Coma - Страница 3

Доступ к книге ограничен фрагменом по требованию правообладателя.

Major carefully curetted the inside of the uterus, noting the consistency of the endometrial tissue. As Dr. Major passed the second curette, Dr.

Billing noted a slight change in the rhythm of the cardiac monitor. He watched the electronic blip trace across the oscilloscope screen. The pulse fell to about sixty. Instinctively he inflated the blood pressure cuff and listened intently for the familiar far-away deep sound of the blood surging through the collapsed artery. As the air pressure drained off more, he heard the rebound sound indicating the diastolic pressure.

The blood pressure was 90/60. This was not terribly low, but it puzzled his analytical brain. Could Nancy be getting some vagal feedback from her uterus, he wondered. He doubted it, but just the same be took the stethoscope from his ears.

“Dr. Major, could you hold on for just a minute? The blood pressure has sagged a little. How much blood loss do you estimate?”

“Couldn’t be more than 500 cc,” said Dr. Major, looking up from between Nancy’s legs.

“That’s funny,” said Dr. Billing, replacing the stethoscope in his ears. He inflated the cuff again. Blood pressure was 90/58. He looked at the monitor: pulse sixty.

“What’s the pressure?” asked Dr. Major.

“Ninety over sixty, with a pulse of sixty,” said Dr. Billing, taking the stethoscope from his ears and rechecking the flow valves on the anesthesia machine.

“What the hell’s wrong with that, for Christ’s sake?” snapped Dr. Major, showing some early surgical irritation.

“Nothing,” agreed Dr. Billing, “but it’s a change. She had been so steady.”

“Well, her color is fantastic. Down here, she’s as red as a cherry,” said Dr. Major, laughing at his own joke. No one else laughed.

Dr. Billing looked at the clock. It was 7:48. “OK, go ahead. I’ll tell you if she changes any more,” said Dr. Billing, while giving the breathing bag a healthy squeeze to inflate Nancy’s lungs maximally. Something was bothering Dr. Billing; something was keying-off his sixth sense, activating his adrenals and pushing up his own heart rate. He watched the breathing bag sag and remain still. He compressed it again, mentally recording the degree of resistance afforded by Nancy’s bronchial tubes and lungs. She was very easy to breathe. He watched the bag again. No motion, no respiratory effect on Nancy’s part, despite the fact that the second dose of the succinylcholine should have been metabolized by then.

The blood pressure came up slightly, then went down again: 80/58. The monotonous beep of the monitor skipped once. Dr. Billing’s eyes shot to the oscilloscope screen. The rhythm picked up again.

“I’ll be finished here in five minutes,” said Dr. Major for Dr. Billing’s benefit With a sense of relief, Dr. Billing reached over and turned down both the nitrous oxide and the halo-thane flow, while turning up the oxygen. He wanted to lighten Nancy’s level of anesthesia. The blood pressure came up to 90/60, and Dr. Billing felt a little better. He even allowed himself the luxury of running the back of his hand across his forehead to scatter the beads of perspiration that had appeared as evidence of his increasing anxiety. He glanced at the soda-lime CO2

absorber. It appeared normal. Time was 7:56. With his right hand he reached up and lifted Nancy’s eyelids. They moved with no resistance and the pupils were maximally dilated. The fear returned to Dr. Billing in a rush. Something was wrong ... something was very wrong.

Monday, February 23, 7:15 A.M.

Several small flakes of snow danced down Longwood Avenue in the half-light of February 23, 1976. The temperature was a crisp twenty degrees and the delicate crystalline structures fluttering earthward were intact even after striking the pavement. The sun was obscured by a low cover of thick gray clouds which shrouded the waking city. More and more clouds were swept in by the sea breeze, enveloping the tops of the taller buildings in a mist, making it become paradoxically darker as dawn spread its frail fingers over Boston. It was not supposed to snow, yet a few flakes had crystallized over Cohasset and had blown all the way into the city. The few that reached Longwood Avenue and were blown right on Avenue Louis Pasteur were the survivors until a sudden down-draft slammed them against a third-story window of the medical school dorm.

They would have slid off had it not been for the layer of greasy Boston grime on the pane. Instead they stuck there while the glass slowly transmitted the heat from within, and their delicate bodies dissolved and mingled with the dirt.

Within her room Susan Wheeler was totally unaware of the drama on the window pane. Her mind was preoccupied with extracting itself from the clutches of a meaningless, disturbing dream after a restless, near-sleepless night. February 23 was going to be a difficult day at best and possibly a disaster. Medical school is made up of a thousand minor crises occasionally interrupted by truly epochal upheavals. February 23 was in the latter category for Susan Wheeler. Five days earlier she had completed the first two years of medical school, the basic science part taught in the lecture halls and science labs with books and other inanimate objects. Susan Wheeler had done very well because she could handle the classroom, the lab, and the papers. Her class notes were renowned and people always wanted to borrow them. At first she lent them indiscriminately. Later, as she began to perceive the realities of the competitive system which she thought she had left behind in Radcliffe, she changed her tactics. She lent her notes only to a small group of people who were her friends, or at least were people from whom she could borrow notes if she had had to miss a class. But she rarely missed a class.

A number of people chided Susan playfully about her. marvelous attendance record. She always responded by saying she needed all the help she could get. Of course that was not the reason. Having entered a profession dominated by males, in which essentially all the professors and instructors were males, Susan Wheeler could not skip a class without being missed. Despite the fact that Susan looked on her mentors in a neutral sexless way as her professional superiors, they did not return the view in kind. The fact of the matter was that Susan Wheeler was a very attractive twenty-three-year-old female.

Her hair was the color of winter wheat and very wispy. Since it was long and fine it drove her batty in the wind unless she had it pulled back and clasped with a barrette at the back of her head. From there it fell in a sheen to the lower edges of her shoulder blades. Her face was broad with high cheekbones, and her eyes, set well back in their sockets, were a mixture of blue and green with flecks of brown so that the chromatic effect changed with different light sources. Her teeth were ultra white and perfectly straight, the result of fifty percent nature and fifty percent suburbanite orthodontist.

All in all Susan Wheeler appeared like the girl of the Pepsi-Cola people’s dreams. At twenty-three years old she was young, healthy, and sexy with that American, Californian style that made eyes turn and hypothalamuses awaken. And on top of it all, perhaps in spite of it all, Susan Wheeler was very sharp. Her grammar school IQ ratings had hovered around the 140

range and were a source of infinite delight to her socially committed parents. Her school record was a monotonous series of A’s with numerous other evidences of achievement. Susan liked school and learning and reveled in using her brain. She read voraciously. Radcliffe had been perfect for her. She did well but she earned her grades. She had majored in chemistry but had taken as much literature as possible. She had no trouble getting into medical school.

But being attractive as Susan was had certain definite drawbacks. One was the difficulty of missing class without being noticed. Whenever questions were asked, she was among those unfortunate few who served to demonstrate the stupidity of the students or the brilliance of the professors. Another drawback was that people formed opinions about Susan, with very little information. She so resembled models glaring out from advertisements that people continuously confused her with those frequently mindless girls.

There were advantages, though, to being bright and beautiful, and Susan was slowly beginning to realize that it was reasonable to exploit them to a degree. If she needed a further explanation regarding some complicated topic, she only had to ask once. Instructors and professors alike would hasten to help Susan understand a fine point of endocrinology or a subtle point of anatomy.

Socially, Susan did not date as much as people imagined she would. The explanation for this paradox was severalfold. First, Susan preferred reading in her room to a boring date, and with her intelligence, Susan, found quite a few men boring. Second, few men actually asked Susan out, just because Susan’s combination of beauty and brains was a bit intimidating. Susan spent many Saturday nights engrossed in novels, some literary, some otherwise.

Starting February 23, Susan feared her comfortable world was going to be blown up. The familiar lecture routine was over. Susan Wheeler and one hundred and twenty-two of her classmates were being rudely weaned from the security of the inanimate and tossed into the arena of the clinical years. All the confidence in one’s abilities formed during the basic science years were hardly proof against the uncertainties of actual patient care.

Susan Wheeler had no illusions concerning the fact that she knew nothing about actually being a doctor, about taking care of real live patients. Inwardly she doubted that she ever would. It wasn’t something she could read about and assimilate intellectually. The idea of trial by fire was diametrically opposed to her basic methodology. Yet on February 23 she was going to have to deal with patients some way, somehow. It was this crisis of confidence that made sleep difficult for her and filled the night with bizarre, disturbing dreams in which she found herself wandering through foreign mazes searching for horrible goals. Susan had no idea how closely her dreams would approximate her experience during the next few days.