Bruce Wilkinson went from dead asleep to full awake with such suddenness that he felt overwhelmed with a sense of fear, like a child awakening from a nightmare. He had no idea what had awakened him but guessed it was some noise or movement. He wondered if something had touched him. He stayed still, holding his breath, and stared straight ahead, listening. At first he was disoriented, but as his mind took in his limited field of vision, he remembered he was in the Boston Memorial Hospital: in room 1832 to be exact. At about the same instant that he realized where he was, Bruce perceived that it was the middle of the night. The hospital was clothed in a heavy stillness.

On his current admission for cardiac bypass surgery, Bruce had been in the hospital for over a week. But a month or so before he’d spent three weeks several floors down, recovering from his unexpected heart attack. As a consequence Bruce had become accustomed to the hospital routine. Such things as the squeak of the nurse’s medication cart as it was pushed up the hall, or the distant sounds of an arriving ambulance, or even the hospital page calling a doctor’s name had become reassuring phenomena. In fact, Bruce could often tell merely by listening to these familiar sounds what time of day it was without looking at his watch. They all signified that help for any medical emergency was close at hand.

Bruce had never worried much about his health even though he was a victim of multiple sclerosis. The problem with his vision that had brought him to the doctor five years ago had cleared, and Bruce had made a conscious effort to forget the diagnosis because hospitals and doctors tended to frighten him. Then, out of the blue, came the heart attack with its attendant hospitalization and the current major surgery. His doctors assured him that the heart problem was not related to the multiple sclerosis, but that disclaimer had done little to buoy his sagging courage.

Now, as Bruce awoke in the middle of the night and heard none of the usual reassuring hospital sounds, the hospital seemed like an ominous and lonely place, evoking fear rather than hope. The silence was intimidating, providing no immediate explanation for his sudden wakefulness. Bruce felt himself inexplicably paralyzed by a sensation of acute terror.

As the seconds passed, Bruce’s mouth became dry, exactly as it had been after his preop medication five days earlier. He attributed this to fear, as he continued to lie perfectly still like a wary animal, his senses straining for any disturbance. He’d done the same thing as a boy after awakening in the night from bad dreams. If he didn’t move, perhaps the monsters would not see him. Lying on his back, he couldn’t see much of the room, especially since the only illumination came from a small floor-level night-light behind his bed. All he could see was the indistinct juncture of ceiling and wall. Silhouetted against it was the magnified shadow of his IV pole, bottle, and tubing. The bottle seemed to be swaying slightly.

Trying to dismiss his fears, Bruce began monitoring his internal messages. The big question loomed in his mind: Am I all right? Having been rudely betrayed by his body by the heart attack, he wondered if some new catastrophe had awakened him. Could his stitches have split? That had been one of his fears immediately after the operation. Could the bypass have come loose?

Bruce could feel his pulse in his temples, and, despite a clamminess to his palms and a somewhat disagreeable sensation in his head that he associated with fever, he felt okay. At least there was no pain, particularly not the crushing, searing pressure that had come with the initial heart attack.

Tentatively Bruce took a breath. There was no stabbing knifelike pain although it seemed to take extra effort to inflate his lungs.

In the semidarkness, a throaty, phlegm-laden cough reverberated within the confines of the room. Bruce felt a new surge of fright, but he quickly realized that it was just his roommate. Perhaps Mr. Hauptman’s coughing had been the sound that had awakened him, Bruce thought, feeling a modicum of relief. The old man coughed anew, then noisily turned over in his sleep.

Bruce entertained the idea of calling a nurse to check Mr. Hauptman, more for the opportunity for Bruce to speak to someone than because he thought there was a real problem. The truth of the matter was that Mr. Hauptman coughed like that all the time.

The disagreeable feverish sensation became more intense and began to spread. Bruce could feel it in his chest like a hot liquid. The concern that something had gone wrong on the “inside” reasserted itself.

Bruce tried to turn to locate the nurse’s call button that was looped through the side rails of the bed. His eyes moved, but his head felt heavy. Out of the corner of his eye he saw quick, staccato movement. Looking up he could see his IV bottle. The movement he’d seen was coming from the rapid running of his IV. The drops in the micropore chamber were falling in quick succession, and the night-light glinted off the liquid with an explosive sparkle.

That was strange! Bruce knew that his IV was only being maintained for emergencies and was supposed to run as slowly as possible. It should not be running quickly. Bruce could remember having checked it as he always did before turning out his reading light.

He tried to reach out and find the nurse’s call button. But he couldn’t move. It was as if his right arm had not gotten the command. He tried again with the same result.

Bruce felt his terror become panic. Now he was certain something terrible was happening to him! He was surrounded by the best medical care but unable to reach it. He had to get help. He had to get help instantly. It was like a nightmare from which he could not awaken.

Yanking his head off the pillow, Bruce screamed for a nurse. His voice surprised him with its weakness. He’d intended to yell but instead he whispered. At the same time he became aware that his head felt tremendously heavy, requiring all his strength to keep it off the pillow. The exertion caused a trembling that rattled the bed.

With a barely audible sigh, Bruce collapsed back onto his pillow, compounding his panic. Trying again to call out, he heard an incomprehensible hiss almost devoid of vocalization. Whatever was wrong with him was rapidly worsening. He felt as if an invisible lead blanket was settling over him, pressing him flat against the bed. His attempts to breathe were pitiful, uncoordinated heaves of his chest. With utter terror Bruce comprehended he was being suffocated.

Somehow he organized his thoughts enough to remember again the nurse’s call button. With horrendous effort he lifted his arm from the bed, and in an uncoordinated, spastic fashion pulled it across his chest. It was as if he were immersed in some viscous liquid. His fingers brushed the rails, and he grasped vainly for the button. It wasn’t there. With the last vestiges of strength, he heaved himself onto his left side, rolling over and thudding up against the rail. His face pressed heavily against the cold steel, occluding the view from his right eye, but he did not have the strength to move. With his left eye he saw the emergency button. It was on the floor, curled on itself like a snake.

Panic and desperation filled Bruce’s consciousness, but the oppressive weight on his body increased, precluding all movement. In his terror he guessed that something had happened to his heart; perhaps all the stitches had burst. The sense of being smothered intensified as Bruce’s brain screamed for life-giving oxygen. Yet Bruce was totally paralyzed, able only to grunt in agony as he desperately tried to breathe. Yet through all of this, Bruce’s senses were sharp, his mind painfully clear. He knew he was dying. There was a ringing in his ears, a sense of revolving, nausea. Then blackness…