The Final Diagnosis (23 page)

“The way we do all our tests are according to Dr. Pearson’s instructions.” The elderly technician made it plain that in his opinion the entire discussion was a waste of time.

“Perhaps Dr. Pearson doesn’t know you’re doing the Rh tests that way.”

“He knows all right.” This time Bannister let his surliness come through. It was always the same with new people. They weren’t inside a place five minutes before they started making trouble. He had tried to be pleasant with this new doctor, and look what you got for it. Well, one thing was for sure—Joe Pearson would soon put this fellow in his place. Bannister just hoped he was around to see it happen.

Coleman decided to ignore the senior technician’s tone. Whether he liked it or not he was going to have to work with this man for a while. All the same, this thing had to be cleared up now. He said, “I’m afraid I don’t quite understand. Surely you know that some antibodies in the blood of pregnant women will get past a saline test and a high-protein test, whereas they won’t if you go on and do a further test in Coombs serum.”

Alexander interjected, “That’s what I’ve been saying.”

Bannister made no answer. Coleman went on, “Anyway, I’ll mention it to Dr. Pearson sometime. I’m sure he wasn’t aware of it.”

“What shall we do about this test?” Alexander asked. “And the others from here on?”

Coleman answered, “Do them in all three mediums, of course—saline, high protein,
and
Coombs serum.”

“We haven’t any Coombs serum in the lab, Doctor.” Alexander was very glad now that he had brought this up. He liked the look of this new pathologist. Maybe he’d change some other things around the place. Goodness knows, he thought, there’s plenty that can stand it.

“Then let’s get some.” Coleman was deliberately brisk. “There’s no shortage anywhere.”

“We can’t just go out and get lab supplies,” Bannister said. “There has to be a purchase requisition.” He wore a superior smile. There were some things, after all, these Johnny-come-latelys didn’t know.

Coleman carefully kept his feelings in check. Sometime soon it might be necessary to have a showdown with this man Bannister; he certainly had no intention of taking this kind of behavior permanently. But the first day of arrival was obviously not the time. He said pleasantly enough, but firmly, “Let me have the form then. I imagine I can sign it. That’s one of the reasons I’m here.”

Briefly the older technician hesitated. Then he opened a drawer and produced a pad of forms which he handed to Coleman.

“A pencil, please?”

With the same reluctance Bannister produced one. Handing it over, he said pettishly, “Dr. Pearson likes to order all lab supplies himself.”

Coleman scribbled the order and signed it. With a tight, cool smile, “I expect to have a good deal more responsibility here than just ordering fifteen dollars’ worth of rabbit serum,” he said. “There you are.” As he handed back the pad and pencil the phone rang on the other side of the lab.

It was an excuse for Bannister to turn his back. His face red with anger and frustration, he crossed to the wall phone to answer it. After listening briefly he gave a curt answer and replaced the instrument. “Gotta go down to Outpatients.” The words, almost mumbled, were addressed to Coleman.

He answered icily, “You can go ahead.”

With the incident closed Coleman found himself more angry than he had realized. What kind of discipline existed which allowed insolence like this from a lab technician? The inadequate procedure was serious enough. But having to correct it over the objections of someone like this man Bannister was intolerable. If this were the general order of things, it seemed probable that the entire pathology department was even more run-down than he had believed at first.

With Bannister gone he began to take a more careful look at the rest of the lab. The worn equipment, some of it inadequate, had already been evident. Now he saw how deplorably sloppy and disorganized the whole place was. The tables and benches were cluttered untidily with an assortment of apparatus and supplies. He noticed a heap of dirty glassware, a pile of yellowed papers. Moving across the lab, he observed a section of a worktable with fungus growing from it. From the other side of the room Alexander was uncomfortably watching the inspection.

“Is this the way the lab is usually kept?” Coleman asked.

“It isn’t very tidy, is it?” Alexander felt a surge of shame that anyone should see this place the way it was. What he could not say was that he had already offered to reorganize it but Bannister had emphatically told him to leave things the way they were.

“I’d put it a little stronger than that.” Coleman ran one of his fingers over a shelf. It came away grimed with dust. He thought disgustedly: All this is something to be changed. On second thought, though, it might have to wait awhile. He knew he was going to have to be cautious in his dealings with people here, and his own experience had already taught him that there were limits to what you could accomplish quickly. All the same, he knew it would be hard to curb his own natural impatience, especially with this sort of mess visible right under his nose.

For the past few moments John Alexander had been watching Coleman closely. Ever since this new doctor had first come in with Bannister there had been something vaguely familiar about him. He was young—probably not much older than Alexander himself. But it was not that alone. Now Alexander said, “Doctor, excuse my mentioning it, but I have a feeling we’ve met somewhere before.”

“It’s possible.” Coleman was elaborately casual. Because he had supported this man in one incident, he did not want him to get any impression there was some sort of alliance between them. Then it occurred to him that perhaps he had been a little too curt. He added, “I interned at Bellevue, then I was at Walter Reed and Massachusetts General.”

“No.” Alexander shook his head. “It must have been before then. Have you ever been in Indiana? New Richmond?”

“Yes,” Coleman said, startled, “I was born there.”

John Alexander beamed. “I should have remembered the name, of course. Your father would be . . . Dr. Byron Coleman?”

“How do you know that?” It had been a long time since someone other than himself had recalled his father’s name.

“I’m from New Richmond too,” Alexander said. “So is my wife.”

“Really?” Coleman asked. “Did I know you there?”

“I don’t think so, though I remember seeing you a couple of times.” In the social life of New Richmond, John Alexander had been several stages removed from the orbit of the doctor’s son. As the thought occurred to him, there was a “ping” from the centrifuge timer. He paused to remove the blood sample which had been spun down, then went on, “My father was a truck farmer. We lived a few miles outside town. You may remember my wife though. Her family had the hardware store. She was Elizabeth Johnson.”

Coleman said thoughtfully, “Yes, I believe I do.” Memory stirred. “Wasn’t there something about her . . . she was in an accident of some sort?”

“That’s right; she was,” John Alexander said. “Her father was killed in his car at the rail crossing. Elizabeth was with him.”

“I remember hearing about it.” David Coleman’s mind flew back over the years—to the country doctor’s office in which his father had healed so many bodies until in the end his own had failed him. He said, “I was away at college at the time, but my father told me afterward.”

“Elizabeth almost died. But they gave her blood transfusions and she made it. I think that was the first time I was ever in a hospital. I almost lived there for a week.” Alexander paused. Then, still pleased at his discovery, “If you happen to be free one evening, Dr. Coleman, I’m sure my wife would enjoy meeting you. We have a small apartment . . .” He hesitated, sensing the truth: though both had moved on from New Richmond, there was still a social gulf between them.

Coleman was aware of it too. His brain clicked out a warning: be cautious of alliances with subordinates—even one like this. He rationalized: It isn’t snobbery; it’s just a matter of hospital discipline and common sense. Aloud he said, “Well, I’m going to be working quite hard for a while. Let’s leave it, shall we, and see how things go?”

Even as he spoke them the words sounded hollow and false. He thought: You could have let him down more lightly than that. Mentally he added a footnote to himself: You haven’t changed, my friend; you haven’t changed at all.

Momentarily Harry Tomaselli found himself wishing that Mrs. Straughan would go back to her kitchens and stay there. Then he checked himself: a good chief dietitian was a pearl to be prized. And Mrs. Straughan was good; of that fact the administrator was well aware.

But there were times when he wondered if Hilda Straughan ever thought of Three Counties Hospital as a unified whole. Most times when talking with her he gained the impression that the hospital’s heart consisted of kitchens, from which other and less important facilities radiated outward. He reflected, though—Harry Tomaselli was, above all, a fair-minded man—that this sort of attitude was often found in people who took their jobs seriously. And, if it were a failing, he certainly preferred it to slackness and indifference. Another thing: a good department head was always willing to fight and argue for something which he or she believed in, and Mrs. Straughan was a fighter and arguer in every ample cubic inch of her.

At this moment, her big bulk overflowing a chair in the administrator’s office, she was fighting hard.

“I wonder if you realize, Mr. T., how serious this is.” Mrs. Straughan invariably used the surname initial when addressing people she knew; she had a habit of referring to her own husband as “Mr. S.”

“I think so,” Harry Tomaselli said.

“The dishwashers I have now were obsolete at least five years ago. Every year since I’ve been here I’ve been told: Next year we’ll give you your new ones. And when next year comes, where are my dishwashers? I find they’re put off for another twelve months. It won’t do, Mr. T. It just won’t do.”

Mrs. Straughan always used the personal pronoun “my” when referring to equipment in her charge. Tomaselli had no objection to this. What he did object to was Hilda Straughan’s unwillingness to consider any problems other than her own. He prepared to cover, once more, the ground they had gone over just a week or two before.

“There’s no question, Mrs. Straughan, that the dishwashers are going to be replaced eventually. I know the problem you have down there in the kitchens, but those are big, expensive machines. If you remember, the last estimate we had ran a little under eleven thousand dollars, allowing for changes in the hot-water system.”

Mrs. Straughan leaned over the desk, her massive bosom brushing a file tray aside. “And the longer you leave it the more the cost will go up.”

“Unfortunately I’m aware of that too.” The rising cost of everything the hospital bought was a problem Tomaselli lived with daily. He added, “But right at this moment hospital money for capital expenditures is extremely tight. The building extension, of course, is partly responsible. It’s simply a question of allocating priorities, and some of the medical equipment has had to come first.”

“What good is medical equipment if your patients don’t have clean plates to eat their food from?”

“Mrs. Straughan,” he said firmly, “the situation is not as bad as that, and both of us know it.”

“It’s not very far removed from it.” The chief dietitian leaned forward and the file tray took another shove; Harry Tomaselli found himself wishing she would keep her breasts off his desk. She went on, “Several times lately whole loads of dishes going through my machines have still been dirty when they came out. We try to check as much as we can, but when there’s a rush it isn’t always possible.”

“Yes,” he said. “I can understand that.”

“It’s the danger of infection I’m worried about, Mr. T. There’s been a lot of intestinal flu among the hospital staff lately. Of course, when that happens everyone blames the food. But it wouldn’t surprise me if this was the cause of it.”

“We’d need considerably more evidence to be sure of that.” Harry Tomaselli’s patience was beginning to wear thin. Mrs. Straughan had come to him on an exceptionally busy morning. There was a board meeting this afternoon, and right now he had several pressing problems to consider in advance of it. Hoping to wind up the interview, he asked, “When did Pathology last run a bacteria test on the dishwashers?”

Hilda Straughan considered. “I could check, but I think it’s about six months ago.”

“We’d better have them do another. Then we’ll know exactly where we stand.”

“Very well, Mr. T.” Mrs. Straughan resigned herself to accomplishing nothing more today. “Shall I speak to Dr. Pearson?”

“No, I’ll do it.” The administrator made a penciled note. At least, he thought, I can save Joe Pearson a similar session to this.

“Thank you, Mr. T.” The chief dietitian eased herself upward and out of the chair. He waited until she had gone, then carefully moved the file tray back to its original position.

David Coleman was returning to Pathology from lunch in the cafeteria. Making his way through the corridors and down the basement stairway, he pondered over the time he had spent so far with Dr. Joseph Pearson. Up to this moment, he decided, it had been unsatisfactory and inconclusive.

Pearson had been cordial enough—later, if not at the beginning. On finding Coleman waiting in his office his first remark had been, “So you really meant what you said about starting right away.”

“There didn’t seem much point in waiting.” He had added politely, “I’ve been looking around the labs. I hope you don’t mind.”

“That’s your privilege.” Pearson had said it with a half-growl, as if it were an invasion he did not like but had to put up with. Then, as if realizing his own ungraciousness, he had added, “Well, I guess I should welcome you.”

When they had shaken hands the older man had said, “First thing I have to do is get some of this work cleared away.” He gestured at the untidy pile of slide folders, dockets, and loose memoranda on his desk. “After that maybe we can figure out what you’ll be doing around here.”