“Twenty-three or twenty-four, that doesn’t make much difference,” said Bellows as he tried to think of the best way to present the fluid balance problem.
It made a difference to Susan.
“Where is she,” asked Susan, not sure if she really wanted to be told.
“In the corner on the left,” said Bellows without looking up from the input-output sheet in the chart. “What we need to check is the exact amount of fluid the patient has put out versus the exact amount that has been given. Of course this is static data and we are more interested in the dynamic state. But we can get a pretty good idea. Now let’s see, she put out 1650 cc of urine …”
Susan was not listening at this point. Her eyes fought to discern the motionless figure in the bed in the corner. From where she was standing, she could make out only a blotch of dark hair, a pale face, and a tube issuing from the area of the mouth. The tube was connected to a large square machine next to the bed that hissed to and fro, breathing for the patient. The patient’s body was covered by a white sheet; the arms were uncovered and positioned at forty-five-degree angles from the torso. An I.V. line ran into the left arm. Another I.V. line ran into the right side of her neck. Heightening the somber effect, a small spotlight directed its concentrated beam down from the ceiling above the patient, splashing over the head and upper body. The rest of the corner was lost in shadow. There was no motion, no sign of life save for the rhythmical hiss of the breathing machine. A plastic line curled down from under the patient and was connected to a calibrated urine container.
“We also have to have an accurate daily weight,” continued Bellows.
But for Susan his voice drifted in and out of her awareness. “A twenty-three-year-old woman …” The thought reverberated in Susan’s mind. Without the aid of an extensive clinical experience, Susan was instantly lost in the human element. The age and sex similarity struck too close to home for her to avoid the identification. In a naive way she associated such serious medicine with old people who had had their fling at life.
“How long has she been unresponsive,” asked Susan absently, without taking her eyes from the patient in the corner, without even blinking.
Bellows, interrupted by this non sequitur, turned his head up to glance at Susan. He was insensitive to Susan’s state of mind. “Eight days,” said Bellows, slightly vexed at the interruption of his harangue about fluid balance. “But that has little to do with today’s sodium level, Miss Wheeler. Could you kindly keep your mind on the subject at hand.”
Bellows shifted his attention to the others. “I’m going to be expecting you people to start writing routine fluid orders by the end of the week. Now where the hell was I?” Bellows returned to his input-output calculations, and everyone except Susan leaned over to catch the expanding figures.
Susan continued to stare at the motionless individual in the corner, racing through a mental checklist of her friends who had had D&Cs, wondering what really divided herself or her friends from the plight of Nancy Greenly. Several minutes passed as she bit her lower lip, as was her custom when in deep thought.
“How’d it happen?” asked Susan, again unexpectedly.
Bellows’s head popped up for the second time, but more rapidly, as if he expected some imminent catastrophe. “How’d what happen?” he countered, scanning the room for some telltale activity.
“How’d the patient become comatose?”
Bellows sat up straight, closed his eyes and put his pencil down. As if counting to ten, he passed before speaking.
“Miss Wheeler, you’ve got to try to give me a hand,” said Bellows slowly and condescendingly. “You’ve got to stay with us. As for the patient, it was just one of those inexplicable twists of the fickle finger of fate. OK? Perfect health … routine D&C … anesthesia and induction without a ripple. She just never woke up. Some sort of cerebral hypoxia. The squash didn’t get the oxygen it needed. OK? Now let’s get back to work. We’ll be here all day getting these orders written and we’ve got Grand Rounds at noon.”