Artropods and Human Disease 8 page

It was close to midnight now, but Vivian had signed the late book and there was no problem about hurrying in. Some of the older nurses, who had done their training under spartan regimes, felt the students were allowed too much freedom nowadays. But in practice it was seldom abused.

Mike touched her arm. “Let’s go through the park.”

Vivian laughed. “That’s an old line I’ve heard before.” But she offered no resistance as he steered her to a gateway and into the park beyond. In the darkness she could make out a line of poplars on either side, and the grass was soft underfoot.

“I’ve a whole collection of old lines. It’s one of my specialties.” He reached down and took her hand. “Do you want to hear more?”

“Like what, for example?” Despite her self-assurance her voice held the slightest of tremors.

“Like this.” Mike stopped and took both her shoulders, turning her to face him. Then he kissed her fully on the lips.

Vivian felt her heart beat faster, but not so much that her mind could not weigh the situation. Should she stop at once or let this go on? She was well aware that if she took no action now, later it might not be so easy.

Vivian already knew that she liked Mike Seddons and believed she could come to like him a good deal more. He was physically attractive and they were both young. She felt the stirrings of desire within her. They were kissing again and she returned the pressure of his lips. The tip of his tongue came lightly into her mouth; she met it with her own and the contact set up a delicious tingling. Mike tightened his arms around her, and through the thin summer dress she felt his thighs pressing tighter. His hands were moving, caressing her back. The right dropped lower; it passed lightly over the back of her skirt, then more heavily, each caress pulling her closer to him. Against her own body she felt a bulkiness. It stirred, intoxicatingly, heavenly. She knew clearly, as if with a second mind, that if she were going to, this was the moment to break away. Just a moment longer, she thought; just a moment longer!

Then suddenly it seemed as if this were an intermission, a release from other things around. Closing her eyes she savored the seconds of warmth and tenderness; these past months there had been so few. So many times since coming to Three Counties she had had to use control and self-discipline, her emotions pent up and tears unshed. When you were young, inexperienced, and a little frightened, sometimes it was hard to do. There had been so many things—the shocks of ward duty, pain, disease, death, the autopsy—and yet no safety valve to release the pressures building up inside. A nurse, even a student nurse, had to see so much of suffering and give so much in care and sympathy. Was it wrong, then, to grasp a moment of tenderness for herself? For an instant, with Mike holding her, she felt the same solace and relief as when, years before, she had run as a little girl into her mother’s arms. Mike had released her a little now and was holding her slightly away. He said, “You’re beautiful.” Impulsively she buried her face in his shoulder. Then he put a hand under her chin and their lips were together again. She felt the same hand drop and, from outside her dress, move lightly over her breasts. From every part of her body the desire to love and be loved welled up, madly, uncontrollably.

His hand was at the neckline of her dress. It was made to open at the front, and a hook and eye secured the top. He was fumbling for it. She struggled. Breathlessly, “No, Mike! Please! No!” She failed even to convince herself. Her arms were around him tightly. He had the dress open a little way now and she felt his hand move, then gasped at the contact as it cupped her own young, soft flesh. He took the nipple gently between his fingers, and a shudder of ecstasy moved through her in a sensual wave. Now she knew that it was too late to stop. She wanted, craved him desperately. Her lips to his ear, she murmured, “Yes, oh yes.”

“Darling, darling Vivian.” He was equally excited; she could tell from his whispered, breathless voice.

Womanlike, a moment’s common sense came through. “Not here, Mike. There are people.”

“Let’s go through the trees.” He took her hand and they moved closely together. She felt a trembling excitement, a wondering curiosity to know what it would be like. She dismissed any consequence; it seemed unimportant. And Mike was a doctor; he would know how to be careful.

They had reached a small clearing surrounded by trees and shrubs. Mike kissed her again, and passionately she returned his kisses, her tongue darting and fighting his. So this is where it’s to be, she thought. The real thing. Vivian was not a virgin; she had ceased to be while in high school, and there had been another incident in her first year of college, but neither experience had been satisfactory. She knew this would be. “Hurry, Mike, please hurry.” She felt her own excitement transmit itself to him.

“Over here, darling,” he said, and they moved toward the far side of the clearing.

Suddenly she felt a searing pain. It was so intense at first she could not be sure where it was. Then she knew it was her left knee. Involuntarily she cried out.

“What is it? Vivian, what is it?” Mike turned to her. She could see he was puzzled, not knowing what to make of it. She thought: He probably thinks it’s a trick. Girls do this sort of thing to get out of these situations.

The first sharpness of pain had subsided a little. But it still returned in waves. She said, “Mike, I’m afraid it’s my knee. Is there a seat somewhere?” She flinched again.

“Vivian,” he said, “you don’t have to put on an act. If you want to go back to the hospital, just say so and I’ll take you.”

“Please believe me, Mike.” She took his arm. “It is my knee. It hurts me terribly. I have to sit down.”

“This way.” She could tell he was still skeptical, but he guided her back through the trees. There was a park bench nearby, and they made for it.

When she had rested, Vivian said, “I’m sorry, I didn’t do that on purpose.”

He said doubtfully, “Are you sure?”

She reached for his hand. “Mike—in there; I wanted to, as much as you. Then this.” Again the pain.

He said, “I’m sorry, Vivian. I thought . . .”

She said, “I know what you thought. But it wasn’t that. Honestly.”

“All right. Tell me what’s wrong.” He was the doctor now. Back in there he had forgotten.

“It’s my knee. All of a sudden—the sharpest pain.”

“Let me see.” He was down in front of her. “Which one?”

She lifted her skirt and indicated the left knee. He felt it carefully, his hands moving lightly. For the moment Mike Seddons dismissed the thought that this was a girl to whom, a few minutes earlier, he had been about to make love. His behavior now was professional, analytical. As he had been trained to do, his mind went methodically over the possibilities. He found Vivian’s nylons impeded his sense of touch.

“Roll down your stocking, Vivian.” She did so, and his probing fingers moved over the knee again. Watching him, she thought: He’s good; he’ll be a fine doctor; people will come to him for help and he’ll be kind and do the utmost that he can. She found herself wondering what it would be like—the two of them together always. As a nurse there would be so much she could do to help him and to understand his work. She told herself: This is ridiculous; we scarcely know each other. Then, momentarily, the pain returned and she winced.

Mike asked, “Has this happened before?”

For a moment the absurdity of the situation struck her and she giggled.

“What is it, Vivian?” Mike sounded puzzled.

“I was just thinking. A minute or two ago . . . And now here you are, just like in a doctor’s office.”

“Listen, kid.” He was serious. “Has this happened before?”

She said, “Just once. It wasn’t as bad as this though.”

“How long ago?”

She thought. “About a month.”

“Have you seen anybody about it?” He was all professional now.

“No. Should I have?”

Noncommittally he said, “Maybe.” Then he added, “You will tomorrow anyway. I think Dr. Grainger would be the best one.”

“Mike, is something wrong?” Now she felt an undercurrent of alarm.

“Probably not,” he reassured her. “But there’s a small lump there that shouldn’t be. Lucy Grainger will give us the word though. I’ll talk with her in the morning. Now we have to get you home.”

The earlier mood was gone. It could not be recaptured, not tonight anyway, and both of them knew it.

Mike helped her up. As his arm went around her, he had a sudden feeling of wanting to help and protect her. He asked, “Do you think you can walk?”

Vivian told him, “Yes. The pain’s gone now.”

“We’ll just go to the gate,” he said; “we can get a taxi there.” Then because she looked glum he added cheerfully, “That patient was a cheap skate. He didn’t send any cab fare.”

Nine

“Give me the details.”

Hunched over the binocular microscope, Dr. Joseph Pearson half grunted the words to Roger McNeil.

The pathology resident looked at his folder of notes. “Case was a forty-year-old man, admitted for appendicitis.” McNeil was seated opposite Pearson at the desk of the pathology office.

Pearson took out the slide he had been studying and substituted another. He asked, “What did the tissue look like at gross?”

McNeil, who had made the gross examination when the removed appendix came down from the operating room, said, “Grossly it looked normal enough to me.”

“Hm.” Pearson moved the slide around. Then he said, “Wait a minute; here’s something.” After a pause he slipped the second slide out and selected a third. Now he said, “Here it is—an acute appendicitis. It was just beginning in this section. Who was the surgeon?”

McNeil answered, “Dr. Bartlett.”

Pearson nodded. “He got it good and early. Take a look.” He made way at the microscope for McNeil.

Working with the resident, as the hospital’s teaching program required him to, Pearson was endeavoring to catch up on the pathology department’s surgical reports.

Despite his best efforts, though, both men knew they were seriously in arrears with work. The slides being studied now had been sectioned from a patient’s appendix removed several weeks earlier. The patient had long since been discharged, and in this case the report would merely confirm or deny the surgeon’s original diagnosis. In this instance Gil Bartlett had been entirely right, in fact, creditably so, since he had caught the disease in its early stages and before the patient could have had much distress.

“Next.” Pearson moved back to the microscope as McNeil returned to the other side of the desk.

The resident pushed over a slide folder and, as Pearson opened it, McNeil consulted a fresh set of notes. As they worked Bannister entered the room quietly. With a glance at the other two he passed behind them and began to file papers into a cabinet.

“This is a current one,” McNeil said. “It came down five days ago. They’re waiting to hear what we say.”

“You’d better give me any like this first,” Pearson said sourly, “otherwise there’ll be more bleating from upstairs.”

McNeil was on the point of saying that several weeks ago he had suggested changing their procedure in just that way, but Pearson had insisted on reviewing all specimens in the order they came into the department. However, the resident checked himself. Why bother? he thought. He told Pearson, “It’s a fifty-six-year-old woman. The specimen is a skin lesion—superficially a mole. Question is: Is it a malignant melanoma?”

Pearson put in the first slide and moved it around. Then he nipped over the highest-powered lens and adjusted the binocular eyepiece. “It could be.” He took the second slide, then two more. After that he sat back thoughtfully. “On the other hand it could be a blue nevus. Let’s see what you think.”

McNeil moved in. This one, he knew, was important. A malignant melanoma was a tumor that was viciously malignant. Its cells could spread rapidly and murderously in the body. If diagnosed as such from the small portion already removed, it would mean immediate major surgery for the woman patient. But a blue nevus tumor was entirely harmless. It could stay where it was in the body, doing no harm, for the rest of the woman’s life.

From his own studies McNeil knew that a malignant melanoma was not common, but he also knew that a blue nevus was extremely rare. Mathematically the odds were on this being malignant. But this was not mathematics. It was pathology at its purest.

As he had learned to do, McNeil ran over in his mind the comparative features of the two types of tumor. They were distressingly similar. Both were partly scarred, partly cellular, with a good deal of pigmentation in them. Again, in both, the cellular structure was very pronounced. Something else McNeil had been taught was to be honest. After looking at all the slides he said to Pearson, “I don’t know.” He added, “What about previous cases? Could we get any out? To compare them.”

“It’d take us a year to find any. I don’t remember when I last had a blue nevus.” Pearson was frowning. He said heavily, “One of these days we’ve got to set up a cross file. Then when a doubtful case like this comes up we can go back and compare it.”

“You’ve been saying that for five years.” Bannister’s dry voice came from behind, and Pearson wheeled. “What are you doing here?”

“Filing.” The senior lab technician answered laconically. “Something the clerks should be doing if we had some proper help.”

And probably a lot better, McNeil thought. He knew the department badly needed more clerical staff and the filing methods used now were hopelessly archaic. The reference to a cross file, too, had reminded him of a gaping hole in their administrative system. There were few good hospitals now whose pathology departments did not have one. Some called them organ-lesion files, but, whatever the name, one purpose of the system was to help resolve the kind of problem they were facing at this moment.

Pearson was studying the slides again. He mumbled, as a lot of pathologists did when they were mentally crossing off some factors and confirming others. McNeil heard, “It’s a little small . . . absence of hemorrhage . . . no necrosis of the tissue . . . negative but no indication . . . yes, I’m satisfied.” Pearson straightened up from the microscope, replaced the last slide, and closed the slide folder. Motioning to the resident to write, he said, “Diagnosis—a blue nevus.” Courtesy of Pathology, the woman patient had been reprieved.

Methodically, for McNeil’s benefit, Pearson ran over the reasons for his decision again. As he passed the slide folder he added, “You’d better study these. It’s a specimen you won’t see often.”

McNeil had no doubt that the old man’s finding was right. This was one place where years of experience paid off, and he had come to respect Pearson’s judgment in matters of pathological anatomy. But when you’ve gone, he thought, looking at the old man, that’s when this place will need a cross file—badly.

They studied two more cases, both fairly straightforward, then Pearson slipped in the first slide from the next series. He took one look through the microscope eyepiece, straightened up, and told McNeil explosively, “Get Bannister!”

“I’m still here.” It was Bannister, calmly, behind them at the file cabinets.

Pearson wheeled. “Look at this!” He was using his loudest, hectoring voice. “How many times do I have to give instructions about the way I want slides made? What’s wrong with the technicians in Histology? Are they deaf or just plain stupid?”

McNeil had heard the same kind of outburst before. He sat back and watched as Bannister asked, “What’s the trouble?”

“I’ll tell you what’s the trouble.” Pearson ripped the slide from his microscope and tossed it across the table. “How can I give a proper diagnosis with this kind of tissue section?”

The senior lab technician picked up the slide and held it to the light. “Too thick, eh?”

“Of course it’s too thick.” Pearson picked out a second slide from the same set. “Look at this one. If I had some bread I could scrape off the meat and make a sandwich.”

Bannister grinned. “I’ll check the microtome. We’ve been having trouble with it.” He pointed to the slide folder. “Do you want me to take these away?”

“No. I’ll have to make do with them.” The explosiveness had gone now; the old man was merely growling. “Just do a better job in supervising Histology.”

Bannister, disagreeable himself by this time, grumbled on his way to the door. “Maybe if I didn’t have so much else . . .”

Pearson shouted after him, “All right. I’ve heard that record before.”

As Bannister reached the door, there was a light tap and Dr. Charles Dornberger appeared. He asked, “May I come in, Joe?”

“Sure.” Pearson grinned. “You might even learn something, Charlie.”

The obstetrician nodded pleasantly to McNeil, then said casually to Pearson, “This was the morning I arranged to come down. Had you forgotten?”

“Yes, I had.” Pearson pushed the slide folder away from him. He asked the resident, “How many more in this batch?”

McNeil counted the slide folders remaining. “Eight.”

“We’ll finish later.”

The resident began to gather up the case papers already completed.

Dornberger took out his pipe and leisurely filled it. Looking around the big drab room, he shivered. He said, “This place feels damp, Joe. Every time I come here I feel like I’m going to get a chill.”

Pearson gave a deep chuckle. He said, “We spray flu germs around—every morning. It discourages visitors.” He watched McNeil cross the room and go out of the door. Then he asked, “What’s on your mind?”

Dornberger wasted no time. He said, “I’m a deputation. I’m supposed to handle you tactfully.” He put the pipe in his mouth, his tobacco pouch away.

Pearson looked up. “What is this? More trouble?”

Their eyes met. Dornberger said quietly, “That depends.” After a pause he added, “But it looks as if you may get a new assistant pathologist.”

Dornberger had expected an outburst, but Pearson was strangely quiet. He said thoughtfully, “Whether I want one or not, eh?”

“Yes, Joe.” Dornberger made it definite; there was no point in holding back. He had thought a good deal about this since the meeting of several days ago.

“I suppose O’Donnell is back of this.” Pearson said it with a touch of bitterness but still quietly. As always, he was being unpredictable.

Dornberger answered, “Partly but not entirely.”

Again surprisingly, “What do you think I should do?” It was a question asked by one friend of another.

Dornberger laid his pipe, unlighted, in an ash tray on Pearson’s desk. He was thinking: I’m glad he’s taking it this way. It means I was right. I can help him accept this, adjust to it. Aloud he said, “I don’t believe you’ve much choice, Joe. You are behind with surgical reports, aren’t you? And a few other things?”

For a moment he thought he had gone too far. This was a sensitive area. He saw the other man brace up and waited for the storm to break. But again it did not. Instead, more strongly than before, but reasonably, Pearson said, “Sure, a few things need straightening out. I’ll admit that to you. But there’s nothing I can’t handle myself—if I can just get the time to do it.”

He has accepted it, Dornberger thought. He’s sounding off now. But he has accepted it just the same. He said casually, “Well, maybe you’ll get the time—with another pathologist.” With equal casualness he pulled from his inside pocket the paper which the administrator had given him.

Pearson asked, “What’s that?”

“There’s nothing definite about this, Joe. It’s a name that Harry Tomaselli had—apparently some young fellow who might be interested in coming here.”

Pearson took the single sheet. He said, “They sure didn’t waste any time.”

Dornberger said lightly, “Our administrator is a man of action.”

Pearson was scanning the paper. He read aloud, “Dr. David Coleman.” There was a pause. Then with bitterness, frustration, and envy the old man added, “Age thirty-one.”

It was twenty minutes after midday, and the hospital cafeteria was at its busiest. Most of the doctors, nurses, and hospital employees usually took their lunch about this time, and a line-up was beginning to form at the point where newcomers collected trays before passing counters and steam tables where the food was served.

Mrs. Straughan, as usual at this period, had her eye on proceedings, ensuring that as fast as one batch of food was used up another was brought from the kitchens to keep the line out front moving briskly. Today there was a choice of Irish stew, lamb chops, and broiled halibut. The chief dietitian noticed that the lamb chops were moving slowly. She decided to try some herself in a few minutes to see if there were any reason. Perhaps the meat was not as succulent as it might be; word of something like that was often passed to those arriving in the cafeteria by others who were leaving. Mrs. Straughan noticed a dish at the top of a pile on the servery that appeared to have a mark on it. She stepped forward and removed it quickly; sure enough, it still bore traces of an earlier meal. The dishwashing machines again! she thought. Their inadequacy was a recurring problem, and she decided to broach the subject with the administrator again very soon.

Over at the tables reserved for the medical staff there was the sound of noisy laughter. It came from a group of which Dr. Ralph Bell, the radiologist, was the center.

Gil Bartlett, who had come from the serving counter with a tray, put it down and went over with extended hand. “Congratulations, Ding Dong,” he said. “I just heard.”

“Heard what?” It was Lewis Toynbee, the internist, also with a tray, behind him. Then as Bell, beaming, passed a cigar to Bartlett, Toynbee exclaimed, “My God! Not again?”

“Certainly again. Why not?” The radiologist held out another cigar. “Join us, Lewis. It’s exactly eight Bells.”

“Eight! When was this?”

Bell said calmly, “This morning. Another boy for the ball team.”

Bill Rufus put in, “Don’t sound critical, Lewis. He’s doing his best. After all, he’s only been married eight years.”

Lewis Toynbee offered his hand. “Don’t squeeze it too tight, Ding Dong. I’m afraid some of that fertility might rub off.”

“I’m impervious to jealousy,” Bell said good-naturedly. He had been through all this before.

Lucy Grainger asked, “How is your wife?”

Bell answered, “She’s fine, thanks.”

“How does it feel to be a sex fiend?” The question was from Harvey Chandler, the chief of medicine, lower down the table.

Bell said, “I’m not a sex fiend. At our house we have intercourse once a year. I’m just a dead shot.”

Lucy Grainger joined in the ensuing laughter, then she said, “Ralph, I’m sending you a patient this afternoon. It’s one of our student nurses—Vivian Loburton.”

The laughter had simmered down. “What is it you’re looking for?” Bell asked.

“I want you to take some films of the left knee,” Lucy answered. Then she added, “There’s some sort of growth there. I don’t like the look of it.”

Back in his own office, Dr. Charles Dornberger had telephoned Kent O’Donnell to report the outcome of the talk with Pearson. At the end he had told the chief of surgery, “I’ve let Joe know about the man you people have been corresponding with.”

O’Donnell had asked, “How did he take it?”

“I wouldn’t say he was enthusiastic,” Dornberger said. “But I think if you want to have this fellow . . . what’s his name—Coleman? . . . if you want to have him come here for a talk, Joe won’t be difficult. But I’d suggest you keep Joe posted on everything you do from here on in.”

“You can be sure of that,” O’Donnell had said. Then, “Thanks, Charlie. Thank you very much.”

Afterward Dornberger had made another telephone call. It was to Mrs. John Alexander, who had phoned earlier that morning and left a message. Before calling he had looked up his record card and was reminded that this was the wife of the pathology technologist, referred to him by Joe Pearson. Talking with Mrs. Alexander, he learned that she had just arrived in town to join her husband. They made an appointment for her to come to Dornberger’s downtown office the following week.

About the same time that Mrs. Alexander was talking with Dornberger her husband was receiving his first tongue-lashing from Dr. Joseph Pearson. It happened this way.

After Pearson’s outburst that morning about the poor-quality surgical slides, Bannister had come back to the serology lab where John Alexander was working and had told him the whole story. By this time Bannister was seething, and later he had taken out some of his own bad humor on the two girl technicians and their male helper who worked in the histology lab next door. Alexander had heard what was said through the doorway which Bannister had left open behind him.

Alexander, though, knew that not all the blame for the bad slides lay with the histology technicians. Even in the short time he had been at the hospital he had sensed the real problem, and afterward he had told Bannister, “You know, Carl, I don’t believe it’s all their fault. I think they have too much to do.”

Bannister had answered sourly, “We’ve all got too much to do.” Then with clumsy sarcasm he had added, “Maybe if you know so much about it you can do your own work and part of theirs as well.”

Alexander had declined to be provoked. “I don’t think so. But I do think they’d be a lot better off with a tissue-processing machine instead of having to do everything by hand—the old-fashioned way.”

“Forget it, kid. It isn’t your problem.” Bannister had been loftily condescending. “And, besides, anything that means spending money around here is a dead duck before it starts.”

Alexander had not argued. But he resolved to raise the subject, the first chance he got, with Dr. Pearson.

He had had to go into Pearson’s office that afternoon to leave some lab reports for signature, and he had found the pathologist going through a pile of mail with obvious impatience. Glancing up at Alexander, Pearson had motioned him to put the papers on the desk and had gone on with his reading. Alexander had hesitated, and the old man had barked, “What is it? What is it?”

“Dr. Pearson, I was wondering if I could make a suggestion.”

“Now?”

A more experienced hand would have known the tone of voice meant: Leave me alone. Alexander answered, “Yes, sir.”

Resignedly Pearson said, “Well?”

A little nervously Alexander began, “It’s about speeding up the surgical reports, Doctor.” As he mentioned surgical reports, Pearson had put down his letter and looked up sharply. Alexander went on, “I was wondering if you’d ever thought of getting a tissue-processing machine.”

“What do you know about tissue processors?” There was an ominous note in Pearson’s voice. “And anyway, I thought we put you to work in Serology.”

Alexander reminded him, “I did a full course in histology at technologists’ school, Doctor.” There was a pause. Pearson said nothing, so Alexander went on. “I’ve used a tissue processor and it’s a good machine, sir. It would save us at least a day in preparing slides. Instead of processing tissue by hand through all the solutions, you set the machine overnight and automatically by morning—”

Abruptly Pearson cut in. “I know how it works. I’ve seen them.”

Alexander said, “I see, sir. Then don’t you think—”

“I said I’ve seen these so-called tissue processors and I’m not impressed.” Pearson’s Voice was harsh and grating. “There’s not the quality in the slides that there is with the old hand method. What’s more, the machines are expensive. You see these?” He riffled through a stack of typed yellow forms in a tray on his desk.

“Yes, sir.”

“They’re purchase requisitions. For things I need in this department. And every time I put a bunch through I have a fight with the administrator. He says we’re spending too much money.”

Alexander had made his first mistake in broaching the suggestion when Pearson had not wanted to hear. Now he made a second error. He mistook Pearson’s statement as an invitation to continue the discussion.

He said placatingly, “But surely, if it would save a whole day, maybe two . . .” He became more earnest. “Dr. Pearson, I’ve seen slides made with a processor and they’re good. Perhaps the one you saw wasn’t being used properly.”

Now the older man had risen from his chair. Whatever the provocation, Alexander had overstepped the bounds between physician and technologist. Head forward, Pearson shouted, “That’ll do! I said I’m not interested in a tissue processor, and that’s what I meant, and I don’t want any argument about it.” He came around the desk until he was directly in front of Alexander, his face close to the younger man’s. “And there’s something else I want you to remember: I’m the pathologist here and I’m running this department. I don’t mind suggestions if they’re reasonable. But don’t get stepping out of line. Understand?”

Date: 2014-12-21; view: 821