The Final Diagnosis (37 page)

“I thought when that happened they changed the baby’s blood at birth.”

“You mean by an exchange transfusion?”

“Yes.”

“That only happens in some cases.” The charge nurse went on patiently, “It may depend on the sensitization report on the mother’s blood. If the report is positive, it usually means the baby will be born with erythroblastosis and must be given an exchange transfusion immediately after birth. In this case the lab report was negative, so an exchange transfusion wasn’t necessary.” The charge nurse stopped. Then she added, thoughtfully, half to herself, “It’s strange, though, about those symptoms.”

Since their argument of several days ago on the subject of laboratory checks the senior pathologist had made no reference to David Coleman’s activities in the serology lab. Coleman had no idea what this silence implied—whether he had achieved his point and was to have direct charge of Serology, or if Pearson intended to return to the attack later. Meanwhile, though, the younger pathologist had fallen into the habit of dropping into the lab regularly and reviewing the work being done. As a result he had already formulated several ideas for changes in procedure, and some of the minor ones had been put into effect during the last day or two.

Between himself and Carl Bannister, the elderly lab technician, there was something with might be considered close to an armed truce. John Alexander, on the other hand, had made it plain that he welcomed Coleman’s attention to the lab and in the last two days already had made a few suggestions which Coleman had approved.

Alexander had returned to work the day after his wife had been brought to the hospital, despite a gruff but kindly suggestion from Pearson that he could take time off if he wished. Coleman had heard Alexander tell the old pathologist, “Thank you all the same, Doctor; but if I don’t work I’ll think too much, and it wouldn’t help.” Pearson had nodded and said that Alexander could do as he pleased and leave the lab to go upstairs and see his wife and baby whenever he wished.

Now David Coleman opened the door of the serology lab and went in.

He found John Alexander at the center lab bench, looking up from a microscope, and, facing him, a white-coated woman with extremely large breasts whom Coleman recalled vaguely having seen around the hospital several times since his own arrival.

As he entered Alexander was saying, “I think perhaps you should ask Dr. Pearson or Dr. Coleman. I’ll be making my report to them.”

“What report is that?” As Coleman asked casually, the heads of the other two turned toward him.

The woman spoke first. “Oh, Doctor!” She looked at him inquiringly. “You
are
Dr. Coleman?”

“That’s right.”

“I’m Hilda Straughan.” She offered him her hand and added, “Chief dietitian.”

“How do you do.” As she shook his hand he noticed, fascinated, that her magnificent breasts moved with her arm—an undulant, whalelike rolling motion. Checking his thoughts, he asked, “Is there some sort of problem we can help you with?” He knew from his own experience that pathologists and dietitians usually worked closely in matters of food hygiene.

“There’s been a lot of intestinal flu these past few weeks,” the dietitian said. She added, “Mostly among the hospital staff.”

Coleman laughed. “Tell me a hospital where it doesn’t happen now and again.”

“Oh, I know.” Mrs. Straughan gave the faintest hint of disapproval at the flippancy. “But if food is the reason—and it usually is—I like to pin down the cause if it’s possible. Then one can try to prevent the same thing occurring again.”

There was an earnestness about this woman which David Coleman found himself respecting. He asked politely, “Do you have any ideas?”

“Very definitely. I suspect my dishwashing machines, Dr. C.”

For a moment Coleman was startled at the form of address. Then, recovering, he asked, “Oh, why?” Out of the corner of his eye he saw Bannister enter the room. Now both lab technicians were listening to the conversation.

The dietitian said, “My hot-water booster system is quite inadequate.”

The phraseology tempted him to smile, but he resisted it and asked instead, “Has anyone ever pointed that out?”

“I certainly have, Dr. C.” Obviously this was a subject on which Mrs. Straughan had strong feelings. She went on, “I’ve talked to the administrator, Mr. Tomaselli, on several occasions. It was my last talk with Mr. T., in fact, which caused him to ask Dr. Pearson for new lab tests on the dishwashers.”

“I see.” Coleman turned to John Alexander. “Did you run some tests?”

“Yes, Doctor.”

“What did you find?”

“The water temperature
isn’t
high enough.” Alexander consulted a clip board holding several pages of notes. “I did three tests on each dishwasher, each at a different time of day, and the temperature range was 110 to 130 degrees.”

“You see?” The dietitian held up her hands expressively.

“Oh yes.” Coleman nodded. “That’s much too low.”

“That isn’t all, Doctor.” John Alexander had put the clip board down and taken a slide from the lab bench. “I’m afraid I’ve found gas formers of the fecal group. On the plates—
after
they’ve been through the dishwashers.”

“Let me see.” Coleman took the slide and moved to the microscope. When he had adjusted the eyepiece the characteristic worm-like bacteria were visible at once. He straightened up.

Mrs. Straughan asked, “What is it? What does it mean?”

Coleman said thoughtfully, “The slide shows gas-forming bacteria. Normally the hot water should destroy them, but as it is they’re getting through the dishwashers onto your clean plates.”

“Is that serious?”

He considered carefully before answering. “Yes and no. It probably accounts for some of the intestinal flu you spoke of, but that’s not too serious in itself. The way in which it might become dangerous is if we happened to get a disease carrier in the hospital.”

“A disease carrier?”

Coleman went on to explain. “It’s someone who carries disease germs in their body without having the clinical disease themselves. A carrier can be an apparently normal, healthy person. It happens more frequently than you’d think.”

“Yes, I see what you mean,” Mrs. Straughan said thoughtfully.

Coleman had turned to the two technicians. He asked, “I suppose we
are
doing regular lab checks on all food handlers in the hospital?”

Bannister answered, self-importantly, “Oh yes. Dr. Pearson’s very fussy about that.”

“Are we right up to date?”

“Yeah.” The senior technician thought, then added, “Don’t think we’ve had any for quite a while.”

“When was the last?” Coleman asked the question casually, as a matter of routine.

“Just a minute. I’ll look at the book.” Bannister crossed to the opposite side of the lab.

In his mind David Coleman was weighing the factors involved. If the dishwashers were inefficient—and they appeared to be—something needed to be done promptly; there was no question about that. On the other hand, as long as a careful check was being kept on food handlers—and, according to Bannister, it was—there was no real reason for alarm. Indifference, though, was something else again. He told John Alexander, “You’d better get your report to Dr. Pearson as soon as you can.”

“Yes, Doctor.” Alexander went back to his clip board of notes.

Across the room Bannister looked up from a ruled ledger he had spread open on a file cabinet. He called out, “February the twenty-fourth.”

Surprised, Coleman asked, “Did you say February?”

“That’s right.”

“That’s almost six months ago.” To the dietitian he observed, “You don’t appear to have much of a turnover in kitchen staff.”

“Oh yes, we do—unfortunately.” Mrs. Straughan shook her head emphatically. “We’ve taken on a lot of new people since February, Dr. C.”

Still not understanding, Coleman asked Bannister, “Are you sure about that date?”

“That’s the last one.” Bannister was cockily sure of himself. It was a pleasing change to be able to tell something to this know-all young doctor. He added, “See for yourself if you like.”

Ignoring the suggestion, Coleman said, “But what about the new employees—those who’ve been taken on since then?”

“There’s nothing else here.” Bannister shrugged. “If the health office doesn’t send us specimens for test, we’ve no way of knowing about new food handlers.” His attitude was one of complete indifference, almost contempt.

A slow burn was rising in Coleman. Controlling it, he said evenly to the dietitian, “I think this is a matter you should look into.” For the first time he had begun to realize that something, somewhere, was seriously wrong.

Mrs. Straughan appeared to have had the same thought. She said, “I will—immediately. Thank you, Dr. C.” Her breasts bouncing with each step, she went out of the lab.

There was a moment’s silence. For the first time Coleman sensed a feeling of unease in Bannister. As their eyes met he asked the technician icily, “Had it occurred to you to wonder
why
no tests for food handlers were coming in?”

“Well . . .” Bannister fidgeted, his earlier confidence evaporated. “I guess I would have—sooner or later.”

Coleman surveyed the other with disgust. He said angrily, “I’d say later, wouldn’t you?—especially if it meant that you would have had to do some thinking.” At the door he turned. “I’ll be with Dr. Pearson.”

The color drained from his face, the older technician still stood, looking at the door through which Coleman had gone. His lips framed words—bitter and defeated. “He knows it all, don’t he? Everything in the book. Every perishing thing.”

At this moment around Bannister was an aura of failure and downfall. His own familiar world—the world he had believed inviolate and therefore had done nothing to protect—was crumbling. A new order was emerging, and in the new order, through his own shortcoming, there was no room for himself. Crestfallen, out of place, he appeared only a weak, pathetic figure whom time was passing by.

Joe Pearson looked up from his desk as Coleman came in.

Without preliminary the younger pathologist announced, “John Alexander has found gas-forming bacteria—on clean plates which have been through the dishwasher.”

Pearson seemed unsurprised. He said dourly, “It’s the hot-water system.”

“I know.” David Coleman tried, but failed, to keep sarcasm from his voice. “Has anyone ever tried to do something about it?”

The old man was looking at him quizzically. He said, with surprising quietness, “I suppose you think things are run pretty poorly around here.”

“Since you ask me—yes.” Coleman’s own lips were tight. He wondered how long the two of them could continue working together in this kind of atmosphere.

Pearson had flung open a lower drawer of his desk, fumbling among files and papers, talking as he searched. He seemed to be speaking with a strange mixture of anger and sorrow. “You’re so young and green and full of lofty ideas. You come here, and it happens to be a time when there’s a new administration, when money is freer than it has been in years. So you figure that whatever’s wrong is because nobody has thought of changing it. Nobody’s tried!” He had found what he wanted and flung a bulging file of papers on the desk.

“I didn’t say that.” The words were snapped out, almost defensively.

Pearson pushed the file toward him. “This is a record of correspondence about the kitchen hot-water supply. If you’ll take the trouble to read it, you’ll find I’ve been pleading for a new system for years.” Pearson’s voice rose. He said challengingly, “Go ahead—take a look!”

Opening the file, Coleman read the top memo. He turned a page, then another, then skimmed the other pages beneath. At once he realized how much in error he had been. The memos contained a damning condemnation by Pearson of hospital kitchen hygiene, couched in even stronger terms than he would have used himself. The correspondence appeared to go back several years.

“Well?” Pearson had been watching as he read.

Without hesitation Coleman said, “I’m sorry. I owe you an apology—about that anyway.”

“Never mind.” Pearson waved his hand irritably, then as the words sank in, “You mean there’s something else?”

Coleman said evenly, “In finding out about the dishwashers I also discovered there haven’t been any lab tests of food handlers for more than six months.”

“Why?” The question rapped out like a sharp explosion.

“Apparently none were sent down from the health office. The chief dietitian is checking on that now.”

“And you mean we didn’t query it? Nobody in Pathology asked why none were coming?”

“Apparently not.”

“That fool Bannister! This is serious.” Pearson was genuinely concerned, his earlier hostility to Coleman forgotten.

Coleman said quietly, “I thought you’d want to know.”

Pearson had picked up the telephone. After a pause he said, “Get me the administrator.”

The conversation which followed was brief and to the point. At the end Pearson replaced the phone and stood up. To Coleman he said, “Tomaselli is on his way down. Let’s meet him in the lab.”

It took only a few minutes in the lab to run over, for a second time, what David Coleman had already learned. With Pearson and Harry Tomaselli listening, John Alexander recapped his notes and Pearson inspected the slides. As he straightened up from the microscope the chief dietitian entered the lab. The administrator turned to her. “What did you find out?”

“It’s incredible but true.” Mrs. Straughan shook her head in a gesture of unbelief. She addressed Pearson. “Earlier this year the health office hired a new clerk, Dr. P. Nobody told her about lab tests on food handlers. That’s the reason none were sent down.”

Tomaselli said, “So there have been no tests now for—how long?”

“Approximately six and a half months.”

Coleman noticed Carl Bannister standing dourly away from the group, apparently occupied, but he sensed the senior technician was missing nothing of what was going on.

The administrator asked Pearson, “What do you suggest?”