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?”

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Categories: Cook, Robin