Artropods and Human Disease 20 page

A few minutes ago two student nurses had slipped into the room and now, following a habit of instruction, O’Donnell began to describe procedure as he worked.

“An exchange transfusion, as perhaps you know”—O’Donnell glanced toward the student nurses—“is actually a flushing-out process. First we remove some blood from the child, then replace it with an equivalent amount of donor blood. After that we do the same thing again and keep doing it until most of the original, unhealthy blood is gone.”

The assisting nurse was inverting a pint bottle of blood on a stand above the table. O’Donnell said, “The blood bank has already crossmatched the patient’s blood with that of the donor to ensure that both are compatible. What we must be sure of also is that we replace exactly the amount of blood we remove. That’s the reason we keep a score sheet.” He indicated the intern’s clip board.

“Temperature ninety-six,” the assisting nurse announced.

O’Donnell said, “Knife, please,” and held out his hand.

Using the knife gently, he cut off the dry portion of the umbilical vein, exposing moist tissue. He put down the knife and said softly, “Hemostat.”

The intern was craning over, watching. O’Donnell said, “We’ve isolated the umbilical vein. I’ll go into it now and remove the clot.” He held out his hand and the nurse passed forceps. The blood clot was miniscule, scarcely visible, and he drew it out, painstakingly and gently. Handling a child this small was like working with a tiny doll. What were the chances of success, O’Donnell wondered—of the child’s survival. Ordinarily they might have been fair, even good. But now, with this procedure days late, the hope of success had been lessened drastically. He glanced at the child’s face. Strangely it was not an ugly face, as the faces of premature children so often were; it was even a little handsome, with a firm jaw line and a hint of latent strength. For a moment, uncharacteristically allowing his mind to wander, he thought: What a shame this all is I—to be born with so much stacked against you.

The assisting nurse was holding a plastic catheter with a needle attached; it was through this that the blood would be drawn off and replaced. O’Donnell took the catheter and with utmost gentleness eased the needle into the umbilical vein. He said, “Check the venous pressure, please.”

As he held the catheter vertical, the nurse used a ruler to measure the height of the column of blood. She announced, “Sixty millimeters.” The intern wrote it down.

A second plastic tube led to the bottle of blood above them; a third ran to one of the two Monel-metal basins at the foot of the table. Bringing the three tubes together, O’Donnell connected them to a twenty-milliliter syringe with a three-way stopcock at one end. He turned one of the stopcocks through ninety degrees. “Now,” he said, “we’ll begin withdrawing blood.”

His fingers sensitive, he eased the plunger of the syringe toward him gently. This was always a critical moment in an exchange transfusion; if the blood failed to flow freely it would be necessary to remove the catheter and begin the early preparation all over again. Behind him, O’Donnell was conscious of Dornberger leaning forward. Then, smoothly and easily, the blood began to flow, flooding the catheter tube and entering the syringe.

O’Donnell said, “You’ll notice that I’m suctioning very slowly and carefully. We’ll also remove very little at any one time in this case—because of the smallness of the infant. Normally, with a term baby, we would probably take twenty milliliters at once, but in this instance I shall take only ten, so as to avoid too much fluctuation of the venous pressure.”

On his score sheet the intern wrote, 10 ml. out.”

Once more O’Donnell turned one of the stopcocks on the syringe, then pressed hard on the plunger. As he did, the blood withdrawn from the child was expelled into one of the metal basins.

Turning the stopcock again, he withdrew donor blood into the syringe, then, tenderly and slowly, injected it into the child.

On his score sheet the intern wrote, 10 ml. in.

Painstakingly O’Donnell went on. Each withdrawal and replacement, accomplished gradually and carefully, took five full minutes. There was a temptation to hurry, particularly in a critical case like this, but O’Donnell was conscious that speed was something to be shunned. The little body on the table had small enough resistance already; any effect of shock could be immediate and fatal.

Then, twenty-five minutes after they had started, the baby stirred and cried.

It was a frail, thready cry—a weak and feeble protest that ended almost as soon as it began. But it was a signal of life, and above the masks of those in the room eyes were smiling, and somehow hope seemed a trifle closer.

O’Donnell knew better than to jump to hasty conclusions. Nevertheless, over his shoulder to Dornberger, he said, “Sounds like he’s mad at us. Could be a good sign.”

Dornberger too had reacted. He leaned over to read the intern’s score card, then, conscious that he himself was not in charge, he ventured tentatively, “A little calcium gluconate, do you think?”

“Yes.” O’Donnell unscrewed the syringe from the double stopcock and substituted a ten-cc. syringe of calcium gluconate which the nurse had given him. He injected one cc., then handed it back. The nurse returned the original syringe which, in the meantime, she had rinsed in the second metal bowl.

O’Donnell was conscious of a lessening of tension in the room. He began to wonder if, after everything, this baby would pull through. He had seen stranger things happen, had learned long ago that nothing was impossible, that in medicine the unexpected was just as often on your side as against you.

“All right,” he said, “let’s keep going.”

He withdrew ten milliliters, then replaced it. He withdrew another ten and replaced that. Then another ten—in and out. And another.

Then, fifty minutes after they had begun, the nurse announced quietly, “The patient’s temperature is falling, Doctor. It’s ninety-four point three.”

He said quickly, “Check the venous pressure.”

It was thirty-five—much too low.

“He’s not breathing well,” the intern said. “Color isn’t good.”

O’Donnell told him, “Check the pulse.” To the nurse he said, “Oxygen.”

She reached for a rubber mask and held it over the infant’s face. A moment later there was a hiss as the oxygen went on.

“Pulse very slow,” the intern said.

The nurse said, “Temperature’s down to ninety-three.”

The intern was listening with a stethoscope. He looked up. “Respiration’s failing.” Then, a moment later, “He’s stopped breathing.”

O’Donnell took the stethoscope and listened. He could hear a heartbeat, but it was very faint. He said sharply, “Coramine—one cc.”

As the intern turned from the table O’Donnell ripped off the covering sheets and began artificial respiration. In a moment the intern was back. He had wasted no time; in his hand was a hypodermic, poised.

“Straight in the heart,” O’Donnell said. “It’s our only chance.”

In the pathology office Dr. David Coleman was growing restless. He had remained, waiting with Pearson, ever since the telephone message had come announcing the blood-test result. Between them they had disposed of some accumulated surgical reports, but the work had gone slowly, both men knowing that their thoughts were elsewhere. Now close to an hour had gone by and there was still no word.

Fifteen minutes ago Coleman had got up and said tentatively, “Perhaps I should see if there’s anything in the lab . . .”

The old man had looked at him, his eyes doglike. Then, almost pleadingly, he had asked, “Would you mind staying?”

Surprised, Coleman had answered, “No; not if you wish,” and after that they had gone back to their task of time filling.

For David Coleman, too, the waiting was hard. He knew himself to be almost as tense as Pearson, although at this moment the older man was showing his anxiety more. For the first time Coleman realized how mentally involved he had become in this case. He took no satisfaction from the fact that he had been right and Pearson wrong about the blood test. All he wanted, desperately now, for the sake of the Alexanders, was for their child to live. The force of his own feeling startled him; it was unusual for anything to affect him so deeply. He recalled, though, that he had liked John Alexander right from the beginning at Three Counties; then later, meeting his wife, knowing that all three of them had had their origins in the same small town, there had seemed to spring up a sense of kinship, unspoken but real.

The time was going slowly, each successive minute of waiting seeming longer than the last. He tried to think of a problem to keep his mind busy; that always helped when you had time to kill. He decided to concentrate on some of the aspects of the Alexander case. Point one, he thought: The fact that the baby’s Coombs test now shows positive means that the mother has Rh-sensitized blood also. He speculated on how this might have come about.

The mother, Elizabeth Alexander, could, of course, have become sensitized during her first pregnancy. David Coleman reasoned: It need not have affected their first child; that was the one who had died of—what was it they had told him?—oh yes, bronchitis. It was much more common to find the effect of Rh sensitization during a second pregnancy.

Another possibility, of course, was that Elizabeth might have been given a transfusion of Rh-positive blood at some time or other. He stopped; at the back of his mind was a nagging, unformed thought, an uneasy feeling that he was close to something but could not quite reach it. He concentrated, frowning. Then suddenly the pieces were in place; what he had been groping for was there—vivid and sharply in focus. His mind registered: Transfusions! The accident at New Richmond! The railroad crossing at which Elizabeth’s father had been killed, where she herself had been injured but had survived.

Once more Coleman concentrated. He was trying to remember what it was John Alexander had said about Elizabeth that day. The words came back to him: 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.

It could never be proved, of course, not after all this time; but he was willing to wager everything he had that that was the way it happened. He thought: Existence of the Rh factor only became known to medicine in the 1940s; after that it took another ten years before Rh testing was generally adopted by all hospitals and doctors. In the meantime, there were plenty of places where blood transfusions were given without an Rh cross match; New Richmond was probably one. The time fitted. The accident involving Elizabeth would have been in 1949; he remembered his father telling him about it afterward.

His father! A new thought came to him: it was his own father—Dr. Byron Coleman—who had taken care of the Alexander family, who would have ordered the transfusions Elizabeth Alexander had received. If she had had several transfusions they would have come from more than one donor; the chance of at least some of the blood being Rh positive was almost inevitable. That was the occasion, then, when Elizabeth had become sensitized; he was sure of it now. At the time, of course, there would have been no apparent effect. None, that is, except that her own blood would be building antibodies—antibodies to lurk hidden and unsuspected until, nine years later, they rose in anger, virulent and strong, to destroy her child.

Naturally David Coleman’s father could not be blamed, even if the hypothesis were true. He would have prescribed in good faith, using the medical standards of his day. It was true that at the time the Rh factor had been known and in some places Rh cross matching was already in effect. But a busy country G.P. could scarcely be expected to keep up with everything that was new. Or could he? Some physicians of the time—G.P.’s included—were aware of the new horizons opened up by modern blood grouping. They had acted promptly to enforce the latest standards. But possibly, David Coleman reasoned, these were younger men. His father at that time was growing old; he worked too hard and long to do much reading. But was that an adequate excuse? Was it an excuse that he himself—David Coleman—would accept from others? Or was there perhaps a double standard—a more lenient set of rules when it came to judging your own kin, even a father who was dead? The thought troubled him. He sensed uneasily that a feeling of personal loyalty was obtruding across some of his own most cherished views. David Coleman wished he had not thought of this. It gave him an uneasy feeling of doubt, of not being absolutely sure . . . of anything at all.

Pearson was looking across at him. He asked, “How long is it now?”

Coleman checked his watch, then answered, “Just over an hour.”

“I’m going to call them.” Impetuously Pearson reached for the telephone. Then he hesitated and drew his hand away. “No,” he said, “I suppose I’d better not.”

In the serology lab John Alexander, too, was conscious of the time. An hour ago he had come back from visiting Elizabeth, and since then he had made several halfhearted attempts to work. But it was obvious to himself that his mind was far removed from what he was doing and he had desisted, rather than risk mistakes. Now, taking up a test tube, he prepared to begin again, but Bannister came over and took it from him.

Looking at the requisition sheet, the older technician said kindly, “I’ll do that.”

He protested halfheartedly, then Bannister said, “Go on, kid; leave it to me. Why don’t you go up with your wife?”

“Thanks all the same, but I think I’ll stay. Dr. Coleman said as soon as he heard . . . he’d come and tell me.” Alexander’s eyes turned to the wall clock again. He said, his voice strained, “They can’t be much longer now.”

Bannister turned away. “No,” he said slowly, “I guess not.”

Elizabeth Alexander was in her hospital room alone. She was lying still, head back on the pillows, her eyes open, when Nurse Wilding came in. Elizabeth asked, “Is there any news?”

The elderly, gray-haired nurse shook her head. “I’ll tell you just as soon as we hear.” Putting down the glass of orange juice she had brought, she said, “I can stay with you for a few minutes if you like.”

“Yes, please.” Elizabeth smiled faintly, and the nurse pulled a chair near the bed and sat down. Wilding felt relieved to rest her feet; just lately they had been giving her a good deal of pain, and she suspected they would probably force her to quit nursing soon, whether she wanted to or not. Well, she had a feeling she was pretty close to being ready to go.

Wilding wished, though, that she could do something for these two young people. She had taken a fancy to them from the beginning; to her the two of them—husband and wife—seemed almost children. In a way, taking care of this girl, who, it seemed now, was likely to lose her baby, had been almost like caring for the daughter that long ago Wilding had wanted but never had. Wasn’t that silly now?—she, with all her years of nursing, getting sentimental at this late day. She asked Elizabeth, “What were you thinking about—when I came in just then?”

“I was thinking about children—fat, roly-poly children scrambling on green grass in afternoon sunshine.” Elizabeth’s voice had a dreamlike quality. “It was like that in Indiana when I was a little girl—in the summers. Even then I used to think that someday I would have children and that I would sit beside them while they rolled on the grass in the sunshine, just as I had.”

“It’s a funny thing about children,” Wilding said. “Sometimes things turn out so different from the way you thought they would. I had a son, you know. He’s a man now.”

“No,” Elizabeth said, “I didn’t know.”

“Don’t misunderstand me,” Wilding said. “He’s a fine man—a naval officer. He got married a month or two ago; I had a letter from him telling me.”

Elizabeth found herself wondering—what it would be like to bear a son and then have a letter, telling about his getting married.

“I never did feel we got to know one another very well,” Wilding was saying. “I expect that was my fault in a way—getting divorced and never giving him a real home.”

“But you’ll go and see him sometimes?” Elizabeth said. “And there’ll be grandchildren, I expect.”

“I’ve thought a lot about that,” Wilding said. “I used to think it would be fun. You know—having grandchildren, living somewhere near, then going in the evenings to baby-sit, and all the rest.”

Elizabeth asked, “But won’t you—now?”

Wilding shook her head. “I have a feeling that when I go it’ll be like visiting strangers. And it won’t be often either. You see, my son is stationed in Hawaii; they left last week.” She added with a touch of defiant loyalty, “He was coming to see me and bring his wife. Then something came up at the last minute, so they couldn’t make it.”

There was a silence, then Wilding said, “Well, I’ll have to be getting on now.” She eased to her feet, then added from the doorway, “Drink your juice, Mrs. Alexander. I’ll come and tell you—just as soon as we hear anything at all.”

Kent O’Donnell was sweating, and the assisting nurse leaned forward to mop his forehead. Five minutes had passed since artificial respiration had begun, and still there was no response from the tiny body under his hands. His thumbs were on the chest cavity, the remainder of his fingers crossed around the back. The child was so small, O’Donnell’s two hands overlapped; he had to use them carefully, aware that with too much pressure the fragile bones would sunder like twigs. Gently, once more, he squeezed and relaxed, the oxygen hissing, trying to induce breath, to coax the tired, tiny lungs back into life with movement of their own.

O’Donnell wanted this baby to live. He knew, if it died, it would mean that Three Counties—his hospital—had failed abjectly in its most basic function: to give proper care to the sick and the weak. This child had not had proper care; it had been given the poorest when it needed the best, and dereliction had edged out skill. He found himself trying to communicate, to transmit his own burning fervor through his finger tips to the faltering heart lying beneath them. You needed us and we failed you; you probed our weakness and you found us wanting. But please let us try—again, together. Sometimes we do better than this; don’t judge us for always by just one failure. There’s ignorance and folly in this world, and prejudice and blindness—we’ve shown you that already. But there are other things, too; good, warm things to live for. So breathe! It’s such a simple thing, but so important. O’Donnell’s hands moved back and forth . . . compressing . . . releasing . . . compressing . . . releasing . . . compressing . . .

Another five minutes had passed and the intern was using his stethoscope, listening carefully. Now he straightened up. He caught O’Donnell’s eye and shook his head. O’Donnell stopped; he knew it was useless to go on.

Turning to Dornberger, he said quietly, “I’m afraid he’s gone.”

Their eyes met, and both men knew their feelings were the same.

O’Donnell felt himself gripped by a white-hot fury. Fiercely he ripped off the mask and cap; he tore at the rubber gloves and flung them savagely to the floor.

He felt the others’ eyes upon him. His lips in a thin, grim line, he told Dornberger, “All right. Let’s go.” Then, harshly, to the intern, “If anyone should want me, I’ll be with Dr. Pearson.”

Twenty-one

In the pathology office the telephone bell jangled sharply and Pearson reached out for the receiver. Then, his face pale, nervousness showing, he stopped. He said to Coleman, “You take it.”

As David Coleman crossed the room there was a second impatient ring. A moment later he was saying, “Dr. Coleman speaking.” He listened, expressionless, then said, “Thank you,” and hung up.

His eyes met Pearson’s. He said quietly, “The baby just died.”

The other man said nothing. His eyes dropped. Slouched in the office chair, the lined, craggy face half in shadow, his body motionless, he seemed aged and defeated.

Coleman said softly, “I think I’ll go to the lab. Someone should talk with John.”

There was no answer. As Coleman left the pathology office, Pearson was still sitting, silent and unmoving, his eyes unseeing, his thoughts known only to himself.

Carl Bannister had gone out of the lab when David Coleman came in. John Alexander was there alone, seated on a stool before one of the wall benches, the lab clock immediately above his head. He made no attempt to turn around as Coleman approached, his footsteps slow, the leather of his shoes creaking as he crossed the floor.

There was a silence, then, still without turning, Alexander asked softly, “It’s . . . over?”

Without answering Coleman reached out his hand. He let it rest on the other’s shoulder.

His voice low, Alexander said, “He died, didn’t he?”

“Yes, John,” Coleman said gently, “he died. I’m sorry.”

He withdrew his hand as Alexander turned slowly. The younger man’s face was strained, the tears streaming. He said, softly but intensely, “Why, Dr. Coleman? Why?”

Groping for words, he tried to answer. “Your baby was premature, John. His chances were not good—even if . . . the other . . . hadn’t happened.”

Looking him directly in the eyes, Alexander said, “But he might have lived.”

This was a moment of truth in which evasion had no place. “Yes,” Coleman said. “He might have lived.”

John Alexander had risen to his feet. His face was close to Coleman’s, his eyes imploring, questioning. “How could it happen . . . in a hospital . . . with doctors?”

“John,” Coleman said, “at this moment I haven’t any answer for you.” He added softly, “At this moment I haven’t any answer for myself.”

Alexander nodded dumbly. He took out a handkerchief and wiped his eyes. Then he said quietly, “Thank you for coming to tell me. I think I’ll go to Elizabeth now.”

Kent O’Donnell had not spoken during his progress through the hospital with Dr. Dornberger; the intense anger and frustration, which had engulfed him like a wave as he had looked down at the dead child, kept him tight-lipped and silent. As they swept through corridors and pattered down stairways, eschewing the slow-moving elevators, bitterly once more O’Donnell reviled himself for his own inaction about Joe Pearson and the pathology department of Three Counties. God knows, he thought, there had been plenty of danger signs: Rufus and Reubens had warned him, and he had had the evidence of his own eyes to tell him Pearson was failing with his years, his responsibilities growing beyond him in the busy, expanded hospital. But no! He, Kent O’Donnell, M.D., F.R.C.S. (Eng.), F.A.C.S., chief of surgery, medical-board president—off with your hats for a fine, big man! “Send him victorious, happy and glorious, long to reign over us, God save O’Donnell!”—he had been too preoccupied to bestir himself, to use the toughness his job demanded, to face the unpleasantness which was bound to follow action. So, instead, he had looked the other way, pretended all was well, when experience and instinct had told him deep inside he was only hoping that it would be. And where had he been all this time—he, the great man of medicine? Wallowing in hospital politics; supping with Orden Brown; fawning on Eustace Swayne, hoping that by inaction, by permitting a status quo, by leaving Swayne’s friend Joe Pearson severely alone, the old tycoon would graciously come through with money for the fancy new hospital buildings—O’Donnell’s dream of empire, with himself as king. Well, the hospital might receive the money now, and again it might not. But whether it did or didn’t, one price, at least, had already been paid. He thought: You’ll find the receipt upstairs—a small dead body in an O.R. on the fourth floor. Then, as they came to Pearson’s door, he felt his anger lessen and sorrow take its place. He knocked, and Dornberger followed him in.

Joe Pearson was still sitting, exactly as Coleman had left him. He looked up but made no attempt to rise.

Dornberger spoke first. He spoke quietly, without antagonism, as if wanting to set the mood of this meeting as a service to an old friend. He said, “The baby died, Joe. I suppose you heard.”

Pearson said slowly, “Yes. I heard.”

“I’ve told Dr. O’Donnell everything that happened.” Dornberger’s voice was unsteady. “I’m sorry, Joe. There wasn’t much else I could do.”

Pearson made a small, helpless gesture with his hands. There was no trace of his old aggressiveness. He said expressionlessly, “It’s all right.”

Matching his tone to Dornberger’s, O’Donnell asked, “Is there anything you want to say, Joe?”

Twice, slowly, Pearson shook his head.

“Joe, if it were just this one thing . . .” O’Donnell found himself searching for the right words, knowing they did not exist. “We all make mistakes. Maybe I could . . .” This was not what he had intended to say. He steadied his voice and went on more firmly. “But it’s a long list. Joe, if I have to bring this before the medical board, I think you know how they’ll feel. You could make it less painful for yourself, and for all of us, if your resignation were in the administrator’s office by ten o’clock tomorrow morning.”

Pearson looked at O’Donnell. “Ten o’clock,” he said. “You shall have it.”

There was a pause. O’Donnell turned away, then back. “Joe,” he said, “I’m sorry. But I guess you know, I don’t have any choice.”

“Yeah.” The word was a whisper as Person nodded dully.

“Of course, you’ll be eligible for pension. It’s only fair after thirty-two years.” O’Donnell knew, as he said them, the words had a hollow ring.

For the first time since they had come in Pearson’s expression changed. He looked at O’Donnell with a slight, sardonic smile. “Thanks.”

Thirty-two years! O’Donnell thought: My God! It was most of any man’s working life. And to have it end like this! He wanted to say something more: to try to make it easier for them all; to find phrases in which to speak of the good things Joe Pearson had done—there must be many of them. He was still debating how when Harry Tomaselli came in.

The administrator had entered hurriedly, not waiting to knock. He looked first at Pearson, then his glance took in Dornberger and O’Donnell. “Kent,” he said quickly, “I’m glad you’re here.”

Before O’Donnell could speak Tomaselli had swung back to Pearson. “Joe,” he said, “can you come to my office immediately? There’s an emergency staff meeting in an hour. I’d like to talk with you first.”

O’Donnell said sharply, “An emergency meeting? What for?”

Tomaselli turned. His expression was serious, his eyes troubled. “Typhoid has been discovered in the hospital,” he announced. “Dr. Chandler has reported two cases, and there are four more suspected. We’ve an epidemic on our hands and we have to find the source.”

As Elizabeth looked up the door opened and John came in. He closed the door, then stood for a moment with his back against it.

There was nothing said, only with their eyes—grief, entreaty, and an overwhelming love.

She held out her arms and he came into them.

“Johnny! Johnny, darling.” It was all she could murmur before she began to cry softly.

After a while, when he had held her tightly, he moved back, then dried her tears with the same handkerchief he had used for his own.

Later still he said, “Elizabeth, honey, if you’re still willing, there’s something I’d like to do.”

“Whatever it is,” she answered, “it’s ‘yes.’ ”

“I guess you always wanted it,” he said. “Now I want it too. I’ll write for the papers tomorrow. I’m going to try for medical school.”

Mike Seddons got up from the chair and paced around the small hospital room. “But it’s ridiculous,” he said heatedly. “It’s absurd; it isn’t necessary, and I won’t do it.”

“For my sake, darling. Please!” From the bed Vivian eased herself around so that her face was toward him.

“But it isn’t for your sake, Vivian. It’s just some damn silly, stupid idea you might have got out of a fourth-rate sentimental novel.”

“Mike darling, I love you so much when you get mad. It goes with your beautiful red hair.” She smiled at him fondly as, for the first time, her mind moved away from immediate things. “Promise me something.”

“What?” He was still angry, the answer curt.

“Promise me that when we’re married sometimes you’ll get mad—really mad—so we can have fights, then afterward enjoy the fun of making up.”

He said indignantly, “That’s just about as daft a suggestion as the other one. And anyway, what’s the point of talking about getting married when you want me to stay away from you?”

Date: 2014-12-21; view: 627