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Coma by Robin Cook. Part four

“Crawford! I thought that was an examiner’s case.” There was another pause.

The resident came back into the room as the timer went off again. The ringing noise made Susan jump once more. The resident squirted more distilled water onto the slides.

“The medical examiner released both cases to the department, as usual. Lazy son of a bitch. Anyway they’re doing Crawford right now.”

“Thanks,” said Susan. “All right if I go in and take a look?”

“By all means, our pleasure,” said the resident, shrugging his shoulders.

Susan paused momentarily at the doors, but she knew the resident was watching her, so she pushed open one of the doors and entered the room.

The room was probably forty feet square, old and dingy. Its walls were surfaced in white tile, which was ancient, cracked, and missing in places. The floor was a type of gray terrazzo. In the center of the room there were marble tables built with slanted tops. A stream of water constantly ran down each table toward a drain at the foot, which emitted a constant sucking noise. Over each table hung a hooded light, a scale, and a microphone. Susan found herself standing on a level three to four steps above the level of the main floor. Immediately to her right were several wooden benches on progressively lower tiers. These benches were a remnant from older days when groups would assemble to observe autopsies.

Only one of the hooded lights was on, that over the table nearest to Susan. It cast its relatively narrow beam down onto the naked corpse on the table immediately below. On each side of the table stood a pathology resident wearing an oilcloth apron and rubber gloves. The focal point of light caused the rest of the room to slide into graded burnt umber shadow like a sinister Rembrandt painting. The table in the center of the room was in shadow but it was possible for Susan to see that it also held a naked corpse, a manila tag tied around its right big toe. A large Y-shaped sutured incision crossed the thorax and abdomen. The third table was barely visible in the darkness, but it appeared to be empty.

Susan’s entrance stopped all progress in the room. Both residents were staring at her with their heads tilted down to avoid the glare of the overhead light. One of the residents with a large moustache and sideburns, was in the process of suturing the Y-shaped incision on the male corpse under the light. The other resident, taller by almost a foot, was standing before a basin containing the disemboweled organs.

Having sized up Susan, the taller resident went back to work. He reached into the tangle of organs with his left hand, grasping the liver. His right hand gripped a large, razor-sharp butcher knife. A few strokes freed the liver from the other organs. The liver made a sloshing sound as it oozed into the scale. The resident stepped on a foot pedal on the floor, speaking into the microphone. “The liver appears reddish brown with a lightly mottled surface, period. The gross weight is … a … two point four kilograms, period.” He then reached into the pan and lifted the liver out, dropping it back into the basin.

Susan descended several steps toward the group. The smell was slightly fishy; the air seemed greasy and heavy, like an uncleaned bus depot restroom.

“The liver consistency is more firm than usual but definitely pliant, period.” The knife flashed in the light and the liver surface separated. “The cut surface demonstrates an enhanced lobar pattern, period.” The knife sliced across the liver in four or five more places, then finally cut a piece out of the center. “The cut specimen demonstrates the usual friable character, period.”

Susan moved up to the foot of the table. The sucking drain was directly in front of her. The taller resident on the left reached into the basin for another organ but he stopped when the moustached resident spoke.

“Well, hello …”

“Greetings,” said Susan; “sorry to bother you.”

“No bother. Join the party, except we’ve almost finished.”

“Thanks, but I’m happy to just watch. Is this Crawford or Ferrer?”

“This is Ferrer,” said the resident. Then he pointed at the other body. “That’s Crawford.”

“I was wondering if you’ve determined a cause of death.”

“No,” said the taller resident. “But we haven’t opened the lungs on this case yet. Crawford was clean grossly. Maybe the microscopic sections will shed some light.”

“Do you expect something in the lungs?” asked Susan.

“Well, from the history of apparent respiratory arrest, we were considering pulmonary embolism. But I don’t think we’re going to find anything, though. Maybe there’ll be something in the brain sections.”

“Why don’t you think you’ll find anything?”

“Well, because I’ve posted a few cases like this before, and I’ve never found anything. And the history is exactly the same. Relatively young, somebody comes by and they’re not breathing. There’s a resuscitation attempt but without luck. Then we get them, or at least after the medical examiner turns them over to us.”

“About how many such cases would you estimate?”

“Over what time span?”

“Whatever … a year, two years.”

“Maybe six or seven over the last two years. I’m guessing.”

“And you don’t have any ideas about the cause of death?”

“Nope.”

“None?” asked Susan, a bit surprised.

“Well, I think it’s something with the brain. Something turns off their breathing. Maybe a stroke, but I did brain sections like you wouldn’t believe on two similar cases.”

“And?”

“Nothing. Clean as a whistle.”

Susan began to feel a bit queasy. The atmosphere, the smell, the images, the noises all joined forces to make her feel light-headed and she shuddered with a mild wave of nausea. She swallowed.

“Are the hospital charts for Ferrer and Crawford down here?”

“Sure, they’re in the coffee room through the lab.”

“I’d like to look at them for a few minutes. If you find anything significant, would you give me a yell? I’d be interested in seeing it.”

The taller resident lifted the heart and placed it on the scale. “These your patients?”

“Not exactly,” said Susan, starting toward the exit, “but they might be.”

The taller resident looked quizzically over at the other as Susan left. His companion was watching Susan exit, trying to figure out a smooth way of getting her name and number.

The coffee room could have been anywhere in the hospital. The coffee machine was an ancient device, the paint on one side burned and the wire frayed to the point of being a real hazard. The countertop desk along both side walls was spread with charts, paper, books, coffee cups, and a welter of ballpoint pens.

“That was quick,” said the resident who had been staining the slides. He was sitting at one of the desks, with a half-filled cup of coffee and a half-eaten doughnut. He was busy signing a large stack of typed pathology reports.

“Autopsies are apparently too much for me,” admitted Susan.

“You get used to it, like everything else,” said the resident, stuffing more doughnut into his mouth.

“Possibly. Where would I look for the charts of the patients they are posting?”

The resident washed down the doughnut with coffee, swallowing with some effort.

“In that shelf marked ‘Post.’ When you finish with them, put them over there in the shelf marked ‘Medical Records’ because we’re finished with them.”

Turning to the rear wall, Susan faced a series of cubic shelves. One of the shelves was marked “Post.” On it she found Ferrer’s and Crawford’s charts. Clearing one of the desks of debris, Susan sat down and took out her notebook. At the top of an empty page she wrote, “Crawford,” on the top of another page she wrote, “Ferrer.” Methodically she began to extract the charts as she had done with Nancy Greenly’s.

Tuesday, February 24, 8:05 A.M.

Susan had found it unbelievably difficult to emerge from the warmth and comfort of her bed when the radio alarm went off the following morning. The fact that it was a Linda Ronstadt selection was a big help in that it caused some degree of pleasant association in Susan’s mind and instead of turning the radio off, she lay there and let the sounds and rhythm course through her. By the time the song was over Susan was fully awake, her mind beginning to race over the events of the previous day. The night before, at least until three A.M., had been passed in deep concentration with the large pile of journal articles, the books on anesthesiology, her own internal medicine book, and her clinical neurology text. She had amassed an enormous amount of notes, and her bibliography had increased to some one hundred articles that she planned to drag from the library stacks. The project had become more complex, more demanding, yet at the same time more fascinating, more absorbing. As a consequence Susan had become even more determined, and she realized that she was going to have to accomplish a great deal that day.

Shower, dressing, and breakfast were dispatched with commendable speed. During breakfast, she reread some of her notes, realizing that she would have to reread the last few articles she had read the night before.

The walk to the MBTA stop on Huntington Avenue proved to Susan that the weather had not changed and she cursed the fact that Boston had to be situated so far north. With luck she found a seat on the aging street car and was able to unfold a portion of her IBM printout. She wanted to check once more the number of cases which it suggested.

“Good to see you, Susan. Don’t tell me you’re going to go to lecture today?”

Susan looked up into the grinning face of George Niles, who was holding on to the bar above her head.

“I’d never miss lecture, George; you know that.”

“Looks like you missed rounds. It’s after nine.”

“I could say the same to you.” Susan’s tone hovered between being friendly and combative.

“I was told in no uncertain terms that I had to be seen in Student Health to rule out a comminuted compound skull fracture from yesterday’s gala event in the OR.”

“You are OK, aren’t you?” asked Susan with genuine sincerity and concern.

“Yeah, I’m fine. It’s just hard to patch up my injured ego. That was the only thing that broke. But the clinic doc said that the ego had to heal itself.”

Susan allowed herself to laugh. Niles joined. The car stopped at Northeastern University.

“Missing half of your first day at Surgery at the Memorial, then skipping rounds the next day, that’s commendable, Miss Wheeler.” George assumed a serious expression. “In no time at all you’ll be able to run for medical student Phantom of the Year. If you keep it up you’ll be able to challenge the record set by Phil Greer during second-year Pathology.”

Susan didn’t answer. She went back to her IBM sheets.

“What are you working on, anyway?” asked Niles, twisting himself in an attempt to view the printout right side up.

Susan looked up at Niles. “I’m working on my Nobel Prize acceptance speech. I’d tell you about it but you might miss lecture.”

The car plunged down into the tunnel, beginning its transit under the city. Conversation became impossible. Susan resumed her check of the IBM printout sheet. She wanted to be damn sure of the numbers.

With its private offices Beard 8 resembled Beard 10. Susan walked down the corridor, stopping at room 810. The door had crisp black lettering across its aged but polished mahogany surface: “Department of Medicine, Professor J. P. Nelson, M.D., Ph.D.”

Nelson was Chief of Medicine, Stark’s counterpart, but associated with internal medicine and its subspecialties. Nelson was also a powerful figure in the medical center but not quite as influential as Stark, nor was he as dynamic, and as a fund raiser, he couldn’t even compare. Nevertheless, it took a bit of fortitude on Susan’s part to get up the nerve to approach this Olympian figure. With some hesitation she pushed open the mahogany door and faced a secretary with wire-rimmed glasses and a comfortable smile.

“My name is Susan Wheeler and I called a few minutes ago to see Dr. Nelson.”

“Yes of course. You’re one of our medical students?”

“That’s right,” said Susan, unsure of what “our” meant in that context.

“You’re lucky, Miss Wheeler, to catch Dr. Nelson in. Plus I believe he remembers you from a class or something. Anyway, he’ll be with you shortly.”

Susan thanked her and retreated to one of the stiff black waiting-room chairs. She pulled out her notebook to scan more of her notes, but instead found herself viewing the room, the secretary, and the lifestyle it meant for Dr. Nelson. As far as the value system in medical school was concerned, such a position represented the final triumph of years of effort and even luck. It was just the kind of luck Susan felt could be behind her present quest. All someone needed was one lucky break and the doors would open.

The reverie was cut short by the door to the inner office being opened. Two doctors in long white coats came from within, continuing their conversation at the door. Susan could get bits and pieces and it seemed to be about an enormous amount of drugs that had been located in a locker in the surgical lounge. The younger of the two men was quite agitated and spoke in a whisper whose sound level was approximately equal to normal speech. The other gentleman had the portly bearing of a mature physician, replete with soft, knowing eyes, luxuriant graying hair, and a consoling smile. Susan knew it had to be Dr. Nelson. He seemed to be trying to console the other with reassuring words and a lingering pat on the shoulder. Once the other doctor had left, Dr. Nelson turned to Susan and beckoned for her to follow him.

Nelson’s office was a tumble of reprinted journal articles, scattered books, and stacks of letters. It appeared as if a tornado had swept through the room several years previously with no subsequent effort at reconstruction. The furniture consisted of a large desk and an old cracked leather chair that squeaked as Dr. Nelson lowered his weight into it. There were two other smaller leather chairs facing the desk. Susan was motioned to take one of them as Dr. Nelson took one of his briars and opened a tobacco canister on the desk. Before filling the pipe he hit it on the palm of his left hand a few times. The few ashes that appeared were carelessly scattered on the floor.

“Ah yes, Miss Wheeler,” began Dr. Nelson, scanning a note card on his desk. “I remember you well from physical diagnosis class. You were from Wellesley.”

“Radcliffe.”

“Radcliffe, of course.” Dr. Nelson corrected his note card. “What can we do for you?”

“I’m not sure how to start. But I’ve become very interested in the problem of prolonged coma, and I have begun to look into it.”

Dr. Nelson leaned back, the chair squeaking in agony. He placed the tips of his fingers together.

“That’s fine, but coma is a big subject, and, more important, it is a symptom rather than a disease in itself. It is the cause of the coma that is important. What is the cause of the coma you have become interested in?”

“I don’t know. In short, that’s why I’m interested in it I’m interested in the kind, of coma that just seems to happen and no cause is found.”

“Are you concerned with emergency room patients or in-hospital patients?” asked Dr. Nelson, whose voice changed slightly.

“Inpatients.”

“Are you referring to the few cases that have occurred during surgery?”

“If you call seven few.”

“Seven,” said Dr. Nelson taking several long pulls from his pipe, “I believe is a rather high estimate.”

“It’s not an estimate. Six previous cases occurred during surgery. Presently there is another case upstairs, operated on yesterday, that appears to fit into the same category. In addition, there have been at least five cases on the medical floor occurring in patients admitted for some seemingly unrelated complaint.”

“How did you get this information, Miss Wheeler?” asked Dr. Nelson with an altogether different tone of voice. The previous warmth was gone. His eyes regarded Susan without blinking. Susan was unaware of this change in apparent mood.

“I got the information from this computer printout right here.” Susan leaned forward with the printout and handed it across the desk to Dr. Nelson. “The cases I’ve mentioned have been indicated with yellow ink. You’ll see that there is no mistake. Besides, this represents only coma cases for the last year. I don’t know what the incidence was before then, and I think it would be essential to get a year-by-year printout. In that way one could have a better idea if this problem is static or on a dynamic upswing. And perhaps even more important, or at least equally important, I have a feeling that a number of sudden deaths here at the Memorial could be ascribed to the same unknown category. I believe the computer could help on that as well. Anyway, it is for these reasons that I wanted to speak with you. I was wondering if you would support me on this endeavor. What I need is full clearance to use the computer and the opportunity to get the hospital charts on these patients. I came to you because I have an intuitive feeling that it represents some sort of unknown medical problem.”

With her case presented, Susan allowed herself to sit back into the chair. She felt she had put the matter fairly and completely; if Dr. Nelson was going to be interested, he certainly had enough to go on to make up his mind.

Dr. Nelson did not speak right away. Instead he continued to regard Susan; then he studied the printout, taking short, quick puffs on his pipe.

“This is all very interesting information, young lady. Of course I have been aware of the problem. However, there are other implications in these statistics and I can assure you that this apparent high incidence is occurring because … well, frankly … we have been lucky over the last five or six years that we haven’t had any such cases. Statistics have a way of catching up with you, though … and indeed that seems to be the case at present. As to your request, I’m afraid I’m not in a position to grant it. You undoubtedly understand one of the major impediments to our establishing our central computer information bank was the creation of adequate safeguards concerning the confidentiality of most of the information stored. It is impossible for me to give blanket authorization. In fact, this type of endeavor is really … what should I say … hmm … beyond … or above that which a medical student of your level is equipped to deal with. I think it would be in everyone’s best interest, yours included, if you would limit your research interests to more scientific projects. I’m certain I could find room for you in our liver lab, if you were interested.”

Susan was so accustomed to academic encouragement that she was totally caught off guard by Dr. Nelson’s negative response to her investigation. Not only was he not interested, but he was obviously trying to talk Susan out of the project as well.

Susan hesitated, then stood up.

“Thank you very much for the offer. But I’ve just gotten so involved with this study that I think I’ll follow it up for a while.”

“Suit yourself, Miss Wheeler. But I’m sorry; I cannot help you.”

“Thank you for your time,” said Susan, reaching out for her computer printout.

“I’m afraid this information cannot be made available for you any longer,” said Dr. Nelson interposing his hand between Susan’s and the IBM sheet.

Susan kept her hand extended for a second of indecision. Once again Dr. Nelson had caught her off guard with an unexpected response. It seemed absurd that he would actually have the gall to confiscate material she already had.

Susan did not say another word and she avoided looking at Dr. Nelson. She got her things together and left. Dr. Nelson instantly picked up the telephone and placed a call.

Tuesday, February 24, 10:48 A.M.

In Dr. Harris’s office there was an entire bookcase full of the latest books on anesthesiology, some still in prepublication bound galleys, sent for his endorsement. For Susan this was a boon, and her eyes scanned the titles for any books specifically on complications. She located one, and she wrote down the title and publisher. Next she looked for any general texts which she had not seen in the library. And her eyes registered another find: Coma: Pathophysiological Basis of Clinical States. Excitedly she withdrew the volume and thumbed through it, noticing the chapter headings. She wished she had had the book at the onset of her reading.

The door to the office opened and Susan looked up to face Dr. Robert Harris for the second time. Instantly she felt a certain sense of intimidation or scorn as Dr. Harris regarded her without the slightest sign of recognition or friendliness. It had not been Susan’s idea to wait for him in his office; it had been the direct order of the secretary who had arranged the meeting for Susan. Now Susan felt an uneasiness, as if she were an interloper in Dr. Harris’s private sanctum. The fact that she was holding one of his books made it that much worse.

“Be sure to put the volume back where you found it,” said Harris as he turned to close the door, his speech slow and deliberate as if addressed to a child. He removed his long white coat and hung it on the hook on the back of the door. Without another word he retreated behind his desk to open a large ledger and make several notations. He acted as if Susan were not even there.

Susan closed the textbook and replaced it on the shelf. Then she returned to the director’s chair in which she had started her wait for Dr. Harris thirty minutes before.

The only window was directly behind Harris, and its light, combining with the overhead fluorescent light, gave a strange shimmering quality to Harris’s appearance. Susan had to squint against the glare coming directly at her.

The smooth tawny color of Harris’s arms was a perfect setting for the gold digital watch on his left wrist. His forearms were massive, tapering to surprisingly narrow shafts. Despite the time of year and the temperature, Dr. Harris was dressed in a short-sleeved blue shirt. Several minutes went by before he finished with the ledger. After closing the cover he pressed a buzzer for his secretary to come in and take it. Only then did he turn and acknowledge Susan’s existence.

“Miss Wheeler, I am certainly surprised to see you in my office.” Dr. Harris slowly leaned back in his chair. He seemed to have some difficulty looking directly at Susan. Because of the background lighting Susan could not see the details of his face. His tone was cold. There was a silence.

“I would like to apologize,” began Susan, “for my apparent impertinence yesterday in the recovery room. As you probably are aware, this is my first clinical rotation, and I’m unaccustomed to the hospital environment, particularly to the recovery room. On top of that there had been a strange coincidence. About two hours prior to our meeting I had spent some time with the very patient you were attending. I had started his I.V. prior to surgery.”

Susan paused, hoping for some sign of acknowledgment from the faceless figure in front of her. There was none. There was no movement whatsoever. Susan continued.

“The fact of the matter was that my conversation with the patient had not remained on an entirely professional level; in fact, we had tentatively agreed to meet sometime on a social basis.”

Susan paused again but silence continued from Dr. Harris.

“I’m offering this information more as an explanation than an excuse for my reaction in the recovery room. Needless to say, when I was confronted with the reality of the patient’s condition, I became quite upset.”

“So you reverted to the vestiges of your sex,” said Harris condescendingly.

“Excuse me?” Susan had heard his comment, but by reflex she questioned whether she had heard him correctly.

“I said, so you reverted to the vestiges of your sex.”

Susan felt a flush spread across her cheeks. “I’m not sure how to take that.”

“Take it at face value.”

There was an awkward pause. Susan fidgeted, then spoke. “If that is your opinion of being a woman, then I plead guilty; emotionalism under such circumstances is understandable from any human being. I admit the fact that I was not the archetypical professional at the first meeting with the patient, but I think that if the roles had been reversed, I being the patient and the patient being the doctor, it probably would have come out the same. I hardly think that susceptibility to human responses is a frailty reserved for female medical students, especially when I have to put up with the patronizing attitudes of my male counterparts with the female nurses. But I did not come here to discuss such matters. I came here to apologize for impertinence to you and that is all. I’m not apologizing for being a woman.”

Susan paused again, expecting some sort of reply. None was forthcoming. Susan felt a definite feeling of irritation spread through her.

“If my being a woman bothers you, then that’s your problem,” said Susan with emphasis.

“You’re being impertinent again, my dear,” said Harris.

Susan stood up. Gazing down, she looked at Harris’s face, his narrowed eyes, his full cheeks and broad chin. Light played through the edge of his hair, making it appear like silver filigree.

“I can see this is getting us nowhere. I’m sorry I came. Goodbye, Dr. Harris.”

Susan turned and opened the door to the corridor.

“Why did you come?” said Harris after her.

With her hand on the door, Susan looked out into the corridor and considered Harris’s question. Obviously debating with herself whether to leave or not, she finally turned and faced the Chief of Anesthesiology again.

“I thought I’d apologize so that we could let bygones be bygones. I had the irrational hope that you might be willing to lend me some assistance.”

“In what regard?” said Harris, his voice relaxing its aloofness by a degree.

Susan hesitated again, debating, then let the door shut. She walked up to the chair she had been sitting in but she did not sit down. She eyed Harris and thought that she had nothing to lose and should say what she had originally come to say despite his coldness.

“Since you said that there have been six cases of prolonged coma following anesthesia during the last year, I decided to look into the problem as a potential subject for my third-year paper. Well, I found out that you were absolutely correct. There have been six cases following anesthesia during the last year. But there also have been five cases of sudden. unexplained coma occurring in patients on the medical floors during the past year. Yesterday there were two deaths for apparent respiratory arrest. These patients gave no history to suggest that such an event might take place. They were in the hospital for essentially peripheral problems; one had a minor foot operation followed by phlebitis, the other had Bell’s palsy. Both were essentially well individuals, except one of them had glaucoma. There was no explanation for their respiratory arrest and I have a feeling that they are possibly related to the other coma cases. In other words, I think I have twelve cases representing gradations of the same problem. And if Berman turns out to be in the same boat as the others, then there are thirteen people suffering from some unexplained phenomenon. Perhaps worst of all, the incidence seems to be on the upswing, especially for the cases occurring during anesthesia. The interval between cases seems to be getting shorter and shorter. Anyway, I have decided to try to look into the problem. In order for me to continue my investigation I need some help from someone like yourself. I need authorization to search the data bank and see how many cases the computer could find if it’s asked directly. Also I need the charts of the previous victims.”

Harris leaned forward and slowly placed his arms on his desk.

“So the Medical Department has had some trouble too,” he murmured. “Jerry Nelson didn’t mention that.”

Looking up at Susan, he spoke louder.

“Miss Wheeler, you are dabbling in troubled waters. It’s refreshing to hear someone, fresh from the basic science years of medical school, interested in clinical research. But this is not the proper subject for you. There are many reasons for my saying this. First of all, the problem of coma is far more complex than might-be apparent to you. It is a wastepaper-basket term, a mere description. And for someone to immediately assume all cases of coma are related simply because the causative agent is not precisely known is intellectually absurd. Miss Wheeler, I advise you to stick to something more specific, less speculative, for your so-called third year paper. As far as helping you is concerned, I must admit I do not have the time. And let me admit something else that might be rather apparent to you. I don’t try to hide it. I’m not keen on women in medicine.”

Harris pointed his finger at Susan and aimed across it almost as if were a gun.

“They treat it like a game, something to do for now … something chic … later, who knows. It’s a fad. And on top of that, they are invariably, impossibly emotional and …”

“Dr. Harris, cut the bullshit,” interrupted Susan, lifting up the back of the chair and letting it fall a few inches. She was furious. “I didn’t come here to listen to this type of nonsense. In fact it’s people like you who keep medicine in the old rut, unable to respond to the challenge of relevancy and change.”

Harris pounded the top of the desk with his open hand causing a few papers and pencils to flee for safety. Almost in one step he came from behind his desk with a speed that caught Susan off guard. His movement brought his face only inches from Susan’s. She froze before the unexpected fury she had unleashed.

“Miss Wheeler, you do not know your place here,” hissed Harris, holding himself in check with great difficulty. “You are not to be the Messiah who is going to miraculously deliver us from a problem which has already been under the scrutiny of the best minds in this hospital. In fact, I see you as a very destructive influence and I can promise you this: you’ll be out of this hospital in twenty-four hours. Now get out of my office.”

Susan backed up, afraid to expose her unguarded back to this man who seemed about to explode with hatred. She opened the door and ran down the corridor, feeling the tears well up from her mixture of fear and anger.

Behind her, Harris kicked the door shut and snatched the phone off the hook. He told his secretary to get him the director of the hospital without delay.

Tuesday, February 24, 11:00 A.M.

Susan slowed to a deliberate walk, avoiding the questioning expressions of the people using the corridor. Her emotions, she was afraid, could be read from her face like an open book. Usually when she cried or was about to cry, her cheeks and eyelids turned bright crimson. Although she knew she wasn’t going to cry now, the proper neural connections had been made. If someone she knew stopped her and said something innocuous, like “What’s the matter, Susan?” she probably would have cried. So Susan wanted to be alone for a few moments. As it was, she was more angry and frustrated than anything else as the fear generated by her encounter with Harris evaporated. Fear seemed so out of place in the context of a meeting with a professional superior that she wondered if she was becoming delusional. Had she really crossed Harris to the extent that he had had to keep himself in check to avoid some sort of physical encounter? Was he just about to strike her, as she had feared, when he came bounding out from behind his desk? The idea seemed ludicrous and it was difficult for her to believe that the situation had been so precipitous. She knew that she could never make someone else believe what she had felt. It reminded her of the situation with Captain Queeg in The Caine Mutiny.

The stairwell was the only haven she could think of, and she pushed through the metal door. It closed behind her rapidly, cutting off the raw fluorescent lights and the voices. The single bare incandescent bulb above her had a warmer glow and the stairway offered a soothing silence.

Susan was still clutching her notebook and a ballpoint pen. Gritting her teeth, and swearing loudly enough to hear an echo, she threw the notebook and the pen down the course of stairs to the landing below. The notebook bounced on the edge of a stair, then fell flat, cover down, onto the floor. It skidded across the landing and struck the wall, coming to a rest unhurt and open. The pen flipped over the edge of the stairs and a few telltale sounds suggested that it had descended to the bowels of the hospital.

Uninviting as it was, Susan sat down on the top stair, her feet on the very next step, bringing her knees up at acute angles. Her elbows rested on the tops of her knees. She closed her eyes tightly. So much of her experience in medicine with relationships had been reemphasized in the short time she had been at the Memorial. Professional superiors, instructors to professors, reacted to her in a manner that unpredictably varied from warm acceptance to overt hostility. Usually the hostility was more passive-aggressive than Harris’s had been; Nelson’s reaction was more typical. Nelson had been friendly at first, then later had slipped into an obstructive stance. Susan felt an old familiar feeling, a feeling which had developed ever since she had chosen medicine as a career: it was a paradoxical loneliness. Although constantly surrounded by people who reacted to her, she felt apart. The day and a half at the Memorial had not been an auspicious beginning for her clinical years. Even more than during her first days at medical school, she felt that she was entering a male club; she was an outsider forced to adapt, to compromise.

Susan opened her eyes and looked down at her notebook sprawled on the landing below. Throwing the book had given some vent to her frustrations, and she felt a degree more relaxed. Control was returning. At the same time the childish aspect of the gesture surprised her. It was not like her to do such a thing. Perhaps Nelson and Harris were, in the final analysis, right. Perhaps being a medical student so early in training, she was not the right person to investigate such a serious clinical problem. And perhaps her emotionalism was a built-in handicap. Would a male have responded in the same way to Harris’s reaction? Was she more emotional than her male counterparts? Susan thought about Bellows and his cool detached manner, how he could concentrate on the sodium ions while confronting a tragedy. Susan had found fault with his behavior the day before, but now, daydreaming in the stairwell, she was no longer so sure. She wondered if she could achieve that type of detachment if it were necessary.

A door opening somewhere far above brought Susan to her feet. There were some hushed and hurried footsteps on the metal stairs, then the sound of another door, then silence returned. The crude cement walls of the stairwell combined with the curious longitudinal rust-colored stains enhanced Susan’s sense of isolation. In slow motion she descended to where her notebook lay. By chance it had opened to the page copied from Nancy Greenly’s chart. Reaching for the book, Susan read her own handwriting. “Age 23, Caucasian, previous medical history negative except for mononucleosis at age 18.” Quickly Susan’s mind conjured up the image of Nancy Greenly, her ghostly pallor, lying in the ICU. “Age twenty-three,” Susan said aloud. In a rush she re-experienced the intensity of her feelings of transference. Susan felt a rekindling of her commitment to investigating the coma problem to the limit of her abilities despite Harris, despite Nelson. Without questioning why, she felt a strong urge to find Bellows. Within a single day her feeling toward Bellows had taken a one-hundred-and-eighty-degree turn.

“Susan, for Christ’s sake, haven’t you had enough yet?” With his elbows on the table, Bellows placed his palms against his face so that his fingers could lightly massage his closed eyes. His hands rotated, bringing his fingers below his ears. With his face cradled in his hands, he looked at Susan sitting across from him in the hospital coffee shop. The place had a relatively clean appearance with indeterminate modern furnishings. It was primarily meant for visitors to the hospital, although the staff frequented it on occasion. The prices were higher than the cafeteria’s but the quality was equivalently better. At eleven-thirty it was crowded but Susan had found a table in the corner and had paged Bellows. She was pleased when he agreed to see her immediately.

“Susan,” continued Bellows after a pause, “you’ve got to give up this self-destructive crusade. I mean it’s absolutely sure suicide. Susan, there’s one thing about medicine, you’ve got to flow with the river or you’ll drown. I’ve learned that. God, whatever could have possessed you to go to Harris, especially after that little episode yesterday?”

Susan sipped her coffee in silence, keeping her eyes on Bellows. She wanted him to talk because it sounded good; he seemed to care. But also she wanted him to get involved, if that were at all possible. Bellows shook his head as he took a drink of his coffee.

“Harris is powerful, but he’s not omnipotent around here,” added Bellows. “Stark can reverse anything Harris does if he has reason to do so. Stark has raised most of the money for construction around here, millions. So people listen to what he says. So why not give him a reason; why not pretend to be a normal medical student for a few days? Christ, I need it myself. Guess who was on rounds this morning to welcome you medical students? Stark. And the first thing he wanted to know was why there were only three students out of five. Well I told him that, foolishly enough, I had taken you all in to see a case on the first day, and one of you had fainted and smashed his head on the floor. You can guess how that went over. And then I couldn’t think of anything appropriate to say about you. So I said you were doing a literature search on coma following anesthesia. I decided that since I couldn’t think of a good lie I might as well tell the truth. Well he immediately assumed that it had been my idea to put you on the project. I cannot repeat what he said to me in response. It should be enough for me to say that I need you to behave like a normal medical student. I’ve covered for you to the extent that I’m already overdrawn.”

Susan felt an urge to touch Bellows, kind of a reassuring people-to-people hug. But she didn’t; instead she played with her coffee spoon with her head down. Then she looked at Bellows.

“I’m really sorry if I’ve caused you some difficulties, Mark, really I am. Needless to say, it was unintentional. I’m the first to admit this thing has gotten out of hand so rapidly that it’s uncanny. I started because of an emotional crisis of sorts. Nancy Greenly is the same age as I, and I’ve had some occasional irregularities with my periods, probably just like Nancy Greenly. I cannot help but feel some … some kinship with her. And then Berman … what a Goddamned coincidence. By the way, did Berman have an EEG?”

“Yeah, it was completely flat. The brain is gone.”

Susan searched Bellows’s face for some response, some sign of emotion. Bellows lifted the coffee cup to his lips and took a sip.

“The brain is gone?”

“Gone.”

Susan bit her lower lip and looked down into her coffee cup. A small amount of oil opalesced on the surface in colorful swirls. Somehow she had expected the news, but it still cut into her and she fought with her mind, suppressing emotion as best she could.

“Are you OK?” asked Bellows, reaching across and gently lifting her chin with his hands.

“Don’t say anything for a second,” said Susan, not daring to look at him. The last thing she wanted to do was cry and if Bellows persisted, it would happen. Bellows cooperated and returned to his coffee while keeping his eyes on Susan.

After a few moments Susan looked up; her eyelids were slightly reddened.

“Anyway,” continued Susan, avoiding eye contact with Bellows, “I started with an emotional sort of commitment, but that quickly mixed with intellectual commitment. I really thought I had stumbled onto something … a new disease or a new complication of anesthesia or a new syndrome … something, I don’t know what. But then there was another change. The problem loomed bigger than I had imagined initially. They’ve had coma cases on the medical floors as well as in surgery. On top of that, there were those deaths you told me about. I know you think it’s crazy, but I think they are related, and the pathologist intimated they have had a number of such cases. My intuition tells me there is something else in all this, something … I don’t know how to explain it… call it supernatural or call it sinister …”

“Ah, now paranoia,” said Bellows, nodding his head in mock understanding.

“I can’t help it, Mark. There was something very strange about the reaction of Nelson and Harris. You have to admit that Harris’s reaction was totally inappropriate.”

Bellows tapped his forehead in succession with the heel of his hand. “Susan, you’ve been staying up watching old horror movies. Admit it, Susan … admit it or I’ll think you’re having a psychotic break. This is absurd. What do you suspect, some sort of sinister inversion layer spreading evil forces, or is it a crazed killer who hates people with minor ailments? Susan, if you hypothesize so extravagantly and with such creativity, then come up with some ideas of motive. I mean, a demented killer was OK for Hollywood and George C. Scott in Hospital just to create an artificial mystery … but it’s a little too farfetched for reality. I admit Harris’s performance sounds a bit weird, there’s no doubt about that. But at the same time I think I could come up with some reasonable explanation for his unreasonable behavior.”

“Try.”

“OK, I’m sure Harris is already completely uptight about this problem of coma. After all, it’s his department which essentially has to shoulder the responsibility. And here comes a young medical student to drive in the painful spikes a little more. I think it’s understandable for an individual to overreact under that kind of stress.”

“Harris did a little more than overreact. This nut came from behind his desk with the intent of knocking me around the room.”

“Maybe you turned him on.”

“What?”

“On top of everything else maybe he was reacting to you sexually.”

“Come on, Mark.”

“I’m serious.”

“Mark, this guy’s a doctor, a professor, a chief of a department.”

“That does not rule out sexuality.”

“Now you’re the one being absurd.”

“A lot of doctors spend so much time with the nuts and bolts of their profession that they fail to ever really adequately resolve the usual social crises of life. Socially speaking, doctors are not very accomplished, to say the least.”

“Are you speaking for yourself?”

“Possibly. Susan, you have to realize you are a very seductive girl.”

“Fuck you.”

Bellows looked at Susan, stunned. Then he glanced around to see if anyone was listening to their conversation. He had not forgotten they were in the coffee shop. He took a sip of coffee and then regarded Susan for several minutes. She returned his stare.

“Why did you say that?” said Bellows with a lowered voice.

“Because you deserved it. I get a little tired of that kind of stereotyping. When you say I’m seductive you imply to me that I am actively trying to seduce. Believe me, I am not. If medicine has done anything to me, it certainly has cut into my image of myself as conventionally female.”

“All right, maybe it was a bad word. I didn’t mean to imply it was your fault. You’re an attractive girl …”

“Well there’s a helluva difference between saying someone’s attractive and saying someone’s seductive.”

“OK, I meant attractive. Sexually attractive. And there are people who may find that hard to deal with. Anyway, Susan, I didn’t mean to get into an argument. Besides, I’ve got to go. I’ve got a case in fifteen minutes. If you want, we can talk about it tonight over dinner. That is, if you still want to have dinner?” Bellows started to get up, taking his tray.

“Sure, dinner’s fine.”

“Meanwhile, couldn’t you try to be normal for a little while?”

“Well, I have one more stone to turn over.”

“What’s that?”

“Stark. If he doesn’t help me, I’ll have to give up. Without some support I’m doomed to failure, unless of course you want to get the computer information for me.”

Bellows let his tray drop back onto the table. “Susan, don’t ask me to do anything like that, because I can’t. As for Stark, Susan, you’re crazy. He’ll eat you alive. Harris is a jewel in comparison to Stark.”

“That’s a risk I have to take. It’s probably safer than undergoing minor surgery here at the Memorial.”

“That’s not fair.”

“Fair? What a choice word. Why don’t you ask Berman if he thinks it’s fair?”

“I can’t.”

“You can’t?” Susan paused, waiting for Bellows to explain himself. Susan did not want to think of the worst but it came to her automatically. Bellows started toward the tray rack without explaining himself.

“He’s still alive, isn’t he?” asked Susan with a tingle of desperation in her voice. She got up and walked behind Bellows.

“If you call that heart beating being alive, he’s alive.”

“Is he in the recovery room?”

“No.”

“The ICU?”

“No.”

“OK, I give up, where is he?”

Bellows and Susan put their trays into the rack and walked from the coffee shop. They were immediately engulfed by the mob in the hall and forced to quicken their steps.

“He was transferred to the Jefferson Institute in South Boston.”

“What the hell is the Jefferson Institute?”

“It’s an intensive care facility built as part of the area’s Health Maintenance Organization design. Supposedly it’s been designed to curtail costs by applying economics of scale in relation to intensive care. It’s privately run but the government financed construction. The concept and plans came out of the Harvard-MIT health practices report.”

“I’ve never even heard about it. Have you visited it?”

“No, but I’d like to. I saw it from the outside once. It’s very modern … massive and rectilinear. The thing that caught my eye was that there were no windows on the first floor. God only knows why that caught my eye.” Bellows shook his head.

Susan smiled.

“There’s a tour organized for the medical community,” continued Bellows, “to visit the place on the second Tuesday of each month. Those that have gone have been really impressed. Apparently the program is a big success. All chronic-care ICU patients who are comatose or nearly so can be admitted. The idea is to keep the ICU beds in the acute-care hospitals available for acute cases. I think it’s a good idea.”

“But Berman just became comatose. Why would they transfer him so quickly?”

“The time factor is less important than stability. Obviously he’s going to be a long-term-care problem and I guess he was very stable, not like our friend Greenly. God, she’s been a pain in the ass. Just about every complication known, she’s had it.”

Susan thought about emotional detachment. It was difficult for her to understand how Bellows could be so out of touch emotionally with the problem Nancy Greenly represented.

“If she were stable,” continued Bellows, “even threatened stability, I’d transfer her to the Jefferson in a flash. Her case demands an inordinate amount of time with thin rewards. Actually, I have nothing to gain by her. If I keep her alive until the services switch, then at least I’ve suffered no professional harm. It’s like all those Presidents keeping Vietnam alive. They couldn’t win, but they didn’t want to lose either. They had nothing to gain but a lot to lose.”

They reached the main elevators and Bellows made sure one of the silently waiting crowd had pushed the “up” button.

“Where was I?” Bellows scratched his head, obviously preoccupied.

“You were talking about Berman and the ICU.”

“Oh, yeah. Well, I guess he was stable.” Bellows looked at his watch, then eyed the closed doors with hatred. “Goddamn elevators.

“Susan, I’m not one to give advice usually, but I can’t help myself. See Stark if you must, but remember I’ve gone out on a limb for you, so act accordingly. Then after you see Stark, give this crusade up. You’ll ruin your career before you begin.”

“Are you worried about my career or your own?”

“Both, I guess,” said Bellows standing aside for the disembarking elevator passengers.

“At least you’re honest.”

Bellows squeezed into the elevator and waved to Susan, saying something about seven-thirty. Susan presumed he meant their dinner date. At that moment her watch said eleven forty-five.

Tuesday, February 24, 11:45 A.M.

Bellows looked up at the floor indicator above the door. He had to cock his head way back, as he was almost directly under it. He knew that he had to hustle in order to be on time for his case, a hemorrhoid operation on a sixty-two-year-old man. It wasn’t his idea of a fascinating case but he loved to operate. Once he got going and felt the strange sense of responsibility which the knife afforded, he didn’t really care where he was working, stomach or hand, mouth or asshole.

Bellows thought about seeing Susan that night, and he felt a sense of pleasurable anticipation. Everything would be fresh and unspoiled. Their conversation could range over any one of a thousand topics. And physically? Bellows had no idea what to expect. In fact he wondered how he would be able to bridge the colleaguelike rapport they had already established. Within himself he sensed a very positive physical reaction toward Susan but it began to trouble him. In a lot of ways, sex meant aggression to Bellows, and he didn’t feel any aggression toward Susan, not yet.

A smile crept over his face as he imagined himself kissing Susan impulsively. It made him remember those awkward adolescent moments in his early youth when he would continue some banal conversation with his pimpled date right up to her doorstep. Then without warning he would kiss the girl, hard and sloppy. Then he’d step back to see what happened, hoping for acceptance but fearing rejection. It had never ceased to amaze him when he found acceptance, because in many ways he didn’t know why he was kissing the girl in the first place.

The concept of seeing Susan socially reminded Bellows of those early years of dating because he felt an inner urge for physical contact yet did not expect it. Susan was obviously palpable and luscious, yet she was going to be a doctor, as he was. Hence she would have little appreciation for the trump card Bellows always felt in a social situation—most everyone was impressed when he said he was a doctor, a surgeon! It didn’t matter that Bellows himself knew that being a doctor did hot assure any special attributes, contrary to popular mythology. In fact, if he used many of the attending surgeons at the Memorial as examples, the effect of admitting such an association should have been a handicap. But what really bothered Bellows was the knowledge that a penis would hold little fascination for Susan; in all probability she had dissected one.

Bellows did not reduce his own sexual urges and fantasies to anatomical and physiological realities, but what about Susan? She looked so normal with her smile, her soft skin, the hint of her breast gently rising with her breathing. But she had studied the parasympathetic reflexes, and the endocrine alterations that make sex possible, even enjoyable. Maybe she had studied too much, too much of the wrong thing. Maybe even if the occasion was auspicious, Bellows would find his penis limp, impotent. The thought made Bellows doubtful about seeing Susan. After all, once away from the hospital, Bellows wanted to escape, and mindless sex was a superb method. With Susan, if it happened at all, it wasn’t going to be mindless. It couldn’t be. Finally there was the sticky question about the wisdom of dating a student currently under his supervision on the surgery rotation. Bellows was undoubtedly going to be called upon to evaluate Susan’s performance as a student. Dating her represented a ridiculous conflict of interest.

The elevator door opened on the OR floor and Bellows quickly crossed to the main OR desk. The clerk was preparing the OR schedule of the following day.

“What room is my case in? It’s a Mr. Barron, a hemorrhoid.”

The clerk looked up to see who it was, then down at the current schedule.

“You’re Dr. Bellows?”

“None other.”

“Well, you have been taken off that case.”

“Taken off? By whom?” Bellows was perplexed.

“By Dr. Chandler, and he left word for you to meet him in his office when you appeared.”

To be taken off one of his own cases was very strange for Bellows. Certainly it was within George Chandler’s prerogative since he was the chief resident. But it was highly irregular. Occasionally Bellows had been removed from a scrub on which he was to assist, usually to help on some other case, and usually for purely logistic reasons. But to be removed from one of his own cases where the patient had been assigned to Beard 5 was a totally new experience.

Bellows thanked the OR clerk without bothering to hide his surprise and irritation. He turned and headed for George Chandler’s office.

The chief resident’s office was a windowless cubicle on 2. From this tiny area came the tactical edicts that ran the surgical department from day to day. Chandler was in charge of all the schedules for all the residents, including the on-call and weekend duty assignments. Chandler was also in charge of the operating room schedule, assigning the staff and clinic cases as well as the assists for the attending surgeons who asked for them.

Bellows knocked on the closed door, entering after hearing a muffled “Come in.” George Chandler was sitting at his desk, which nearly filled the tiny room. The desk faced the door, and Chandler had to squeeze past to gain access to the seat. Behind him was a file cabinet. In front of the desk was a single wooden chair. The room was bare; only a bulletin board adorned the walls. Blank but neat, the room was somewhat like Chandler himself.

The chief resident had successfully risen up the competitive pyramidal power structure of the lower world of students and residents. Now he was the liaison between the upper world, the full-fledged surgeons certified by specialty boards, and the lower world. As such he was a member of neither class. This fact was the source of his power as well as his weakness and isolation. The years of competition had taken their inexorable toll. Chandler was still young by most standards: thirty-three years old. He was not tall: about five eight. His hair was half-heartedly combed in some sort of modern Caesar look. His face had a gentle pudginess that belied his easily aroused temper. In many ways Chandler represented the young boy who has been bullied too much.

Bellows took the wooden chair opposite Chandler. At first no words Were spoken. Chandler regarded a pencil he had in his fingers. His elbows were resting on the arms of his chair. He had rocked back from what he had been working on when Bellows knocked.

“Sorry about taking you off your case, Mark,” said Chandler without looking up.

“I can manage without another hemorrhoid,” said Bellows, maintaining a neutral tone.

There was another pause. Chandler tipped his chair forward to the level position and looked directly at Bellows. Bellows thought that he’d be a perfect individual to play Napoleon in a play.

“Mark, I’m going to assume you’re serious about surgery, surgery here at the Memorial, to be exact.”

“I think that’s a fair assumption.”

“Your record has been reasonable. In fact I’ve heard your name on several occasions in relation to possibly being considered for the chief residency. That leads me to one of the reasons I wanted to talk with you. Harris gave me a call not too long ago and he was completely strung out. I wasn’t even sure what he was talking about for a few minutes. Apparently one of your students has been nosing around about these coma cases, and it’s got Harris bullshit. Now, I have no idea what’s going on, but he thinks that you might be behind getting the student interested and helping him.”

“It’s a her.”

“Him, her, I don’t give a damn.”

“Well, it might be significant. She happens to be a very well put-together specimen. As for my role in the matter, it’s a big fat zero! If anything, I have constantly tried to talk her out of the whole affair.”

“I’m not about to argue with you, Mark. All I wanted to do is warn you of the situation. I’d hate to have you gamble your chances on the chief residency because of some student’s activities.”

Mark looked at Chandler and wondered what Chandler would say if he told Chandler that he was going to see Susan that night on a social basis.

“I have no idea if Harris has said anything to Stark about all this, Mark, and I can assure you that I won’t unless it gets to the point where I have to cover my own tracks. But let me emphasize that Harris was livid, so you’d better tone your student down and tell him …”

“Her!”

“OK, tell her to find something else to get interested in. After all there must be ten people who are working on the problem already. In fact most of Harris’s department has been doing nothing else since the present run of anesthetic coma catastrophes.”

“I’ll try to tell her again, but it’s not as easy as it may sound. This girl has a mind of her own, with a rather fertile imagination.” Bellows wondered why he chose that way to describe Susan’s imagination. “She’s gotten into this thing because the first two patients she came in contact with are victims of the problem.”

“Anyway, let’s just say you have been warned. What she does is going to reflect on you, especially if you aid her in any way at all. But that was only one of the reasons I wanted to talk with you. There is another problem, more serious, to be sure. Tell me, Mark, what is your locker number up in the OR?”

“Eight.”

“What about number 338?”

“That was my temporary locker. I used it for about one week before number eight became available.”

“Why didn’t you stay with 338?”

“I guess it actually belonged to someone else, and I got to use it until I could get one of my own.”

“Do you know the combination of 338?”

“Maybe, if I thought long enough. Why do you ask?”

“Because of a strange finding by Dr. Cowley. He claims that 338 opened by magic when he was changing his clothes and the whole Goddamn thing was filled with drugs. We checked it out and he was right. Every kind of drug that you could imagine and a few more, including narcotics. The locker list I have has you down for 338, not eight.”

“Who’s down for eight?”

“Dr. Eastman.”

“He hasn’t done a case in years.”

“Exactly. Tell me, Mark, who gave you number eight? Walters?”

“Yup. Walters first told me to use 338, and then he gave me number eight.”

“OK, don’t say anything to anybody about this, least of all to Walters. Finding a hoard of drugs like this is a pretty serious business, considering all the rigmarole you have to go through to get a narcotic in the first place. Because of my locker list, you will probably be contacted by the hospital administration. For obvious reasons they are not excited about letting this information out, especially with the recertification deal corning up. So keep it under your hat. And for God’s sake, get your student interested in something else besides anesthesia complications.”

Bellows emerged from Chandler’s cubicle with a strange feeling. He wasn’t surprised about hearing that he was being associated with Susan’s activities. He was already afraid of that. But the news about the drugs found in a locker to which he was assigned, that was a different story. His mind conjured up an image of Walters oozing around the OR area. He questioned why anyone would hoard drugs like that. Then there was the suggestion of association. Susan had used the words supernatural and sinister. Bellows wondered exactly what kind of drugs were stored in locker 338. He also wondered if he should tell Susan about the discovery.

Tuesday, February 24, 2:36 P.M.

Susan allowed her eyes to wander around the Chief of Surgery’s office. It was spacious and exquisitely decorated. Large windows occupying most of two walls afforded a splendid view of Charleston in one direction and a corner of Boston and the North End in the other. The Mystic River bridge was partially concealed by gray snow clouds. The wind had shifted from the sea and was now blowing in from the northwest with arctic air.

Stark’s teak desk, with its white marble top, was situated eater-corner in the northwest section of the office. The wall behind and to the right of the desk was mirrored from floor to ceiling. The fourth wall contained the door from the reception room and carefully constructed, recessed bookshelves. A section of the shelves was hinged; partly ajar, it revealed gleaming glasses, bottles, and a small refrigerator.

In the southeast corner, where the huge expanse of windows met the bookshelves, there was a low, glass-topped table surrounded by molded fiberglass chairs. Their leather cushions were made of bright colors ranging through the oranges and greens.

Stark himself was seated behind his massive desk. His image was recreated a hundred times in the mirror to the right thanks to the reflection from the tinted window glass to his left The Chief of Surgery had his feet propped up on the corner of his desk so that daylight fell over his shoulder onto the paper he was reading.

He was impeccably dressed in a beige suit tailored to fit close to his lean body, accented by an orange silk scarf in his left breast pocket. His graying hair was moderately long and brushed back from his high forehead, just covering the tops of his ears. His face was aristocratic, with sharp features and a thin nose. He wore executive half-glasses framed in delicate reddish tortoiseshell. His green eyes rapidly scanned back and forth across the sheet of paper in his hand.

Susan would have been greatly intimidated by a combination of the impressive surroundings and Stark’s awe-inspiring reputation as a surgical genius had it not been for his initial smile and his seemingly incongruous posture. The fact that he had his feet up on the corner of the desk made Susan feel more comfortable, as if Stark really didn’t take his power position within the hospital too seriously. Susan correctly surmised that his skill as a surgeon and his ability as a medical administrator-businessman made it possible for Stark to ignore conventional executive posturing. Stark finished reading the paper and looked up at Susan sitting in front of him.

“That, young lady, is very interesting. Obviously I am totally aware of the surgical cases, but I had no idea a similar problem was occurring on the medical floors. Whether they are indeed related is uncertain but I must give you credit for coming up with the idea that they may be related. And these two recent respiratory arrests and deaths; associating them is … well, both far-out and brilliant at the same time. It gives food for thought. You have related them because you feel that depression of respiration is the common ground for all the cases. My first reaction to that—now, this is just my first reaction—is that it does not explain the anesthesia cases because in that circumstance, the respiratory pattern is being artificially maintained. You suggest some previous encephalitis or brain infection making people more susceptible to complications during anesthesia … let me see.”

Stark swung his feet from his desk and turned toward the window. Unconsciously he took his reading glasses from his nose and lightly chewed one of the earpieces. His eyes narrowed in concentration.

“Parkinsonism has now been related to previous unsuspected viral insult, so I suppose your theory is possible. But how could it be proved?”

Stark rotated around, facing Susan.

“And you must be assured that we investigated the anesthesia complication cases ad nauseam. Everything—and I mean everything—was studied with a fine-tooth comb by a host of people, anesthesiologists, epidemiologists, internists, surgeons … everybody we could think of. Except, of course, a medical student.”

Stark smiled warmly and Susan found herself responding to the man’s renowned charisma.

“I believe,” said Susan, her confidence rallying, “the study should start with the central computer bank. The computer information I obtained was only for the past year and called up by an indirect method. I have no idea what data would emerge if the computer was asked directly for all cases over, say, the last five years of respiratory depression, coma, and unexplained death.

“Then with a complete list of the potentially related cases, the charts would have to be painstakingly reviewed to try to elicit any common denominators. The families of the involved patients would have to be interviewed to obtain the best possible record of previous viral illness and patterns of illnesses. The other task would be to obtain serum from all existing cases for antibody screens.”

Susan watched Stark’s face, intently preparing herself for an untoward response like that she had experienced with Nelson and then more dramatically with Harris. In contrast, Stark maintained an even expression, obviously in thought over Susan’s suggestions. It was apparent that he had an open, innovative mind. Finally he spoke.

“Shotgun-style antibody screening is not very productive; it is time-consuming and it is horribly expensive.”

“Counter-immunoelectrophoresis techniques have relieved some of these disadvantages,” offered Susan, encouraged by Stark’s response.

“Perhaps, but it still would represent an enormous outlay of capital with a very low probability of positive results. I’d have to have some specific evidence before I could justify that type of resource commitment. But maybe you should suggest this to Dr. Nelson, down in Medicine. Immunology is his special field.”

“I don’t think Dr. Nelson would be interested,” said Susan.

“Why is that?”

“I haven’t the faintest idea. To tell the truth, I already spoke with Dr. Nelson. So I already know he’s not interested. And he wasn’t the only one. I mentioned my ideas to another department head and I thought I was going to get swatted like some naughty child that needed chastising. Trying to incorporate that episode into the whole picture, I get a feeling that something else could be operating here.”

“And what is that?” asked Stark, glancing over the figures Susan had provided.

“Well, I don’t know what word to use … foul play … or something sinister.”

Susan stopped talking quite suddenly, expecting either laughter or anger. But Stark merely rotated in his chair, looking out over the city again.

“Foul play. You do have an imagination, Dr. Wheeler, no doubt about that.”

Stark turned back toward the room, rising up and walking around his desk.

“Foul play,” he repeated. “I must admit I’d never even considered that.” Stark had been briefed only that morning about Cowley’s discovery of the drugs in locker 338; that information had disturbed him. He leaned against his desk and looked down at Susan.

“If you think about foul play, motive becomes of paramount importance. And there just isn’t any motive for such a series of heartbreaking episodes. They are too dissimilar. And coma? You’d have to implicate some very clever psychopath operating on a premise that’s beyond rationality. But the biggest problem with the idea of foul play is that it would be impossible in the OR. There are too many people involved who are watching the patient too closely.

“Certainly investigative activities should be carried out with an open mind, but I don’t think foul play is possible in this instance. But, I must admit, I had not thought of it.”

“Actually,” said Susan, “I hadn’t planned on suggesting foul play to you, but I’m glad that I did so that I can forget it. But back to the problem itself. If antibody screening is too expensive, the chart review and interviews would, be comparatively cheap. I could take that on myself, except I’d need a little help from you.”

“What kind of help?”

“First of all, I’d need to have authorization to use the computer. That’s number one. Secondly, I’d need authorization to get the charts. Thirdly, I may have run into a problem downstairs.”

“What kind of a problem?”

“Dr. Harris. He’s the one who blew his cool. I think he intends to have my surgical rotation here at the Memorial cut short. It seems that he is not fond of women in medicine, and perhaps I have served to underline that prejudice.”

“Dr. Harris can be difficult to get along with. He’s an emotional type. But at the same time he’s probably the best mind in anesthesiology in the country. So don’t damn him until you see his other side. I believe he has specific personal reasons for his attitude toward women in medicine. It’s not admirable, perhaps, but it is potentially understandable. Anyway, I’ll see what I can do for you. At the same time I must tell you that you have picked a very touchy subject to become involved in. You have undoubtedly considered the malpractice implication, the potential bad publicity for the hospital and even the Boston medical community. Tread lightly, young lady, if you choose to tread at all. You’ll make no friends on the course you are embarking on, and it’s my opinion you should drop the whole affair. If you choose to go on, I’ll try to help you, although I can guarantee nothing. If you do turn up any information, I will be happy to offer an opinion. Obviously the more information you have, the easier it will be for me to get you what you need.”

Stark moved toward the door from his office, opening it.

“Give me a call later this afternoon and I’ll let you know if I’ve had any luck with your requests.”

“Thank you for your time, Dr. Stark.” Susan hesitated in the doorway, looking at Stark. “It is reassuring that you have not lived up to your reputation of being a man-, or should I say, woman-eater.”

“Perhaps you will agree with the others when you find time to come on teaching rounds,” said Stark, with a laugh.

Susan said goodbye and left. Stark returned to his desk and spoke into his intercom, talking to his secretary.

“Call Dr. Chandler and see if he has talked with Dr. Bellows yet. Tell him that I want to get to the bottom of those drugs in the locker room as soon as possible.”

Stark turned and looked out over the complex of buildings that made up the Memorial. His life was so closely linked to the hospital that at certain points they merged. As Bellows had told Susan, Stark had personally raised an enormous amount’ of the money it had taken to revitalize the hospital and build its seven new buildings. It was partly due to his fund-raising abilities that he was Chief of Surgery at the Memorial.

The more he thought about the drugs in 338 and their possible implications, the angrier he got. It was just another glaring example of how people in general could not be trusted to think in terms of the long-run effects.

“Christ,” he said out loud, his eyes mesmerized by the swirling snow clouds. Fools could undermine all his efforts at insuring the Memorial’s position as the number one hospital in the country. Years of work could go down the drain. It underscored his belief that he had to attend to everything if he wanted it done right.

Tuesday, February 24, 7:20 P.M.

The gloom of the winter Boston night had long since invaded the city when Susan alighted from the Harvard line train at the open-air Charles Street MBTA station. The wind, still blowing in from the Arctic, whistled in the river end of the station and traversed the length of the platform in short turbulent gusts. Susan bent over as she headed toward the stairs. The train lunged and slid out of the station, passing her on her right, its wheels screeching as it turned into the tunnel.

Susan used the pedestrian overpass to cross the intersection of Charles Street and Cambridge Street. Underneath, the traffic had dissipated to a minor dribble of cars, but the noxious odor of exhaust gases still fouled the night air. Susan descended to Charles Street. In front of the all-night drugstore there was the usual collection of wayward individuals, either drunk or stoned. Several of them reached toward Susan, asking for spare change. She responded by quickening her step. Then she collided with a seedy, bearded fellow who had deliberately stepped into her way.

“Real Paper or Phoenix, beautiful?” asked the bearded fellow with seborrheic eyelids. He held several newspapers in his right hand.

Susan recoiled, then pressed on, ignoring the lurid jibes and laughter of the night people. She passed down Charles Street and presently the surroundings changed. A few antique shop windows beckoned for her to dally, but the cold night wind urged her on. At Mount Vernon Street she turned up to the left and began to ascend Beacon Hill. From the numbers on the doors she knew she had a way to go. She passed Louisburg Square. The orange glow from the mullioned windows cast warm rays in the cold night. The houses gave a sense of peace and security behind their solid brick facades.

Bellows’s apartment was in a building on the left, about a hundred yards beyond Louisburg Square. The buildings along here sat back behind small lawns and towering elms. Susan pushed open a squeaking metal gate and went up the stone steps to the heavy paneled door. In the foyer she blew on her blue fingers while walking in place to encourage circulation in her feet. She always had cold feet and hands from November to March. While she blew and stamped she scanned the names next to the buzzer. Bellows was number five. She pushed the button hard, and was rewarded with a raucous buzz.

In a minor panic she reached for the doorknob, scraping her knuckle on the metallic guard on the door frame as the door swung open. A small amount of blood oozed from her knuckle, and she lifted her hand to her mouth. In front of her was a staircase twisting up to the left. A shining brass chandelier hovered above, and a gilded frame mirror served to make the hall seem more spacious. By reflex she checked her hair in the mirror, pressing it down at her temples. As she climbed she noticed attractively framed Brueghel prints on every landing.

Exaggerating her exhaustion, she reached the top flight and paused, gripping the banister. Down the stairwell she could see to the tiled floor of the foyer, five storeys below. Bellows opened his door before Susan knocked.

“There’s an oxygen bottle in here if you need it, Grandma,” he said, smiling.

“God, the air is thin up here. Maybe I should sit here on the steps and. recuperate for a few moments.”

“A glass of Bordeaux will fix you up perfectly. Give me your hand.”

Susan allowed Mark to help her into his apartment. Then she took off her coat, her eyes wandering around the room. Mark disappeared into the kitchen, returning with two glasses of ruby red wine.

Susan threw her coat over a straight-back chair near the door and pulled oft her high boots. Distracted, she took the wine and sipped it. Her attention had been captured by the room she found herself in.

“Pretty tastefully decorated for a surgeon,” said Susan, walking into the center of the room.

It was about twenty by forty feet. At each end was a large old-fashioned fireplace, and in each glowed a cheerful fire. The beamed cathedral ceiling was very high, perhaps twenty feet at the peak, slanting down toward both fireplaces. The far wall was an enormous complex of geometric shapes, some housing bookshelves, others with objets d’art and a large stereo, TV, and tape system. The near wall was of exposed brick and covered with paintings, lithographs, and medieval sheet music, attractively framed. An antique Howard clock ticked unobtrusively over the fireplace to the right, a ship model adorned the mantelpiece to the left. Through the windows, on either side of both fireplaces, a myriad of crooked chimneys was silhouetted against the night sky.

The furnishings were of a minimum; Bellows had relied on a collection of thick scatter rugs, dominated by a blue and cream Bukhara in the center of the room. On it was a low onyx coffee table, surrounded by a large number of sizable pillows covered in shocking shades of corduroy.

“This is beautiful,” said Susan twisting around in the center of the room and then collapsing on an armful of cushions. “I never expected anything like this.”

“What did you expect?” Mark sat down on the other side of the low table.

“An apartment. You know, tables, chairs, couch, the usual.”

They both laughed, aware that they really did not know each other very well. Conversation remained on a frivolous level as they enjoyed the wine. Susan hopefully pointed her stocking feet toward the fire, to warm her toes.

“More wine, Susan?”

“For sure. It tastes wonderful.”

Mark disappeared into the kitchen for the bottle. He poured each of them another glass.

“No one would ever believe the day I’ve had today, incredible,” said Susan, holding the glass of wine between her eye and the fire and appreciating its deep luscious red glow.

“If you haven’t abandoned your suicidal crusade, I believe anything. Did you go and see Stark?”

“You bet your ass, and contrary to your fears, he was very reasonable … more than I can say about Harris or even Nelson, for that matter.”

“Be careful, that’s all I can say. Stark is like an emotional chameleon. I usually get along with him extremely well. Yet today, out of the blue, I found out he’s furious at me because of some nut putting half-used medicine in a locker that I had used for a while. He doesn’t come to me and ask me about it the way a normal human being would. Instead he sics poor old Chandler, the chief resident, onto me, and Chandler cancels a case of mine to ask me about it Then later he calls me out of rounds to tell me Stark wants me to get to the bottom of it. You’d think I had nothing to do.”

“What’s this about drugs in a locker?” Susan remembered the doctor talking to Nelson.

“I’m not sure I have the whole story. Something about one of the surgeons coming across a whole bunch of drugs in an OR locker which old friggin’ Walters still had assigned to me. Apparently there were narcotics, curare, antibiotics—a whole pharmacy.”

“And they don’t know who put them there or why?”

“I guess not. It’s my idea that somebody’s been saving the stuff to ship off to Biafra or Bangladesh. There’s always a couple of people around with some cause like that. But why they’ve been storing them in a locker in the lounge is beyond me.”

“Curare is a nerve blocker, isn’t it, Mark?”

“Yup, a competitive nerve blocker. A great drug. Oh, in case you haven’t guessed-, we’re dining here tonight. I got some steaks, and the hibachi is all set on the fire escape outside the kitchen window.”

“Couldn’t be better, Mark. I’m exhausted. But I’m also hungry.”

“I’ll put the steaks on.” Mark walked into the kitchen with his wineglass.

“Does curare depress respiration?” asked Susan.

“Nope. It just paralyzes all the muscles. The person wants to breathe but can’t. They suffocate.”

Susan stared into the fireplace, resting the edge of her glass against her lower lip. The dancing flames hypnotized her and she thought about curare, about Greenly, about Berman. The fire crackled suddenly and angrily spat a red-hot coal against the screen. A piece of the coal ricocheted off the screen, landing in the rug to the side of the fireplace. Susan jumped up, flicked it off the rug and pushed it harmlessly onto the slate hearth. She then walked over to the kitchen door, watching Mark season the steaks.

“Stark actually was interested in what I had found out and has already tried to help. I had asked him to help me get the charts of the patients on my list. When I called back later this afternoon, he said he had tried to get them for me but had been told that they were all signed out to one of the professors of neurology, a Dr. Donald McLeary. Do you know him?”

“No, but that doesn’t mean anything. I don’t know very many of the nonsurgical types.”

“To my way of thinking, it makes McLeary look rather suspicious.”

“Oh oh, here we go again, imagination plus! Dr. Donald McLeary mysteriously destroys the cerebrum of six patients …”

“Twelve …”

“OK, twelve, and then he signs all their charts out to eliminate any chance of suspicion. I can just picture all this in the headlines of the Boston Globe.”

Mark laughed as he put the steaks on the hibachi through the open window, then drew it down against the cold.

“Go ahead and laugh, but at the same time come up with an explanation for McLeary. Everyone else so far has expressed surprise at the idea of relating all these cases together. Everyone except this Dr. McLeary. He has all the charts. I just think it’s worth looking into. Maybe he’s been investigating this thing for some time and he’s far ahead of me. That would be nice to believe and if so, maybe I could help him.”

Mark didn’t answer. He was wondering exactly how he was going to try to talk Susan out of the whole business. He was also concentrating on the salad dressing, his culinary specialty. When he reopened the kitchen window, the cold wind brought in the sizzling aroma of the cooking steaks. Susan leaned against the door frame, watching him. She thought about how marvelous it would be to have a wife, to be able to come home and have a wife keeping the house in order, the meals on the table. At the same time it seemed ridiculously unfair that she could never have a wife. It was a mental game that Susan played with herself, always to the same impasse, as which time she would simply deny the whole problem or at least postpone it until some indeterminate future date.

“I called the Jefferson Institute today.”

“What’d they have to say?” Mark handed Susan some plates, silver and napkins, and pointed toward the onyx table.

“You were right about it being difficult to visit,” said Susan, carrying the material to the table. “I asked if I could come out: and visit the facility because I wanted to see one of the patients. They laughed. They told me that only the very immediate family can visit and only on prearranged, brief visits. They said that the mass methods of taking care of the patients is generally unacceptable, emotionally, to the families, so they have to make special arrangements for them to visit. They did tell me about the monthly tour you mentioned. My being a medical student counted about the same as a wooden nickel, so far as making them alter their routine. Actually the place sounds interesting, especially since, as you say, the concept has been successful in keeping chronic cases from taking up acute-care beds in the local hospitals.”

Susan finished setting the table, then returned to staring into the fire. “I’d really like to visit, though, mostly to see Berman once more. I have a feeling that if I saw him again that I’d probably be able to ease up on this … crusade, as you call it. Even I realize I’ve got to get back to a semblance of normality.”

Mark straightened up from his activities in the kitchen at this last sentence, entertaining a ray of hope. He turned the steaks over again and closed the window.

“Why don’t you just show up there? I mean, it must be like any other hospital when it comes right down to it. It’s probably as chaotic as the Memorial. If you acted like you belong, probably nobody would even question you. You could even wear a nurse’s uniform. If anybody came into the Memorial dressed like a doctor or & nurse, they could go anywhere they chose.”

Susan looked back at Mark, who was standing in the kitchen door.

“That’s not a bad idea … not bad. But there’s a catch.”

“What’s that?”

“Simply that I wouldn’t know where the hell I was going even if I were able to walk into the building. It’s hard to look like you belong when you’re totally lost.”

“That’s not an insurmountable obstacle. All you’d have to do is visit the building department in City Hall and get a copy of the building plans or floor plans. There are plans on file of all public buildings. You’d have yourself a map.”

Mark returned to the kitchen to get the steaks and the salad.

“Mark, that’s ingenious.”

“Practical, not ingenious.” He brought the food into the room and served up the steaks and a generous helping of salad. There were also asparagus with hollandaise sauce and another whole bottle of red Bordeaux.

Each thought the meal perfect. The wine tended to smooth any potential rough edges, and the conversation flowed freely as each learned bits and pieces of the other’s background to fill in the gaps of the personality mosaics each was constructing of the other. Susan from Maryland, Mark from California. There was little intellectual common ground, for Mark’s education had been severely skewed in the direction of Descartes and Newton, while Susan’s tended toward Voltaire and Chaucer. But skiing emerged as a love of both, as well as the beach, and the outdoors in general. And they both liked Hemingway. There was an awkward silence after Susan asked about Joyce. Bellows had not read Joyce.

With the dishes cleared, they settled on a random grouping of pillows before the fireplace at the far end of the room. Bellows put on some additional oak logs, turning the smoldering embers into a crackling blaze. Grand Marnier and Fred’s Home Made vanilla ice cream made them quiet for some moments, both enjoying the peaceful and contented silence.

“Susan, getting to know you just a little better, and liking every minute of it, makes me even more motivated to urge you to forget this coma problem,” said Mark, after a while. “You’ve got an enormous amount of learning to do, and believe me, there’s no place better than the Memorial. In all likelihood this coma problem will be around for some time, plenty of time for you to begin again when you have a real background in clinical medicine. I’m not trying to suggest you cannot contribute; maybe you can. But the chances of making a contribution are small, just like in any research project, no matter how well conceived. And you have to consider the effect your activities will undoubtedly have, in fact already have had, on your superiors. It’s a poor gamble, Susan; the odds are stacked against you.”

Susan sipped her Grand Marnier. The viscous, smooth fluid slid down her throat, and sent warm sensations down her legs. She took in a deep breath and felt a certain levitation.

“Being a female medical student must be hard enough,” continued Bellows, “without adding a further handicap.”

Susan raised her head and looked at Bellows. He was staring into the fire. “Exactly what do you mean by that statement?” asked Susan with a sudden slight edge to her voice. Bellows was suddenly brushing against sensitive areas.

“Just what I said.” Bellows did not look up from the fire. The dancing flames had captured his attention. “I just think it must be particularly difficult being a female medical student. I never really thought too much about it until you forced me to come up with an alternative explanation for Harris’s behavior. Now, the more I think about it, the more I think I am right because … well, to be truthful, I can’t say I reacted to you as a medical student first. As soon as I saw you, I reacted to you as a woman, and maybe in kind of an immature way. I mean I found you immediately attractive—not seductive.” Bellows added the last comment quickly and turned to make sure Susan appreciated his reference to their previous conversation in the coffee shop.

Susan smiled. The defensive attitude, which Bellows’s initial statement had rekindled, had melted.

“That was why I reacted so foolishly when you walked into the dressing room yesterday and caught me in my shorts. If I had thought of you asexually, I wouldn’t have budged. But it was pretty apparent that was not the case. Anyway, I think most of your professors and instructors are going to react to you first as female and only second as a student of medicine.”

Bellows looked back into the fire; he almost had the attitude of a contrite sinner who has confessed. Susan felt a resurgence of the warmth she had begun to feel toward him. She felt again the urge to give him one of her people hugs, as she thought of them. In truth Susan was a physical person, although she did not show it often, especially since entering medicine. Even before applying to medical school, Susan had decided that the physical aspects of her personality had to be suppressed if she was going to make it in medicine. Now instead of reaching for Mark, she sipped her Grand Marnier.

“Susan, you are very apparent in any group and if you don’t show up at my lecture, I’m going to have to account for you.”

“The luxury of anonymity,” said Susan, “has not been something I could enjoy ever since I started medical school. I understand what you are saying, Mark. At the same time I feel I need just one more day. One more.” Susan held up one finger and tilted her head in a coquettish fashion. Then she laughed.

“You know, Mark, it is reassuring to hear you say that you think being a female medical student is difficult, because it is. Some of the girls in my class deny it, but they’re fooling themselves. They’re using one of the oldest and easiest defense mechanisms;, get around a problem by saying it’s not there. But it is. I remember reading a quote by Sir William Osier. He said there were three classes of human beings: men, women, and women physicians. I laughed when I read that the first time. Now I don’t laugh anymore.

“Despite the feminist movement there still lingers the conventional image of wide-eyed feminine naiveté and all that bullshit. As soon as you enter a field which demands a bit of competitive and aggressive action, the men all label you as a castrating bitch. If you sit back and try to use passive, compliant behavior, you find yourself being told that you can’t respond to the competitive atmosphere. So you’re forced to try to find your own compromise somewhere in the middle, which is difficult because all the while you feel like you’re on trial, not as an individual but as a representative of women in general.”

There was silence for a few moments, each digesting what had been said.

“The thing that bothers me the most,” added Susan, “is that the problem gets worse, not better, the farther, into medicine one goes. I cannot imagine how these women with families do it. They have to apologize for leaving work early and then they have to apologize for getting home late, no matter what time it is. I mean, the man can work late, no problem, in fact it makes him seem that much more dedicated. But a woman physician: her role is so diffuse. Society and its conventional female mores make it very difficult.

“How did you get me on this platform?” asked Susan suddenly, realizing the vehemence with which she had been speaking.

“You were just agreeing to my statement that being a female medical student was difficult. So how about agreeing to the last part, about not taking on any more handicaps?”

“Shit, Mark, don’t push me right at this moment. Obviously you can see that once I got involved in this thing, I probably need to resolve it somehow. Maybe it’s related to my feeling like I’m on trial for women. God, I’d like to show that Harris where to get off. Maybe if I can see Berman again, I’ll be able to give up without any loss of intellectual face or … what should I say, self-image or self-confidence. But let’s talk about something else. Would you mind if I were to give you a hug?”

“Me, mind?” Bellows sat up quickly but slightly flustered. “Not at all.”

Susan leaned over and gave him a squeeze with a force that surprised him. Instinctively his arms went around her and he felt her narrow back. Somewhat self-consciously he patted it, as if he were comforting her. She pulled back.

“I hope you’re not waiting for me to burp.”

For several moments they studied each other in the firelight. Then tentatively their lips sought each other, gently at first, then with obvious emotion, finally with abandon.

Wednesday, February 25, 5:45 A.M.

The alarm jangled in the darkness, making the air in the room vibrate with its piercing sound. Susan sat bolt upright from a dead sleep. At first she wondered why her eyes wouldn’t open; then she realized that they were open. It was just that they could not pierce the utter blackness in the room. For several seconds she had no idea where she was. Her only thought was to try to find the alarm clock and deaden its awful nerve-shattering noise.

As suddenly as it had started, it stopped with a metallic click. At the same time Susan became conscious that she was not alone. The memory of the previous evening swept over her, and she remembered that she was still at Mark’s apartment. She lay back, bringing up the covers to cover her nakedness.

“What in God’s name was that noise for?” said Susan to the blackness.

“It’s an alarm. I suppose you’ve never heard one before,” said a voice from beside her.

“An alarm. Mark, it’s the middle of the night.”

“Like hell it is; it’s five-thirty and time to get rolling.”

Mark threw back the covers and put his feet onto the floor. He turned on the lamp next to the bed and rubbed his eyes.

“Mark, you’ve got to be out of your squash. Five-thirty, Christ.” The voice was muffled; Susan had her head underneath the pillow.

“I’ve got to see my patients, grab a bit to eat, and be ready for rounds at six-thirty. Surgery starts at seven-thirty sharp.” Mark stood up and stretched. Disregarding his nakedness and the coldness, he started for the bathroom.

“You surgical masochists defy imagination. Why don’t you start at nine or some other reasonable time? Why seven-thirty?”

“It’s always been seven-thirty,” said Bellows, pausing in the doorway.

“That’s a great reason. It’s seven-thirty because it’s always been seven-thirty—God, it’s that type of reasoning that’s so typical in medicine. Five-thirty in the morning. Shit, Mark, why didn’t you tell me about this when you invited me to stay last night? I would have gone back to the dorm.”

Bellows walked back to the bedside, looking down at the mound of covers indicating Susan’s body. The pillow was still over her head.

“If you’d take your surgical rotation a bit more seriously, I wouldn’t have to tell you what is the normal modus operandi. Time to get up, beauty queen.”

Bellows grabbed the edge of the blankets and, with a forceful jerk, pulled all the covers from the bed, leaving Susan bared to the elements, except for her head, still concealed by the pillow.

“Some hospitality,” said Susan, jumping up. She grabbed a blanket and twisted herself into an instant cocoon, then collapsed back onto the bed.

“Ah, but today is the first day of your new leaf. You’re going to be a normal medical student.”

A tug of war ensued with Susan’s wrapping.

“I need one more full day, just one. Come on, Mark, one more. You can understand that it’s important for me. If I don’t get the charts today, which I think I won’t, then it’s all over. Besides, if I can see Berman, I’ll probably give up. Then you’ll have your normal medical student. But I need one more day.”

Bellows let go of the blankets. Susan fell back, one breast exposed in a fetching Amazonian way.

“All right, one more day. But if Stark is on rounds today, he’ll know that you are phantomizing. I wouldn’t be able to come up with any cover story. I hope you realize that.”

“Let’s just play it by ear, almighty surgeon. I’m sure you’ll think of something.”

“Susan, I’ll just have to say that I had told you to be on rounds.”

“OK, have it your way. But I’m spending one more whole day on this thing. I’ve got some investment into it already.”

Susan snuggled into the warm bed. She barely heard the shower start in the bathroom. She thought she’d wait until Bellows finished before getting up.

When Susan awoke the second time, it was already quite light. Sudden gusts of wind blew rain against the window panes with a sound like rice hitting glass. With a contrariness typical of Boston weather, the wind had shifted during the night from northwest to due east. Thanks to the Gulf Stream, the temperature had risen into the high thirties, so precipitation was in the liquid rather than solid phase. The commuters were relieved, the skiers disgusted.

It was hard for Susan to believe the clock next to the bed, because it said almost nine. Bellows had showered, dressed, and exited without having reawakened her. Susan was amazed, for she was a relatively light sleeper. Just to be sure, she checked the bathroom and the living room for any sign that Bellows might still be there. She was alone.

Susan found a clean towel, then showered vigorously, remembering the previous night’s passion with a pleasant sense of warmth. Bellows had turned out to be a far more sensitive and innately generous lover than Susan had surmised. She was genuinely pleased, although she had some serious reservations about the relationship going very far. Bellows’s commitment to surgery seemed somehow too encompassing, as if everything else in his life would necessarily be relegated to a secondary position like a hobby.

In the refrigerator, Susan found some cheese and an orange. She helped herself to Grapenuts and toast while thumbing through the Yellow Pages. Checking to be sure that she had everything, she left Bellows’s apartment, locking the door securely behind her. It was going to be a busy day.

The rain had let up significantly by the time Susan hit the street. The weather did not appear to be clearing, but now it would be more pleasant to walk about. Susan turned left up Mt. Vernon toward the State House. She crossed the Boston Common at its northern tip and entered the downtown shopping area.

Of all the young girls who had come to the Boston Uniform Company retail store seeking a nurse’s uniform, the salesman found Susan the easiest and fastest customer. She seemed totally uninterested in the bewildering permutations of the plain white dress. She asked for size ten and told the salesman that any size ten would do.

“We have this style here which you might like,” he said, bringing out one uniform.

Susan took the dress and held it against herself as she looked into the mirror.

“The changing rooms are in the back if you’d like to try it.”

“I’ll take it.”

The salesman was stunned if gratified at the speed of the sale.

The rain started again half-heartedly as Susan walked up Washington Street toward Government Center. As she reached the middle of the bricked mall in front of the ultra-geometric City Hall, the wind brought in another moisture-laden cloud over the city. As the rain came down in earnest Susan ran for cover.

The girl at the information booth told Susan that the building department was on the eighth floor. It was easy to find. Once there, though, things were different. Susan waited for twenty-five minutes at the main counter only to be told that she was at the wrong place. This happened twice before she was directed to the rear of the vast room. There was another wait of a quarter of an hour despite the fact she was the only customer. Behind the counter were five desks, of which three were occupied. Two men and one woman. The two men looked surprisingly alike, with large red noses, plastic black-rimmed glasses, and tasteless ties. They were engaged in a heated argument about the Patriots. The woman had a ratted hairdo recalling the early sixties and shocking red lipstick that used the natural lip borders only as suggestions. She was engrossed with a pocket mirror, examining her face from every possible angle.

The smaller of the two men eventually eyed Susan and realized that she was not going to disappear despite the fact that she was being ignored. He rambled over, uninterested. When he reached the counter he took his cigarette from his mouth. A few of the ashes from the tip dusted down the front of his tie. He crushed the butt repeatedly in a cheap and already overflowing metal ashtray.

“What can I do for you?” said the bureaucrat, looking at Susan for a moment. He turned before she could answer.

“Hey, Harry, that reminds me. What are you going to do about the GRI 5 request? Remember, it was filed as urgent and it’s been in your box for two months.” Looking back at Susan, “What is it, honey? Let me guess. You want to file a complaint about your landlord. Well, this isn’t the right place.”

He looked back at his colleague. “Harry, if you’re going for coffee, pick me up a regular and a Danish. I’ll pay you later.” His red eyes turned to Susan. “Now then …”

“I’d like to look at some plans; the floor plans for the Jefferson Institute. It’s a relatively new hospital in South Boston.”

“Plans. What do you want plans for? How old are you, fifteen?”

“I’m a medical student and I’m interested in hospital design and construction.”

“Kids today! With your looks you don’t have to be interested in anything.” He laughed obnoxiously.

Susan closed her eyes, resisting the retort the comment deserved.

The state employee started toward a stack of oversized books on the counter. “What ward is it in?” he asked with obvious ennui.

“I haven’t the slightest idea.”

“All right then,” said the man, making an about-face. “First we’ll have to find out which ward it is in.”

A smaller book on the counter supplied the needed information.

“Ward 17.”

With calculated slowness, he returned to the large books on the counter. From his side pocket he withdrew a crumpled pack of cigarettes. He put one cigarette in his mouth, leaving it unlit. After picking several wrong volumes, he found the Ward 17 volume. The other books were pushed aside. Turning back the cover, he slobbered over his index finger. He flipped the pages forcefully, running his finger across his tobacco-stained tongue every four of five pages. Having found the reference, he copied the figures onto a piece of scrap paper. Motioning for Susan to follow, he started toward a large bank of filing cabinets.

“Harry!” called the bureaucrat, continuing his conversation with his colleague en route to the filing cabinets, the unlit cigarette bobbing up and down in his mouth. “Before you go downstairs, call up Grosser and find out if Lester is coming in today. Somebody’s goin’ to have to file that stuff on his desk if he’s not; that’s been there longer than your GRI 5 request.”

It was a simple affair to find the correct drawer and extract a large packet of plans. “Here you are, Goldilocks; there’s a Xerox machine over in that room beyond the counter, if you want. It takes nickels.” He pointed with his unlit cigarette.

“Maybe you could show me which of these are floor plans.” Susan had withdrawn the contents from the jacket.

“You’re interested in hospital construction and you don’t know what floor plans look like? My God. Here, these are the floor plans … basement, first floor, and second floor.” He lit his cigarette with a pocket lighter.

“How do you decipher these abbreviations?”

“For Christ’s sake, right here in the lower corner. It says ‘OR’, means operating room. ‘W (main)’; that means main ward. And ‘Comp. R.’ stands for computer room and so forth.” The man showed signs of incipient irritation.

“And the Xerox machine?”

“Over there. There’s a change machine on the wall. When you finish with the plans, just put them in the metal bin on the counter.”

Susan carefully Xeroxed the floor plans and labeled the rooms on the copy with a felt-tipped pen. Then she headed for the Memorial.

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