Artropods and Human Disease 19 page

“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?”

“There should be a checkup first on all the new employees—as quickly as possible.” This time the elder pathologist was incisive and brisk. “After that there will have to be re-examination of all the others. That means stool culture, chest X-ray, and a physical. And it should include all the kitchen workers and anyone else who has anything to do with food at all.”

“Will you arrange that, Mrs. Straughan?” Tomaselli said. “Work with the health office; they’ll handle most of the detail.”

“Yes, Mr. T. I’ll get onto it right away.” She undulated out of the lab.

“Is there anything else?” Tomaselli had returned his attention to Pearson.

“We need a new steam booster system for those dishwashers—either that or rip them right out and put new ones in.” Pearson’s voice rose heatedly. “I’ve been telling everybody that for years.”

“I know.” Tomaselli nodded. “I inherited the file, and it’s on our list. The trouble is, we’ve had so many capital expenditures.” He mused. “I wonder what the comparative cost would be.”

Unreasonably, irritably, Pearson said, “How should I know? I’m not the plumber.”

“I know a little about plumbing; perhaps I can help.” At the softly spoken words the others turned their heads. It was Dr. Dornberger, his hands, inevitably, busy with his pipe. He had come into the lab quietly and unnoticed. Seeing Harry Tomaselli, he asked, “Am I interrupting something?”

Pearson said gruffly, “No. It’s all right.”

Dornberger saw John Alexander watching him. He said, “I was with your baby awhile ago, son. I’m afraid he’s not doing too well.”

“Is there any hope, Doctor?” Alexander asked the question quietly. The others had turned, their expressions softening. Bannister put down a glass pipette and moved closer.

“Not very much, I’m afraid,” Dornberger said slowly. There was a silence, then, as if remembering something, he turned to Pearson. “I suppose, Joe, there couldn’t be any doubt about that blood-sensitization test on Mrs. Alexander?”

“Doubt?”

“I mean, that it could be wrong.”

Pearson shook his head. “No doubt at all, Charlie. Matter of fact, I did it myself—very carefully.” He added curiously, “Why did you ask?”

“Just checking.” Dornberger puffed at his pipe. “For a while this morning I suspected the child might have had erythroblastosis. It was only a long shot though.”

“Be highly unlikely.” Pearson was emphatic.

Dornberger said, “Yes, that’s what I thought.”

Again the silence, their eyes turning to Alexander. David Coleman felt he wanted to say something—anything to divert attention, to make things easier for the young technologist. He told Dornberger, almost without thinking, “There used to be some doubt about sensitization tests—when labs were using just the saline and high-protein methods. Sometimes then a few positive cases would get recorded as negative. Nowadays, though, with an indirect Coombs test as well, it’s pretty well foolproof.” As he finished speaking, he realized that this lab had only made the change since his own arrival. He had not meant to take a dig at Pearson; at this moment he found himself hoping the old man would not notice. There had been enough quarreling between them without adding to it needlessly.

“But, Dr. Coleman . . .” Alexander’s mouth was gaping, his eyes alarmed.

“Yes? What is it?” Coleman was puzzled. Nothing he had said was enough to produce this reaction.

“We didn’t do an indirect Coombs test.”

Despite his concern for Alexander, Coleman found himself becoming annoyed. Because of Pearson he had wanted to avoid pursuing this subject. Now he was being given no choice. “Oh yes, you did,” he said offhandedly. “I remember signing the requisition for Coombs serum.”

Alexander was looking at him despairingly, his eyes pleading. He said, “But Dr. Pearson said it wasn’t necessary. The test was done just in saline and high protein.”

It took Coleman several seconds to absorb what had been said. He saw that Harry Tomaselli, not understanding, was watching the scene curiously. Dornberger’s attention had suddenly perked up.

Pearson appeared uncomfortable. He said to Coleman, with a trace of unease, “I meant to tell you at the time. It slipped my mind.”

David Coleman’s brain was now ice-clear. But before going further he wanted to establish one fact. “Do I understand correctly,” he asked Alexander, “that there was no indirect Coombs test whatever?”

As Alexander nodded Dr. Dornberger cut in abruptly. “Wait a minute! Let me get this straight. You mean the mother—Mrs. Alexander—may have sensitized blood after all?”

“Of course she may!” Not caring, Coleman lashed out, his voice rising in pitch. “The saline and high-protein tests are good in a lot of cases but not in all. Anybody who’s kept reasonably up to date in hematology should be aware of that.” He glanced sideways at Pearson, who appeared not to have stirred. To Dornberger he went on, “That’s why I ordered an indirect Coombs.”

The administrator was still trying to grasp the medical significance. “This test you’re talking about; if you ordered it, why wasn’t it done?”

Coleman wheeled on Bannister. His eyes merciless, he asked, “What happened to the requisition I signed—the requisition for Coombs serum?” As the technician hesitated, “Well?”

Bannister was shaking. Barely audible, he mumbled, “I tore it up.”

Dornberger said incredulously, “You tore up a doctor’s requisition—and without telling him?”

Relentlessly Coleman said, “On whose instructions did you tear it up?”

Bannister was looking at the floor. He said reluctantly, “On Dr. Pearson’s instructions.”

Dornberger was thinking quickly now. To Coleman he said, “This means the child may have erythroblastosis; everything points to it, in fact.”

“Then you’ll do an exchange transfusion?”

Dornberger said bitterly, “If it was necessary at all, it should have been done at birth. But there may be a chance, even this late.” He looked at the young pathologist as if, by implication, only Coleman’s opinion could be trusted. “But I want to be sure. The child hasn’t any strength to spare.”

“We need a direct Coombs test of the baby’s blood.” Coleman’s reaction was fast and competent. This scene was between himself and Dornberger now; Pearson was standing still, as if dazed by the swiftness of what had happened. To Bannister, Coleman rapped out, “Is there any Coombs serum in the hospital?”

The technician swallowed. “No.”

This was something within the administrator’s orbit. He asked tersely, “Where do we get it then?”

“There isn’t time.” Coleman shook his head. “We’ll have to get the test done somewhere else—where they’ve facilities.”

“University will do it; they’ve a bigger lab than ours anyway.” Harry Tomaselli had crossed to the telephone. He told the operator, “Get me University Hospital, please.” To the others he said, “Who’s in charge of pathology there?”

Dornberger said, “Dr. Franz.”

“Dr. Franz, please.” Tomaselli asked, “Who’ll talk with him?”

“I will.” Coleman took the phone. The others heard him say, “Dr. Franz? This is Dr. Coleman—assistant pathologist at Three Counties. Could you handle an emergency Coombs test for us?” There was a pause, Coleman listening. Then he said, “Yes, we’ll send the sample immediately. Thank you, Doctor. Good-by.” He turned back to the room. “We’ll need the blood sample quickly.”

“I’ll help you, Doctor.” It was Bannister, a tray of equipment in his hands.

About to reject the offer, Coleman saw the mute appeal in the other man’s eyes. He hesitated, then said, “Very well. Come with me.”

As they left the administrator called after them. “I’ll get a police cruiser. They’ll get the sample over there faster.”

“Please! I’d like to take it—to go with them.” It was John Alexander.

“All right.” The administrator had the telephone to his ear. Into it he snapped, “Get me the City Police.” To Alexander he said, “Go with the others, then bring the blood sample to the emergency entrance. I’ll have the cruiser waiting there.”

“Yes, sir.” Alexander went out quickly.

“This is the administrator, Three Counties Hospital.” Tomaselli was talking into the phone again. “We’d like a police car to deliver an urgent blood sample.” He listened briefly. “Yes; our people will be waiting at the emergency entrance. Right.” Hanging up the phone, he said, “I’d better make sure they all get together.” He went out, leaving Pearson and Dornberger alone.

Within the past few moments a ferment of thoughts had been seething in the elderly obstetrician’s mind. Inevitably, in his long years of medical practice, Charles Dornberger had had patients die. Sometimes about their deaths there had seemed almost a predestination. But always he had fought for their lives, at times savagely, and never giving up until the end. And in all occasions—successes as well as failures—he could tell himself truthfully that he had behaved with honor, his standards high, nothing left to chance, the utmost of his skill expended always. There were other physicians, he knew, who were sometimes less exacting. But never, to the best of his own knowledge and belief, had Charles Dornberger failed a patient through inadequacy or neglect.

Until this moment.

Now, it seemed, near the close of his own career, he was to share the sad and bitter harvest of another man’s incompetence; and worse—a man who was a friend.

“Joe,” he said, “there’s something I’d like you to know.”

Pearson had lowered himself to a lab stool, his face drained of color, his eyes unfocused. Now he looked up slowly.

“This was a premature baby, Joe; but it was normal, and we could have done an exchange transfusion right after birth.” Dornberger paused, and when he went on the turmoil of his own emotions was in his voice. “Joe, we’ve been friends a long time, and sometimes I’ve covered up for you, and I’ve helped you fight your battles. But this time, if this baby dies, so help me God!—I’ll take you before the medical board and I’ll break you in two.”

Twenty

“For Christ sake, what are they doing over there? Why haven’t we heard yet?”

Dr. Joseph Pearson’s fingers drummed a nervous tattoo upon his office desk. It was an hour and a quarter since the blood sample had been taken from the Alexander baby and promptly dispatched to University Hospital. Now the elder pathologist and David Coleman were alone in the office.

Coleman said quietly, “I called Dr. Franz a second time. He said he’ll phone the moment they have a result.”

Pearson nodded dully. He asked, “Where’s the boy—Alexander?”

“The police drove him back. He’s with his wife.” Coleman hesitated. “While we’re waiting—do you think we should check with the health office about the kitchen situation, make sure the foodhandler checks are being started?”

Pearson shook his head. “Later—when all this is over.” He said intensely, “I can’t think of anything else until this thing is settled.”

For the first time since this morning’s events, which had erupted so explosively in the lab, David Coleman found himself wondering about Pearson and what the older man was feeling. There had been no argument about the validity of Coleman’s statements concerning the sensitization test, and Pearson’s silence on the subject seemed a tacit admission that his younger colleague was better informed than himself, at any rate in this area. Coleman thought: It must be a bitter thing to face; and for the first time he felt a stirring of sympathy for the other man.

Pearson stopped drumming and slammed his hand hard on the table. “For Pete’s sake,” he said, “why don’t they call?”

“Is there any news from Pathology?”

Dr. Charles Dornberger, scrubbed and waiting in a small operating room which adjoined Obstetrics, asked the question of the charge nurse who had entered.

The girl shook her head. “No, Doctor.”

“How close are we to being ready?”

The nurse filled two rubber hot-water bottles and placed them beneath a blanket on the tiny operating table that was used for infants. She answered, “Just a few minutes more.”

An intern had joined Dornberger. The intern asked, “Do you intend to go ahead with an exchange transfusion—even if you don’t have the Coombs test result?”

“Yes,” Dornberger answered. “We’ve lost enough time already and I don’t want to add to it.” He considered, then went on, “In any case, the anemia in the child now is sufficiently marked to justify a blood exchange even without the test.”

The nurse said, “By the way, Doctor, the baby’s umbilical cord has been cut short. I wondered if you knew that.”

“Yes, thank you, I did.” To the intern Dornberger explained, “When we know in advance that an exchange transfusion will be necessary, we leave the umbilical cord long at birth. It makes a convenient point of connection. Unfortunately in this case we didn’t know, so the cord was cut.”

“How will you proceed?” the intern asked.

“I’ll use a local anesthetic and cut down just above the umbilical vein.” Turning back to the nurse, Dornberger asked, “Is the blood being warmed?”

She nodded. “Yes, Doctor.”

Dornberger told the intern, “It’s important to make sure the new blood is close to body temperature. Otherwise it increases the danger of shock.”

In a separate compartment of his mind Dornberger was aware that he was talking as much for his own benefit as for the instruction of the intern. Talking at least prevented him from thinking too deeply, and for the moment deep thinking was something Charles Dornberger wanted to avoid. Since he had left Pearson after the showdown in the lab his own mind had been engaged in a torment of anxiety and recrimination. The fact that, technically, he himself was not to blame for what had happened seemed unimportant. It was his patient who was in jeopardy, his patient that might die because of the worst kind of medical negligence, and the ultimate responsibility was his alone.

About to continue talking, Dornberger checked himself abruptly. Something was wrong; he had a feeling of dizziness; his head was throbbing, the room swirling. Momentarily he closed his eyes, then opened them. It was all right; things were back in focus, the dizziness almost gone. But when he looked down at his hands he saw they were trembling. He tried to control the movement and failed.

The incubator containing the Alexander baby was being wheeled in. At the same moment he beard the intern ask, “Dr. Dornberger—are you all right?”

It was on the edge of his tongue to answer “yes.” He knew that if he did he could carry on, concealing what had happened, with no one but himself aware of it. And then perhaps, even at this late moment, by exercise of skill and judgment he could save this child, salving, at least in some measure, his conscience and integrity.

Then, in the same moment, he remembered all that he had said and believed over the years—about old men clinging to power too long; the boast that when his own time came he would know it and make way; his conviction that he would never handle a case with his own facilities unpaired. He thought of these things, then looked down at his shaking hands.

“No,” he said, “I don’t think I am all right.” He paused, and aware for the first time of a deep emotion which made it hard to control his voice, he asked, “Will someone please call Dr. O’Donnell? Tell him I’m unable to go on. I’d like him to take over.”

At that moment, in fact and in heart, Dr. Charles Dornberger retired from the practice of medicine.

As the telephone bell rang Pearson snatched the instrument from its cradle.

“Yes?” A pause. “This is Dr. Pearson.” He listened. “Very well. Thanks.”

Without putting the receiver back he flashed the exchange and asked for an extension number. There was a click, then an answer, and Pearson said, “Get me Dr. Dornberger. It’s Dr. Pearson calling.”

A voice spoke briefly, then Pearson said, “All right, then give him a message. Tell him I’ve just heard from the university. The blood test on the Alexander baby is positive. The child has erythroblastosis.”

Pearson replaced the phone. Then he looked up, to find David Coleman’s eyes upon him.

Dr. Kent O’Donnell was striding through the hospital’s main floor on his way to Neurology. He had arranged a consultation there to discuss a partial paralysis condition in one of his own patients.

It was O’Donnell’s first day back at Three Counties after his return from New York the evening before. He still felt a sense of exhilaration and freshness from his trip; a change of scene, he told himself, was what every physician needed now and then. Sometimes the daily contact with medicine and sickness could become a depressive, wearing you down after a while without your own awareness of its happening. In the larger sense, too, a change was invigorating and broadening for the mind. And akin to this, more and more since his New York meeting with Denise, the question of ending his own tenure at Three Counties, and of leaving Burlington for good, had kept coming back, to be assessed and weighed in mind, and each time the arguments in favor of a move had seemed more convincing. He knew, of course, that he was strongly motivated by his feelings for Denise and that even until their latest meeting the thought of leaving Burlington had not occurred to him. But he asked himself: was there anything wrong with an individual making a professional choice which weighed in favor of personal happiness? It was not as if he would be quitting medicine; he would merely be changing his base of operations and giving of his best elsewhere. After all, any man’s life was the sum of all its parts; without love, if once he found it, the rest of him might wither and be worthless. With love he could be a better man—zealous and devoted—because his life was whole. Again he thought of Denise with a rising sense of excitement and anticipation.

“Dr. O’Donnell. Dr. O’Donnell.”

The sound of his own name on the hospital P.A. system brought him back to reality. He stopped, looking around him for a telephone on which to acknowledge the call. He saw one in a glass-enclosed accounting office a few yards away. Going in to use it, he reported to the telephone exchange and a moment later was given Dornberger’s message. Responding promptly; he changed direction and headed for the elevators which would take him to the fourth floor and Obstetrics.

While Kent O’Donnell scrubbed, Dornberger, standing alongside, described what had happened in the case and his own reason for calling in the chief of surgery. Dornberger neither dramatized nor held anything back; he related the scene in the pathology lab, as well as the events leading up to it, accurately and without emotion. Only at two points did O’Donnell stop him to interject sharp questions; the remainder of the time he listened carefully, his expression growing grimmer as Dornberger’s account proceeded.

O’Donnell’s mood of elation was gone now, shattered suddenly and incredibly by what he had learned, by the knowledge that negligence and ignorance—for which, in a very real sense, he himself Was responsible—might snuff out the life of a patient in this hospital. He thought bitterly: I could have fired Joe Pearson; there was plenty of reason to. But no! I dallied and procrastinated, playing politics, convincing myself I was behaving reasonably, while all the time I was selling medicine short. He took a sterile towel and dried his hands, then plunged them into gloves which a nurse held out. “All right,” he told Dornberger. “Let’s go in.”

Entering the small operating room, O’Donnell ran his eye over the equipment which had been made ready. He was familiar with exchange-transfusion technique—a fact which Dornberger had known in calling for the chief of surgery—having worked with the heads of Pediatrics and Obstetrics in establishing a standard procedure at Three Counties, based on experience in other hospitals.

The tiny, frail Alexander baby had been taken from its incubator and placed on the warm operating table. Now the assisting nurse, with the intern helping her, was securing the infant in place, using diapers—one around each arm and leg—folded in long narrow strips and fastened with safety pins to the cover of the table. O’Donnell noticed the baby lay very still, making only the slightest of responses to what was being done. In a child so small it was not a hopeful sign.

The nurse unfolded a sterile sheet and draped it over the infant, leaving exposed only the head and navel, the latter area still in process of healing where the umbilical cord had been severed at birth. A local anesthetic had already been administered. Now the girl passed forceps to O’Donnell and, taking them, he picked up a gauze pad and began to prep the operative area. The intern had taken up a clip board and pencil. O’Donnell asked him, “You’re going to keep score?”

“Yes, sir.”

O’Donnell noticed the tone of respect and in other circumstances would have smiled inwardly. Interns and residents—the hospital’s house staff—were a notoriously independent breed, quick to observe shortcomings in the more senior attending physicians, and to be addressed as “sir” by any of their number was something of an accolade.

Date: 2014-12-21; view: 770