Kelley walked back to his desk and returned to work. After a few minutes he thought of something else that bothered him. There were no oxygen lines in the boiler room. Kelley made a mental note to ask Peter Barker; assistant administrator, about oxygen line checks. The trouble was that Kelley had a poor memory for everything except mechanical details.
Monday, February 23, 3:36 P.M.
With the cloud cover Boston had enjoyed little daylight that day, and by 3:30 dusk settled over the city. It took a bit of imagination to comprehend that above the clouds shone the same six-thousand-degree fiery star which in summer turned the macadam on Boylston Street molten. The temperature had responded to the surrendering sun by precipitously falling to nineteen degrees. Another flurry of minute crystalline bodies wafted over the city. The outside lights along the hospital walkways had been on for almost a half-hour.
From within the illuminated library, it already appeared pitch black outside. The two-story window at the end of the room responded to the dropping temperature by starting an active convection current of cold air across its face. The weighted colder air fell to the floor at the foot of the window and then swept the length of the room under the tables toward the hissing radiators in the back. It was the cold current which first began “to nudge Susan from the depths of her intense concentration.
As with so many academic subjects, Susan began to perceive that the more she read about coma, the less she felt she knew. To her surprise, it was an enormous subject, spanning many disciplines of medical specialization. And perhaps the most frustrating of all was Susan’s realization that it was not known what determined consciousness, other than saying that the individual was not unconscious. The definition of one consisted of being the opposite of the other. Such a tautologous circle was a travesty of logic until Susan accepted the fact that medical science had not advanced enough to define consciousness precisely. In fact, being fully conscious and being totally unconscious (coma) seemed to represent opposite ends of a continuous spectrum which included partway states like confusion and stupor. Hence the inexact, unscientific terms were more an admission of ignorance than poorly conceived definitions.
Despite the semantics Susan was well aware of the stark difference between normal consciousness and coma. She had observed both states that very day in a patient … Berman. And despite the lack of precision in definition, there was no lack of information regarding coma. Under the heading of “acute coma,” Susan began to fill page after page in her notebook with her characteristically small handwriting.
Her particular interest was in causation. Since science had not decided on what particular aspect of brain function had to be disrupted, Susan had to be content with precipitating factors. Being interested in acute coma, or coma of sudden onset, also helped to narrow the field but still was impressive and growing. Susan looked back over the list of causes that she had noted so far:
Trauma = concussion, contusion, or any type of stroke
Hypoxia = low oxygen:
(1) mechanical
—strangulation
—blocked airway
—insufficient ventilation
(2) lung abnormality
—alveolar block
(3) vascular block
—blood cannot get to brain
(4) cellular block of oxygen use High Carbon Dioxide
Hyper (hypo) Glycemia = high (low) blood sugar
Acidosis = high acid in the blood
Uremia = kidney failure with high uric acid in the blood
Hyper (hypo) Kalemia = high (low) potassium
Hyper (hypo) Natremia = high (low) sodium
Hepatic Failure = increase of toxins which would normally be detoxified by the liver
Addison’s Disease = severe endocrine or glandular abnormality
Chemicals or Drugs …
Susan took an extra couple of pages for the chemicals and drugs associated with acute coma and listed them alphabetically, each with a separate line to make it possible to add information as she got it:
Alcohol Insulin
Amphetamines Iodine
Anesthetics Mercurial diuretics
Anticonvulsants Metaldehyde
Antihistamines Methyl bromide
Aromatic hydrocarbons Methyl chloride
Arsenic Naphazoline
Barbiturates Naphthaline
Bromides Opium derivatives
Cannabis Pentachlorophenol
Carbon disulfide Phenol
Carbon monoxide Salicylates
Carbon tetrachloride Sulfanilamide
Chloral hydrate Sulfides
Cyanide Tetrahydrozaline
Glutethimide Vitamin D
Herbicides Hypnotic agents