The Final Diagnosis Arthur Hailey 10 page

She hesitated. “Well, I suppose not. Not exactly anyway.”

This was what he had expected. He thought for a moment, then said, “Let me put it as simply as I can. All of us have certain factors in our blood. And when you speak of a ‘factor’ you might say that it’s another name for an ‘ingredient.’ ”

Elizabeth nodded. “I see.” She found herself concentrating, adjusting mentally to take in what Dr. Dornberger was saying. For a moment she was reminded, almost nostalgically, of days in class. At school she had always taken pride in her capacity to understand things, to focus on a particular problem—absorbing facts quickly by excluding other things from consciousness. It had made her one of the brighter pupils. She was curious to know if she had retained the ability.

Dornberger continued, “Different human beings have different blood factors. The last time anyone counted there were forty-nine of these factors known to medicine. Most people—you and I, for example—have between fifteen and twenty of them in our own blood stream.”

Elizabeth’s brain clicked: question one. She asked, “What causes people to be born with different factors?”

“Mostly we inherit them, but that isn’t important now. What’s important is to remember that some factors are compatible and some are not.”

“You mean . . .”

“I mean that when these blood factors are mixed together, some will get along quite happily, but some will fight one another and won’t get along at all. That’s why we are always careful in blood typing when we give a transfusion. We have to be sure it’s the right kind of blood for the person receiving it.”

Frowning thoughtfully, Elizabeth said, “And it’s the factors that fight each other—the incompatible ones—that cause trouble? When people have babies, I mean.” Again her own classroom formula: be clear on each point before going on to the next.

Dornberger answered, “Occasionally they do, but more often they don’t. Let’s take the case of you and your husband. You say he’s Rh positive?”

“That’s right.”

“Well, that means his blood contains a factor called ‘big D.’ And because you’re Rh negative you don’t have any ‘big D.’ ”

Elizabeth nodded slowly. Her mind was registering: Rh negative—no “big D.” Using an old memory trick, she quickly made up a mnemonic:

If you haven’t got “big D”

Your blood’s a minus quantity.

She found Dornberger watching her. “You make it so interesting,” she said. “No one’s ever explained it like this before.”

“Good. Now let’s talk about your baby.” He pointed to the bulge below her waist. “We don’t know yet whether Junior here has Rh-negative blood or Rh-positive. In other words, we don’t know if he has any ‘big D.’ ”

For a moment Elizabeth forgot the mental game she was playing. With a trace of anxiety she asked, “What happens if he does? Does it mean that his blood will fight with mine?”

Dornberger said calmly, “There’s always that possibility.” He told her with a smile, “Now listen very carefully.”

She nodded. Her attention was focused again. Briefly, back there, she had let her mind become sidetracked.

He said deliberately, “A baby’s blood is always quite separate from the mother’s. Nevertheless, in pregnancy, small amounts of the baby’s blood often escape into the mother’s blood stream. Do you understand that?”

Elizabeth nodded. “Yes.”

“Very well then. If the mother is Rh negative and the baby happens to be Rh positive, sometimes that can mean our old friend ‘big D’ seeps into the mother’s blood stream, and he isn’t welcome there. Got it?”

Again Elizabeth said, “Yes.”

He said slowly, “When that happens, the mother’s blood usually creates something we call antibodies, and those antibodies fight the ‘big D’ and eventually destroy it.”

Elizabeth was puzzled. “Then where’s the problem?”

“There never is any problem—for the mother. The problem, if there is one, begins when the antibodies—the ‘big D’ fighters which the mother has created—cross over the placental barrier into the baby’s blood stream. You see, although there’s no regular movement of blood between mother and baby, the antibodies can, and do, cross over quite freely.”

“I see,” Elizabeth said slowly. “And you mean the antibodies would start fighting with the baby’s blood—and destroying it.” She had it now—clearly in her mind.

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.”

“Yes, he did,” Coleman said. “I’d like to do something about that quite quickly.”

“You won’t have any problem,” O’Donnell said, then added, “Perhaps you’d like to take a day or two to fix up an apartment before you report at the hospital.”

“I don’t think so, thank you. I plan to start work tomorrow morning.”

Coleman was polite but definite. O’Donnell thought: This is a man who makes up his mind, then states his opinion plainly. He sounded, too, as if he were not dissuaded easily. O’Donnell found himself speculating on how Joe Pearson and David Coleman were going to get along. Superficially it looked as if they might clash. But you could never tell. Sometimes in a hospital the most unlikely people hit it off like lifetime friends.

Looking around him as they drove through the approaches to the city, David Coleman found himself close to a sense of excitement at the prospect ahead. This was unusual because mostly he took whatever came with a matter-of-fact acceptance. But it was, after all, his first staff appointment to a hospital. He told himself: a touch of down-to-earth humanity is nothing to be ashamed of, my friend, then smiled inwardly at the silent self-criticism. Old habits of thought, he reflected, were hard to break.

He wondered about O’Donnell, sitting beside him. Everything he had heard about the chief of surgery at Three Counties had been good. How was it, he wondered, that a man with O’Donnell’s background and qualifications would choose a place like Burlington? Did he, too, have a mixed-up motivation, or was there some other reason? Maybe he just liked it here. There were some people, Coleman supposed, whose preferences were straightforward and uncomplicated.

O’Donnell pulled out to pass a tractor-trailer. Then he said, “I’d like to tell you a couple of things, if I may.”

Coleman said politely, “Please do.”

“We’ve had a number of changes at Three Counties these past few years.” O’Donnell was going slowly, choosing his words. “Harry Tomaselli told me you’d heard of some of them—as well as our plans.”

Coleman smiled. “Yes, I had.”

O’Donnell sounded his horn and a car ahead of them moved over. He said, “The fact of your being here represents a major change, and I imagine that, once installed, there will be other changes you’ll want to make yourself.”

Coleman thought of the hospital’s pathology department as he had seen it during his brief visit. “Yes,” he responded, “I’m sure there will.”

O’Donnell was silent. Then, more slowly, he said, “Whenever we could, we’ve tried to make our changes peaceably. Sometimes that hasn’t been possible; I’m not one who believes in sacrificing a principle just to keep the peace.” He looked sideways at Coleman. “Let’s be clear about that.”

Coleman nodded but made no answer. O’Donnell went on, “All the same, wherever you can, I’d suggest you move discreetly.” He smiled. “Do what you can by persuasion, and save the big guns for things that really matter.”

Noncommittally Coleman said, “I see.” He was not sure just what he was being told; he would need to know O’Donnell better before deciding that. Had he been wrong in his impression of O’Donnell? Was the chief of surgery, after all, just a pussyfooter? Was Coleman being told here and now, as a newcomer, not to rock the boat? If that were so, they would quickly find they had obtained the wrong man. David Coleman made a mental note not to take a long lease on any apartment he might find in Burlington.

O’Donnell was wondering now if he had been wise in saying what he had. They had been fortunate to get this man Coleman, and he had no wish to put him off, not right at the beginning. But all the time at the back of O’Donnell’s mind had been the problem of Joe Pearson and Pearson’s admitted influence with Eustace Swayne. As far as he could O’Donnell wanted to be loyal to Orden Brown; in the past the board chairman had done a good deal to support the chief of surgery. O’Donnell knew that Brown wanted Swayne’s quarter million dollars and, indeed, the hospital needed it badly. And if that meant placating Joe Pearson a little, O’Donnell was prepared to go along—within reason.

But where did hospital politics end and O’Donnell’s responsibility as a medical practitioner begin? It was a question that troubled him; someday he might have to decide just where the line of demarcation lay. Was he himself playing politics now? O’Donnell supposed he was. If he were not, he would not have just said what he had to Dr. Coleman. Power corrupts, he thought; you can’t escape it, no matter who you are. He considered expanding the subject a little more with Coleman, perhaps taking the younger man into his confidence, then decided against it. Coleman was, after all, a newcomer; and O’Donnell was acutely aware that he had not penetrated yet behind those cool gray eyes.

Now they were coming into the city center, the streets of Burlington hot and dusty, sidewalks shimmering and the black-top roadways sticky in the heat. He turned the Buick into the forecourt of the Roosevelt Hotel. A porter opened the car doors and began to remove Coleman’s bags from the rear seat.

O’Donnell said, “Would you like me to come in? Make sure everything’s in order?”

From outside the car Coleman answered, “There’s really no need.” Once more the quiet but definite statement.

O’Donnell leaned across the seat. “All right. We’ll expect you tomorrow then. Good luck.”

“Thank you.”

The porter slammed the doors, and O’Donnell eased the car into the city traffic. He glanced at his watch. It was 2 p.m. He decided he would go to his own office first, the hospital later.

Seated on the leather-covered bench outside the outpatients’ laboratory of Three Counties, Elizabeth Alexander wondered why it was that the corridor walls had been painted two shades of brown instead of something lighter and brighter. It was a dark part of the hospital anyway; a little yellow, or even a light green, would have made the place so much more cheerful.

From as far back as her memory went Elizabeth had liked bright colors. She remembered, as a little girl, the first pair of draperies she had made for her own room at home; they had been powder-blue chintz with shapes of stars and moons woven into them. She suspected now that they had been very badly made, but at the time they had seemed quite wonderful. To hang them she had gone downstairs into her father’s store and indulgently he had sought out the things she needed—a rod cut to the right length, metal brackets, screws, a screw driver. She remembered his groping to find what he wanted among the other hardware—always piled high and untidily so that more often than not he had to search for whatever a customer asked for.

That was back in New Richmond, Indiana—two years before her father had died in the accident. Or was it three? It was hard to be sure; time went by so quickly. She knew it was six months before her father’s death that she had first met John. In a way that had had to do with color too. He was on vacation from high school and had come into the store to buy some red paint. By then Elizabeth was helping in the store, and she had talked him out of it and sold him green instead. Or was it the other way around? That too was misty now.

She knew, though, she had fallen in love with John right at the first moment. Probably it was just to keep him in the store that she had suggested the switch in colors. And looking back, it seemed from then on there had never been any doubt about their feelings for each other. They had stayed sweethearts through the transition from high school to college and had been married six years after their first meeting. Strangely, though neither had any money and John was still at college on a scholarship, no one had urged them to wait. Everyone they knew seemed to accept their marriage as natural and inevitable.

To some people their first year together might have seemed difficult. To John and Elizabeth it had been a gloriously happy time. The previous year Elizabeth had gone to night secretarial’ school. And in Indianapolis, where John was at college, she had worked as a stenographer and supported them both.

That was the year they had discussed seriously the question of John’s future—whether he should aim high and try for medical school or settle for the shorter course of a medical technologist. Elizabeth had favored medical school. Though it would mean several more years before John began earning, she had been willing to continue working. But John was less sure. For as long as he could remember he had wanted to enter medicine, and his college grades were good, but he was impatient to contribute something to their marriage. Then they had discovered that Elizabeth was pregnant and, for John, it was the deciding factor. Over his wife’s protests he had enrolled in medical-technology school and they had moved to Chicago.

There they had had their baby and had called her Pamela. Four weeks later the child had died of bronchitis, and for a while all of Elizabeth’s world seemed to have fallen in about her. For all her stability and common sense, she had gone to pieces and had ceased to care. John had done all he could, had never been kinder or more considerate, but it had not helped.

She had felt she had to get away and had gone home to her mother in New Richmond. But after a week she had longed for John and had gone back to Chicago. From that point on her return to normalcy had been gradual but sure. Six weeks before John’s graduation she had learned she was pregnant again; it was the final thing she had needed for readjustment. Now she felt healthy, her old cheerfulness back, and there was a growing excitement at the thought of the unborn child within her.

In Burlington they had found a small but pleasant apartment. The rent was economical. Out of their careful savings they had made a down payment on furniture and could meet the monthly installments out of John’s hospital pay. As of this moment everything was fine. Except, Elizabeth thought, that horrible brown on the corridor walls.

The door of the outpatients’ lab opened and a woman who had been waiting ahead of Elizabeth came out. A white-coated girl technician was behind her. The technician consulted a clip board. “Mrs. Alexander?”

“That’s right.” Elizabeth stood up.

“Will you come in, please?”

She followed the girl through the doorway.

Date: 2014-12-21; view: 679