Coma

Before Dr. Goodman could get the lidocaine into the I.V. line, the monitor abruptly returned to its steady, pre-crisis rhythm. In utter disbelief Dr. Goodman looked at the electronic blip moving through its familiar and normal pattern. Then he grasped the ventilating bag and inflated Berman’s lungs. Blood pressure read 100/60 and the pulse slowed evenly to about seventy per minute. Perspiration coalesced on Dr.

Goodman’s forehead and dripped off the bridge of his nose onto the anesthesia record. His own heart rate was over one hundred per minute.

Dr. Goodman decided that clinical anesthesia was not always dull.

“What in God’s name was all that about?” asked Dr. Colbert.

“I haven’t the slightest idea,” said Dr. Goodman. “But finish up. I want to wake this guy up.”

“Maybe it’s something wrong with the monitor,” said Mary Abruzzi, trying to be optimistic.

The resident finished the skin sutures. For a few minutes Dr. Goodman had them hold off deflating the tourniquet When they did, the heart rate increased slightly but then returned to normal.

The resident started to cast Berman’s leg. Dr. Goodman continued to aerate the patient while he kept one eye on the monitor. The rate stayed normal. Dr. Goodman tried to record the events on the anesthesia record in between compressions of the ventilating bag. When the cast was completed, Dr. Goodman waited to see if Berman would breathe on his own. There was no breathing effort at all, and Dr. Goodman took over again. He looked at the clock. It was 12:45. He wondered if he should give an antagonist for the fentanyl to try to curtail the respiratory depressant effect it was apparently causing. At the same time he wanted to keep the medication that he gave to Berman to a minimum. His own clammy skin reminded him vividly that Berman was no routine case.

Dr. Goodman wondered if Berman was getting light despite the fact that he was not breathing. He decided to test the lid reflex to find out.

There was no response. Instead of stroking the lid, Dr. Goodman lifted the lid and he noted something very strange. Usually the fentanyl; like other strong narcotics, produced very small pupils. Berman’s pupils were enormous. The black area almost filled the clear cornea. Dr. Goodman reached for a penlight and directed the beam into Berman’s eye. A ruby red reflex flashed back but the pupil did not budge.

In total disbelief, Dr. Goodman did it again, then again. He did it once more before his own eyes looked up at nothing. Dr. Goodman said two words out loud ... “Good God!”

Monday, February 23, 12:34 P.M.

For Susan Wheeler and the other four medical students, the charge down the hall to the elevator fitted perfectly their preconceptions of the excitement of clinical medicine. There was something horribly dramatic about the headlong rush. Startled patients sitting there casually leafing through old New Yorker magazines while waiting to see their doctors reacted to the stampeding group by drawing their legs and feet more closely to their chairs. They stared at the running figures who clutched at pens, penlights, stethoscopes, and other paraphernalia to keep them from flying from their pockets.

As the group came abreast of, then passed, each patient, the patient’s head swung around to watch the group recede down the corridor. Each assumed that a group of doctors had been called on an emergency, and it was reassuring for the patients to see how earnestly the doctors responded; the Memorial was a great hospital.

At the elevator there was momentary confusion and delay. Bellows repeatedly pushed the “down” button as if manhandling the plastic object would bring the elevator more quickly. The floor indicator above each elevator door suggested that the elevators were taking their own sweet time, slowly rising from floor to floor, obviously discharging and taking on passengers in the usual slow motion. For such emergencies there was a phone next to the elevators. Bellows snatched it off its cradle and dialed the operator. But the operator didn’t answer. It usually took the operators at the Memorial about five minutes to answer a house phone.

“Fucking elevators,” said Bellows striking the button for the tenth time.

His eyes darted from the exit sign over the stairwell back to the floor indicator above the elevator. “The stairs,” said Bellows with decision.

In rapid succession the group entered the stairwell and began the long twisting plunge from the tenth floor to the second floor. The journey seemed interminable. Taking two or three steps at a time, constantly turning to the left, the group began to spread out a bit. They passed the sixth floor, then the fifth. At the fourth floor the whole group slowed to a cautious walk in the dark because of the missing light bulb. Then down again at the previous pace.

Fairweather began to slow and Susan passed him on the inside.

“I don’t know what the hell we are running for,” panted Fairweather as Susan passed.