“You really think so? God, eleven cases!” Bellows leaned over toward Susan, his tongue working at the empty spoon. “How’d you manage to get this IBM printout?”
“Henry Schwartz was nice enough to help me,” said Susan nonchalantly.
“Who the hell is Henry Schwartz?” asked Bellows.
“Damned if I know.”
“Spare me,” said Bellows covering his eyes with his hand, “I’m too tired for mental games.”
“Is that a chronic ailment or an acute affliction?”
“Cut the crap. How’d you get this data? Something like this has to be cleared through the department.”
“I went upstairs this afternoon, filled out one of those M804 forms, gave it to the nice man at the desk, and then went back tonight and picked it up.”
“I’m sorry I asked,” said Bellows getting up and waving his spoon to suggest he would let the issue ride. “But eleven cases. Did they all happen during surgery?”
“No,” said Susan, going back to the printout. “Harris was on the level when he said six. The other five were from inpatients on the medical service. Their diagnosis was idiosyncratic reaction. Doesn’t that strike you as pretty odd?”
“No.”
“Oh, come on,” said Susan impatiently. “The word idiosyncratic sounds great but it really means that they had no idea what the diagnosis was.”
“That might be true, but Susan, dear, this happens to be a major hospital, not a country club. It serves as a referral base for the whole New England area. Do you know how many deaths we have here on an average in a single day?”
“Deaths have causes… these cases of coma do not… at least not as yet.”
“Well, deaths don’t always have apparent causes. That’s the purpose of autopsy.”
“There, you hit the nail on the head,” said Susan. “When someone dies, then you do an autopsy and you find out what was the cause of death so that you can possibly add to your fund of knowledge. Well, in the coma cases you can’t do an autopsy because the patients are somewhere hovering between life and death. That makes it even more important that you do another kind of ‘opsy,’ a live-opsy, if you will. You study all the clues you have available, short of dismembering the victim. The diagnosis is just as important, maybe even more important than the autopsy diagnosis. If we could find out what was wrong with these people, maybe we could bring them out of their comas. Or better still, avoid the coma in the first place.”
“Even the autopsy,” said Bellows, “doesn’t always provide the answers. There are plenty of deaths where the exact cause is never determined whether they do an autopsy or not. I happen to know that two patients threw in the towel today, and I doubt very much if a diagnosis will be made.”
“Why do you think that the diagnosis won’t be made?” asked Susan.
“Because both patients expired from respiratory arrest. They apparently just stopped breathing, very calmly with no warning. They were just discovered dead. And in respiratory arrest you don’t always find anything to hang the blame on.”
Bellows had captured Susan’s interest. She was staring at him without moving, without blinking.
“Are you OK?” asked Bellows, waving his hand in front of her face. Still Susan did not move until she looked down at the IBM printout.
“What the hell do you have, psychomotor epilepsy or something?” asked Bellows.
Susan looked up at him. “Epilepsy? No, of course not You said these cases today died of respiratory arrest?”
“Apparently. I mean they stopped breathing. They just gave up.”
“What were they in the hospital for?”
“I’m not positive. I think one of them was in for some problem with his leg. Maybe he had phlebitis and they might find a pulmonary embolus or something. The other one was in for Bell’s palsy.”
“Were they both on I.V.s?”
“I don’t remember but I wouldn’t be surprised if they had been. Why do you ask?”
Susan bit her lower lip, thinking about what Bellows had just told her.
“Mark, do you know something? These deaths you mentioned could be related to the coma victims.” Susan patted the printout with the back of her hand. “You might have hit on something. What were the names? Can you remember?”
“For Christ’s sake, Susan, you’ve got this thing on the brain. You’re working overtime and you’re starting to have delusions.” Bellows switched to an artificially concerned tone. “Don’t be concerned, though; it happens to the best of us after we’ve stayed up for two or three nights in a row.”
“Mark, I’m serious.”
“I know you’re serious, that’s what worries me. Why don’t you give yourself a break and forget about it for a day or so? Then you can pick it up and be more objective. I tell you what. I’ve got tomorrow night off and with a little luck I can get out of here by seven. How about some dinner? You’ve only been here a day but you have to get away from the hospital as much as I do.”
Bellows hadn’t planned on asking Susan out quite so soon and in such a fashion. But he was pleased because it had come so apparently spontaneously and consequently it would be easy to deal with a refusal if it occurred. It sounded more like an offer to get together than an actual date.
“Dinner’s fine, can’t pass up an offer for a dinner even with an invertebrate. But really, Mark, what were the names of the two deaths today?”
“Crawford and Ferrer. They were patients on Beard 6.”
Susan pursed her lips as she wrote the names down in her notebook. “I’ll have to look into those in the morning. In fact…” Susan looked at her” watch “… maybe tonight. If they were going to do an autopsy on these cases, when would it be?”
“Probably tonight or first thing in the morning,” shrugged Bellows.
“Well then I better check tonight.”
Susan refolded her printout.
“Thanks, Mark, old boy; you’ve been a help again.”
“Again?”
“Yeah. Thanks for those articles you Xeroxed for me. You’ll make a good secretary someday.”
“Up yours.”
“Tut, tut. See you tomorrow night. How about the Ritz? I haven’t eaten there for several weeks,” teased Susan, heading for the door.
“Not so fast, Susan. I’ll see you at rounds in the morning at six-thirty. Remember our deal. I’ll cover for you another day if you come to rounds.”
“Mark, you’ve been such a dear, really. Let’s not louse it up so soon.” Susan smiled and pulled some of her hair across her face with coquettish exaggeration. “I’ll be up till all hours reading all this material you got for me. I need one more full day. We’ll discuss it further tomorrow night.”
Then she was gone. Again Bellows felt encouraged about Susan as he sipped his coffee. Then he got up. He had plenty of work to do.
16
Monday, February 23, 8:32 P.M.
The pathology lab was in the basement of the main building. Susan descended the stairs and emerged in the middle of a basement corridor which disappeared into utter darkness to the right and twisted out of view to the left. Stark bare light bulbs glowed from the ceiling at intervals of twenty to thirty feet. The light from each bulb met the light from the next in an uneasy penumbra, causing a strange interplay of shadows from the tangle of pipes along the ceiling. In a vain attempt to provide color to the dim subterranean world, angled stripes of bright orange paint had been painted on the walls.
Directly opposite Susan, partially hidden from view, was an arrow pointing to the left, with the word Pathology stenciled above it. Susan turned down the corridor, her shoes making hollow noises on the concrete floor, competing with the hiss of the steam pipes. The atmosphere was oppressive; the location within the bowels of the hospital was sinisterly appropriate. She was not heading for the pathology lab with any favorable anticipation. As far as Susan was concerned pathology represented the black side of medicine, the specialty that seemed to derive its nourishment from medical failure, death. Arguments about the benefits of biopsies which the pathologists analyzed or the obvious beneficial spinoffs for the living from the autopsies the pathologists performed were all lost on Susan. She had only seen one autopsy done during her course in pathology, and that had been one too many. Life had never seemed quite so fragile nor had death seemed quite so final as when Susan had watched the two overweight pathologists disembowel the body of a recently deceased patient.