"Good morning." "It's 6 a.m. on a beautiful morning in Boston." "These are the top stories:" "Mayor White's assistant has met with the Redevelopment Authority over the controversy on the Town Heights project." "Saugus:" "Police have arrested contractor James McManus on $23 million graft and bribery charges in connection with the Mystic River extension." "Hyannis Port..." "Mrs. Levine is day five post-cholecystectomy." "She remains afebrile and her previous anorexia is gone, draining well." "An AP chest film is clear." "Her white count is nine-four." "BUN has stabilized at 40.2, good output of 1600cc's." " Blood cultures?" " No growth times two." "Well, Harris can't nail us on this one." "Next case." " It was a long time ago." " And is he good?" "Yeah, he can really break it up!" "Billy's weird." "He gets so tired." "Do you like this lipstick?" "She was terrific." "It's 32 now and going fast." "He can't afford to get out." "I got a thousand shares of that." "We have to have the AP, lateral and 10 units done before they can begin." "It says here, type and cross-match was done yesterday." "Just standard workup procedure." "Well, I don't know." "So it was a clear case of endocarditis." "We're ready when you are, Dr. Wheeler." "No response to antibiotics." "Cut her, okay?" " Sponge." " Begin to tie off." "It's all politics." "Today, for instance Rudnick says to me, "I hear you're the new chief resident in surgery."" " That's great!" " He was testing me." "Then he says that Harris told him that Mark Bellows was going to be the next chief resident." " Wonderful, Mark." " But here's the thing." "He waited for me to say I knew about it." "That wouldn't look right." "That would look as if I expected it." "So I said I hadn't heard anything." "Heh." "You've wanted it for two years." "But there's no point in saying that, is there?" "I said, uh I thought it'd be wonderful if it happened." "I said Chandler was doing an excellent job as chief resident." "But I said there was a little room left for improvement." "Chandler's damn good." "I really laid it on thick with old Rudnick." "I told him I was following his hepatic research, cited some references." "He was impressed." "Procedure went well too." "So all in all, it was a good day." "I'm gonna take a shower." "Can you grab me a beer before dinner?" "Hey, Mark." "Get your own beer." " Honey, for chrissakes, come on." " I want to take a shower." " I was on call last night." " So was I." "I know, but I had two arrests aortic aneurysm blew at 4 a.m., had to be done stat." "So I didn't get any sleep, and I'd really like to take a shower." "If you don't mind." "I had a hard day too." "You get in the shower faster than any person alive." "Have a beer." "You'll feel better." "I know what'd make me feel better." "Goddamn doctors." "Couldn't have fallen in love with a nurse." "Dorothy on the eighth floor." "She liked me." "My own apartment." "Did you hear about Louis?" "What about Louis?" "They passed him up as assistant professor." "Guy's really paid his dues too." "Now they don't take him." "Plus his son is waiting for a kidney transplant." "Did you start dinner?" "What?" "Did you start dinner?" " Did you hear anything I said?" " It's in the fridge." "Just heat it up." " I was telling you about my day." " I had a hard day too." "Just go heat it up." "Why is it, whenever we're about to fight, you're always undressed?" "What's the big deal?" "Just heat up the stew." " Why won't you help out?" " Is that the way you see it?" "I make my concessions." "You always take a shower first." " I don't." " You do too, and I'm getting tired of it." " Honey, come on." " Don't call me honey." "I'm trying to tell you about my day." "Something that happened." "Your days are always the same." "What is that supposed to mean?" "Just politics, that's all." "Who said what to whom." "Who's rising, who's falling." "Who's made a good move, a bad move." "Politics!" "Somebody has to be interested in hospital politics." "You certainly are not." "I thought you were a surgical resident, not a political one." "I like politics." "They interest me." "Just because you're always looking for—" "You want me to heat up the dinner, is that it?" "I want some respect." "Susan, come on." "Don't leave again." "Why can't you share half the responsibility?" "I share more than half the responsibility!" " No need to shout." " Why are you running off?" "You think I want this?" "Let me tell you something." "I make concessions for this so-called relationship." " I know it's hard on you politically." " I also want you to—" "Susan, don't go." "You know what the trouble with you is?" "All you care about is being chief resident." "You know what your trouble is?" "You don't want a relationship." "Look at you." "You run away from it." "This is ridiculous." "You don't want a lover you want a goddamn wife!" "Bastard." "Hmm." "I have a bleeder here." " I need more suction." " Clamp." "He's not di-toxic." "He has advanced ASHD." "I just bought some at 43." "Yeah, I hear they have management problems." "I sold at 37." " Hi." " Hi." " How are you?" " Mm-hm." "I'm fine." "The case went well." "No problem." "Good." "I'm really sorry about last night." "So am I." " You want to have some lunch?" " I have class." "You don't think this is more important than the class?" "Mark, that class is the only time I get out of this damn hospital." "Can you understand that?" "It's important to me!" "You're impossible!" "Seven, eight, step!" "Back." "Step." "Out!" "One, two, down three, up four and open." "And one and two, three and four." "Stretch." "Walk two, three, four and five and six, seven, eight and back." " You gonna leave Mark?" " I don't know." "I went home last night." "Again?" "He's impossible." "Did you see Dr. Richards?" " And?" " I don't know." "Apparently you can tell by looking at the cervix." "It's a different color." "He did the lab tests and he says I'm definitely 8 to 10 weeks pregnant." "So Dr. Richards is doing a D and C tomorrow." " For menstrual irregularity." " Mm-hm." "It's simple, isn't it?" "Are you worried?" "I know you do this every day but, sure, I'm worried." "Who wouldn't be?" "It'll be fine, Nancy." "It's routine procedure." "We're going to the Ice Capades." " It's real crowded." " Patient on call?" " Coming right down, Dr. Cowans." " The instruments are autoclaved." "Let's teach you fellas some anesthesiology." "This is your standard anesthesia." "You've got two main wall lines." "Nitrous oxide on the left and oxygen." "We got a case today that's a D and C." "It's one of Dr. Richard's cases." "Actually, it's a TAB." "That's a therapeutic abortion." "Keep it clean." "It's a married patient." "On the cart here, we got two manometers with flow valves here and here to regulate gas." "We got emergency oxygen down here which we checked and that's full." "During surgery, we'll be recording this and the vital signs." "Hey, how is Bess?" "I don't know." "In and out." "Yeah." "Boy, she has more rails than anybody I know." "She's seeing a shrink now." "One, two, three, up!" " Anybody we know?" " Mm-mm." "Morning, Nancy." "Remember me?" "I'm Dr. Cowans." "Dr. Cowans." "That's right, dear, and you'll have a nice long sleep." "Pre-op, she's received a 0.01 of Demerol and 0.4 of atropine so believe me, she's pretty relaxed." "I'll say she's relaxed!" "Come on, Mrs. Greenly, on your back." "That's it." " Gonna meet me for lunch?" " I don't know." " I'll let you know, okay?" " Okay." " I'll be in the lounge." " Yeah." "Henry might be calling, and if he does, you know..." " Okay, no problem." " Yeah, okay." " Afternoon, Tom." " Afternoon, Jim." "How's our lady?" " Just about ready." " I'm still awake." " But not for long, dear." " You promise?" "I'll induce with sodium Pentothal, give an IV by syringe." "Nance, what I want you to do is start counting from 100 backwards real slow, okay?" "Here we go." " A hundred." " Ninety-nine ninety-eight ninety-seven ninety-six..." "It's quick." "Stop the pentothal." "You see, pentothal isn't really an anesthetic." "Any deep pain right now and she'd wake right up." "What we need for anesthesia is gas." "First I'll inject some succinylcholine." "I want you to watch her chest gauge because she'll stop breathing." "She's now experiencing complete muscular paralysis." "She's got three minutes to breathe or she'll suffocate." "So now we intubate." "Taking a laryngoscope like so." "Hold her head in an extended position." "Enter laterally, put up the base of the tongue, up and out visualizing the trachea." "There it is, fellas." "Take a look." "You see it?" "It's right over there." "Come on, guys!" "Take our tube and enter here." "So." "In the middle of surgery, I'll switch over to the telothane." " Stirrups up?" " Yeah." "How is John?" "His fever broke today." "He'll go back to school tomorrow." "Now we can check the pupillary reflexes." "Though she's unconscious, the pupils should react to light and let us know that the old brain is okay." "That's it." "Anesthesia's the easiest job in the world until something goes wrong." "It's 99% boredom and 1% scared-shitless panic which we try to avoid." "The patient's yours, Dr. Richards." "If you move in behind me you'll see what I am going to do for this young woman." "Some music, please." "Actually, what I'm going to do is get her out of a hell of a mess." "She's pregnant." "She doesn't want her husband to know." "It's none of my business." "I'm just her surgeon." "I don't run her life." "So in fact, our task is simplified when the uterus is anteverted and anteflexed." "This is a function of the muscular attachments, of which there are five." "You should know them." "They're the broad ligaments, the round and cardinal ligaments and the endopelvic fascia, the uterosacral ligaments." "Again, part of the endopelvic fascia." " Something wrong?" " Yeah." "She just threw a PVC, and her blood pressure's falling." "I got 90 over 60." "She's fully oxygenated." "Red as a cherry down here." "Uh, how much longer you got?" "Just a couple of minutes." "I don't like this." "Her blood pressure is still falling." "Damn!" "We should stop." "She may be getting too much vagal stimulation." "Jesus Christ." " What's the matter?" " I don't know." "Nothing's the matter!" "Something's the matter." "She's going to arrest!" "I can't find anything!" "I get a 100 over 80." "Her pressure's climbing." "Let's finish up." "I'd like to get this mother off the table." "Sponge, please." "One-twenty over 80 and climbing." "She's okay." " These tissues go to pathology." " Can I start bringing her out?" "Yeah, bring her out, Jim." "Okay, Mrs. Greenly, it's time to wake up." "Okay, Nancy?" "Mrs. Greenly?" "Wake up." "Nance, can you give me a cough, please?" "Nancy?" "Oh, Jesus Christ!" "Her pupils are fixed and dilated." " What?" " The pupils, they're fixed." "Dilated." "Oh, my God!" "Pre-op diagnosis, acute gastric ulceration." "Post-op diagnosis, the same." "Surgeon, Dr. Wilson." "Anesthesia, general..." " Where's Schwartz?" "Cholecystectomy?" " Bed three." " Mr. Schwartz, I'm Dr. Bellows." " You don't got to talk so loud." " How you feel?" " Ehh." "Just "eh"?" "You want to get on your side for me, please?" " On your side." " Speak up, I can't hear you." "What'd they give you in that operating room?" "Do you have any pain?" "If I had any pain, I would go see a doctor." "Now you want to breathe for me real easy?" "That's it." "Slowly." "She was given 4 milligrams narceine to rule out idiosyncratic hyper susceptibility..." " ...to pre-op narcotic..." " Easy!" "Two units without effect, a few peripheral fasciculations." "So it's not succinylcholine?" "Delayed return of consciousness of cryptogenic origin." "I see no reason not to transfer her to the intensive care unit." "Mr. Schwartz, you're gonna be fine." "That's what you think!" " A grim prognosis, to say the least." " Rather tragic." "Someone should notify Dr. George." "He'll want to review the anesthetic protocol." "Right, he's been paged." "Looks like another anesthetic reaction." "Page Dr. Bendix, 44432." "Check." "George is not here." "No, Dr. Bendix." "Bendix!" "Maybe he left the hospital." "Try his office." "Could you page Dr. Wheeler, please?" "So you see, Jimmy, your kidneys are sick." "They don't work right." "We need to take out the sick kidneys and put in a new one." " Today?" " No, not today." "We have to wait until..." " ...there's a kidney we can put in." " Tomorrow?" "I don't know when." "But it could be a while." "Dr. Wheeler, call extension 3-5-6." "You can have one of these." "Which color do you like?" "Purple." "Take two." "I like purple." "I can see that." "I like red too." "Dr. Wheeler." "Yes." "Um—" "Excuse me, I have to go to intensive care now." "A nurse should be right in." "Surgical ICU." "What's her status?" "Greenly?" "Complete squash rot." "She's a total Gomer." "It's brain death." "That patient was transferred to the Jefferson Institute yesterday." "How can this happen?" "All this..." "Did you do an EEG?" "Flat." "Completely flat?" "Completely flat." "Did you repeat it?" "No, not yet." "What happened during the D and C?" "Nothing." "It's an unremarkable case, according to the notes." "Transient PVCs late in the operation." "Nothing else." "She never woke up?" "No." "I want to look at her chart." "If it were my friend, I don't know if I'd be that cool." "The potassium was what?" "One-eight?" "Are you sure?" "It must be a mistake." "Honey, I'm sorry." "I know you two were really close." "Susan?" "Well..." "There doesn't seem to be anything unusual in the chart." "Normal 28-year-old patient in good health for a D and C underwent telothane anesthesia, comes out in irreversible coma." "Hey." "Hey, Susan." "It's well-documented that telothane causes liver damage and severe side effects in a small percentage of surgical cases." " That's just the risk of anesthesia." " I know you're upset." "I'm not upset." "You think because I'm a woman, I'm going to be upset." "I'm fine, Mark." "I want to understand the variables as they apply to this patient." " I'm sure you agree that's indicated." " "This patient"?" "Here we have an ordinary, uninteresting case of surgical reaction to telothane anesthesia in a healthy patient." "As far as I can determine, there are no unusual aspects except that the patient was tissue-typed." "Tissue-typed for D and C?" "There's got to be some mistake." "Here it is." "No name on the slip and no billing number." "The patient is stable." "That's not the first time the lab ran a test on the wrong patient." "Let's go home." "I think you're tired." "I think I'd better check the tissue-typing lab." "Why?" "Nancy's problem was not caused by wrong lab tests." "I know." "Honey, you're grabbing at straws." "Let's go have some dinner." " I'm not hungry." " We'll check the lab later." "Stop acting as if there's something wrong with me or the way I'm thinking!" "I'm checking the lab now." " They're closed." " I won't just stand here!" "Susan, the lab is closed." "It closed at 6:00." "Is she all right?" "Yeah, she just, uh..." "She likes to do things her own way." "Who's that?" " Dr. Wheeler." " Uh, we're closed." "We don't do any determinations after 6, doctor." "I want to look at your requisition book." "Ugh." "What does it mean when there's no name and number on the slip?" "There's..." "There's always a name or a number, doctor." "For example, Nancy Greenly." "You did tissue-typing but there's no physician name and billing number." "Let me see." "Yes, you see, it's been printed out by computer." "That's hospital policy." "See, uh, a certain number of these tests are randomly ordered by computer as a quality check." "We do the tests here, they're sent out and done again by an outside lab." "The computer ordered this test on Greenly?" "Yeah, central computer." "Why don't you just show me?" " I can't." " Why not?" "I'm not supposed to." "It's really important." "Anyway, that information isn't coded." "If it isn't coded, I can't pull it out." "I mean, who would want it?" "Well, let's say, um, I wanted a list of all the patients who had tissue-typing in the last month." "Same thing." "Not coded." "Oh, what do you do?" "What good is all this equipment?" "I thought you recorded information." "We do, but the truth is, we install these computers to bill patients." "We code patient name and number, medical or surgical admission diagnosis, therapy and discharge diagnosis." "Okay, wait a minute." "Can you give me a list of all surgical patients with discharge diagnoses of coma?" "Okay, we have one general category under "coma" and nine subcategories under "brain syndromes."" "Good." "I want a list of all surgical patients with general category of coma in the past year." "Phew." "You're sure you want it?" "I had no idea." "It's a big hospital." "Are you married or what?" "Thank you." "Surgical ICU." "That's right." "Where'd you get this?" "It's against the law." "It's illegal to tap a data bank." "I don't see why." "I'm a doctor." " I've got research—" " That's not the point!" "Every officer got the lecture." "No access without authorization." " They can throw you out." " Never mind that." " What do you mean "never mind"?" " Mark." "Look at this." "Two hundred and forty names." "Ten are young people admitted for minor procedures." "Breast biopsy, appendectomy." "They all come out in a coma." "Aren't you surprised?" "The risk of surgical anesthesia is six per 100,000." "In a hospital this size, 10 patients in a year is not surprising." "So what are you doing?" "You missed your rounds." "You didn't scrub in at the gastrectomy." "I had to do something." "Why don't you do your job?" "Surgical ICU." "Mr. Murphy is a 35-year-old in good health admitted for a meniscectomy." "He's scheduled for this morning." "Promises, promises." "They keep telling me there's a delay, another half-hour." "Well, the suspense is really killing me." "I thought you doctors liked to operate." " We'll get to you." " Oh, I'd hate to be left out." "How did you get your injury?" "Playing touch football." "You know, with the guys, horsing around." "Dr. Wheeler, see Dr. Harris." "See Dr. Harris in his office." "The chief of surgery himself." "Playing touch football, huh?" "Yeah." "So I come in, and all that happens—" "Thanks very much, Herb." "We'll get together on it later." "Would you come in?" "Excuse me." "Sit down, Sue." "Yes." "Dr. Harris, it's Senator Brooke's office." "He wonders if you can change the meeting to 4." "Yes, 4 is fine." "Notify Henry." "Yes, sir." "Sue." "I like to think that Boston Memorial is the best hospital in the city perhaps in the country." "I'm committed to it to the house staff we have here, and to you." "I think you know that." "But we have certain constraints imposed on us." "One is the state law concerning privacy in computer data access." "An unauthorized entry was made last night." "We put the young man on probation." "But he told us he made the illegal entry on your behalf." "That's true, sir." "All the discharge diagnoses of coma over a 12-month period?" " I wanted it because I had an idea—" " Well, forgive me." "But it isn't a question of why you wanted it it's how you got it." "I understand you have personal reasons for being under stress for not acting as carefully as you might." "And I'm sympathetic to the way you must feel about the, uh uh, Greely case." "Greenly." "Nancy Greenly." "Greenly." "Yes, Nancy Greenly case." "I certainly don't want to lose a good surgical resident." "Well..." "I think we can handle this, Sue." "I'll keep the, uh, evidence and we'll forget it ever happened, all right?" "But I'd like you to see someone." "I was thinking of Dick Morelind." "Dr. Harris, I'm fine." "I don't need a shrink." "No, no, I know you don't." "But it's important to have on record a talk with Dick Morelind." " I don't see why." " Actually it's a precondition to your continuing on here at Memorial." "Okay?" "I understand." "I think it's unfair." "Everybody's on my back." "Mark's whining about how I can't make a commitment and I'm cold, and I'm afraid of intimacy." "Then this happens to Nancy and she's my best friend since boarding school." "Everyone jumps on my back, acts like I'm neurotic and I'm not doing my job!" "There's concern about breaking the law." "I wanted to do something." "Do you understand?" "Do something right away." "I just couldn't sit there and watch Nancy and..." "How do you feel about what happened?" "Confused that's all." "Just confused." "It's very confusing." "I wanted to understand what happened to her." "Nobody else here seems to care." " Nobody else cares?" " Listen." "There have been 10 cases of unexplained coma in young, healthy patients in the last year." " Now, don't you find that surprising?" " No." "You don't." "Susan, this hospital does 30,000 operations a year." "I'm not surprised a few turn out with serious unexplained side effects." "Medicine isn't perfect." "We all accept that." "Don't we?" "There's a crisis in her personal life." " She's involved with a resident." " I know." "It's led her to overreact to this situation which she has not consciously faced." "She's under stress and a little paranoid." "Mm." "Think we'll have any more trouble with her?" "I don't think so." "I hope you're right." "I hate to admit it." "I think I was really upset about Nancy." "Yeah." " You on call tonight?" " Mm-hm." "So am I." "Why don't we have a terrific dinner just the two of us in the hospital cafeteria?" " Sounds great!" " About 11?" "You got a date." "Maybe afterwards, we can go to our favorite room..." " ...on the eighth floor." " Mm." "Nobody will be there after midnight." "I think we're looking at cortical anoxia." " I'll check the Babinski." " How old is he?" "Thirty-five." "When did you administer the additional dosage?" "At the onset of cardiac irritability." "The surgeon said he was light." "Surgeons know nothing about anesthesia." "What'd you give?" "Two cc's push." "There was no reason there'd be a problem." "Just seemed a little light." "Some PVC in runs, transient hypotension but no sign of hypoxia." "Skin color and blood were all red and fully oxygenated." "The pupils are fixed and dilated, I must presume brain death." "Any relation to your other case?" "Completely different." "Different staffs, different anesthetic agents." " He better be trached." " Do we need a pulmonary consult?" "Request the consult, but go ahead with the tracheotomy." "This is a long-term management problem." " Come on." " It happened again." "That's Dr. George, chief of anesthesia." "He's got it under control." "Is there a research protocol this case would fit?" "He's a good research case." "Excellent teaching material." "It's true, Mr. Murphy presents challenges electrolyte balance IV, caloric maintenance possible pseudomonas infection." "There may be additional risk of staph osteomyelitis." "But I think you'll be agreeably surprised, Dr. George." "We can keep him alive in stable vital signs, a year two years, indefinitely." "You can't just look the other way." "Nobody's looking the other way." "Mark, twice in two days." "It's not normal." " In certain cases, patients always—" " You told me that." "Two in two days." "You're just sensitized to it." "It just happened to a friend and now you're looking for it." "Twice in two days is just our lousy luck." "Hmm." " Did Harris take the readout?" " Yes." "All right, then forget it." "The hospital has review boards and committees." "They'll look into it." "Now, you got a job to do, so forget about this." "You're right." "You're right." "I'll see you at dinner?" "Mm-hm." "Dr. Williams, Dr. Peter Williams, 1174." "This is Dr. Wheeler." "I know about the conference but I'm tied up with a patient now." "Well, I'm afraid I can't make it there in time." "Where am I?" "I'm in the emergency ward." "Yes, it is important." "Will you hold on?" "Well, that's funny, but all these charts you wanted they're all signed out to Dr. George, the chief of anesthesiology." "Good afternoon, Dr. George." "Good afternoon, staff." "We have a happy lab here." "It's precise." "There's nothing left to chance." "There are no mistakes." "The charts are right here." "There's no mystery." "They're right here." "What is it you wanted?" "I'd like to look at them." "For what reason?" "I'm interested in unexplained coma following routine surgery." " You're interested?" " Yes." "Young lady, I'm more than interested." "My anesthesiology staff is more than interested." "We're deeply, intensely concerned." " I understand your feelings." " I'm not sure you do." "Perhaps something was missed?" "Missed?" "Every professor of anesthesia, most of our staff more than 40 experts have gone over these charts." "You think something was missed?" "But if anything links them together—" "If anything linked them, we'd know it." "Here they are, 10 cases." "There are now 12." "Different ages and sexes." "Different surgeons and anesthetists." "Different methods of induction." "They share nothing in common except they all emerged with unexplained coma." "We're certainly not neglecting that problem." "I didn't say you were." "Do you mind if I have a look?" "I'm afraid I do mind." "Thank you for your interest, however misplaced, Dr. Wheeler." "Good afternoon." "Oh, my God, you did— How could you do that?" "Susan..." "Dr. George is a past president of the American Society of Anesthesiologists." "He's a member of the AAAS." "He's on the board of the NIH and you tell him he's doing his job wrong." " I just wanted to see the charts." " That's not your area." "That's not your responsibility." "You're way off base." "You know who his wife is?" " I don't care." " Well, you should." "His wife is Amy Cabot." "She's related to Godfrey Lowell." "I don't care about Boston society." "Dr. George's wife is worth somewhere between 50 and 100 million dollars." "When she dies, that money will go somewhere." "So what?" "So he has a lot of muscle here." "He's the wrong man to cross." "You afraid to be seen with me?" " Come in." " Hi, Bill." " How are you, Mark?" " Good." "Sit down." "You know, Mark I always thought that you'd have this job when I leave next year." "Everybody thinks so." "You're the logical choice." "You're a good surgeon." "You're well-organized." "You run a good service." "Well, thank you very much, Bill." "I'd hate to see anything stand in your way." "You know what I mean." "She has the chiefs of service in an uproar." " She's under a lot of pressure." " And so are we." "They're talking about releasing her from her position here at the Mem." "But nobody really wants that kind of adverse publicity, that commotion." "Of course not." "You have influence with her?" "I don't know." "She's paranoid." "She thinks there's a conspiracy." "George keeping the charts from her did not help." "Does she think, uh, you're involved?" "No." "No, I don't think so." "Let's hope not, Mark." "What happens to Susan may depend on you." "I understand that, Bill." "You know, a good chief resident handles problems like this every day." "I think if you're able to exert some influence over her people would be appreciative." "Well, I'll try." "Good man." "Where's Greenly?" "That coma case?" "She was to be transferred to the Jefferson Institute." "I guess she went there." "Liz, did Greenly go to Jefferson?" "No, she arrested at 6 this morning." " She's down in pathology." " In pathology?" "Yeah, they're probably doing the autopsy now." "Surgical ICU." "There's a wrinkled appearance." "The interior edge of the organ can be bent without tearing as evidence of its structure." "The gross appearance is consistent with acute yellow necrosis of the liver." "Presumably secondary to fatal viral hepatitis." "Do you have a patient named Greenly?" "I don't know." "Check in there." "I can't keep track of names." "In microscopic section, we may expect evidence of fatty degeneration in necrotic cells with polymorphs and histiocytes around them." "Okay, incise the kidney there." "Looks normal." " Okay, remove it." " Greenly?" "This is Howard." "Greenly's over there." " Hi, Jim." " Hi, Sue." "What brings you here?" "Interested in this case?" " That's right." " Hell of a puzzler." "Young girl, good health in for a therapeutic AB, comes out comatose." " Found anything?" " Naturally, we started with the brain." "Grossly, it was normal." "I'm doing a section." "Want to see?" "Ordinarily, these coma cases get shipped to Jefferson." " What's Jefferson?" " Jefferson Institute." "A chronic-care facility." "Government thing." "They take care of the vegetables." "Sometimes they die before they get there, like this one." "More work for us." "Huh." "Now we'll get an idea." "We're looking for anything." "Micro-infarcts, staph loci gross hemorrhagic areas, congenital defects..." "Nothing." "Just like the other cases, we come up cold." "I know it sounds silly but, um, if you wanted to put people in a coma, what would you do?" " On purpose?" " Diethyl para-amino tannadol." "No, it leaves a serum trace." " If you look for it." " It also peaks alk phos." "A real giveaway." "Besides, who can get tannadol?" " Use paradine." " It has a taste." "We'd make great murderers." "Who knows more than a pathologist?" "Heh." "It keeps my wife in line." "Hell of a lot of crimes slip through our fingers." "But in this case, a coma." "First rule of crime:" "Keep it simple." "What's simple?" " Carbon monoxide." " Boring." " Carbon monoxide?" " Sure, it's perfect." "Anesthetist uses carbon monoxide instead of oxygen." "It's colorless and makes the blood red so the surgeon doesn't notice." "But the brain dies from lack of oxygen." "The patient doesn't wake up." " No other effects?" " Sure other effects." " Cardiac irritability." " Which this case had." "It'd be better to block the neuro-muscular junction with succinylcholine." "That's a nice murder." " Who's gonna do it?" " Who'll feed your carbon monoxide?" "That's the problem." "Been 12 coma cases here in the last year." "They're always different." "Different case, different anesthetist, different operation." "Hard to imagine it's murder." "Are you sure?" "What do you think?" "There's a conspiracy at the Boston Memorial Hospital involving all the anesthetists?" "I've had a rather hysterical call from Dr. George in anesthesiology." "Dr. George is a powerful person here, not only because of his position." " There are other reasons." " I gather." "What does that mean?" "Just because somebody has a rich wife, he shouldn't be able..." " ...to throw his weight around." " Oh." "You're looking for truth and justice, huh?" "I'm looking for fairness." "In fairness, you've challenged the professional competence of a chief of service at this hospital." "And he didn't take it well." "No reason he should." " Now he's out for blood." " I've noticed." "Sue, believe me, I'm on your side for all kinds of reasons." "I don't want to let another chief of service get one of my house officers fired." "Dr. Harris, I just wanted to look at his charts." "Sue, right now, I can protect you because you're good." "And frankly, because you're a woman." "I don't want concessions." "At the moment, you'd better take any you can get." "You know what happened to Greenly?" "Yes." "What happened?" "She died." "How do you feel about that?" "How do I feel?" "I feel..." "She was my best friend." "She understood me." "It's not fair." "None of this is fair." "Here." "Nobody understands." " No one." " I know, I know." "Yes." "Dr. Harris, the secretary of HEW is on the phone from Washington." "Call back." "Too many of us shut ourselves off from our feelings." "We don't explore them." "We don't understand them." "We don't understand ourselves." "It's the toughest thing about our profession." " Dr. Harris—" " I'll take care of the politics." "You just look out for yourself." "Take the weekend off, Sue." "Go walk on the beach." "Get away from the hospital." " I'm so embarrassed by this." " No." "Don't be." "Don't be." "Our emotions are what make us human." "Come on." "Come and see me next week, all right?" " Right." " Good." " Have a good weekend." " Thank you, sir." "Women!" "Christ!" "God!" "Just say you don't believe me." "A man fixed your car so it wouldn't start then followed you into the MTA station." "Well, it's true." "They're gonna wave him in." "Your car is always breaking down." "I just think you're tired." " I'm not tired." " Why don't we go away for the weekend?" "Go up the coast, have some fun and just forget the hospital." "Mark..." "There are 12 coma cases." "Nobody thinks they're linked, but I've seen charts for two of them:" "Nancy, and now this new guy, Murphy." "And?" "And both occurred in O.R. 8." "O.R. 8?" "What if...?" "What if carbon monoxide were being pumped in O.R. 8?" "What if that were true?" " Get your coat on." " Why?" "We're going to take a look." "Right now." "O.R. 8." "Well?" "Well..." "Looks okay." " How many operations you done in here?" " A lot." " You ever had any problems?" " No." "Well, I already checked." "The day Nancy had her problem, there were five other operations." "Four before and one after." "The day Sean Murphy had his, there were six others." "Two before and four after." "They were all normal." "Let's get out of here." "This is what you call really working for it." "No fair." "Fair." "I thought we were taking the weekend off?" "Come on." "Just a quick look." "Please?" "For me?" "I don't know." "There doesn't seem to be anybody around." " You want to go in?" " Not really, no." "I do." "Can I help you?" "I'm Dr. Wheeler." " You're early, aren't you, doctor?" " Early?" "You're supposed to come on Tuesday, day after tomorrow when the tour is scheduled." " The tour?" " Yes, it's every Tuesday at 11." "The regular tour for physicians." "Could I, uh, see it now?" "I'm afraid that's impossible." "I just thought as long as I'm here..." "We're simply not set up for it." "May I speak with the senior physician in charge?" "There is no physician in charge." "Well, then, your supervisor." "I have no supervisor." " Who runs the staff?" " There is no staff." "You're here alone?" "Of course not." "There are technicians, security people..." "I'm sure when you've taken the tour Tuesday, it will all be clear to you." "What did you say your name was?" "Dr. Wheeler." "Susan Wheeler." "We look forward to seeing you at 11 on Tuesday." "Goodbye." "I heard what you said to Dr. George in the lab." "I heard what you said to him." "You're right." "Right about what?" "I've seen how they do it." "I know how it works." " How what works?" " Susan." "Uh..." "Do you want to, uh, scrub in on an aortic valve replacement?" "Harvey's doing one in room 16 in 10 minutes." " Sure." " Great!" "Tom was going to scrub in, but, uh, his case is running late." " I checked them out." " Mm-hm." "You come down to maintenance tonight." "I'll show it to you." "Hello, Sue." "Good morning, sir." " Did you have a good weekend?" " Yes, I did." "Thank you." "Evening." "Good evening." "You just gonna stare at me?" "No." "What'd you do that for?" "They said make it look like an accident." " What's happening?" " Emergency generator will kick in." "Kelly?" "Kelly?" "What do you got now?" "Nothing." "Try the connector cable." "I think that does it for me." "You got anything else?" "No, I don't need anything else." " If we need you again—" " You can reach me at the hospital." "Must be a short in the junction box or the step-down panel." "It should read 14 point something." "14.3." "Okay, now we should have 11.9." "Eleven-nine." "And now there's—" "Fourteen-three." "Good." "Nothing's shorted so far." "We got lucky." "Poor Kelly." "Poor Kelly?" "Heh." "He got sloppy." "You know what it is?" "That drinking at lunch." "I said, "Stop drinking." "You'll get into trouble."" "Two and two's the count." "Can't get much more than that." " What did you leave in here?" " Just some charts." "I'll call Dr. George and tell him I let you in." "It's all right." "I have to call him anyway." "Well, okay." " Boston ahead by one." " That's great." "I've got 20 bucks on this game." "What is it?" "Hospital security, doctor." " What's the score?" " Just a routine check, doctor." "Easy, kids." "Jerry?" " What's going on?" " Jerry, I'm so happy to see you." "That's the nicest thing anybody's said to me all day." "Is something wrong?" "You see, there's this guy." " He said he was hospital security." " Yeah." "Well, I happen to know that he—" "It's a high fly ball and he's out!" " You were saying?" " I guess I have an overactive imagination." "Heh." "Be like me." "Everybody says I have no imagination at all." "I'm going over to the medical school library." "I'll go with you." "The tubular filtration gradient may be more than 500 milliequivalents." "That means there's an active transport with phosphorylated ATP." "But if you trace radioisotopes, densities don't look right." "It's a breakthrough in understanding the kidney." "Remember that yellow cadaver skin under your fingernails?" "Nobody could eat lunch." "It seems like a long time ago." "Back in the days when we couldn't eat lunch." "Wouldn't you know?" "Dr. Marcus." "Yes." "Well, if he's complaining of pain." "Try another five cc's I.M." "I see." "Well, then, uh, MS 10 milligrams." "Yes, morphine sulphate." "He's not in respiratory difficulty." "You can put him on respiratory arrest with morphine." "Particularly if he's on wall O-2." "You'll have to check and see what he's on." "Air is fine, but oxygen..." "If he's on wall oxygen, tell me how many liters of flow." "Six liters!" "You can't put him on MS." "You'll have to stay with Talwin." "Give him five cc's of water." "Say it's morphine." "He won't know." "He's a pain in the ass anyway." "Aah!" "Unh!" "Agh!" "Mark, it's so awful!" "It's so terrible." "Take it easy." "Honey, slow down." "He was trying to kill me." "And I had to keep going." " And all the bodies." "It's horrible!" " Easy." "Easy, honey." "Take it easy." "Slow down." "Mark, it's all happening." "It's really happening." "Somebody's putting people into comas." "They're murdering them." " I know, I know." " No, no, really." "Kelly's dead." "I was down there." "I found the gas line." "It starts in the basement and it goes up the main tunnel then plugs into the oxygen line in the ceiling that goes to O.R. 8." " Honey, slow down." " They're killing people with carbon monoxide in O.R. 8." " They have a radio to turn the valve." " I believe you." "I do, I believe you." "All the cases happened in O.R. 8." "And they all went to the Jefferson Institute." "And this guy, he chased me all over." "And there were so many bodies." "It's all right." "It's okay." "And this is real." "Call the police." "We have to do something!" "This is real, Mark." " Shh, shh." " I can prove it." "Sure, you can." "You can." " Just lie down." " This is real." "I know you can." "Now one thing at a time." " I want to give you a Valium and—" " No." "Okay." "How about a cup of tea to settle you down?" " A cup of hot tea?" " Okay." "Then we're gonna talk after you settle down." " Okay." " All right." "So you just rest right here." "Okay?" "You just stay right here on the bed?" "Thattagirl." "That's it." "You just relax." " I can't—" " That's it." "Just relax." "Close your eyes." "That's it." "Okay, thattagirl." " Now, I'll get you a cup of tea." " You're so great, Mark." "Stay here, honey." "Just stay right here." "That's a hell of a story, Susan." "You really had a lot of people worried." "Don't worry." "Everything's gonna be okay now." "She came back." "Yeah." "No, she's here now." "Of course." "No, I can manage that." "I'll keep her here." "Look, I'd better go." "Susan, you want some honey with your tea?" "Susan?" "Su—?" "Susan!" "Memorial Hospital residents' exchange." "This is Dr. Wheeler." "Are there any messages for me?" "Oh, yes, doctor." "Quite a few." "Just a minute, please." "I'm sorry." "I'll have to call you back." "What number can you be reached at?" "Dr. Wheeler, are you there?" "What number can we reach you at?" "We are dealing in an area of uncertainty." "An area where there are no rules, contradictory laws and no clear social consensus as to what should be done." "And the cost of care for the chronic patient has become prohibitive." "This is particularly the case with the long-term comatose patient." "The Jefferson Institute is a government— sponsored experimental facility designed to provide quality life support to the comatose patient." "I wish to emphasize no moral or ethical position is being taken here." "We do not participate in the debate over whether these patients are alive or dead or whether their care should be continued or terminated." "Society will decide if there will be more of these facilities or not." "In the meantime, we merely provide care as inexpensively as possible." "Now, if you will please come this way..." "This is our visiting room where relatives can see patients who are stored here." "You see, it all looks quite normal." "We've found it is inadvisable for relatives to know the actual circumstances of patient care." "It's too much of a shock." "So we bring the patient here." "After the visit, we return them to the main care facility." "If you will put on your glasses, we'll go there now." "This is our main care facility." "Temperature here is 94.7 degrees Fahrenheit humidity 82 percent." "This stability reduces patient heat loss and caloric requirements." "There's a low-level ultraviolet bacteriostatic flux and to prevent bedsores patients are suspended by wires through long bones." " How do you get to them up there?" " There's no need for contact." "Every one of our patients is individually monitored by the computer." "Indwelling telemetry records weight, fluid balance blood pressure, blood gases, temperature, metabolic balance." "Our computer makes an immediate adjustment for any change in condition." "For example we simulate hypotension by direct compression of the telemetry unit." "The computer will sense this and make an immediate adjustment." "Well, almost immediate." "Sometimes there's a—" "There we are." "Sometimes there is a short delay, but as you can see the computer put the patient in the Trendelenburg position and administered a vasoconstrictor." "We have very few crises here." "With the assistance of technology these patients are maintained beautifully." "Without it, they would have died long ago." "But the law says they must be maintained, and this is one solution." "How large is your staff?" "One nurse, a physician on call two computer technicians and a small security staff." "That's all." "And the rest of the building?" "It's of no interest." "Just mechanical and technical facilities." " What's the cost?" " For each patient, about $60 a day." "But we can store 1,000 patients and then the cost will go down." "We expect to maintain patients for about $5 a day." "Less than it costs to hire a baby-sitter for a few hours." "If there are no further questions this concludes our tour of the Jefferson Institute." "Before you go, we have some literature we'd like you to take." "It explains some of the background and details of our work here." "We hope the tour has been informative." "And if you have any questions about the Jefferson Institute don't hesitate to call." "It shouldn't be about money." "Maybe your patients don't complain about their bills." "Thank you for your interest." "Goodbye." "Do you know what I wanted?" "I wanted corned beef on rye or else a roast beef with Russian." "And what do you bring me?" "Ham and cheese." "Well, that's all they had." "You mean to tell me they didn't have any corned beef?" "No corned beef?" "That's what the man said." "No corned beef." "The guy must have been putting you on." "George says we're having an electrical inspection tomorrow morning." "Are we set for that?" "Norman!" "Yes, we should be." " Do you want the bidding program now?" " In a moment." "Did you see the game last night?" "Two out, Bumbry's up." "He hits a ball to left field." "White misses it and goes for a triple." "Lungs, 1100 grams." "Kidneys, 780, 620." "Eighty and six-twenty." "What about the heart?" " I wrote it down someplace." " What's the temperature?" "Right now, 12 degrees centigrade and all the rest at 14." "Bottom of the ninth." " Hey." " What?" " Where's that heart going?" " Um..." "San Francisco." "I think they're getting $75,000 for it." " Is that all?" " It was a bad match on tissue-typing." "Only two out of four." "But it's a rush order." "The kidney's a four-tissue match and in perfect condition." "They'll get 200 grand for that." "It's going to Texas." "A millionaire's son." "Good old George has the connections." "So far, George is doing fine." "What about the other kidney?" "They're putting it up for bids." "They'll get 100 for it." "We have a left kidney, two hours old, ready to ship." "It's a 4367." "A 31-year-old male." "The bidding now stands at forty-two five." "Thank you." "Forty-five." "Hello?" "It's at 45." "Well, it could be in Zurich in..." "The fastest routing is New York-Rome." "It'll arrive local time 1300 hours, which means elapsed time is 23 hours." "Twenty-three hours elapsed time, which would make it 1 p.m. your time." "That's the best we can do." "Thank you." "Hello." "What's that?" "Look at monitor four." "All units!" "There is an unauthorized woman in the building." " Contain this person maintaining..." " Let's take her alive." "Don't shoot." "Visiting room, clear." "Over." "Second floor lobby, clear." "Has anyone checked the main care facility?" "Over." "We have no reports from that sector." "Now on the second floor corridor." "System's all clear." "Repeat." "Don't you have a key to this place?" "No intruders on sub-basement one." "Repeat:" "No intruders on sub-basement one." "Unit one, she's out on the ledge." "It's too far for her to jump." "I don't see her." "She's out there." "She won't get far." "We got her now." "Have the dogs start on the north side and circle the building." "I want security at all exits." "Notify them by radio." "Search the labs and the roof." "I've had enough of this inefficiency." "Perimeter dog team, come in." "Repeat." "Come in!" "Main control, any readings from outside?" "Where are the dogs?" "I don't know where the hell she is." "She's got to be around here somewhere." "There, there." "It's going to be all right." "First floor lobby, check in." "First floor lobby, please respond." "No, she's not here." "Of course I've been notified." "I'm keeping an eye out for her." "If she comes here, we'll get her." "There's no way she can escape." "Let's get this loaded quick." "I got to make it in time for the Dallas flight." "And we got rush-hour traffic." "Even with the siren, I gotta get through the tunnel." "Life gets tougher all the time." "I see you got the dogs out." " We got a little security problem." " We all got problems." "World's full of problems." "Take it away!" "Dr. Rogers, 2204." "Dr. Earl Rogers, 2204." "Do me a favor, will you?" "Don't say anything to upset her." "I wouldn't say anything." "She's an old woman." "She's sick." " She may die." " Did the doctor say that?" " I don't know." " You don't know what the doctor said?" " I'll believe what the doctor says." " Just don't upset her." "This could be it." "This could be the end." "It's incredible." "Well, I could use a drink." "How about you?" "Scotch?" "Whatever you're having." "I like a woman who drinks Scotch." "You've done a remarkable thing, Sue." "Your dedication your concern your pursuit of this problem." "It's all extremely impressive." "And I'm very grateful." " Thank you." " Cheers." "In fact, I'm more than grateful." "I'm deeply in your debt." "The question is, how do we handle this?" "You arrest Dr. George." "Yes." "Sorry, Dr. Harris." "It's Landis in Washington." "Put him on." "Excuse me." "Hello, Tom." "How are you?" "Fine, fine, just fine." "Sure, I'd be delighted to testify." "You know how strongly I feel about the matter." "But have you consulted the president?" "Uh-huh." "I see." "This won't take long." "Uh-huh." "Good, good." "Good." "Thanks for calling, Tom." "Bye." "You've put me in a difficult position, Sue." "It seems you know everything." "You're George." "I wonder if you can understand if you can take the long view the view of a person in my position." "You did it?" "No decision is easy, Sue." "It only looks that way when you're young." "When you're older everything is complicated." "There is no black and white." "Only gray." "But our society faces momentous decisions." "Decisions about the right to die about abortion, about terminal illness prolonged coma, transplantation." "Decisions about life and death." "But society isn't deciding." "Congress isn't deciding." "The courts aren't deciding." "Religion isn't deciding." "Why?" "Because society is leaving it up to us, the experts." "The doctors." "You're crazy." "Americans spend $125 billion a year on health." "More than defense." "Because Americans believe in medical care." "These great hospital complexes are the cathedrals of our age." "Billions of dollars, thousands of beds a whole nation of sick people turning to us for help." "You..." "You ought to see somebody." " They're children, Sue." " Ha-ha-ha." "They trust us." "We can't tell them everything." "Our job is to make things easier for them." "I'm sure you agree." "You're killing people." "We must always take the long view not of the individual, but of society as a whole because medicine is now a great social force." "The individual is too small." "That's the drug." "It produces abdominal spasm and peritoneal symptoms." "It must be very painful." "It's too bad." "But look at it from the practical standpoint." "Somebody has to make these decisions." "We can't wait around forever." "If society won't decide, we'll decide." "We'll make the hard decisions." "This is Dr. Harris." "Schedule an emergency appendectomy in O.R. 8." "It's a member of the house staff, Dr. Wheeler." "I've examined her." "She requires immediate surgery." "Okay, honey, now just sit up." "Come on, that's it." "That's good." "Yes." "Here we go." "It's the drug." "Yes, yes, it's gonna be just fine." "Doctors make the worst patients." "They know too much, I guess." "Dr. Edwards, 1011." "Dr. Edwards, 1011." "Susan." "Susan." "Why'd you run away?" "I was just talking to your mother." "She was worried about you." " Mark." "Mark." " Everybody's been worried about you." "Mark." "Honey, I love you." "You're gonna be just fine." "No, Mark, listen." "You have to stop this." "I'm fine." "I am." " But your appendix is not fine." " No, Mark." "You've got plus-four peritonitis, guarding and spasm, honey." " No." " Susan, you do." "No, I don't." "There's no question about it." "Mark." "Check my white count and sed. rate." "It's normal." "Please." "Huh." " The tests aren't here." " Unh." "But with these physical signs, it has to be appendicitis." "Please!" "It's better to be safe and have the operation." " Unh." " Besides, you're in the best of hands." "Dr. Harris himself will do the procedure, huh?" "How about that?" "The chief of surgery is taking your case." "I don't want him." " Well, how's our patient doing?" " Fine." "Just slightly delirious." "That's normal with appendicitis." "Besides, we all know doctors make the worst patients." "You gonna scrub in?" "Dr. Harris, we have O.R. 7 ready for your case." "I wanted O.R. 8." "It isn't ready yet." " I specifically requested O.R. 8." " It'll take a couple of minutes." "Well, hurry it up." "Our patient can't wait all night, can she?" "You scrubbing in?" "Uh, excuse me." "Let me just answer this page, sir." "Yeah, this is Dr. Bellows." "Yes, Dr. Bellows." "It's that serious, huh?" "Is what that serious?" "All right, I'll be right there." "Dr. Bellows?" "We're ready in O.R. 8, Dr. Harris." "We'll start at once." "Bellows?" "Patient on surgical two's got convulsions." " Join me as soon as you can." " Yes, sir." "You can take her in." "You certainly are lucky with Dr. Harris doing the operation." "Couldn't ask for a better man, huh?" " I want—" " Now, now, just lie back." "You're going to have a nice sleep." "Just relax." "Easy, we'll take good care of you." "I found the oxygen line." "It starts in the basement and it goes up the main tunnel and then it plugs in the ceiling that goes to O.R. 8." "Do we have enough sponges?" "We better order some more 4-0 Chromex." "We're almost out." "We have to do this one right." "House officers deserve the very best of care in their own hospital." "I'm giving you Pentothal." "Take some good, deep breaths, dear." " In and out." " Unh." "The patient's film, Dr. Harris." "They look normal, don't they?" "Pity acute appendicitis doesn't show up more clearly in the x-rays." "She has an inny." "A what?" "An inny." "The bellybutton." "Some are innies, some are outties." "Hers is an inny." "Let me know when she's fully under." "She's ready for you." "Scalpel, please." " What's that?" " It's a PVC." "There's another one." "Too light?" "I don't think so, sir." "Maybe you'd better deepen anesthesia." "Blood pressure's dropping." "I don't understand." " Want me to stop?" " No." "It'll be all right, sir." " I'll be happy to stop a moment." " It's okay, Dr. Harris." "You recommend I go on?" "Son of a..." "Son of a bitch!" "Son of a bitch!" "Here it is." "Hmm." "Looks normal." "Never know it from her symptoms." "It's nice to see the chief get caught sometimes." "Happens to the best of us." "Okay." "All right." " You can bring her out now." " Right, sir." " Uh-oh, Dr. Harris." " Yes?" "She's not coming around." "Just give her a minute." "I'm sure she'll be just fine." "I don't know, sir." "She's okay, sir." "She's just fine, Dr. Harris." "Nice case, Dr. Harris." "Mark." "Mark." " Don't let him do the operation." " I know, baby." "I know." "We're waiting for you, Dr. Harris."