Coma

This meant having Xeroxed off a thousand of the checklists and bringing a copy along with the other equipment at the start of each operation. By 7:15, the anesthesiologist was right on schedule at step number 12: that meant hooking up the rubber scubalike tubing to the machine. One end went into the ventilating bag, whose four- to five-liter capacity afforded him an opportunity to inflate forcibly the patient’s lungs at any time during the procedure. The other end went to the soda-lime canister in which the patient’s expired carbon dioxide would be absorbed. Step number 13 on his list was to make sure the unidirectional check valves in the breathing lines were lined up in the right direction. Step number 14

was to connect the anesthesia machine to the compressed air, nitrous oxide, and oxygen sources on the wall of the OR room. The anesthesia machine had emergency oxygen cylinders hanging from the side, and Dr.

Billing checked the gauge pressures on both cylinders. They were fully charged. Dr. Billing felt fine.

“I’m going to place some electrodes on your chest so we can monitor your heart,” said Gloria D’Mateo while pulling down the sheet and pulling up the hospital gown, exposing Nancy’s midriff to the sterile air. The gown just barely covered Nancy’s nipples. “This will feel cold for a sec,”

added Gloria D’Mateo as she squeezed a bit of colorless jelly onto three locations on Nancy’s exposed lower chest.

Nancy wanted to say something, but she couldn’t deal rapidly enough with her ambivalent attitudes about what she was experiencing. She was grateful, because it was going to help her, or so she had been assured; she was furious because she felt so exposed, literally and figuratively.

“You’re going to feel a little stick now,” said Dr. Billing, slapping the back of Nancy’s left hand to make the veins stand out. He had placed a piece of rubber tubing tightly around Nancy’s wrist, and she could feel her heart beat in the tips of her fingers. It was all happening too fast for Nancy to assimilate.

“Good morning, Miss Greenly,” said an ebullient Dr. Major as he whisked through the OR door. “I hope you had a good night’s sleep. We’ll get this affair over with in a few minutes and have you back to your bed for a restful sleep.”

Before Nancy could respond, the nerves from the tissues on the back of her hand became alive with urgent messages for her pain center.

After the initial thrust, the intensity of the pain increased to a point and then dissipated. The snug rubber tourniquet disappeared, and blood surged into Nancy’s hand. She felt tears well up from within her head.

“I.V.,” said Dr. Billing to no one, as he made a black check next to number 16 on his list.

“You’ll be going to sleep shortly, Nancy,” continued Dr. Major. “Isn’t that right, Dr. Billing? Nancy, you’re a lucky girl today. Dr. Billing is number one.” Dr. Major called all his patients girls no matter what age they were. It was one of those condescending mannerisms he had adopted unquestioningly from his older partner.

“That’s correct,” said Dr. Billing, placing a rubber face mask on the anesthesia tubing. “Number eight tube, Gloria, please. And you, Dr.

Major, can scrub; we’ll be ready at seven-thirty sharp.”

“OK,” said Dr. Major, heading for the door. Pausing, he turned to Ruth Jenkins, who was setting up the Mayo stand with instruments. “I want my own dilators and curettes, Ruth. Last time you gave me that medieval rubbish that belongs to the house.” He was gone before the nurse could answer.

Somewhere behind her, Nancy could hear the sonarlike beep of the cardiac monitor. It was her own heart rhythm resounding in the room.

“All right, Nancy,” said Gloria. “I want you to slide down the table a bit and put your legs up here in the stirrups.” Gloria grasped Nancy’s legs in turn under the knees and lifted them up into the stainless steel stirrups.

The sheet slid between Nancy’s legs, exposing them from mid-thigh down. The lower part of the table fell away, and the sheet slid to the floor. Nancy closed her eyes and tried not to picture herself spread-eagled on the table. Gloria picked up the sheet and haphazardly put it on Nancy’s abdomen so that it draped between her legs, covering her bloodied and recently shaved perineum.

Nancy wanted to be calm, but she was getting more and more anxious.

She wanted to be grateful, but the tide was swinging more and more in the direction of undirected anger and emotion.

“I’m not sure I want to go through with this,” said Nancy, looking at Dr.

Billing.

“Everything is just fine,” said Dr. Billing in an artificially concerned tone of voice, while checking off number 18 on his list. “You’ll be asleep in a jiffy,” he added, while holding up a syringe and tapping it so that the bubbles all fled upward to the room air. “I’m going to give you some Pentothal right away. Don’t you feel sleepy now?”

“No,” said Nancy.

“Well, you should have told me,” said Dr. Billing.

“I don’t know how I’m supposed to feel,” returned Nancy.