The Final Diagnosis (44 page)

He answered, “Unfortunately I didn’t know that this would happen.”

“But you’re in charge of the hospital. Surely, just for a day or two, you can make someone else responsible.” It was obvious that Denise had no intention of understanding.

He said quietly, “I’m afraid not.”

There was a silence at the other end of the line. Then Denise said lightly, “I did warn you, Kent—I’m a very possessive person.”

He started to say, “Denise dear, please——” then stopped.

“Is that really your final answer?” The voice on the phone was still soft, almost caressing.

“It has to be,” he said. “I’m sorry.” He added, “I’ll call you, Denise—just as soon as I can get away.”

“Yes,” she said, “do that, Kent. Good-by.”

“Good-by,” he answered, then thoughtfully replaced the phone.

It was midmorning—the second day of the typhoid outbreak.

As Dr. Pearson had predicted, while a few stool samples had reached the lab yesterday afternoon, the bulk had arrived within the past hour.

The samples, contained in small cardboard cups with lids, were set out in rows on the center table of the pathology lab. Each was identified as to source, and Pearson, seated on a wooden chair at one end of the table, was adding a lab serial number and preparing report sheets on which the culture results would be recorded later.

As Pearson completed the preliminary paper work, he passed each specimen behind him to where David Coleman and John Alexander, working side by side, were preparing the culture plates.

Bannister, alone at a side table, was handling other orders on the lab which McNeil—now enthroned in the pathology office—had decided could not be delayed.

The lab stank.

With the exception of David Coleman all in the room were smoking, Pearson sending forth great clouds of cigar smoke to combat the odor as lids were lifted from the stool-specimen cups. Earlier Pearson had silently offered Coleman a cigar and the younger pathologist had lighted it for a while. But he had found the cigar almost as unpleasant as the undiluted air and had allowed it to go out.

The youthful hospital messenger who was Bannister’s avowed enemy had derived great satisfaction from bringing the specimens in, and with each new batch he had a fresh line of banter to accompany it. On his first trip he had looked at Bannister and announced, “They certainly found the right place to send this stuff.” Later he had told Coleman, “Got six new flavors for you, Doctor.” Now, setting a series of cartons in front of Pearson, he had asked, “You like cream and sugar in yours, sir?” Pearson grunted and went on writing.

John Alexander was working methodically, his mind concentrated on the work in hand. With the same fluidity of movement which David Coleman had noted at their first meeting he reached for a specimen cup and removed the cardboard lid. He pulled a petri dish toward him and, using a crayon pencil, copied the number from the lid onto the dish. Now he took a small platinum loop fixed to the end of a wooden handle and sterilized it in a burner flame. Next he passed the loop through the stool specimen, transferring a small portion of it to a tube of sterile saline. He repeated the process, then, using the platinum loop again, planted some of the solution on the culture plate, moving the loop in even, steady strokes.

Now he labeled the saline tube and placed it in a rack. The petri dish, with its culture plate, he carried across the lab to an incubator. There it would remain until the following day when subcultures, if necessary, could be begun. The process was one which could not be hurried.

He turned away to find David Coleman close behind him. On impulse Alexander said quietly, conscious of Pearson across the room, “Doctor, there’s something I wanted to tell you.”

“What is it?” Coleman added a petri dish himself to the incubator and closed the door.

“I . . . that is, we . . . have decided to take your advice. I’m going to apply for medical school.”

“I’m glad.” Coleman spoke with genuine feeling. “I’m sure it will turn out well.”

“What will turn out well?” It was Pearson, his head lifted, watching.

Coleman went back to his work position, seated himself, and opened a new specimen. He said matter-of-factly, “John’s just told me he’s decided to apply for medical school. I advised him some time ago that he should.”

“Oh.” Pearson looked at Alexander sharply. He asked, “How will you afford it?”

“My wife can work, for one thing, Doctor. And then I thought I might get some lab work out of school hours; a lot of medical students do.” Alexander paused, then, glancing at Coleman, he added, “I don’t imagine it will be easy. But we think it will be worth it.”

“I see.” Pearson had blown out smoke; now he put down his cigar. He seemed about to say something else, then hesitated. Finally he asked, “How is your wife?”

Quietly Alexander answered, “She’ll be all right. Thank you.”

For a moment there was silence. Then Pearson said slowly, “I wish there was something I could say to you.” He paused. “But I don’t suppose words would do very much good.”

Alexander met the old man’s eyes. “No, Dr. Pearson,” he said, “I don’t believe they would.”

Alone in her hospital room, Vivian had been trying to read a novel which her mother had brought, but her mind would not register the words. She sighed and put the book down. At this moment she wished desperately that she had not forced Mike into promising to stay away. She wondered: should she send for him? Her eyes went to the telephone; if she called he would come, probably within minutes. Did it really matter—this silly idea of hers of a few days’ separation for them both to think things over? After all, they were in love; wasn’t that enough? Should she call? Her hand wavered. She was on the point of picking up the receiver when her sense of purpose won out. No! She would wait. This was already the second day. The other three would go quickly, then she would have Mike to herself—for good and all.

In the house-staff common room, off duty for half an hour, Mike Seddons lay back in one of the deep leather armchairs. He was doing exactly what Vivian had told him—thinking of what it would be like living with a wife who had only one leg.

Twenty-three

It was early afternoon. Four days had gone by since the initial cases of typhoid in Three Counties Hospital had been reported.

Now, in the administrator’s office, serious-faced and silent, Orden Brown, the board chairman, and Kent O’Donnell were listening to Harry Tomaselli speaking on the telephone.

“Yes,” the administrator said, “I understand.” There was a pause, then he continued, “If that becomes necessary we shall be ready with all arrangements. At five o’clock then. Good-by.” He replaced the phone.

“Well?” Orden Brown asked impatiently.

“The City Health Department is giving us until this evening,” Tomaselli said quietly. “If we’ve failed to locate the typhoid carrier by then we shall be required to close the kitchens.”

“But do they realize what that means?” O’Donnell had risen to his feet, his voice agitated. “Don’t they know it will practically have the same effect as closing the hospital. You’ve told them, haven’t you, that we can’t get outside catering for more than a handful of patients?”

Still quietly, Tomaselli said, “I’ve told them, but it doesn’t make any difference. The trouble is, the public-health people are afraid of an outbreak in the city.”

Orden Brown asked, “Is there any news at all from Pathology?”

“No.” O’Donnell shook his head. “They’re still working. I was in there half an hour ago.”

“I can’t understand it!” The board chairman was more disturbed than O’Donnell had ever seen him before. “Four days and ten typhoid cases right here in the hospital—four of them patients—and we still haven’t come up with the source!”

“There’s no question it’s a big job for the lab,” O’Donnell said, “and I’m sure they haven’t wasted any time.”

“No one’s blaming anyone,” Orden Brown snapped; “not at this stage anyway. But we’re got to show some results.”

“Joe Pearson told me they expect to be through with all their cultures by midmorning tomorrow. If the typhoid carrier is among the food handlers, they’ll have to have traced him by then.” O’Donnell appealed to Tomaselli. “Can’t you persuade the public-health people to hold off—at least until midday tomorrow?”

The administrator shook his head negatively. “I tried earlier. But they’ve given us four days already; they won’t wait any longer. The city health officer was here again this morning, and he’s returning at five o’clock. If there’s nothing to report by then I’m afraid we’ll have to accept their ruling.”

“And meanwhile,” Orden Brown asked, “what do you propose?”

“My department is already at work.” Harry Tomaselli’s voice held the sense of shock and unbelief that gripped them all. “We’re proceeding on the assumption that we shall have to close down.”

There was a silence, then the administrator asked, “Kent, could you come back here at five—to meet the health officer with me?”

“Yes,” O’Donnell said glumly. “I suppose I should be here.”

The tension in the lab was equaled only by the tiredness of the three men working there.

Dr. Joseph Pearson was haggard, his eye red-rimmed, and weariness written in the slowness of his movements. For the past four days and three nights he had remained at the hospital, snatching only a few hours of sleep on a cot which he had had moved into the pathology office. It was two days since he had shaved; his clothes were rumpled and his hair wild. Only for one period of several hours on the second day had he been missing from Pathology, with no one knowing where he had gone and Coleman unable to locate him despite several inquiries from the administrator and Kent O’Donnell. Subsequently Pearson had reappeared, offering no explanation for his absence, and had continued his supervision of the cultures and subcultures which occupied them still.

Now Pearson asked, “How many have we done?”

Dr. Coleman checked a list. “Eighty-nine,” he said. “That leaves another five in incubation which we’ll have tomorrow morning.”

David Coleman, though appearing fresher than the senior pathologist, and with none of the outward signs of personal neglect which Pearson exhibited, was conscious of an oppressive weariness which made him wonder if his own endurance would last as long as the older man’s. Unlike Pearson, Coleman had slept at his own apartment on each of the three nights, going there from the lab well after midnight and returning to the hospital around six the following morning.

Early as he had been, though, in arriving, only on one occasion had he preceded John Alexander, and then by a mere few minutes. The other times the young technologist had already been occupied at one of the lab benches, working—as he had since the beginning—like a precisely geared machine, his movements accurate and economic, his written record of each test stage painstakingly recorded in neat and legible lettering. Nor had it been necessary—after the initial start—to issue more instructions. Alexander was so obviously competent and aware of what he was doing that Dr. Pearson, after inspecting his progress briefly, had nodded approval and from that point had left him entirely alone.

Turning from Coleman to Alexander, Pearson asked now, “What are your figures on the subcultures?”

Reading from notes, Alexander answered, “Of the eighty-nine plates checked, forty-two have been separated for subculturing, and two hundred and eighty subcultures planted.”

Pearson calculated mentally. Half to himself he said, “That means another hundred and ten subcultures still to check, including tomorrow’s batch.”

Glancing across at John Alexander, David Coleman wondered what the younger man was feeling at this moment and whether the act of throwing himself so intensely into this endeavor was proving an outlet for at least some of his personal grief. It had been four days since the Alexander baby’s death. In that time the original sense of shock and desolation which the young technologist had shown had disappeared, at any rate superficially. Coleman suspected, though, that John Alexander’s emotions were still not far below the surface, and he had sensed something of their presence in Alexander’s announced intention to enroll in medical school. It was a subject which David Coleman had not pursued so far, but he had resolved, as soon as this present crisis was over, to have a long talk with Alexander. There was a good deal of advice and guidance which Coleman could offer the younger man, based on his own experiences. Certainly, as Alexander had said, it would not be easy for him—particularly financially—to give up a salaried job and become a student once more, but there were certain guideposts Coleman could point to and pitfalls which he might help Alexander to avoid.

The fourth member of the original lab team, Carl Bannister, was temporarily disqualified. The senior technician had worked through three days and most of the nights, handling routine lab work alone and assisting the others whenever he could. This morning, however, his speech had been slurred and he was so obviously near exhaustion that David Coleman, without consulting Pearson, had ordered him home. Bannister had departed gratefully and without argument.

The preparatory work on the stool samples arriving in the lab had gone on continuously. By the second day, however, those samples which had been dealt with first had been in incubation long enough for investigation. Once again Dr. Pearson had divided his forces in order to keep the work flowing, John Alexander and himself handling the new stage, while David Coleman continued to deal with the remaining stool samples still coining in.

Removed from the incubator, the pink-tinged surface of the prepared petri dishes showed small, moist bacteria colonies where the tiny amounts of human feces had been added the previous day. With every individual stool containing millions of bacteria, the next task was to separate those colonies which were obviously harmless from those which must be investigated further.

Pink-tinged colonies of bacteria were eliminated at once as harboring no typhoid. Pale colonies, where typhoid bacilli might conceivably lurk, had samples taken from them for subculture in sugar tubes with liquid media. There were ten sugar tubes to each original culture, each tube containing a different reagent. It was these reagents which, after further incubation, would finally show which stool sample, if any, contained the marauding and infectious typhoid germs.