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Coma by Robin Cook. Part six

Susan nodded in agreement, looking down at the pile of paper filled with her tiny writing.

Bellows’s eyes followed hers.

“Well, have they shed any light on this … this crusade of yours?”

“Not much, I’m afraid. At least not yet, or at least I’ve not been clever enough to spot it. I wish I had all the charts. So far the ages have all been relatively young, twenty-five to forty-two. Otherwise they seem to be of random sex, racial background, social background. I can’t find any relationship in their previous medical histories. Their vital signs and progress up until the onset of coma were uncomplicated in all cases. Their personal physicians were all different. Of the surgical cases, only two had the same anesthesiologist. The anesthetic agents were varied, as expected. There were some overlaps in the preoperative medications. A number of the cases had Demerol and Phenergan, but others had totally different agents. Innovar was used on two cases. But all that’s not surprising.

“It does seem, as far as I can tell without going up in the OR, that most if not all the surgical cases occurred in room eight. That does seem a little strange, but then again that’s the room used most often for the shorter operations. And this problem is most often associated with the shorter operations. So that’s probably to be expected as well. Laboratory values are all generally normal. Oh, by the way, all cases seemed to have been blood-typed and tissue-typed. Is that normal procedure?”

“They blood-type most surgical patients, especially if they anticipate much blood loss during the operation. Tissue-typing is not usual, although the lab may be doing it as part of a check on new equipment or new tissue-typing sera. See if there is an accounting number on one of the lab reports on the typing.”

Susan flipped back through the pages of the chart in front of her until she located the tissue-type report.

“No, there’s no accounting number.”

“Well, that explains that, then. The lab is doing it at their expense. That’s not abnormal.”

“The medical patients were all on I.V.s for one reason or another.”

“So are ninety percent of the people in the hospital.”

“I know.”

“Sounds like you got a lot of nothing.”

“I’d have to agree at this point.” Susan paused, sucking on her lower lip. “Mark, before the endotracheal tube is placed in a patient during anesthesia, the anesthesiologist paralyzes the patient with succinylcholine. Isn’t that right?”

“Succinylcholine or curare, but usually succinyl.”

“And when a patient is given a pharmacological dose of succinylcholine, he can’t breathe.”

“That’s true.”

“Couldn’t an overdose of succinylcholine be the way these patients are rendered hypoxic? If they can’t breathe, then oxygen doesn’t get to the brain.”

“Susan, the anesthesiologist gives succinylcholine and then monitors the patient like a hawk; he even breathes for the patient. If there is too much succinylcholine, it just means the anesthesiologist has to breathe the patient for a longer time until the patient metabolizes the drug. The paralyzing effect is completely reversible. Besides, if something like that were being done maliciously, all the anesthesiologists in the hospital would have to be involved, and that’s hardly likely. And maybe even more important is the fact that under the combined eye of the anesthesiologist and the surgeon, who can actually see how red the blood is and how well it is oxygenated, it would be absolutely impossible to alter the patient’s physiologic state without one or both knowing it. When blood is oxygenated, it is bright red. When oxygen gets low, the blood becomes dark brownish-bluish-maroon. The anesthesiologist meanwhile is breathing the patient, constantly checking the pulse and blood pressure, and watching the cardiac monitor. Susan, you are hypothesizing some sort of foul play, and you don’t have a why or a who or a how. You’re not even sure you have a victim.”

“I’m sure I have a victim, Mark. It might not be a new disease but it’s something. One more question. Where do the anesthetic gases come from that the anesthesiologists use?”

“It varies. Halothane comes in cans like ether. It’s a liquid and it’s vaporized as needed in the OR. Nitrous, oxygen, and air come from central sources and are piped into the OR’s. There are standby cylinders of oxygen and nitrous oxide in the OR for emergency use. … Look, Susan, I’ve got a little more work to do, then I’m free. How about coming over to the apartment for a drink?”

“Not tonight, Mark. I want to get a good night’s sleep and I’ve got a few more things to do. But thanks. Also, I’ve got to get these charts back to their hiding place. After that I intend to look around in OR room number eight.”

“Susan, I personally think you should get your ass out of this hospital before you really get yourself in hot water.”

“You’re entitled to your opinion, doctor. It’s just that this patient doesn’t feel like following orders.”

“I think you’re carrying all of this too far.”

“You do, do you? Well, I might not have a who, but I’ve got a number of suspects. …”

“Sure you do. …” Bellows fidgeted. “Are you going to make me guess or are you going to tell me?”

“Harris, Nelson, McLeary, and Oren.”

“You’re out of your squash!”

“They all act as guilty as hell and want me out of here.”

“Don’t confuse defensive behavior with guilt, Susan. After all, complications are hard to live with in medicine, no matter from what cause.”

Wednesday, February 25, 11:25 P.M.

Susan felt a definite sense of relief when she had returned the charts to their hiding place in McLeary’s closet. At the same time, she was very disappointed. Having finally inspected them was an anticlimax of sorts. She had placed a great deal of emphasis on the importance of the charts, but after she had finished studying them, she felt no further in her mission. She had a lot more data but no correlates, no intercepts. The cases still seemed to be random and unassociated.

The elevator slowed and stopped, the door quivered, then opened. Susan stepped out into the OR area. There was still a case going on in room No. 20, a ruptured abdominal aneurysm that had been admitted through the emergency room. The operation had been in progress for over eight hours; that didn’t look so good. Otherwise the OR area was in its nightly repose. There were a few people busy cleaning the floor and restocking the supply room with freshly laundered linen. A girl in a scrub dress was behind the main desk, trying to fit the last few cases into the following day’s master schedule.

The nurse’s uniform ruse was still working well for Susan and the few people in the hall did not seem to notice her passing. She went directly to the nurses’ locker rooms and changed into a scrub dress, hanging the nurse’s uniform in an open locker.

Reentering the main hall, Susan eyed the swinging doors into the area of the operating rooms. A large sign on the right door said “Operating Rooms: Unauthorized Entry Forbidden.” The main desk was just to the side of these doors. The nurse sitting behind the desk was still hard at work. Susan had no idea if she would be challenged if she tried to enter.

In order to survey the scene in its totality, Susan walked the length of the hall several times, half-hoping the girl at the main desk would take a break and leave. But she didn’t budge, nor even look up. Susan tried to think of some appropriate explanation in case the girl questioned her. But she couldn’t think of any. It was almost midnight and she knew she’d have to have some reasonably convincing story to explain her presence.

Finally, with no cover story in mind except for some weak comment about wanting to check on progress in room No. 20, or being sent up from the lab to do random cultures for contamination, Susan made her move. Pretending not to notice the girl at the desk, she headed for the doors. As she passed, the girl did not look up. A few more steps. When Susan reached the doors, she straight-armed the one on the right. It opened and Susan was about to enter.

“Hey, just a minute.”

Susan froze, waiting for the inevitable. She turned to face the girl.

“You forgot your conductive boots.”

Susan looked down at her shoes. As it dawned on her what the nurse was concerned about, Susan felt relieved.

“Damn, you’d think this was my second time in the OR.”

The nurse’s attention went back to the master schedule. “I forget the bastards now and then myself.”

Susan walked over to a stainless steel cabinet against the wall. The conductive booties—designed to prevent static electricity, so hazardous where inflammable gas was flowing—were kept in a large cardboard box on the lower shelf. Susan put them on the way Carpin had shown her on the first visit to the OR two days before, tucking the black tapes inside her shoes. When she opened the swinging door the second time, the nurse at the desk didn’t even look up. The Memorial was large enough so that new faces were to be expected.

The operating rooms at the Memorial were grouped in a large U-shape with supply, holding area, and anesthesia offices in the center. The entrance to the OR area was at the bottom of the U and the recovery room was on the left arm of the U, closest to the elevators. Susan found that room No. 8 was on the right arm of the U, on the outside.

No. 20, where the operation continued, was in the opposite direction, and Susan found herself quite alone approaching room No. 8. Pausing at the door, she looked through the glass. It looked exactly like room No. 18, where Niles had passed out. The walls were tile, the floor a speckled vinyl. Although the lights were out, Susan could see the large kettledrum operating lights above, and the operating table immediately below. She opened the door and turned on the lights.

Without any specific objective in mind, Susan roamed around the room, noticing the larger objects. Then in a more systematic fashion she began to examine details. She found the gas line terminals, noticing that oxygen had a green male connector. The nitrous connector was blue and structurally different so that no mistake could be made. A third male connector was not labeled or colored. Susan assumed it was the compressed air line. A larger female connector was labeled “suction”; above it was a gauge with a large adjusting dial.

In the back of the room were a number of stainless steel cabinets filled with various supplies. There was a desk of sorts for the circulating nurse. The right wall had an X-ray screen. The rear wall, next to the door, had a large institutional clock. The large red second hand swept around smoothly. Another door led into an adjoining supply room, shared with OR No. 10, which contained the sterilizers and other paraphernalia.

Susan spent almost an hour going over room No. 8, as well as No. 10 for comparison. She found nothing abnormal or even mildly curious about room No. 8. It was an OR room like so many thousands. No. 10 appeared no different.

Without challenge, Susan retraced her steps to the nurses’ locker room and changed back into her nurse’s uniform. She threw her scrubdress into a hamper and started for the door. But she paused then, looking up at the ceiling. It was a drop ceiling, made with large blocks of acoustical tile.

The wastebasket provided an intermediate step. Susan moved from the wastebasket to the sink to the top of the lockers. The ceiling was about three feet above the top of the lockers. Crouching on all fours, she tried the first ceiling block. It would not lift up because of some piping immediately above it. She tried another. Same problem. The third tile, however, lifted easily, and Susan slid it to one side. She then stood up on top of the locker, projecting half of herself into the ceiling space. Contrary to her estimate, the ceiling space was generous in its size. There was almost five feet of vertical space from the dropped acoustical ceiling to the cement of the floor slabs above. A myriad of pipes and ducts ran through this space, carrying the hospital’s vital supplies and wastes. The light was very poor, with only pencil-like beams seeping up from below in scattered locations between ceiling tiles.

The dropped ceiling was composed of the cardboard tile, held in place by thin metal strips, which were in turn hung from the cement slab above. Neither the tiles nor the metal strips were strong enough to carry any weight. In order to enter the ceiling space, Susan had to pull herself up onto the pipes, which she found either ice cold or very hot. Once up in the ceiling space, she replaced the ceiling tile she had moved. It fell back into place, cutting off the direct source of light.

Susan waited until her eyes made the adjustment from the fluorescent world below to the semidarkness above. Eventually outlines took forms and Susan could move ahead along the pipes. She noticed a row of studs which continued through the ceiling space to connect with the concrete above. She guessed that they marked the wall of the corridor.

Progress was slow; it was difficult to move on the pipes, treading on one, keeping hold of another or, here and there, a stud for support. She did not want to make any noise, especially when she guessed she was over the area of the main desk. Once over the OR area itself, the going became definitely easier. The ceilings over the OR and the recovery room were fixed and made of prestressed concrete. Susan could move at will provided she avoided tripping on the piping and provided she bent over considerably, for the space here was only about three feet high.

Susan found a concrete wall which she guessed housed the elevator shafts. Then she discovered that the corridor of the OR area had a dropped ceiling. Beyond the OR corridor, over what was probably part of central supply, Susan could see that the maze of pipes and ducts running through the ceiling space converged in what seemed a tangled vortex. Susan guessed that was the location of the central chase which housed all the piping and ducts coursing vertically in the building.

Susan was interested primarily in locating room No. 8. But that was not easy. There were no specific demarcations from one OR to the next The pipes seemed to spread out and dive through the concrete to the operating rooms below in utter anarchy. The corridor ceiling led to a solution. By carefully picking up the edges of the ceiling blocks over the corridor, Susan was able to orient herself and locate the ceiling area of rooms No. 8 and No. 10. Susan satisfied herself that the number and configuration of the pipes to and from the two rooms were identical.

The gas lines corresponding to the painted intake connectors she had seen down below in the ORs had the same color codes in the ceiling space. Over room No. 8, Susan found the oxygen line with a splash of green paint. Susan traced the oxygen line from room No. 8. It coursed back to the edge of the corridor then bent at a right angle to run parallel to it, alongside similar oxygen lines coming from other ORs. As Susan passed additional OR rooms, more lines joined the oxygen line she was trailing. In order to be sure she was still following the pipe from No. 8, Susan kept her finger on it all the way to the edge of the central chase. Then her finger hit something. In the dim light she had to bend over to see what it was. She saw a stainless steel female connector. Just over the edge of the chase carrying the pipes up from the hospital depths was a high-pressure T-valve on the oxygen line leading to room No. 8.

Susan stared at the valve. She looked at the other gas lines coming up the chase. There were no similar valves on any of the other lines. With her finger she examined the valve. It was obvious that the oxygen could be tapped from the line at that point. But equally as possible was that something, another gas, could be bled into the oxygen line at the same point.

Keeping to the fixed ceilings of the ORs, Susan worked her way back to the area of the main desk. Then she began the difficult part of crossing the large expanse of non-fixed ceiling. Wishing she had dropped some bread crumbs in the forest of pipes, Susan was forced to reconnoiter. She lifted a corner of a ceiling tile, but it was over the hall. She lifted another tile only to find herself over the doctors’ lounge. The third tile was over the nurses’ locker, but too far from the lockers she needed to step on. The fourth tile was perfect, and Susan descended with little difficulty.

Thursday, February 26, 1:00 A.M.

Like any major city, Boston never completely goes to sleep. But unlike many a major city, Boston becomes almost silent. As Susan settled back in the taxi speeding along Storrow Drive, only two or three cars passed, all going in the opposite direction. She was very tired, and she craved sleep. It had been an unbelievable day.

The laceration of her lip and the bruise on her cheek had grown more painful. Gingerly she touched her cheek to see if the swelling had increased. It had not. She looked out over the Esplanade and the frozen Charles River to her right The lights of Cambridge were sparse and uninviting. The taxi banked sharply left off Storrow Drive onto Park Drive, requiring Susan to steady herself with her arm.

She tried to assess her progress. It wasn’t encouraging. To keep within a reasonable limit of safety, she thought she had another thirty-six hours or so to press her search. But she was stymied. As the cab crossed the Fenway, Susan admitted to herself that she had run out of ideas on how to proceed. She felt she could not chance the Memorial by day with Nelson, Harris, McLeary, and Oren all lined up against her. She doubted the nurse’s uniform would work on a direct confrontation.

But she wanted more data from the computer. She needed the other charts, too. Was there a way to do it? Would Bellows help? Susan doubted it. She now knew that he was truly anxious about his position. He really is an invertebrate, she thought.

And what about Walters’s suicide? How could those drugs be tied in?

Susan paid her fare and got out of the taxi. Walking up to the door, she decided that in the morning she would try to find out as much as possible about Walters. He had to be related. But how?

Susan stood by the front door with her hand on the knob, expecting to be buzzed in by the watchman at the front desk. But he wasn’t sitting there. Susan cursed as she rummaged in her coat for her keys. It was uncanny how the man at the desk seemed to disappear whenever you needed him.

The four flights up to her floor seemed longer than usual to Susan. She paused on several occasions, because of a combination of physical fatigue and mental effort.

Susan tried to remember if Bellows had said succinylcholine was among the drugs found in the locker in the doctors’ dressing room. She distinctly remembered his saying curare but she could not remember succinylcholine. She got to the top of the stairs still very much lost in thought. It took another minute to find the correct key. As she had done countless times, she inserted the key in the lock. It took a bit of effort.

Despite her deep thought and exhaustion, Susan remembered about the wad of paper. Leaving the key in the door she bent down to look.

The paper was not there. The door had been opened.

Susan backed away from the door, half-expecting it to open suddenly. She remembered the horrid face of her assailant. If he was within the room, he was undoubtedly poised, expecting her to enter as usual. She thought of the knife he had not used the last time. She knew that she had very little time. The only factor in her favor was that if he were in the room, he would not know Susan suspected his presence. At least for a few moments.

If she called the authorities and the man was found, she’d be safe for some hours perhaps. But she recalled the threat about telling the police, the photograph of her brother. Did that suggest a burglar or a rapist? Not likely. Susan understood that the man who attacked her before was both professional and serious, deadly serious. She should run, perhaps even leave town. Or should she call the police anyway, as Stark had suggested? She was no professional; that was painfully apparent.

Why would they be after her already? She felt confident she had not been followed. Maybe the wad of paper had fallen out by itself. Susan advanced toward the door again.

“What the hell’s the matter with this lock?” she said aloud, shaking the keys, playing for time. She remembered that the watchman was not at his desk downstairs. Should she go down and knock on someone else’s door, saying that hers was stuck? Susan backed away again and moved over to the stairs. She thought that was the best idea under the circumstances. She knew Martha Fine on three well enough to knock at this hour. She didn’t know what she should tell her. It was probably best for Martha if she told her nothing. All she’d say was that she couldn’t get into her own room and she needed to sleep on Martha’s floor.

Susan stepped slowly onto the wooden stairs. They creaked mercilessly under her weight. The sound was unmistakable and Susan knew it. If someone was poised behind her door he would have heard it. Susan ran down the stairs headlong. As she got to the third floor she heard the latch on her door snap open. She went on down, not bothering to stop. What if Martha wasn’t there, or wouldn’t answer? Susan knew that she could not let the man get hold of her again. The dorm seemed asleep, although it was only a little after one.

Susan heard her door fly open and hit the wall of the hall. She heard some steps and imagined that someone had run to the banister. Susan dared not to look up. Her mind was made up. She’d leave the dorm. It would be easy to lose whoever was following her within the medical school complex. Susan felt she could run relatively quickly and she knew every inch of the area. She was at the ground floor when she heard her pursuer start down the stairs above.

At the bottom of the stairs Susan turned sharply to the left and ran through a small archway. Quickly she opened the door to the quad outside, but she did not exit. Instead, she let the hydraulic hinge begin to close the door. She turned and passed through the door into the adjacent wing of the dorm, shutting that door after her. She could hear feet running on the landing of the second floor.

Avoiding the noise her shoes would make if she ran normally, Susan moved down the ground-floor hall of the adjacent dorm, keeping her legs relatively stiff. She moved quickly but silently, passing the Student Health Office. At the end of the hall she opened the stairwell door quietly and allowed it to close behind her without a noise. She found herself on a stairway to the basement level and wasted no time in descending.

D’Ambrosio was tricked by the slowly closing door to the quad but not for long. D’Ambrosio was no novice at pursuit and he knew just how much time Susan was ahead of him. As he ran into the quad, he knew immediately that he had been duped. He would have been, except there were no other doors close enough for her to have got back into the building.

D’Ambrosio darted back through the door he had just opened. There were only two alternate routes. He chose the nearest door and ran forward down the hall.

Susan entered the tunnel connecting the dorm with the medical school. She was sure she must be in the clear. The tunnel proceeded straight for twenty-five or thirty yards, then twisted out of sight to the left. Susan moved ahead as quickly as she could: the tunnel was fairly well lit by bulbs in open wire cages.

At the end of the tunnel she reached for the handle on the fire door and opened it. A breeze of air hit her as she went through. A sinking feeling passed over her as she realized that could mean only one thing. The door behind her had to be open at the same time! Then she heard the unmistakable heavy footsteps of a man running in the tunnel.

“My God,” she whispered in a panic. Perhaps she had misjudged. She had left a dorm full of people, even if asleep, for the labyrinthine spaces of a dark, deserted building.

Susan rushed up the stairs ahead, feeling a sense of helplessness as she remembered the strength of D’Ambrosio. Quickly she tried to think of the layout of the building she was now in. It was the Anatomy-Pathology Building, which had four floors. There were two large lecture amphitheaters on the first floor as well as several ancillary rooms. The second floor had the anatomy hall with a number of smaller labs. The third and fourth floors were mostly offices, and Susan was not familiar with them.

She opened the door onto the first floor. Unlike the tunnel, the building was totally dark except for light from the street-lamps filtering through infrequent windows. The floor was made of marble and it echoed with her footsteps. The hall followed a circular pattern as it skirted the pit of one of the amphitheaters.

With no particular plan in mind, Susan rushed up to one of the wide but low doors leading into the first amphitheater. It was the door through which patients were wheeled for demonstrations. As Susan closed the door she heard running footsteps on the marble hall behind her. She moved away from the low door into the center of the amphitheater. The banks of seats rose in regular tiers until they were lost in darkness. She mounted the steps leading up one aisle from the pit.

The footsteps got louder and Susan hurried upward, afraid to look back. The footsteps passed and became less audible. Then they stopped altogether. Susan moved higher and higher. Behind her the pit of the amphitheater became more and more difficult to distinguish. Susan reached the upper tier of seats and moved laterally along it. She heard the footsteps on the marble again. She had a few moments to think. She knew there was no way she could cope with this man directly; she had to lose him or hide long enough so that he would give up and leave. She thought about the tunnel to the Administration Building. But she wasn’t one hundred percent sure that it would be open. Occasionally it had been locked when she tried to take that route home from the library in the evening.

She froze as she heard the door open into the pit of the amphitheater. The shadowy figure of a man entered. She could barely see him. But she was dressed in the white nurse’s uniform and she feared that she was more easily visible. She slowly crouched down behind a row of seats, but the backs of the chairs only rose eight to twelve inches above the level she was on. The man stopped and did not move. Susan guessed that he was trying to scan the room. She carefully lay down on the floor. She could see between the backs of two of the seats. The man walked over to the podium and seemed to be searching. Of course. He was searching for the lights! Susan felt panic again take control. Ahead of her, about twenty feet away, was a door to the hall on the second floor. Susan prayed that the door would be open and not locked. If it were locked she would have to try to make it to the door on the opposite side of the amphitheater. That would take about as long as it would take D’Ambrosio to get from the pit up to her level. If the door ahead of her was locked, she was lost.

There was a snap of a light switch and the lamp on the podium went on. Suddenly and eerily D’Ambrosio’s horrid pockmarked face was illuminated from below, casting grotesque shadows and making his eye sockets appear like burnt holes in a ghoulish mask. His hands groped along the side of the podium, and the sound of a second switch reverberated in Susan’s ears. A strong ray of light sprang from the darkened ceiling, illuminating the pit in a brilliant beam. Now Susan could see D’Ambrosio clearly.

She crawled forward as rapidly as she could toward the door. Another light switch snapped and a bank of lights lit up the blackboard behind D’Ambrosio. At that point D’Ambrosio noted the switches for the room lights to the left of the blackboard. As he walked over to the switches, Susan got up and broke for the door. She turned the knob as the lights went on in the room. Locked!

Susan stared down into the pit. D’Ambrosio saw her and a smile of anticipation came to his thin, scarred lips. Then he ran for the stairs, taking them in twos and threes.

Susan shook the door in despair. Then she noted that it was bolted from within. She threw the bolt and the door opened. She flung herself through it and slammed the door behind her. She could hear D’Ambrosio’s deep breaths as he neared the top row of seats.

Directly across from the second-floor amphitheater door was a CO2 fire extinguisher. Susan ripped it from the wall and turned it upside down. She spun around, hearing the metallic click of D’Ambrosio’s shoes coming closer and closer, and got set just as the knob turned and the door swung open.

At that instant, Susan depressed the button on the fire extinguisher. The sudden phase change and expansion of the gas caused an explosive noise that shrieked and echoed in the silence of the empty building as the spray of dry ice caught D’Ambrosio full in the face. He reeled backward and tripped over the upper row of seats, his big body teetering, then crashing sideways onto the second and third rows. A seat back dug deeply into his side, snapping his left eleventh rib. His arms flew out to protect himself, grabbing at the seat backs as his feet continued over his head. He fell lengthwise facedown into the fourth row, stunned.

Susan herself was amazed at the effect and stepped into the amphitheater, watching D’Ambrosio’s fall. She stood there for an instant, thinking that D’Ambrosio must be unconscious. But the man drew his knees up and pulled himself into a kneeling position. He looked up at Susan and managed a smile despite the intense pain of his broken rib.

“I like ’em … when they fight back,” he grunted between clenched teeth.

Susan picked up the fire extinguisher and threw it as hard as she could at the kneeling figure. D’Ambrosio tried to move, but the heavy metal cylinder struck his left shoulder, knocking him down again, and forcing the upper part of his body to fall over the backs of the seats of the next row down. The fire extinguisher bounced down four or five more rows with a terrific clatter, coming to rest in the eighth row.

Slamming the door to the amphitheater shut on her pursuer, Susan stood panting. My God, was he superhuman? She had to find a way to detain him. She knew that she had been unbelievably lucky in injuring him, but plainly he was not out of the picture. Susan thought of the large deep-freeze in the anatomy room.

The hall was dark except for the window at the far end, which provided a paltry amount of pale light. The entrance to the anatomy room was at the very end of the hall near to the window. Susan ran for the door. As she reached it, she heard the door from the amphitheater open.

D’Ambrosio was hurt but not badly. It was painful to cough or take a deep breath, but it was bearable. His left shoulder was bruised but functioning. More than anything else, he was mad. The fact that this screwy chick had managed to get the best of him even for a few moments pissed him off. Now he’d kill her first and fuck her later. He had his Beretta in his right hand, its silver silencer screwed in place. As he stepped from the amphitheater, he just caught sight of Susan entering the anatomy hall. He fired without really aiming and the bullet missed Susan several inches, slamming into the edge of the door frame and throwing splinters of wood into the air.

The sound of the gun was like that of a rug beater. Susan had no idea what it was until the noise and effect of the slug entering the woodwork made it clear to her that it was a gun, a gun with a silencer.

“All right, you bitch, the game’s over,” shouted D’Ambrosio, coming down the hall at a walk. He knew he had her cornered and that it would hurt to run.

Inside the anatomy hall, Susan paused for a moment, trying to recall the layout in the faint light. Then she bolted the door behind her. The first-year class at that time of the year was in the middle of their anatomy course. The dissecting tables in the room were covered with green plastic sheets. In the dim light they appeared light gray. Susan ran between the shrouded tables to the freezer door at the far end of the room. There was a large stainless pin through the latch. She pulled the pin free and let it hang by its chain, releasing the latch. With some effort Susan opened the heavy insulated door and squeezed through. She pulled the door shut behind her and heard the heavy click. She groped for a light beside the door and switched it on.

The freezer was at least ten feet wide and thirty feet deep. Susan remembered all too clearly the first day she had seen it. The diener loved to show it to the students, one at a time, and he particularly liked female students for some unknown but undoubtedly perverse reason. He had charge of the cadavers stored here for dissection. After embalming, they were hung up with tongs hooked into the external ear canals. The tongs were connected to roller bearings on tracks in the ceiling, to facilitate movement. The bodies were stiff, naked, misshapen; most were the color of pale marble. The females were mixed with the males, the Catholics with the Jews, the whites with the blacks in the equality of death. The faces were frozen into a wide variety of distorted grimaces. Most of the eyes were closed but here and there was an open one, blankly staring into infinity. The first time Susan had seen these four rows of frozen cadavers hanging up like unwanted clothes in a closet of ice, she had felt sick. She had vowed never to return. And until that night she had avoided the “fridge,” as it was affectionately called by the diener. But now it was different.

The anatomy hall had been dark. The inside of the freezer was lit by a single hundred-watt bulb from the rear of the compartment, casting horrid shadows on the ceiling and floor. Susan tried not to look directly at the grotesque bodies. She shivered from the cold and frantically tried to think. There were only a few moments. Her pulse was racing. She knew that D’Ambrosio would be coming into the freezer within minutes. She had to have a plan but she didn’t have much time.

Smiling, D’Ambrosio stepped back and kicked the locked door of the anatomy hall, but it held firm. He kicked out a pane of frosted glass, pulled out a few of the splintered pieces, and reached in, opening the door. He looked around the room, not comprehending what it was.

As a precaution against his prey bolting, he closed the door and moved a nearby table in front of it. The room was large, some sixty feet by one hundred feet, with five rows of seven shrouded tables each. D’Ambrosio went up to the nearest table and whipped off the plastic drape.

D’Ambrosio gasped, not even feeling the pain from his broken rib. He was staring at a cadaver. The head was dissected free of skin, the teeth and the eyes were bared. The hair had been undermined and folded back like a pelt The front of the chest was gone, as was the front of the abdomen. The organs, which had been removed, were piled back into the opened body haphazardly.

D’Ambrosio walked back to the door and thought about turning on the lights. Then he decided against it because of the large windows and the fear of alerting the security police. Not that he didn’t feel confident about handling a couple of inexperienced guards, but he wanted to get Susan without any interference.

Systematically D’Ambrosio removed all the shrouds from all the cadavers in the room. He tried not to look at the dissected bodies. He just wanted to make sure that Susan was not among them.

D’Ambrosio looked around the room. On the right side of the hall several skeletons hung on chains, turning slowly in the air stirred by the opening and closing of the door. Behind the skeletons was a huge cabinet containing numerous specimen jars. At the end of the room were three desks and two doors. One of the doors looked like a freezer door, the other a closet. The closet was empty. Then D’Ambrosio noted the stainless steel pin hanging from the latch on the freezer door. The light smile returned, and he transferred the gun to his left hand. He opened the freezer door and again fell back in horror. The hanging bodies appeared like an army of ghouls.

D’Ambrosio was shaken by the appearance of the bodies and his eyes darted from one to another. Reluctantly he stepped over the threshold of the freezer, feeling the sudden chill.

“I know you’re in here, cunt. Why not come out so we can have another talk?” D’Ambrosio’s voice trailed off. The close quarters in the freezer and the appearance of the stiffs made Mm nervous, more nervous than he ever remembered being.

He looked down between the first two rows of frozen corpses. Warily he took two steps to the right and looked down the middle row. He could see the bare light bulb in the rear of the compartment. Glancing back at the door, he took several more steps to the right so he could look down the last corridor.

Susan’s fingers were losing their grip around the overhead track in the back of the second row of corpses. She did not know D’Ambrosio’s position, not until he called the second time.

“Come on, sweetheart. Don’t make me search this place.”

Susan was sure that D’Ambrosio was at the head of the last row. She knew it was now or never. With all the force she could muster, she pushed with her legs against the back of the wizened female cadaver in front of her. By holding onto the track above, Susan had lifted her legs up and coiled them against the old woman’s back. Her own back was pressed against the rock-hard chest of the last cadaver in the row, a two-hundred-pound black male.

Almost imperceptibly at first, the entire second row of frozen corpses began to move forward. Once the initial inertia was overcome, Susan was able to lunge with her feet, imparting a terrific thrust. Like a row of dominoes the entire group of bodies slid forward on their ball bearings.

D’Ambrosio’s ears picked up the sound of the movement He held himself still for a fraction of a second, trying to locate the weird sound. With the swiftness of a cat, he whirled and retreated toward the door. Not fast enough. As he stepped past the third row, he saw the movement. Instinctively he raised his gun and fired. But his attacker was already dead.

Coming at D’Ambrosio with surprising speed was a ghostly white male whose lips were frozen in a horrid half-smile. Two hundred pounds of frozen human meat slammed into the hit man, sending him crashing into the side of the freezer. In rapid succession the other corpses tumbled after the first, several falling from their hooks, creating a huddle of corpses, a tangle of frozen extremities.

Susan let go of the track, dropping to the floor. Then she ran for the open door. D’Ambrosio was trying to pull the bodies off himself. But he was in pain and had little leverage. The reek of embalming fluid was choking him. As Susan passed he tried to grab her. He struggled to free his gun and aim but it caught in the gnarled hand of a corpse.

“Fuck!” shouted D’Ambrosio as he used all of his might against oppressive weight of dead flesh.

But Susan was through the door.

D’Ambrosio was upright now. Pushing the toppled bodies right and left, he flung himself at the closing door. But outside it Susan was pushing with all her might, and the momentum of the insulated door carried it home. The latch clicked. Susan fumbled with the stainless steel pin. Inside, D’Ambrosio was grabbing for the latch release. Susan beat him by a fraction of a second as the pin dropped home.

Susan backed up, her heart pounding. She heard a muffled cry. Then there was a thud. D’Ambrosio was shooting into the door. But it was twelve inches thick. There were several more ineffectual thuds.

Susan turned and ran. She finally understood the reality of the danger she had been in. Trembling uncontrollably, she fought back tears. She had to find help, real help.

Thursday, February 26, 2:11 A.M.

Beacon Hill was definitely asleep. As the cab turned off Charles Street onto Mount Vernon and drove up into the residential area, there were no people, no cars, not even any dogs. The lights in the windows were few; only the gas lamps suggested that the area was populated, not deserted. Susan paid the cab driver, then looked up and down the street to see if anyone was following her.

After escaping from D’Ambrosio in the freezer, Susan was terrified and decided not to return to her room. She had no idea if D’Ambrosio was working alone or with an accomplice, but she was in no mood to find out. She had run out of the Anatomy Building, crossed in front of the Administration Building and had reached Huntington Avenue by passing the School of Public Health. At that hour it had taken fifteen minutes to find a cab.

Bellows. Susan thought that he was the only person she could turn to at two A.M. who would understand her present plight. But she was worried about being followed, and she did not want to involve Bellows in any danger. So as she entered the foyer of Bellows’s building she determined to wait five minutes before ringing his apartment, to be certain she had not been followed.

The foyer was not heated and Susan ran in place for a few minutes to keep warm. Becoming rational again after the experience with D’Ambrosio, she tried to understand why D’Ambrosio had returned so quickly. As far as she knew, no one had followed her when she went back to the Memorial to get the charts and explore the ORs. No one even knew that she was there.

She stopped running and looked out at Mount Vernon Street through the glass door. Bellows! He had seen her in the lounge. He was the only one who knew that she had not given up her search. She had shown him the charts. She started running in place again, cursing her own paranoia. Then she stopped as she remembered about Bellows being involved with the drugs that were found in the locker room, about Bellows being the one who found Walters, after Walters had committed suicide.

Susan turned her head and looked through the glass of the locked inner door. The stairway rose upward, its steps covered with a red runner. Could Bellows be involved? The possibility penetrated Susan’s overworked brain and fatigued body. She was beginning to suspect everyone. She shook her head and laughed; the paranoia was too obvious. Yet it started her thinking, and the thoughts troubled her.

Her watch said two-seventeen. Bellows was going to be in for a surprise, having a caller at such an hour. At least Susan thought he’d be surprised. What if he were surprised only because he expected her to be quite occupied elsewhere—that he knew all about D’Ambrosio. Susan decided impulsively that was nonsense. She pushed the buzzer with determination. She had to push it again and hold it before Bellows responded.

Susan started up the stairs. She was midway up the second flight when Bellows appeared above in his bathrobe.

“I might have known. Susan, it’s after two A.M.”

“You asked me if I wanted a drink. I’ve changed my mind. I want one.”

“But that was at eleven.” Bellows disappeared into his apartment, leaving the door ajar.

Susan reached Bellows’s floor and entered his apartment. He was nowhere to be seen. She closed the door and locked it, throwing both bolts. She found Bellows already back in bed, the covers up under his chin, his eyes closed.

“Some hospitality,” said Susan sitting on the edge- of the bed. She looked at Bellows. God, she was glad to see him. She wanted to throw herself onto him, feel his arms around her. She wanted to tell him about D’Ambrosio, about the freezer. She wanted to scream; she wanted to cry. But instead she did nothing. She sat there just looking at Bellows, her mind vacillating.

Bellows didn’t budge, not at first Finally the right eye opened, then the left. Then he sat up. “Damn, I can’t sleep with you sitting here.”

“How about that drink, then? I need it!” Susan forced herself to be calm, analytical. But it was hard. Her pulse was still over one hundred fifty per minute.

Bellows eyed Susan. “You’re really too much!” He got up and put his robe back on. “OK, what will you have?”

“Bourbon, if you have it. Bourbon and soda, light on the soda.” Susan looked forward to the fiery fluid. Her hands were still visibly trembling. She followed Bellows into the kitchen.

“I had to come over, Mark. I was attacked again.” Susan’s voice reflected her forced calmness. She watched Bellows’s reaction to the information. He stopped with his hands in the freezer, taking out an ice tray.

“Are you serious?”

“I’ve never been more serious.”

“Same person?”

“Same person.”

Bellows went back to the ice tray, chipping at it with a fork. Finally it came away. Susan felt that he was surprised at the news but not overly surprised, and not terribly concerned. Susan felt uneasy.

She tried another tack.

“I found something else out when I visited the OR. Something very interesting.” She waited for a response.

Bellows poured the bourbon, then opened a bottle of soda and poured it over the ice. The ice snapped in the glass. “OK, I believe you. Are you going to tell me or not?” Bellows handed Susan her drink. She took a slug.

“I traced the oxygen line from room No. 8 up in the ceiling space. Just before it turns down the main chase there is a valve in it.”

Bellows took a sip from his drink, motioning for them to return to the living room. The dock over the fireplace chimed. It was two-thirty.

“Gas lines have valves,” said Bellows at length.

“The others didn’t have them.”

“You mean a type of valve which would allow gas to be introduced into the line?”

“I think so. I don’t know much about valves and the like.”

“Did you trace the others to each room to be sure?”

“No, but room eight was the only line with a valve at the main chase.”

“Simply having a valve doesn’t surprise me. Maybe they all have one someplace in their lines. I wouldn’t use that valve to draw my conclusions, at least not until I had traced all the lines.”

“It’s too much of a coincidence, Mark. All these cases apparently happened in room No. 8, and room No. 8 has an oxygen line that has a valve in it at a funny place, rather well concealed.”

“Susan, look. You’re forgetting that some twenty-five percent of your supposed victims weren’t even near the OR, much less room No. 8. Now, even under the best of circumstances, I find your crusade ridiculous and threatening. And when I’m exhausted, I find it numbing. Can’t we talk about something soothing, like socialized medicine?”

“Mark, I’m sure about this.” Susan could sense the exasperation in Bellows’s voice.

“I’m sure you’re sure, but I’m also sure I’m unsure.”

“Mark, the man who attacked me this afternoon warned me, and then he returned tonight, and I don’t think he wanted to talk. I think he wanted to kill me. In fact, he tried to kill me. He shot at me!”

Bellows rubbed his eyes, then the sides of his head. “Susan, I don’t know what to even think about that, much less have something intelligent to say. Why don’t you go to the police if you’re so sure?”

Susan did not hear Bellows’s last comment; her mind was racing ahead. She started to speak out loud. “It has to be from lack of oxygen. If they were given too much succinylcholine or curare, must enough so that the people would have a hypoxic episode …” Susan trailed off, thinking. “That could be why respiratory arrest occurred. The one they autopsied, Crawford.” Susan took out her notebook. Bellows took another drink. “Here it is, Crawford. He had severe glaucoma in one eye and was on phospholine iodide. That’s an anticholinesterase and that means that his ability to break down the succinylcholine would have been impaired and a sublethal dose could be lethal.”

“Susan, I’ve already told you that succinylcholine would not work in the OR, not with the surgeon and the anesthesiologist right there. Besides you cannot give succinylcholine by gas … at least, I’ve never heard of it. Maybe you could, but anyway, they’d just keep respiring the patient until it was gone; there wouldn’t be any hypoxia.”

Susan took another slow sip from the bourbon.

“What you’re saving is that the hypoxia in the OR has to occur without the color of the blood changing so the surgeon stays nice and happy. How could that be done? … You’d have to block the use of oxygen by the brain somehow … maybe at the cellular level … or block the release of oxygen to the brain cells. It seems to me there is a drug that can block oxygen utilization, but I can’t think of it offhand. If the valve on the oxygen line were significant, it would have to be a drug that comes in a gas form. But there’s another way to do it. You could use a drug that blocks the uptake of oxygen on the hemoglobin and yet still keeps the color. … Mark, I’ve got it!” Susan sat bolt upright, her eyes wide open, her mouth forming a half-smile.

“Sure you do, Susan; sure you do,” soothed Mark sarcastically.

“Carbon monoxide! Carefully bled-in carbon monoxide, by way of the T-valve, titrated to cause just the right amount of hypoxia. The blood color would stay the same. In fact it would get even brighter red, cherry red. Even a very small amount would cause the oxygen to be displaced from the hemoglobin. The brain is starved of oxygen and—coma. In the OR everything has seemed absolutely normal. Then the patient’s brain dies; there is not a trace of the cause.”

There was a silence as the two people looked at each other. Susan expectantly, Bellows with tired resignation.

“You want me to say something? OK, it’s possible. Ridiculous but possible. I mean it’s theoretically possible for the OR cases to be caused by carbon monoxide. It’s an awful idea, maybe it’s even ingenious, but at any rate, it’s possible. The trouble is there are still twenty-five percent of the coma victims who didn’t even get close to the OR.”

“They’re the easy ones to explain. That was never hard. It was the OR cases that were hard. It was also hard for me to break away from the idea in the diagnosis of disease in medicine that one should search for single causes. But in this case we’re not dealing with a disease. The cases on the medical floors were given sublethal doses of succinylcholine. Something like that happened in a V.A. hospital in the Midwest, and even in New Jersey.”

“Susan, you can hypothesize until you’re blue in the face,” said Bellows with a tinge of anger growing out of frustration. “What you’re suggesting is some fantastic organized plan—a criminal plan—with the sole purpose of making people comatose. Well, let me tell you this: you haven’t given an ounce of effort to the biggest question: the question of why. Why, Susan? Why? I mean, you’re spinning your mental wheels at ninety miles per hour, taking all sorts of risks with your career, and mine, I might add, to come, up with a potentially plausible although fantastic explanation for what is a series of unconnected, unfortunate incidences. But at the same time, you’ve conveniently forgotten to ask why. Susan, there would have to be motive, for Christ’s sake. It’s ridiculous. I’m sorry, but it is ridiculous. And besides, I’ve got to go to sleep. Some of us work, you know. … And there isn’t one bit of solid evidence. A valve on the oxygen line! God, Susan, that’s pretty weak. I mean you’ve got to come to your senses. I can’t take any more of this. Really. I’m finished. I’m a surgical resident, not a part-time Sherlock Holmes.”

Bellows got up and finished his bourbon in one long drink.

Susan watched him intently, her paranoia awakening once again. Bellows was no longer on her side. Why indeed? The criminal aspect of the matter was horribly apparent to her at that point.

“What makes you so sure,” continued Bellows, “that all this has anything to do with Nancy Greenly or Berman? Susan, I think you’re jumping to conclusions. There’s an easier explanation for this character who seems so interested in getting hold of you.”

“I’m waiting.” Susan was angry now.

“The guy was probably looking for some action and you …”

“Screw you, Bellows!” Susan went livid.

“Now she gets mad. God damn it, Susan, you take this whole affair as some sort of complicated game. I don’t want to argue with you.”

“Every time I tell you about some aggressive behavior from Harris to this fucker who tried to kill me, all you can come up with is some Goddamn sexist explanation.”

“Sex exists, my child. You’d better learn to face that.”

“I think it’s more your problem. You male doctors never do seem to grow up. I guess it’s too much fun being an adolescent.” Susan got up and put her coat back on.

“Where are you going at this hour?” said Bellows with an authoritarian air.

“I have a feeling I’m safer on the street than here in this apartment.”

“You’re not going out now,” said Bellows with determination.

“Ah, now the male chauvinist is displaying his true colors. The great protector! Bull crap. The egoist says I’m not going. Just watch.”

Susan left quickly, slamming the door.

Indecision kept Bellows immobile and silent as he watched the door. He was silent because he knew that she was right in a lot of ways. He was immobile because he really wanted to be rid of the whole mess. “Carbon monoxide, holy shit.” He walked back into his bedroom and got into bed once more. Looking at the clock, he realized morning was going to arrive very, very quickly.

D’Ambrosio began to panic. He had never liked confined spaces and the walls of the freezer began to move in on him. He began to breathe faster, gulping for air, and then he thought he might be going to suffocate. And the cold. The deathly cold wormed its way through his heavy Chicago overcoat, and despite constant motion, his feet and hands had gone numb.

But by far the most disturbing aspect of the whole miserable affair was the bodies and the acrid odor of formaldehyde. D’Ambrosio had seen a lot of grisly scenes in his life and had been through some gruesome experiences, but nothing could compare with being in the freezer with the stiffs. At first he had tried not to look at them, but involuntarily and out of mounting fear, his eyes had been drawn to the faces. After some time it had begun to look as if they were all smiling. Then they were laughing and even moving when he didn’t watch them carefully. He emptied the clip in his pistol by blasting away at one particularly sneering corpse whom he imagined he recognized.

Finally D’Ambrosio retreated to the corner so he could keep the whole group in view. Slowly he sank into a sitting position. He couldn’t feel his knees any longer.

Thursday, February 26, 10:41 A.M.

The path dipped down to the left, through a thicket of gnarled oak trees standing in a bed of twisted briars. The branches of the trees arched over the pathway, enclosing it like a tunnel and precluding a view for more than a few feet. Susan was running and she dared not look behind her. Safety was ahead; she could make it. But the pathway narrowed and the branches clutched at her, hindering her. The briars caught in her clothing. She desperately tried to force her way through. She could see some lights ahead. Safety. But the harder she pulled, the more entangled she got, as if she were in a giant spider web. With her hands, she tried to free her feet But then her arms became hopelessly entangled. There were only minutes left. She had to get free. Then she heard a car horn and one arm came free. The born repeated itself and she opened her arms. She was in room 731 at the Boston Motor Lodge.

Susan sat up in the bed, looking around the room. It had been a dream, a recurrent dream which she hadn’t had in years. With wakefulness came relief, and she sank back, pulling the covers up around herself. The auto horn which had awakened her sounded for the third time. There were some muffled shouts, then silence.

Susan looked around the room. Tasteless American. Two large beds with a neutral flower-print spread. The rug was a heavy shag, a shade of spring green. The near wall was papered with a repeating floral design in green. The far wall was a pale yellow. There was a picture over the bed, a tawdry reproduction, portraying an idyllic barnyard scene with a few ducks and sheep. The furniture too was cheap, but there was an impressive, twenty-eight-inch color TV set—the indispensable solace of motel life. Aesthetics had low priority at the Boston Motor Lodge.

But the place was safe. After leaving Bellows’s apartment in the wee hours of the morning, Susan had wanted only to find someplace where she could sleep in peace. She had noticed the gaudy motel sign from Cambridge Street on a number of occasions. The sign was awful, certainly not something to beckon the weary. Nonetheless, the room had provided the haven she needed. She had checked in as Laurie Simpson and had waited in the lobby for a good quarter of an hour before going up to the room. When the man at the desk looked at her strangely, she gave him an extra five dollars and told him to call her if anybody inquired about her. She said she was worried about a jealous lover. The desk clerk had winked at her, grateful both for the five dollars and the confidence she extended to him. Susan knew that he accepted the story without question; it was part of the male vanity.

Having taken these precautions, and after moving the desk in front of the door, Susan had allowed herself to fall asleep. She had not slept soundly, as her terminal dream demonstrated, but she felt reasonably refreshed.

She remembered the strong words with Bellows the night before and debated about calling him. She regretted the exchange, feeling that it had been totally unnecessary. She also remembered her feelings of paranoia and felt embarrassed. Yet she remembered her hyper state of mind and felt that her reactions were understandable. She was surprised that Bellows had not been more tolerant. But of course he wanted to be a surgeon, and she had to recognize that his career aspirations made it difficult if not impossible for him to view the situation with an open mind. Still, she regretted the split, if for no other reason than the fact that Bellows had played an effective devil’s advocate to her ideas. After all, he was correct that Susan had no idea of motive, and if some large organization was involved, then there must be one.

Maybe the coma victims were the targets of some gangland vendetta? Susan dismissed the idea instantly, remembering Berman and even Nancy Greenly. No, that couldn’t be. Maybe extortion was involved; perhaps the families hadn’t paid off and—wham! But that seemed unlikely. It would be too hard to keep the coma business secret. It would be easier to kill people outright, outside the hospital. There had to be some reason for these comas happening in the hospital. There must be some pattern for each victim, some common denominator.

As Susan mused, she lifted the phone onto the bed. She dialed the medical school and asked for the dean’s office.

“Is this Dr. Chapman’s secretary? … This is Susan Wheeler … that’s right, the infamous Susan Wheeler. Look, I’d like to leave a message for Dr. Chapman. There’s no need to bother him. I was supposed to start a surgery rotation at the V.A. today, but I’ve spent a terrible night and I’ve got some abdominal cramps that won’t quit. I’ll be better by tomorrow morning, I’m sure, and I’ll call if I’m not. Would you please see that Dr. Chapman is informed of this, and the Department of Surgery at the VA.? Thanks.”

Susan replaced the receiver. The time was quarter to ten. She dialed the Memorial and asked for Dr. Stark’s office.

“This is Miss Susan Wheeler calling. I’d like to speak to Dr. Stark.”

“Oh, yes, Miss Wheeler. Dr. Stark expected your call at nine. He’ll be with you shortly. He was worried when you didn’t call.”

Susan waited, twisting the cord to the phone between her thumb and index finger.

“Susan?” Dr. Stark’s voice was concerned. “I’m very glad to hear from you. After what you described happening to you yesterday afternoon, I became concerned when you didn’t call. Are you all right?”

Susan hesitated, wondering if she should use the same cover with Stark as she used for Chapman. Stark might have dealings with Chapman. She decided she’d best be consistent.

“I have some abdominal cramps which have kept me in bed. Otherwise I’m fine.”

“The rest will do you good. As for your requests: I have some good news and some bad news. What do you want first?”

“I’ll take the bad.”

“I’ve talked with Oren, then Harris, and finally Nelson about getting you reinstated here at the Memorial, but I’m afraid they are adamant. Obviously they don’t run the Surgery Department, but we do depend on cooperation around here and, to be truthful, I was not overly insistent. If they had wavered, I would have been more forceful. But they didn’t. You certainly stirred the fire, young lady!”

“I see. …” Susan was not surprised.

“Besides, if you came back here, I think it would be hard for you to overcome your reputation. It would follow you. It’s best to let things cool off.”

“I suppose. …”

“The V.A. program is a popular affiliated program and you’ll get to do more surgery there than you would here.”

“That may be true, but as for teaching, it’s far inferior to the Memorial.”

“But on your other request about the Jefferson Institute, I had some luck. I managed to speak to the director, and I told him about your special interest in intensive care. I also told him you were particularly interested in visiting his hospital. Well, he has obligingly agreed to allow you to come, if you come after the busiest part of the day, sometime after five. But there are some conditions. You must go alone, since only you will be permitted inside.”

“Of course.”

“And since I have really extended myself and have gone off channels, so to speak, I would prefer that you don’t mention your visit to anyone. I must admit, Susan, that I really had to make an effort to get you invited. I’m telling you this not because I want you to feel indebted or anything, but rather as partial atonement for my not getting you reinstated here at the Memorial. The director of the institute told me categorically that he would not allow any others to visit with you. They do allow group visits when they have time to supervise them. It’s a rather special place, as I believe you’ll see. It would be somewhat embarrassing if you wanted to bring someone else. So you must go alone. You can understand that, I presume.”

“Of course.”

“Well, then, let me know what you think of the facility. I haven’t been there myself yet.”

“Thank you very much, Dr. Stark. Oh, there’s one other thing. …” Susan considered telling Stark about the second experience with D’Ambrosio. She decided against it, because he had wanted Susan to go to the police yesterday; now he’d be insistent. Susan did not want the police, not yet. If it were some large organization behind the whole affair, it was naive to think they didn’t have a contingency plan to allow for police probes.

“I’m not sure,” continued Susan, “if it’s significant, but I found a valve on the oxygen line into room No. 8 in the OR. It’s near to the main chase.”

“Near the what?”

“The main chase where all the piping in the hospital courses from floor to floor.”

“Susan, you’re pretty remarkable. How did you find out about that?”

“I went up into the ceiling space and traced the gas lines to the ORs.”

“Ceiling space!” Stark’s voice rose in irritation. “Susan, that’s carrying this affair a bit too far. I cannot condone your climbing around in the ceiling spaces over the operating rooms.”

Susan waited for the ax to fall as it had with McLeary or Harris. Instead there was a pause. Stark broke it. “Anyway, you say you found a valve in the oxygen line to room No. 8.” His voice was almost back to normal.

“That’s right,” said Susan cautiously.

“Well, I think I know what that’s for. I’m chairman of the OR Committee, as you might have guessed. That valve is probably the bleed valve for getting rid of air bubbles when the system is charged up. But one way or another, I’ll have someone check it and make certain. By the way, what is the name of the patient you wanted to see at the Jefferson Institute?”

“Sean Berman.”

“Oh yes, I remember the case. It was just the other day. One of Spallek’s. A meniscus case, as I recall. Tragedy … the man was about thirty. A real shame. Well, good luck. Tell me, are you off to the V.A. today?”

“No, my stomach condition will keep me in bed, at least for the morning. I’m quite sure I’ll be able to get back to work tomorrow, though.”

“I hope so, Susan, for your sake.”

“Thank you for your time, Dr. Stark.”

“Not at all, Susan.”

The line disconnected and Susan hung up.

The soiled gloves fell into the wastebasket beside the sponge rack. On the rack was a group of blood-stained sponges hanging like dirty clothes on a line. A nurse passed behind Bellows and undid the string at the neck of his operating gown. Bellows tossed it into the hamper by the door and left.

It had been an uncomplicated gastrectomy, a procedure Bellows usually liked to perform. But on this particular morning Bellows’s mind had been somewhere else and the double-layer closure of the stomach pouch and the small bowel had been tedious rather than enjoyable. Bellows could not stop thinking about Susan. His thoughts ran the gamut from tender concern, accompanied by remorse for the words that had driven Susan away the night before, to self-righteous pleasure in the comments he had felt justified in making. He had already gone too far, gambled too much, and it was quite apparent that Susan had no intentions of easing up on her idiotic drive in the direction of career suicide.

On the other hand, the sweetness of the evening before last was still very much in Bellows’s mind. He had responded to Susan in a way that had been so natural, so fresh. He had made love with her in such a manner that orgasm had been a mere part, not a goal. There had felt something so wonderfully equal, a communion of sorts. Bellows realized that he cared for Susan very much, despite the fact that he knew so little about her, and despite the fact that she was so blasted stubborn.

Bellows dictated his operative note on the gastrectomy case into a tape recorder with the usual medical monotone, ending each sentence with a vocalized “period.” Then he went into the dressing room and began to change back to his street clothes.

Acknowledging affection for Susan put Bellows on guard. His rationality persuaded him that such feelings would diminish his objectivity and sense of perspective. He could not afford that, not now, when his career opportunities were in the balance. Since Susan had been transferred to the V.A., things had already quieted down. Stark had been civil on rounds, even to the extent of semiapologizing for his ungrounded implications concerning Bellows’s association with the drugs found in locker 338.

Bellows completed dressing and walked over to the recovery room to check the post-op orders on his gastrectomy patient.

“Hey, Mark,” called a loud voice from the recovery room desk. Bellows turned to see Johnston coming toward him.

“How the hell are those students of yours? I understand that the girl’s a piece of ass.”

Bellows didn’t answer. He waved his hand in a questioning fashion. The last thing he wanted to do was get into some idiotic conversation with Johnston about Susan.

“Did your students tell you what happened at the med school this morning? It’s one of the funniest stories I’ve heard in a long time. Some guy broke into the Anatomy Building last night He must have been some kind of a nut because he discharged a fire extinguisher, unveiled all the first-year students’ cadavers, shot up the place, got himself locked in the freezer, and then had a brawl with the bodies. He knocked a bunch of the corpses down and shot up some of them. Can you imagine?” Johnston erupted in gusts of laughter.

The effect was just the opposite on Bellows. He looked at Johnston but thought about Susan. She had told him that she had been chased again, that someone had tried to kill her. Could that have been the same man? The freezer? Susan was rapidly becoming a total mystery. Why hadn’t she told him more?

“Did the guy freeze?” asked Bellows.

Johnston had to pull himself together in order to talk.

“No, at least not all of him. The police had been tipped off by an anonymous phone call in the middle of the night. They thought it was a med school prank so they didn’t check it out until the morning shift came in. By the time they got there the guy was unconscious, sitting in the corner. His body temperature was ninety-two degrees, but the medical boys succeeded in thawing him out without any trouble with acidosis. I think that’s pretty commendable for those assholes. The only trouble was that they waited for two hours before calling me on consult. Hey, you know what the nurses in the ICU call him?”

“I can’t guess.” Bellows was only half-listening.

“Ice Balls.” Johnston broke down in laughter again. “I thought that was pretty clever. It’s a takeoff on Hot Lips from M*A*S*H. What a pair, Hot Lips and Ice Balls.”

“Is he going to make it?”

“Sure. I’m going to have to amputate some. At the very least he’s going to lose part of his legs. How much will be determined over the next day or so. The poor bastard might even lose those ice balls.”

“Did they find out anything about him?”

“What do you mean?”

“Well, his name, where he was from, you know.”

“Nothing. It turned out he had some I.D. which proved to be fake. So the police are very interested. He mumbled something about Chicago. Weird!” Johnston mouthed the last word as if it were some important secret message, as he went back to the recovery room desk.

Bellows went over and checked his gastrectomy patient. Vital signs were stable. Then he checked the chart. The orders had been written by Reid, and they were fine. He thought about the man in the freezer. The story seemed so bizarre. He wondered again if it really was the man that had been chasing Susan. But how could she have locked him in the freezer? Why the hell hadn’t she mentioned it? Maybe he had never given her the chance. If she had locked the man in the freezer, she was now definitely in trouble legally. Could she have been the anonymous phone caller?

Bellows examined the dressing on the patient. It was still in place and not blood-soaked. The I.V. was running well.

Then he thought about Susan again and decided that the nut in the freezer must have been the man who chased her. And if he was, then it would be important for her to know that he was hospitalized and in critical condition.

Bellows dialed the medical school and asked to be connected to the dorm. He let Susan’s phone ring twelve times before giving up. Then he called back the dorm switchboard and left a message for her to call when she came back to her room.

After that, Bellows went to lunch.

Thursday, February 26, 4:23 P.M.

Thirty-six dollars plus tax seemed to Susan an awfully high price for the tasteless room at the Boston Motor Lodge. But at the same time it was worth it. Susan felt refreshed and rested—and safe. She had spent the time during the day rereading her notebook. All the information she had about the OR cases fit the idea of carbon monoxide poisoning. The information about the medical cases fit with the idea of succinylcholine poisoning. But still she had no motive, no rhyme or reason. The cases were too disparate.

Susan made a number of calls to the Memorial to try to learn Walters’s home address, but she was unsuccessful. At one point she had called the Memorial and had Bellows paged, but she hung up before he could answer. Slowly but inexorably, Susan began to comprehend that she was at a dead end. She thought that it was probably time to go to the authorities, tell what she had learned, then take a vacation. She had a month’s vacation coming to her as part of her third year and she was sure that she would be able to get permission to take the time immediately. She’d leave, get away, for get. She thought about Martinique. She liked things French, and she longed for the sun.

The doorman of the motel whistled a cab for her and she got in. She told the driver the address: 1800 South Weymouth Street, South Boston. Then she settled back.

It was stop and go down Cambridge Street, a little better on Storrow Drive, but worse on Berkeley. The cab driver took her through the nicer sections of the South End to avoid traffic. At Mass. Ave. he turned left and the surroundings deteriorated. Once into South Boston, Susan knew she was lost. The housing became monotonous, the streets badly littered. Soon the cab entered an area of warehouses, deserted factories, and dark streets. Nearly every streetlamp had a broken bulb.

When Susan alighted from the cab she found herself in an area that seemed isolated from life. Straight ahead, the only streetlight she could see emitted a beam of light from a modern hooded fixture which illuminated the door of a building, a sign, and the walk leading up to the door. The sign was fabricated in block letters of a deep azure. The sign read: “The Jefferson Institute.” Below the blue letters was a brass plaque. It said: “Constructed with the Support of the Department of Health, Education and Welfare, US Government, 1974.”

The Jefferson Institute was surrounded by an eight-foot-high hurricane fence. The building was set back about fifteen feet from the street. It was a strikingly modern structure surfaced with a white terrazzo conglomerate polished to a high gloss. The walls slanted inward at an angle of eighty degrees, rising in a first story of some twenty-five feet. Then there was a narrow horizontal ledge before the wall soared another twenty-five feet at the same angle. Except for the front entrance, there were no windows or doors along the entire length of the facade on the ground floor. The second story had windows but they were recessed and could not be seen from the street. Only the sharply geometric embrasures were visible and the glow of lights from within.

The building occupied a city block. In a strange way, Susan found it beautiful, though she realized that its effect was enhanced by the surrounding squalor. Susan guessed that it was the centerpiece of some urban renewal scheme. It gave the impression of a two-storey ancient Egyptian mastaba, or the base of an Aztec pyramid.

Susan walked up to the front door. Made of bronzed steel, it had no knobs, no openings of any kind. To the right of the door was a recessed microphone. As Susan stepped onto the Astroturf immediately before the door, she activated a recording which told her to give her name and the purpose of her visit. The voice was deep, reassuring, and measured.

Susan complied, although she hesitated about the purpose of the visit. She was tempted to say tourism, but she changed her mind. She wasn’t feeling very jokey. So, finally, she said, “Academic purposes.”

There was no answer. A rectangular red light beneath the microphone came on. Printed on the glass was the word wait. The light flashed green and the word changed to proceed. Without a sound the bronzed door glided to the right, and Susan stepped over the threshold.

Susan found herself in a stark white hall. There were no windows, no pictures, no decorations at all. The only illumination seemed to be from the floor, which was made of a milky opaque plastic material. Susan found the effect curious and futuristic; she walked ahead.

At the end of the hall, a second silent door glided into the wall, and Susan entered what appeared to be a large, ultramodern waiting room. Its far and near walls were mirrored from floor to ceiling. The two side walls were spotlessly white and totally devoid of any interruptions or decoration. The sameness was somewhat disorienting. As Susan looked at the walls, her eyes began to focus on her own vitreous floaters. She had to blink and make an effort to focus at a distance. Looking into the mirror at the end of the room had the opposite effect Because of the opposing mirrors Susan saw the image of herself reflected to infinity.

The room was furnished with rows of molded white plastic chairs. The floor was the same as in the hall, the light from it casting strange shadows on the ceiling. Susan was about to sit down when another door slid open in the farthest mirrored wall. A tall woman entered and walked directly up to Susan. She had very short, medium brown hair. Her eyes were deeply set and the line of her nose merged imperceptibly with her forehead. Susan was reminded of the classic features of a cameo. The woman wore a white pants suit as devoid of decoration as the walls. A pocket dosimeter peeped from her jacket. Her expression was neutral.

“Welcome to the Jefferson Institute. My name is Michelle. I will show you our facilities.” Her voice was as noncommittal as her expression.

“Thank you,” said Susan, trying to see through the woman’s facade. “My name is Susan Wheeler. I believe you are expecting me.” Susan let her eyes sweep around the room once more. “It certainly is modern. I’ve never seen anything quite like this.”

“We have been expecting you. But before we begin I’d like to warn you that it is very warm inside. I suggest that you leave your coat here. And please leave your bag as well.”

Susan took off her coat, a bit embarrassed by the wrinkled and soiled nurse’s uniform she still had on. She took her notebook from her bag.

“Now then … I suppose that you know that the Jefferson Institute is an intensive-care hospital. In other words, we only take care of chronic intensive-care patients. Most of our patients are in some level of coma. This particular hospital was built as a pilot project with HEW funds, although the actual running of it has been delegated to the private sector. It has been very successful in freeing up beds in the acute intensive care units of the city’s hospitals. In fact, since the project has been so successful, an equivalent hospital is either being built or is in the planning stages in most of the large cities of the country. Research has shown that any city or population center with a population of a million or more can economically support a hospital of this sort. … Excuse me, but why don’t we sit down?” Michelle indicated two of the chairs.

“Thank you,” said Susan, taking one of the chairs.

“Visiting the Jefferson Institute is strictly regulated because of the methodology we use to care for the patients. We have developed very new techniques here, and if people are not prepared, some may react on an emotional level. Only immediate family may visit, and only once every two weeks on a preplanned basis.”

Michelle paused in her monologue, then she managed a half-smile. “I must say that your visit here is highly unusual. Normally we have a group of medical people on the second Tuesday of each month, and there is a planned program for them. But since you have come by yourself, I guess I can improvise a bit. But we do have a short film if you would like to see it.”

“By all means.”

“Good.”

Without any sign from Michelle, the room darkened and on the wall opposite from where they were sitting, a film began to roll. Susan was intrigued. She presumed that the film was being projected through a translucent section of the wall serving as a screen.

The film itself reminded Susan of old newsreels. Its outdated technique seemed an anachronism in the modern surroundings. The first section was devoted to the concept of the intensive care hospital. The Secretary of Health, Education and Welfare was shown discussing the problem with policy planners, economists, and health care specialists. The problem of spiraling hospital costs spearheaded by the cost of long-term intensive care was illustrated by graphs and charts. The men explaining the charts were dull and uninspiring, as commonplace as the suits they wore.

“This is a terrible film,” said Susan.

“I agree. Government films are all alike. You’d think that they’d try a little creativity.”

The movie moved on to ground-breaking ceremonies, at which politicians smiled and joked idiotically. More graphs and charts followed, attesting to the enormous savings that had been accrued by the hospital. There were several more scenes showing how the Jefferson Institute’s facilities freed the beds in the city’s hospitals for the care of acute cases. Then followed a comparison of the number of nurses and other personnel needed at the Jefferson facility to the number needed in a conventional hospital for the same number of intensive care patients. The people used to illustrate this point were photographed milling about aimlessly in a parking lot. Finally, the film showed the heart of the new hospital: the huge computer, both digital and analog. It concluded by pointing out that all the functions of homeostasis were monitored and maintained by the computer. The film ended with a burst of inspirational marching music, like the finale of a war movie. The lights under the floor came on as the last image disappeared.

“I could have done without that,” said Susan, smiling.

“Well, at least it emphasizes the point about the economy. That’s the central concept of the institute. Now, if you’ll follow me, I’ll show you the principal features of the hospital.”

Michelle stood up and walked toward the mirrored wall from which she had appeared. A door glided open. It shut behind them as they entered another corridor about fifty feet long. The far end of the corridor was also mirrored from floor to ceiling. As Susan passed down the hallway she noted other doors but they were all closed. None of the doors had any exposed hardware. Apparently they were automatically activated.

When they reached the far end of the corridor, a door slid open and Susan entered a familiar-looking room. It was about forty by twenty feet and looked exactly like an intensive care unit in any hospital. There were five beds and the usual assortment of gadgets, EKG screens, gas lines, etcetera. But four of the beds appeared different: each was constructed with a gap of some two feet running lengthwise. It was as if each bed were constructed of two very narrow beds with a fixed two-foot span between them. In the ceiling above the beds there were complicated tracklike mechanisms. The fifth bed, which seemed conventional, was occupied. A patient was being breathed by a small respirator. Susan was reminded of Nancy Greenly.

“This is the visiting area for the immediate families,” explained Michelle. “When a family is scheduled to visit, the patient is transferred here automatically. When he is placed in one of these special beds and it is made up, the bed appears like a normal one. This patient was visited this afternoon.” Michelle pointed toward the patient in the fifth bed. “We purposely did not return him to the main ward for your benefit.”

Susan was confused. “You mean that bed the patient is in is the same as these other beds?”

“Exactly. And when family visits, these other beds are filled with other patients so that the area looks like a normal intensive care unit Follow me, please.”

Michelle walked the length of the room, past the patient in the bed. At the end of the room was a door, which opened silently and automatically.

Susan was amazed when she passed the fifth bed with the patient. The bed appeared exactly like a regular hospital bed. There was no evidence that its central section, its basic support, was missing. But Susan had no time to examine the bed more closely as she followed Michelle into the next room.

The first thing Susan became aware of was the light; there was something strange about it. Then she felt the warmth and the humidity. Finally she saw the patients, and she stopped in utter astonishment. There were more than a hundred patients in the room, and all of them were completely suspended in midair about four feet from the floor. All of them were naked. Looking closely, Susan could see the wires piercing multiple points on the patients’ long bones. The wires were connected to complicated metal frames and pulled taut. The patients’ heads were supported by other wires from the ceiling which were attached to screw eyes in the patients’ skulls. Susan had an impression of grotesque, horizontal, sleeping marionettes.

“As you can see, the patients are all suspended by wires under tension. Some visitors react strongly to this, but it has proven to be the best method of long-term care, totally preserving the skin and minimizing nursing care. Its origin was in orthopedics, where wires are passed through bones to provide traction. Burn treatment research showed the benefits to be obtained when the skin does not rest on any kind of surface. It was a natural progression to apply the concept to the care of the comatose patient.”

“It is rather gruesome.” Susan recalled the upsetting image of the cadavers hung in the freezer. “What is the strange lighting?”

“Oh, yes, we should put on glasses if we stay in here much longer.” Michelle fetched several pairs of goggles from a. table.

“There is a low-level of ultraviolet light in here. It has been found useful in controlling bacteria as well as helping to maintain the integrity of the skin.” Michelle offered a set of goggles to Susan, and they both put them on.

“The temperature in here is maintained at ninety-four point five Fahrenheit, plus or minus five hundredths of a degree. The humidity is held at eight-two percent with a one percent variance. That tends to reduce patient heat loss and hence reduces the patients’ caloric needs. The humidity has reduced the respiratory infection problem, which you know is critical for coma patients.”

Susan was spellbound. She gingerly moved closer to one of the suspended patients. A profusion of wires perforated various long bones. The wires then passed horizontally through an aluminum frame around the patient before running up to a complicated trolley device on the ceiling. Susan looked up at the ceiling and saw that it was a maze of tracks for the trolleys. All the I.V. lines, suction tubes, and monitoring lines from the patient ascended to the trolley. Susan looked back at Michelle. “And there are no nurses?”

“I happen to be a nurse, and there are two others on duty, plus one doctor. That’s quite a reasonable ratio for one hundred and thirty-one intensive care patients, wouldn’t you say? You see, everything is automated. The patient’s weight, blood gases, fluid balance, blood pressure, body temperature—in fact, an enormous list of variables—are being constantly scanned and compared to standards by the computer. The computer actuates solenoid valves to rectify any abnormalities or discrepancies it finds. It is far better than conventional care. A doctor tends to concern himself with isolated variables and in a static fashion. The computer is able to sample over time, hence it treats dynamically. But more important still is that the computer correlates all the variables at any given moment. It’s much more like the bodies’ own regulatory mechanisms.”

“Modern medicine carried to the nth degree. It’s incredible, really it is. It’s like some science fiction setting. A machine taking care of a host of mindless people. It’s almost as if these patients aren’t people.”

“They aren’t people.”

“I beg your pardon?” Susan looked up from the patient toward Michelle.

“They were people; now they’re brain stem preparations. Modern medicine and medical-technology have advanced to the point where these organisms can be kept alive, sometimes indefinitely. The result was a cost-effectiveness crisis. The law decided they had to be maintained. Technology had to advance to deal with the problem realistically. And it has. This hospital has the potential to handle up to a thousand such cases at a time.”

There was something about the basic philosophy Michelle elucidated that made Susan uncomfortable. She also had a feeling that her guide had herself been very carefully indoctrinated. Susan could tell that Michelle did not question what she was saying. Nevertheless Susan did not dwell on the institute’s philosophical foundations. She was overwhelmed by the place’s physical aspects. She wanted to see more. She looked around the room. It was more than a hundred feet long, with a fifteen- to twenty-foot ceiling. In the ceiling the maze of tracks was bewildering.

There was another door at the far end of the room. It was closed. But it was a normal door with normal hardware. Susan decided that only the doors they had so far traversed were centrally controlled. After all, most visitors, the families, never came into the main ward.

“How many operating rooms are there here in the Jefferson Institute?” asked Susan suddenly.

“We don’t have operating rooms here. This is a chronic care facility. If a patient needs acute care, he is transferred back to the referring institution.”

The reply was so fast that it gave the impression of a reflex or trained response. Susan distinctly remembered seeing the ORs in the floor plans she had obtained at City Hall. They were on the second floor. Susan began to sense that Michelle was lying.

“No operating rooms?” Susan deliberately acted very surprised. “Where do they do emergency procedures, like tracheotomies?”

“Right here on the main ward or in the ICU visiting room next door. That can be set up as a minor OR if needed. But it rarely happens. As I said, this is a chronic-care hospital.”

“I still would have thought that they would have included an OR.”

At that moment almost directly in front of Susan, one of the patients was automatically tipped back so that his head was about six inches below his feet.’

“There is a good example of the computer working,” said Michelle. “The computer probably sensed a fall in the blood pressure. It put the patient into the Trendelenburg position prior to correcting the main cause for the blood pressure fall.”

Susan was barely listening; she was trying to figure a way to do a little exploring on her own. She wanted to see those operating rooms indicated on the floor plans.

“One of the reasons I asked to come here was to see a particular patient. The name is Berman, Sean Berman. Do you have any idea where he is located?”

“No; not offhand. To tell you the truth, we don’t use names here for the patients. The patients are given numbers, sample 1, sample 2, etcetera. It’s infinitely easier to key into the computer. In order to find Berman’s number, I’ll have to match the name with the computer. It takes a minute or so, that’s all.”

“Well, I would like to find out.”

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