“Couldn’t an overdose of succinylcholine be the way these patients are rendered hypoxic? If they can’t breathe, then oxygen doesn’t get to the brain.”
“Susan, the anesthesiologist gives succinylcholine and then monitors the patient like a hawk; he even breathes for the patient. If there is too much succinylcholine, it just means the anesthesiologist has to breathe the patient for a longer time until the patient metabolizes the drug. The paralyzing effect is completely reversible. Besides, if something like that were being done maliciously, all the anesthesiologists in the hospital would have to be involved, and that’s hardly likely. And maybe even more important is the fact that under the combined eye of the anesthesiologist and the surgeon, who can actually see how red the blood is and how well it is oxygenated, it would be absolutely impossible to alter the patient’s physiologic state without one or both knowing it. When blood is oxygenated, it is bright red. When oxygen gets low, the blood becomes dark brownish-bluish-maroon. The anesthesiologist meanwhile is breathing the patient, constantly checking the pulse and blood pressure, and watching the cardiac monitor. Susan, you are hypothesizing some sort of foul play, and you don’t have a why or a who or a how. You’re not even sure you have a victim.”
“I’m sure I have a victim, Mark. It might not be a new disease but it’s something. One more question. Where do the anesthetic gases come from that the anesthesiologists use?”
“It varies. Halothane comes in cans like ether. It’s a liquid and it’s vaporized as needed in the OR. Nitrous, oxygen, and air come from central sources and are piped into the OR’s. There are standby cylinders of oxygen and nitrous oxide in the OR for emergency use. ... Look, Susan, I’ve got a little more work to do, then I’m free. How about coming over to the apartment for a drink?”
“Not tonight, Mark. I want to get a good night’s sleep and I’ve got a few more things to do. But thanks. Also, I’ve got to get these charts back to their hiding place. After that I intend to look around in OR room number eight.”
“Susan, I personally think you should get your ass out of this hospital before you really get yourself in hot water.”
“You’re entitled to your opinion, doctor. It’s just that this patient doesn’t feel like following orders.”
“I think you’re carrying all of this too far.”
“You do, do you? Well, I might not have a who, but I’ve got a number of suspects. ...”
“Sure you do. ...” Bellows fidgeted. “Are you going to make me guess or are you going to tell me?”
“Harris, Nelson, McLeary, and Oren.”
“You’re out of your squash!”
“They all act as guilty as hell and want me out of here.”
“Don’t confuse defensive behavior with guilt, Susan. After all, complications are hard to live with in medicine, no matter from what cause.”
Wednesday, February 25, 11:25 P.M.
Susan felt a definite sense of relief when she had returned the charts to their hiding place in McLeary’s closet. At the same time, she was very disappointed. Having finally inspected them was an anticlimax of sorts.
She had placed a great deal of emphasis on the importance of the charts, but after she had finished studying them, she felt no further in her mission. She had a lot more data but no correlates, no intercepts.
The cases still seemed to be random and unassociated.
The elevator slowed and stopped, the door quivered, then opened. Susan stepped out into the OR area. There was still a case going on in room No.
20, a ruptured abdominal aneurysm that had been admitted through the emergency room. The operation had been in progress for over eight hours; that didn’t look so good. Otherwise the OR area was in its nightly repose. There were a few people busy cleaning the floor and restocking the supply room with freshly laundered linen. A girl in a scrub dress was behind the main desk, trying to fit the last few cases into the following day’s master schedule.
The nurse’s uniform ruse was still working well for Susan and the few people in the hall did not seem to notice her passing. She went directly to the nurses’ locker rooms and changed into a scrub dress, hanging the nurse’s uniform in an open locker.
Reentering the main hall, Susan eyed the swinging doors into the area of the operating rooms. A large sign on the right door said “Operating Rooms: Unauthorized Entry Forbidden.” The main desk was just to the side of these doors. The nurse sitting behind the desk was still hard at work. Susan had no idea if she would be challenged if she tried to enter.
In order to survey the scene in its totality, Susan walked the length of the hall several times, half-hoping the girl at the main desk would take a break and leave. But she didn’t budge, nor even look up. Susan tried to think of some appropriate explanation in case the girl questioned her. But she couldn’t think of any. It was almost midnight and she knew she’d have to have some reasonably convincing story to explain her presence.
Finally, with no cover story in mind except for some weak comment about wanting to check on progress in room No. 20, or being sent up from the lab to do random cultures for contamination, Susan made her move.
Pretending not to notice the girl at the desk, she headed for the doors.
As she passed, the girl did not look up. A few more steps. When Susan reached the doors, she straight- armed the one on the right. It opened and Susan was about to enter.
“Hey, just a minute.”
Susan froze, waiting for the inevitable. She turned to face the girl.
“You forgot your conductive boots.”
Susan looked down at her shoes. As it dawned on her what the nurse was concerned about, Susan felt relieved.
“Damn, you’d think this was my second time in the OR.”
The nurse’s attention went back to the master schedule. “I forget the bastards now and then myself.”
Susan walked over to a stainless steel cabinet against the wall. The conductive booties—designed to prevent static electricity, so hazardous where inflammable gas was flowing—were kept in a large cardboard box on the lower shelf. Susan put them on the way Carpin had shown her on the first visit to the OR two days before, tucking the black tapes inside her shoes. When she opened the swinging door the second time, the nurse at the desk didn’t even look up. The Memorial was large enough so that new faces were to be expected.
The operating rooms at the Memorial were grouped in a large U-shape with supply, holding area, and anesthesia offices in the center. The entrance to the OR area was at the bottom of the U and the recovery room was on the left arm of the U, closest to the elevators. Susan found that room No. 8 was on the right arm of the U, on the outside.
No. 20, where the operation continued, was in the opposite direction, and Susan found herself quite alone approaching room No. 8. Pausing at the door, she looked through the glass. It looked exactly like room No.
18, where Niles had passed out. The walls were tile, the floor a speckled vinyl. Although the lights were out, Susan could see the large kettledrum operating lights above, and the operating table immediately below. She opened the door and turned on the lights.
Without any specific objective in mind, Susan roamed around the room, noticing the larger objects. Then in a more systematic fashion she began to examine details. She found the gas line terminals, noticing that oxygen had a green male connector. The nitrous connector was blue and structurally different so that no mistake could be made. A third male connector was not labeled or colored. Susan assumed it was the compressed air line. A larger female connector was labeled “suction”; above it was a gauge with a large adjusting dial.
In the back of the room were a number of stainless steel cabinets filled with various supplies. There was a desk of sorts for the circulating nurse. The right wall had an X-ray screen. The rear wall, next to the door, had a large institutional clock. The large red second hand swept around smoothly. Another door led into an adjoining supply room, shared with OR No. 10, which contained the sterilizers and other paraphernalia.
Susan spent almost an hour going over room No. 8, as well as No. 10 for comparison. She found nothing abnormal or even mildly curious about room No. 8. It was an OR room like so many thousands. No. 10 appeared no different.
Without challenge, Susan retraced her steps to the nurses’ locker room and changed back into her nurse’s uniform. She threw her scrubdress into a hamper and started for the door. But she paused then, looking up at the
