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 grant
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.
You've wanted it for two years.
But there's no point
in saying that, is there?
I said...
...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.
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.
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.
How are you?
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?
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?
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.
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?
Lt'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.
Boy, she has more rails
than anybody I know.
She's seeing a shrink now.
One, two, three, up!
Anybody we know?
Morning, Nancy. Remember me?
I'm 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?
I'll be in the lounge.
Henry might be calling,
and if he does, you know...
- Okay, no problem.
- Yeah, okay.
- Good 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.
In the middle of surgery,
I'll switch over to the telothane.
Stirrups up?
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.
Something wrong?
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.
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 can 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?
Jesus Christ!
Her pupils are fixed and dilated.
The pupils, they're fixed.
Dilated.
Oh, my God!
Pre-op diagnosis,
acute gastric ulceration.
Post-op diagnosis, the same.
Surgeon, Dr. Wilson.
- Where's Schwartz? Cholecystectomy?
- Bed three.
- Mr. Schwartz, I'm Dr. Bellows.
- You don't got to talk so loud.
How you feel?
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 narceine
to rule out 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 going to 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.
4-4-4-3-2.
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.
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?
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?
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.
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.
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 tell,
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.
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 six 6:00.
Is she all right?
Yeah, she just...
She likes to do things
her own way.
Who's that?
Dr. Wheeler.
We're closed.
We don't do any determinations
after six, doctor.
I want to look at
your requisition book.
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.
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 I wanted a list
of all the patients...
...who had tissue-typing
in the last month.
Same thing. Not coded.
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.
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.
"Never mind"?
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?
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.
- 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.
It's Senator Brooke's office.
He wonders if you can
change the meeting to four.
Yes, four is fine.
Notify Henry.
Yes, sir.
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.
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 Greely case.
Greenly. Nancy Greenly.
Greenly. Yes, Nancy Greenly case.
I certainly don't want to lose
a good surgical resident.
I think we can handle this, Sue.
I'll keep the 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.
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?
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.
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.
You on call tonight?
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.
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.
- 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?
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?
I'm more than interested.
My anesthesiology staff
is more than interested.
We're deeply concerned.
I understand.
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.
Good afternoon.
Oh, my God, you did...
How could you do that?
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?
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 you're involved?
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 six
this morning.
- She's down in pathology.
- In pathology?
Yeah, they're probably doing
the autopsy now.
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 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.
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 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.
- Lf 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?
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. Cardiac irritability.
Which this case had.
It'd be better to block
the neuro-muscular junction...
...with succinylcholine.
- 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 he has a rich wife,
he's able to throw his weight around.
You're looking for truth and justice.
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.
She understood me.
It's not fair.
None of this is fair.
Here.
Nobody understands.
- No one.
- I know, I know.
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.
Don't be. Don't be.
Our emotions are what make us human.
Come on.
Come and see me next week.
- 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.
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.
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 carbon monoxide
were being pumped into 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?
Looks okay.
- How many operations you done in here?
- A lot.
You ever had any problems?
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 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 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?
Do you want to 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 his case is running late.
I checked them out.
You come down to maintenance tonight.
I'll show it to you.
Good morning, sir.
- Did you have a good weekend?
- I did. Thank you.
Good evening.
Good evening.
You just gonna stare at me?
What'd you do that for?
They said make it look
like an accident.
- What's happening?
- The 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.
- Lf 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?
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.
He can't get more.
- 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 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.
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.
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.
Well, if he's complaining of pain.
Try another five cc's I.M.
I see.
Well, then 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.
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!
Take it easy.
Slow down.
Mark, it's all happening.
It's really happening.
Somebody's putting people into comas.
They're murdering them.
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.
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.
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...
How about a cup of tea
to settle you down?
A cup of hot tea?
Then we're going to talk
after you settle down.
So you just rest right here.
You just stay right here
on the bed?
That-a-girl.
That's it. You just relax.
I can't...
That's it. Just relax.
Close your eyes.
That's it. Okay, that-a-girl.
- 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 going to be okay now.
She came back.
No, she's here now.
Of course.
No, I can manage that.
I'll keep her here.
Look, I'd better go.
You want some honey with your tea?
Memorial Hospital
residents' exchange.
This is Dr. Wheeler.
Are there any messages for me?
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?
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.
Where's that heart going?
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 4-3-6-7.
A 31-year-old male.
The bidding now stands
at forty-two five.
Thank you.
Forty-five.
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.
What's that?
Look at monitor four.
All units!
All units!
There is an unauthorized woman
in the building.
Let's take her alive.
Visiting room, clear.
Second floor lobby, clear.
Has anyone checked
the main care facility?
We have no report from that sector.
Now on the second floor corridor.
Don't you have a key to this place?
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.
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!
Do me a favor.
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.
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.
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?
I see.
This won't take long.
Good, good.
Good. Thanks for calling.
You've put me in a difficult position.
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.
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 ought to see somebody.
They're children, Sue.
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.
Here we go.
It's...
...the drug.
Doctors make the worst patients.
They know too much, I guess.
Why'd you run away?
I was just talking to your mother.
She was worried about you.
Everybody's been worried about you.
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.
You've got plus-four peritonitis,
guarding and spasm, honey.
Susan, you do.
No, I don't.
There's no question about it.
Check my white count
and sed. Rate. It's normal.
Please.
The tests aren't here.
But with these physical signs,
it has to be appendicitis.
Please!
It's better to be safe
and have the operation.
Besides, you're in the best of hands.
Dr. Harris himself will do
the procedure. 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?
Excuse me.
Let me just answer this page, sir.
Yeah, this is Dr. Bellows.
Yes, Dr. Bellows.
It's that serious?
Is what that serious?
I'll be right there.
Dr. Bellows?
We're ready in O.R. 8.
We'll start at once.
Bellows?
Patient on surgical two's
got convulsions.
Join me as soon as you can.
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 there.
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.
The patient's film.
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?
Lt'll be all right.
- I'll be happy to stop a moment.
- It's okay, Dr. Harris.
You recommend I go on?
Son of a bitch! Son of a bitch!
Here it is.
Looks normal.
Never know it from her symptoms.
It's nice to see the chief
get caught sometimes.
Happens to the best of us.
All right.
- You can bring her out now.
- Right.
She's not coming around.
Just give her a minute.
I'm sure she'll be fine.
I don't know.
She's okay, sir.
She's just fine, Dr. Harris.
Nice case, Dr. Harris.
- Don't let him do the operation.
- I know, baby.
I know.
We're waiting for you, Dr. Harris.