Coma

Bellows fixed his gaze on Carpin and continued, “Beard 5 rotation includes the surgical intensive care unit. Hence you will be subjected to an intensive teaching experience. That’s the good part. The disadvantage is that it occurs so early in your clinical exposure. I understand this is your first clinical rotation. Is that correct?”

Carpin looked from side to side to make sure that this last question was directed at him. “We ...” His voice faltered, and he cleared his throat.

“That’s right,” he managed to say with some difficulty.

“The intensive care unit,” continued Bellows, “is an area where you all have the most to learn, but it represents the most critical area for patient care. All the orders that you write on any patient must be countersigned by myself or one of the two interns on the service, whom you will meet presently. If you write orders in the ICU they have to be countersigned the moment you write them. Orders for patients on the ward can be countersigned en masse at various times during the day. Is that clear?”

Bellows looked at each student, including Susan, who returned his gaze without altering her neutral expression. Susan’s immediate impression of Bellows was not particularly favorable. His manner seemed artificial and his opening mini-lecture on punctuality seemed a little unnecessary so early in the course of events. The monotone of his remarks combined with the pitiful stab at philosophy tended to support the image Susan had begun to construct of the surgical personality from previous conversations and her reading ... unstable, egotistical, sensitive to criticism, and above all, dull. Susan did not notice that Mark Bellows was male. Such a thought did not even register in her mind.

“Now,” said Bellows in his artificial monotone, “I’ll have some schedules Xeroxed for you which will outline the basic calendar we’ll follow while you are assigned to Beard 5. The patients on the ward and in the ICU will be divided among you, and you are to work directly with the intern on the case. As for admissions, I want you to set up your own schedule for equitably dividing them. One of you will do a full workup on each admission. As for night call, I want at least one of you to stay here. That means you’ll be on only one in five nights and that’s not overburdening you. In fact, that is less than usual. If others want to stay in the evenings, that’s fine, but at least one of you stays here all night. Get together some time today and give me a schedule of who will be on when.”

“Rounds will begin each morning in the ICU at six-thirty. Before then I want you to have seen your patients, collated all the necessary information to present during the rounds. Is that clear?”

Fairweather looked at Carpin in dismay. He leaned over and whispered in Carpin’s ear, “Christ, I’ll have to get up before I go to bed!”

“Do you have a question, Mr. Fairweather?” demanded Bellows.

“No,” answered Fairweather rapidly. He was intimidated by the fact that Bellows knew his name.

“As for the rest of the morning,” said Bellows, eyeing his watch again.

“First I will take you to the ward and introduce you to the nursing staff, who will be thrilled to meet you all, I’m sure,” said Bellows with a wry smile.

“We have experienced their joy already,” said Susan, speaking for the first time. Her voice brought Bellows’s eyes around and held them. “We didn’t expect a brass band for our arrival but at the same time we didn’t expect a cold shoulder.”

Susan’s appearance had already somewhat unnerved Bellows. With the animation that the sound of her voice provided, Bellows’s pulse quickened slightly. There was a certain surge within his body which reminded him of watching cheerleaders in high school and wishing that they were naked.

Bellows searched for words.

“Miss Wheeler, you’ll have to understand that the nurses here are primarily interested in one thing.”

Niles winked in agreement to Goldberg, who didn’t understand what Niles was implying.

“And that is patient care, damn good patient care. And when new medical students and/or new interns arrive that becomes a rather difficult goal From actual experience they have all learned that new house staff is probably more deadly than bacteria and virus put together. So don’t expect to be greeted as saviors here, least of all from the nurses.”

Bellows paused but Susan did not respond. She was thinking about Bellows. At least he was a realist and that was a glimmer of hope in the otherwise poor impression he had made on her.

“At any rate, after showing you the ward, we’ll head up to surgery.

There’s a staff gallbladder at ten-thirty and it will give you all a chance to get into a scrub suit and see the inside of an OR.”

“And the handle of a retractor,” added Fairweather. For the first time the atmosphere lightened and everyone laughed.