday, February 24, 10:48 A.M.
In Dr. Harris’s office there was an entire bookcase full of the latest books on anesthesiology, some still in prepublication bound galleys, sent for his endorsement. For Susan this was a boon, and her eyes scanned the titles for any books specifically on complications. She located one, and she wrote down the title and publisher. Next she looked for any general texts which she had not seen in the library. And her eyes registered another find: Coma: Pathophysiological Basis of Clinical States. Excitedly she withdrew the volume and thumbed through it, noticing the chapter headings. She wished she had had the book at the onset of her reading.
The door to the office opened and Susan looked up to face Dr. Robert Harris for the second time. Instantly she felt a certain sense of intimidation or scorn as Dr. Harris regarded her without the slightest sign of recognition or friendliness. It had not been Susan’s idea to wait for him in his office; it had been the direct order of the secretary who had arranged the meeting for Susan. Now Susan felt an uneasiness, as if she were an interloper in Dr. Harris’s private sanctum. The fact that she was holding one of his books made it that much worse.
“Be sure to put the volume back where you found it,” said Harris as he turned to close the door, his speech slow and deliberate as if addressed to a child. He removed his long white coat and hung it on the hook on the back of the door. Without another word he retreated behind his desk to open a large ledger and make several notations. He acted as if Susan were not even there.
Susan closed the textbook and replaced it on the shelf. Then she returned to the director’s chair in which she had started her wait for Dr. Harris thirty minutes before.
The only window was directly behind Harris, and its light, combining with the overhead fluorescent light, gave a strange shimmering quality to Harris’s appearance. Susan had to squint against the glare coming directly at her.
The smooth tawny color of Harris’s arms was a perfect setting for the gold digital watch on his left wrist. His forearms were massive, tapering to surprisingly narrow shafts. Despite the time of year and the temperature, Dr. Harris was dressed in a short-sleeved blue shirt.
Several minutes went by before he finished with the ledger. After closing the cover he pressed a buzzer for his secretary to come in and take it. Only then did he turn and acknowledge Susan’s existence.
“Miss Wheeler, I am certainly surprised to see you in my office.” Dr.
Harris slowly leaned back in his chair. He seemed to have some difficulty looking directly at Susan. Because of the background lighting Susan could not see the details of his face. His tone was cold. There was a silence.
“I would like to apologize,” began Susan, “for my apparent impertinence yesterday in the recovery room. As you probably are aware, this is my first clinical rotation, and I’m unaccustomed to the hospital environment, particularly to the recovery room. On top of that there had been a strange coincidence. About two hours prior to our meeting I had spent some time with the very patient you were attending. I had started his I.V. prior to surgery.”
Susan paused, hoping for some sign of acknowledgment from the faceless figure in front of her. There was none. There was no movement whatsoever. Susan continued.
“The fact of the matter was that my conversation with the patient had not remained on an entirely
