The Final Diagnosis (19 page)

Dornberger looked at her admiringly. This is one smart girl, he thought. She hadn’t missed a thing. Aloud he said, “The antibodies might destroy the baby’s blood—or part of it—if we let them. That’s a condition we call
Erythroblastosis Foetalis
.”

“But how do you stop it happening?”

“If it happens we can’t stop it. But we can combat it. In the first place, as soon as there are any antibodies in the mother’s blood we get a warning through a blood-sensitization test. That test will be done on your blood—now and later during your pregnancy.”

“How is it done?” Elizabeth asked.

“You’re quite a girl with the questions.” The obstetrician smiled. “I couldn’t tell you the lab procedure. Your husband will know more about that than I do.”

“But what else is done? For the baby, I mean.”

He said patiently, “The most important thing is to give the baby an exchange transfusion of the right kind of blood immediately after birth. It’s usually successful.” He deliberately avoided mention of the strong danger of an erythroblastotic child being born dead or that physicians often induced labor several weeks early to give the child a better chance of life. In any case he felt the discussion had gone far enough. He decided to sum it up.

“I’ve told you all this, Mrs. Alexander, because I thought you had something on your mind about Rh. Also, you’re an intelligent girl, and I always believe it’s better for someone to know all the truth than just a part of it.”

She smiled at that. She guessed she really was intelligent. After all, she had proved she still possessed her old classroom ability to understand and memorize. Then she told herself: Don’t be smug; besides, it’s a baby you’re having, not an end-of-semester exam.

Dr. Dornberger was talking again. “But just let me remind you of the important things.” He was serious now, leaning toward her. “Point one: you may never have an Rh-positive baby, either now or later. In that case there can’t be any problem. Point two: even if your baby happens to be Rh positive, you may not become sensitized. Point three: even if your baby were to have erythroblastosis, the chances of treatment and recovery are favorable.” He looked at her directly. “Now—how do you feel about it all?”

Elizabeth was beaming. She had been treated like an adult and it felt good. “Dr. Dornberger,” she said, “I think you’re wonderful.”

Amusedly Dornberger reached for his pipe and began to fill it. “Yes,” he said, “sometimes I feel that way too.”

“Joe, can I talk to you?”

Lucy Grainger had been on her way to Pathology when Pearson’s bulky figure loomed ahead in the main-floor corridor. As she called to him he stopped.

“Got a problem, Lucy?” It was his usual catarrhal, rumbling voice, but she was glad to notice there was no unfriendliness. She hoped she was still immune from his bad temper.

“Yes, Joe. I’d like you to see a patient of mine.”

He was busy lighting one of the inevitable cigars. When he had it going he surveyed the red tip. “What’s the trouble?”

“It’s one of our own student nurses. A girl named Vivian Loburton. She’s nineteen. Do you know her?”

Pearson shook his head. Lucy went on. “The case is worrying me a little. I suspect a bone tumor and I’ve a biopsy scheduled for the day after tomorrow. The tissue will be coming down to you, of course, but I thought perhaps you’d like to take a look at the girl.”

“All right. Where is she?”

“I’ve had her admitted for observation,” Lucy said. “She’s on the second floor. Could you see her now?”

Pearson nodded. “Might as well.” They moved toward the main vestibule and the passenger elevators.

Lucy’s request to Pearson was not unusual. In a case like this, where malignancy was a possibility, it was the pathologist who would give a final opinion on the patient’s condition. In the diagnosis of any tumor there were many factors—sometimes conflicting—for a pathologist to weigh in balance. But determination of bone tumors was even more difficult, something of which Lucy was aware. Consequently it was an advantage for the pathologist to be involved with a case at the beginning. In that way he could know the patient, discuss symptoms, and hear the radiologist’s opinion, all of which added to his knowledge and aided diagnosis.

As they moved into the elevator Pearson paused and winced. He put a hand to his back.

Lucy pressed the button for the second floor. As the automatic doors slid closed she asked, “Is your back bothering you?”

“Sometimes it does.” With an effort he straightened up. “Probably too much hunching over a microscope.”

She looked at him concernedly. “Why don’t you come to my office? I’ll take a look at it.”

He puffed his cigar, then grinned. “I’ll tell you, Lucy. I can’t afford your fees.”

The doors opened and they went out on the second floor. Walking down the corridor, she said, “It’ll be complimentary. I don’t believe in charging my colleagues.”

He gave her an amused glance. “You’re not like the psychiatrists then?”

“No, I’m not.” She laughed. “I hear they send you a bill, even if you work in the same office.”

“That’s right.” She had seldom seen him quite so relaxed as this. “They say it’s part of the treatment.”

“Here we are.” She opened a door and Pearson went first. Then she followed him in, closing the door behind her.

It was a small semi-private room with two patients. Lucy greeted a woman in the bed nearest the door, then moved over to the second bed where Vivian looked up from the magazine she had been reading.

“Vivian, this is Dr. Pearson.”

“Hullo, Vivian.” Pearson said it absently as he took the chart which Lucy offered him.

She answered politely, “Good afternoon, Doctor.”

It was still a puzzle to Vivian why she was here at all. Her knee had been paining her again, it was true, but it seemed such a small thing to be put to bed for. However, she didn’t mind very much. In a way the break from nursing-school routine was welcome, and it was pleasant to be reading and resting for a change. Mike had just phoned too. He seemed concerned on hearing what had happened and had promised to come in later, as soon as he could.

Lucy drew the overhead curtain between the two beds, and now Pearson said, “Let me see both knees, please.”

Vivian turned back the bedclothes and lifted the hem of her nightgown. Pearson put down the chart and bent over for a close inspection.

Lucy watched the pathologist’s short stubby fingers move carefully over the limbs. She thought: For someone who can be so rough with people he’s surprisingly gentle. Once Vivian winced as a finger probed. Pearson looked up. “Hurt you there, eh?” Vivian nodded.

“I see from Dr. Grainger’s report that you hit your knee about five months ago,” he said.

“Yes, Doctor.” Vivian was being careful to get her facts straight. “I didn’t remember it at first—not until I started thinking back. I hit it on the bottom of a swimming pool though. I guess I dived too deeply.”

Pearson asked her, “Did it hurt very much at the time?”

“Yes. But then the pain went away and I didn’t think any more about it—not until now.”

“All right, Vivian.” He gestured to Lucy, who pulled the bedclothes back into place.

He asked Lucy, “Have you got the X-rays?”

“I have them here.” She produced a large manila envelope. “There are two sets. The first set didn’t show anything. Then we softened them up to see the muscles, and that showed an irregularity in the bone.”

Vivian listened interestedly to the exchange. She found herself experiencing a sense of importance that all this should be about her.

Now Pearson and Lucy had moved to the window and the pathologist held the X-ray negatives to the light. As he studied the second one Lucy pointed. “There. You see?” They looked at it together.

“I guess so.” Pearson grunted and handed back the negatives. His attitude to X-rays was always that of one specialist groping on the unfamiliar territory of another. He said, “Shadows from shadow land. What does Radiology say?”

“Ralph Bell confirms the irregularity,” Lucy answered. “But he can’t see enough for a diagnosis. He agrees we should have a biopsy.”

Pearson turned back to the bed. “Do you know what a biopsy is, Vivian?”

“I have an idea.” The girl hesitated. “But I’m not really sure.”

“Haven’t taken it in your nursing course yet, eh?”

She shook her head.

Pearson said, “Well, what happens is that Dr. Grainger will take out a small piece of tissue from your knee—just where the trouble seems to be. Then it will come down to me and . . . I’ll study it.”

Vivian asked, “And can you tell from that . . . what’s the matter?”

“Most times I can.” He started to leave, then hesitated. “Do you play a lot of sports?”

“Oh yes, Doctor. Tennis, swimming, skiing.” She added, “I love horse riding too. I used to do a lot in Oregon.”

“Oregon, eh?” He said it thoughtfully; then, turning away, “All right, Vivian; that’s all for now.”

Lucy smiled. “I’ll be back later.” She gathered up the chart and X-rays and followed Pearson out.

As the door closed, for the first time Vivian felt an uneasy chill of fear.

When they were well down the corridor Lucy asked, “What’s your opinion, Joe?”

“It could be a bone tumor.” Pearson said it slowly, thinking.

“Malignant?”

“It’s possible.”

They came to the elevator and stopped. Lucy said, “Of course, if it’s malignant, I’ll have to amputate the leg.”

Pearson nodded slowly. Suddenly he looked very old. “Yes,” he said. “I was thinking of that.”

Eleven

The prop-jet Viscount turned evenly into wind and began to lose height. Landing gear and flaps down, it was lined up with number one runway of Burlington’s municipal airport, dead ahead. Watching the airplane’s approach from the public mezzanine, just below the control tower, Dr. Kent O’Donnell reflected idly that aviation and medicine had a good deal in common. Both were products of science; both were changing the world’s life and destroying old concepts; both were moving toward unknown horizons and a future only dimly seen. There was another parallel too. Aviation nowadays was having trouble keeping pace with its own discoveries; an aircraft designer he knew had told him recently, “If an airplane’s flying it’s already out of date.”

The practice of medicine, O’Donnell thought, shading his eyes from the bright afternoon sun of mid-August, was very much the same. Hospitals, clinics, physicians themselves, were never able to be entirely up to date. No matter how they tried, experimentation, development, new techniques were always ahead—sometimes by years. A man might die today when the drug that could save him was already invented and even, perhaps, in limited use. But it took time for new developments to become known and to gain acceptance. The same was true of surgery. One surgeon, or a group of surgeons, might develop a new life-saving technique. But before it could be used generally others must master it and pass their skill along. Sometimes it was a long process. Heart surgery, for example, was fairly general now and within reach of most who needed it badly. But for a long time only a handful of surgeons were qualified or willing to attempt it.

There was always the question, too, with new things: is this good; is it a wise development? Not all change meant progress. Plenty of times in medicine there were false scents, theories running contrary to fact, individuals with enthusiasms and obsessions who would go off half cocked, misleading others when they did. Sometimes it was hard to steer a mid-course between open-mindedness and reasonable caution. At Three Counties, with its quota of diehards and progressives—and with good men in both camps—it was a continuing problem for someone like O’Donnell to know, at any given moment, exactly where and with whom his allegiance lay.

His thoughts were broken by the Viscount taxiing in, the shrill whine of its motors drowning out the voices of others around him. O’Donnell waited until the motors stopped and passengers began to disembark. Then, seeing Dr. Coleman among them, he went down the stairs to greet the hospital’s new assistant director of pathology in the arrival lobby.

David Coleman was surprised to see the chief of surgery—tall, bronzed, standing out from the crowd—waiting for him with outstretched hand. O’Donnell said, “It’s good to see you. Joe Pearson couldn’t make it, but we thought that someone should be around to say ‘welcome.’ ” What O’Donnell failed to add was that Joe Pearson had flatly refused to go and, Harry Tomaselli being out of town, O’Donnell had taken the time to drive out himself.

As they moved through the hot, crowded lobby O’Donnell saw Coleman glance around him. He got the impression that the younger man was making a quick assessment of his surroundings. Perhaps it was a habit—if so, a good one. Certainly David Coleman would stand up to scrutiny himself. Though he had had a three-hour air journey, his gabardine suit was uncreased, his well-trimmed hair carefully parted and brushed, his shave recent. He wore no hat, which made him look younger than his thirty-one years. Though slighter than O’Donnell in build, his features were clear-cut and well defined; he had a longish face and an incisive jaw. The brief case under his arm added a professional touch; picture of a young scientist, O’Donnell thought. He steered Coleman toward the baggage counter. A trailerload of bags was being unloaded, and they joined the scrimmage with other passengers who had disembarked.

O’Donnell said, “This is the part of air travel I dislike.”

Coleman nodded and smiled faintly. It was almost as if he had said, Let’s not waste our talents on small talk, shall we?

This is a cool customer, O’Donnell thought. He noticed, as he had at their previous meeting, the steel-gray eyes and wondered what it took to penetrate behind them. Now Coleman was standing, unmoving among the crowd, glancing around. Almost as if by command, ignoring others, a redcap gravitated toward him.

Ten minutes later, as O’Donnell threaded his Buick through the airport traffic and headed toward town, he said, “We’ve put you up in the Roosevelt Hotel. It’s as comfortable as any and quiet. I believe our administrator wrote you about the apartment situation.”