Coma Page #2

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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

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