Artropods and Human Disease 11 page

For a moment he had been shocked. Then he had laughed and fallen in love all over again with her honesty and simple frankness. He said, “You mean here? Now?”

“Why not?”

“If anyone came I’d be thrown out of the hospital.”

Softly she said, “You weren’t so worried about that the other night.” Her finger tips moved lightly down his face. Impulsively he had bent and kissed her neck. As his lips moved lower he heard her breathing quicken and felt her fingers tighten on his shoulder.

For a moment he had been tempted, then sanity won out. He put his arms around her. Tenderly he murmured, “When all this is over, Vivian darling, then we’ll be really alone. What’s more, we’ll have all the time we want.”

That was yesterday. This afternoon, on the operating floor, Lucy Grainger would be performing the biopsy. Mike Seddons looked at his watch. It was 2:30 p.m. According to the O.R. schedule, they should be starting now. If Pathology worked fast the answer might be known by tomorrow. With a fervor at once incongruous and real he found himself praying: Oh, God! Please, God—let it be benign!

The anesthetist nodded. “We’re ready when you are, Lucy.”

Dr. Lucy Grainger came around to the head of the operating-room table. She was already gloved and gowned. Smiling down at Vivian, she said reassuringly, “This won’t take long, and you won’t feel a thing.”

Vivian tried to smile back confidently. She knew, though, she didn’t quite succeed. Maybe it was because she was a little drowsy—she was aware that she had been given some kind of sedation as well as the spinal anesthetic which had taken away all feeling from the lower portion of her body.

Lucy nodded to her assisting intern. He lifted Vivian’s left leg, and Lucy began to remove the towels which were taped around it. Earlier this morning, before Vivian had been brought to the operating floor, the leg had been shaved, bathed thoroughly, and painted with merthiolate. Now Lucy repeated the antiseptic procedure and draped fresh sterile towels above and below the knee.

On the other side of the operating table the scrub nurse was holding a folded green sheet. With Lucy taking one side, they draped it over the table so that a hole in the sheet was immediately above the exposed knee. The anesthetist reached over, fastening the top of the sheet to a metal bar above Vivian’s head, so that her view of the rest of the operating room was cut off. As he looked down at her he said, “Just stay relaxed, Miss Loburton. This is really like having a tooth out—only a lot more comfortable.”

“Knife, please.” Lucy held out her hand and the scrub nurse put a scalpel into it. Using the belly portion of the blade, she made a quick, firm incision, just below the knee and about four centimeters long. Immediately blood welled up.

“Mosquito clamps.” The scrub nurse was ready, and Lucy clamped off two small spurters. “Will you tie off, please?” She moved back to allow the intern to put ligatures around both clamps.

“We’ll make our incision through the periosteum.” The intern nodded as Lucy applied the knife she had used previously to the thick fibrous tissue above the bone, cutting cleanly down.

“Ready for the saw.” The scrub nurse passed Lucy a Stryker oscillating saw. Behind her a circulating nurse held the trailing electric cable clear of the operating table.

Talking again for the intern’s benefit, Lucy said, “We shall take a wedge-shaped sample of bone. About half to three-quarters of an inch should be enough.” She glanced up at the X-ray films, in place on a lighted screen at the end of the room. “We must be sure, of course, that we are into the tumor and don’t take a piece of normal bone that has been forced outward.”

Lucy switched on the saw and applied it twice. There was a soft crunching sound each time it bit into bone. Then she switched off and passed the saw back. “There, I think that will do. Tweezers!”

Gingerly she extracted the bone sample, dropping it into a small jar of Zenker’s solution which the circulating nurse was holding out. Now the specimen—identified and accompanied by a surgical work requisition—would go to Pathology.

The anesthetist asked Vivian, “Still feel all right?”

She nodded.

He told her, “They won’t be long now. The bone sample is out. All they have to do is zip up your knee.”

At the table Lucy was already sewing the periosteum, using a running suture. She was thinking: If only this were all, how simple everything would be. But this was merely exploratory. The next move would depend on Joe Pearson’s verdict about the bone sample she was sending to him.

The thought of Joe Pearson reminded Lucy of what she had learned earlier from Kent O’Donnell: that this was the day on which the hospital’s new assistant pathologist was due to arrive in Burlington. She hoped that things would go smoothly with the new man—for O’Donnell’s sake as much as any other reason.

Lucy respected the chief of surgery’s efforts to achieve improvement within the hospital without major upheavals, though she knew from observation that O’Donnell would never shun an issue if it really became necessary to meet it head on. There she went again, she reflected: thinking about Kent O’Donnell. It was strange how, just recently, her thoughts had kept returning to him. Perhaps it was the proximity in which they worked; there were few days when the two of them failed to meet sometime during their stint in surgery. Now Lucy found herself wondering how soon it would be before he invited her to dinner once more. Or perhaps she could arrange a small dinner party at her own apartment. There were a few people she had been planning to invite for some time, and Kent O’Donnell could be among them.

Lucy let the intern move in to sew the subcutaneous tissue. She told him, “Use interrupted sutures; three should be sufficient.” She watched closely. He was being slow but careful. She knew some of the surgeons at Three Counties gave interns very little to do when they were assisting. But Lucy remembered how many times she herself had stood by an operating table, hoping for at least a little practice in tying knots.

That had been in Montreal—all of thirteen years ago since she had begun her internship at Montreal General, then stayed on to specialize in orthopedic surgery. She had often thought how much chance there was in the specialty which anyone in medicine decided to enter. Often so much depended on the kind of cases you became involved in as an intern. In her own case, in pre-med school at McGill, and later at Toronto University School of Medicine, her interest had switched first to one field, then to another. Even on return to Montreal she had been undecided whether to specialize at all or enter general practice. But then chance had caused her to work for a while under the tutelage of a surgeon known to the hospital generally as “Old Bones,” because of his concern with orthopedics.

When Lucy first knew him, Old Bones had been in his mid-sixties. In terms of behavior and personality, he was one of the most objectionable people she had ever met. Most teaching centers have their prima donnas; in Old Bones the worst habits of them all had appeared to be combined. He regularly insulted everyone in the hospital—interns, residents, his own colleagues, patients—with equal impartiality. In the operating room, if crossed at all, he had shouted abuse at nurses and assistants in language borrowed from the barroom and the water front. If handed a wrong instrument, on his normal days he would throw it back at the offender; in a more tolerant mood he would merely hurl it at the wall.

Yet, for all the performance, Old Bones had been a master surgeon. He had worked mostly on correcting bone deformities in crippled children. His spectacular successes had made his fame world-wide. He never modified his manner, and even the children he dealt with got the same rough treatment as their elders. But, somehow, children seldom seemed to fear him. Lucy had often wondered if childish instinct were not a better barometer than adult reasoning.

But it was the influence of Old Bones that really decided Lucy’s future. When she had seen at first hand what orthopedic surgery could accomplish, she had wanted to share the accomplishment herself. She had stayed at Montreal General as a three-year intern, assisting Old Bones whenever it was possible. She had copied everything from him except his manner. Even toward Lucy that had never changed, though near the end of her senior internship she took pride in the fact that he had shouted at her a good deal less than at other people.

Since then, in the time she had been in practice, Lucy had had successes of her own. And in Burlington her referrals from other physicians nowadays made her one of the busiest people on Three Counties’ staff. She had gone back to Montreal only once—on an occasion two years earlier, to attend Old Bones’ funeral. People said it was one of the biggest funerals of a medical man the city had ever seen. Practically everyone the old man had ever insulted had been present in the church.

Her mind switched back to the present. The biopsy was almost complete. At a nod from Lucy the intern had gone on to sew up the skin, again using interrupted sutures. Now he was putting in the final one. Lucy glanced at the wall clock above her. The whole procedure had taken half an hour. It was 3 p.m.

At seven minutes to five a sixteen-year-old hospital messenger sashayed, whistling, hips swaying, into the serology lab. Usually he came in this way because he knew it infuriated Bannister, with whom he maintained a state of perpetual running warfare. As usual, the senior lab technician looked up and snarled at him. “I’m telling you for the last time to stop making that infernal racket every time you come in here.”

“I’m glad it’s the last time.” The youth was unperturbed. “Tell you the truth, all that complainin’ o’ yours was get’n on my nerves a bit.” He went on whistling and held up the tray of blood samples he had collected from the outpatients’ lab. “Where you want this blood, Mr. Dracula?”

John Alexander grinned. Bannister, however, was not amused. “You know where it goes, wise guy.” He indicated a space on one of the lab benches. “Put it over there.”

“Yessir, captain, sir.” Elaborately the youth put down the tray and gave a mock salute. Then he essayed a pelvic gyration and moved toward the door singing:

“Oh, give me a home where the viruses roam,

Where the bugs and the microbes all play,

When often is heard an old bloodsucker’s word,

And the test tubes stand stinkin’ all day.”

The door swung closed and his voice faded down the corridor.

Alexander laughed. Bannister said, “Don’t laugh at him. It just makes him worse.” He crossed to the bench and picked up the blood specimens, glancing casually at the work sheet with them. Halfway across the lab he stopped.

“Hey, there’s a blood sample here from a Mrs. Alexander. Is that your wife?”

Alexander put down the pipette he had been using and moved across. “It probably is. Dr. Dornberger sent her in for a sensitivity test.” He took the work sheet and looked down it. “Yes, it’s Elizabeth all right.”

“It says typing and sensitivity both,” Bannister said.

“I expect Dr. Dornberger wanted to be sure. Actually Elizabeth is Rh negative.” As an afterthought he added, “I’m Rh positive.”

Expansively, and with a fatherly air of great knowledge, Bannister said, “Oh well, most of the time that doesn’t cause any trouble.”

“Yes, I know. All the same, you like to be sure.”

“Well, here’s the specimen.” Bannister picked out the test tube labeled “Alexander, Mrs. E.” and held it up. “Do you want to do the test yourself?”

“Yes, I would. If you don’t mind.”

Bannister never objected to someone else doing work which might otherwise fall to himself. He said, “It’s all right with me.” Then, glancing at the clock, he added, “You can’t do it tonight though. It’s quitting time.” He replaced the test tube and handed the tray to Alexander. “Better put this lot away until the morning.”

Alexander took the blood samples and put them in the lab refrigerator. Then, closing the refrigerator door, he paused thoughtfully.

“Carl, there’s something I’ve been meaning to ask you.”

Bannister was busily clearing up. He always liked to leave right on the dot of five. Without turning his head he asked, “What is it?”

“The blood-sensitization tests we’re doing here—I’ve been wondering about them.”

“Wondering what?”

Alexander chose his words carefully. Right from the beginning, because of his own college training, he had realized the possibility of arousing resentment in people like Bannister. He tried now, as he had before, to avoid giving offense. “I noticed we’re only doing two sensitization tests—one in saline, the other in high protein.”

“So?”

“Well,” Alexander said diffidently, “isn’t just doing the two tests alone . . . a bit out of date?”

Bannister had finished clearing up. He came around the center table, wiping his hands on a paper towel. He said sharply, “Suppose you tell me why.”

Alexander ignored the sharpness. This was important. He said, “Most labs nowadays are doing a third test—an indirect Coombs—after the test in saline.”

“A ‘what’ test?”

“An indirect Coombs.”

“What’s that?”

“Are you kidding?” The moment the words were out Alexander knew he had made a tactical mistake. But he had spoken impulsively, reasoning that no serology technician could fail to know of an indirect Coombs test.

The senior technician bridled. “You don’t have to get smart.”

Hastily trying to repair the damage, Alexander replied, “I’m sorry, Carl. I didn’t mean it to sound like that.”

Bannister crumpled the paper towel and threw it into a waste bin. “Well, that’s the way it did sound.” He leaned forward aggressively, his bald head reflecting a light bulb above. “Look, fella, I’ll tell you something for your own good. You’re fresh out of school, and one thing you haven’t found out is that some things they teach you there just don’t work out in practice.”

“This isn’t just theory, Carl.” Alexander was in earnest now, his blunder of a moment ago seeming unimportant. “It’s been proven that some antibodies in the blood of pregnant women can’t be detected either in a saline solution or high protein.”

“And how often does it happen?” Bannister put the question smugly, as if knowing the answer in advance.

“Very seldom.”

“Well, there you are.”

“But it’s enough to make the third test important.” John Alexander was insistent, trying to penetrate Bannister’s unwillingness to know. “Actually it’s very simple. After you’ve finished the saline test you take the same test tube—”

Bannister cut him off. “Save the lecture for some other time.” Slipping off his lab coat, he reached for the jacket of his suit behind the door.

Knowing it to be a losing argument, Alexander still went on. “It isn’t much more work. I’d be glad to do it myself. All that’s needed is Coombs serum. It’s true it makes the testing a little more expensive . . .”

This was familiar ground. Now Bannister could understand better what the two of them were talking about. “Oh, yeah!” he said sarcastically. “That would go great with Pearson. Anything that’s more expensive is sure to be a big hit.”

“But don’t you understand?—the other way isn’t foolproof.” Alexander spoke tensely; without realizing it he had raised his voice. “With the two tests we’re doing here you can get a negative test result, and yet a mother’s blood may still be sensitized and dangerous to the baby. You could kill a newborn child that way.”

“Well, it isn’t your job to worry about it.” This was Bannister at his crudest, the words almost snarled.

“But—”

“But nothing! Pearson isn’t keen on new ways of doing things—especially when they cost more money.” Bannister hesitated, and his manner became less aggressive. He was aware that it was one minute to five and he was anxious to wind this up and get away. “Look, kid, I’ll give you some advice. We’re not doctors, and you’d be smart to quit trying to sound like one. We’re lab assistants and we work in here the way we’re told.”

“That doesn’t mean to say I can’t think, does it?” It was Alexander’s turn to be aroused. “All I know is, I’d like to see my wife’s test done in saline, and in protein, and in Coombs serum. You may not be interested, but this baby happens to be important to us.”

At the door the older man surveyed Alexander. He could see clearly now what he had not realized before—this kid was a troublemaker. What was more, troublemakers had a habit of involving other people in uncomfortable situations. Maybe this smart-aleck college graduate should be allowed to hang himself right now. Bannister said, “I’ve told you what I think. If you don’t like it you’d better go see Pearson. Tell him you’re not satisfied with the way things are being run around here.”

Alexander looked directly at the senior technician. Then he said quietly, “Maybe I will.”

Bannister’s lip curled. “Suit yourself. But remember—I warned you.”

With a final glance at the clock he went out, leaving John Alexander in the laboratory alone.

Twelve

Outside the main entrance to Three Counties Hospital Dr. David Coleman paused to look around him. It was a few minutes after eight on a warm, mid-August morning, with promise already of a hot and sultry day ahead. At this moment there was little activity outside the hospital. Beside himself, the only other people in sight were a janitor, hosing some of yesterday’s dust from a section of the forecourt, and a middle-aged nurse who had just alighted from a bus on the opposite side of the street. The main stream of hospital business, he supposed, would not begin to flow for another hour or so.

David Coleman surveyed the block of buildings which comprised Three Counties. Certainly, he decided, the hospital’s builders could never be accused of having wasted money on aesthetic frills. The architecture was strictly utilitarian, the facings of plain brick unadorned by any other masonry. The effect was a succession of conventional rectangles: walls, doors, and windows. Only near the main doorway did the pattern vary, and here a single foundation stone announced, “Laid by His Honor Mayor Hugo Stouting, April 1918.” As he walked up the entry steps David Coleman found himself wondering what kind of a man that long-forgotten dignitary had been.

Carl Bannister was sorting papers on Dr. Pearson’s desk when Coleman knocked and entered the pathologist’s office.

“Good morning.”

Surprised, the senior lab technician looked up. It was unusual to have visitors this early. Most people around the hospital knew that Joe Pearson seldom arrived before ten o’clock, sometimes later.

“Good morning.” He returned the greeting, not too affably. Bannister was never at his best in the early morning. He asked, “Are you looking for Dr. Pearson?”

“In a way, yes. I’m starting work here today.” Seeing the other start, he added, “I’m Dr. Coleman.”

The effect, Coleman thought, was somewhat like letting off firecrackers under a hen. Bannister put down his papers hurriedly and came around the desk, almost at a run, his bald head gleaming. “Oh, excuse me, Doctor. I didn’t realize. I’d heard you were coming, but we had no idea it would be this soon.”

Coleman said calmly, “Dr. Pearson is expecting me. Is he in, by the way?”

Bannister seemed shocked. “You’re too early for him. He won’t be here for another two hours.” His face creased in a confidential man-to-man smile. It seemed to say: I expect you’ll keep the same kind of hours yourself as soon as the newness wears off.

“I see.”

As Coleman glanced around him Bannister remembered an omission. He said, “Oh, by the way, Doctor, I’m Carl Bannister—senior lab technician.” With careful geniality he added, “I expect we’ll be seeing a lot of each other.” Bannister made a habit of taking no chances with anybody senior to himself.

“Yes, I expect we will.” Coleman was not sure how much the idea appealed to him. But he shook hands with Bannister, then looked around for a place to hang the light raincoat he had brought; the morning forecast predicted thunder showers later in the day. Once again Bannister was alert to serve and please.

“Let me take your coat.” He found a wire hanger and carefully put coat and hanger on a rack near the door.

“Thank you,” Coleman said.

“That’s perfectly all right, Doctor. Now, would you like me to show you around the labs?”

Coleman hesitated. Perhaps he ought to wait for Dr. Pearson. On the other hand, two hours was a long time to sit around and he might as well be doing something in the meantime. The labs would be his domain anyway. What was the difference? He said, “I saw part of the labs with Dr. Pearson when I was here a few weeks ago. But I’ll take another look if you’re not too busy.”

“Well, of course, we’re always busy around here, Doctor. But I’ll be glad to take the time for you. In fact, it’ll be a pleasure.” The working of Bannister’s mind was incredibly transparent.

“This way, please.” Bannister had opened the door of the serology lab and stood back for Coleman to enter. John Alexander, who had not seen Bannister since their argument the night before, looked up from the centrifuge in which he had just placed a blood sample.

“Doctor, this is John Alexander. He just started work here.” Carl Bannister was warming to his role of showman. He added facetiously, “Still wet behind the ears from technology school, eh, John?”

“If you say so.” Alexander answered uncomfortably, resenting the condescension but not wanting to be rude.

Coleman moved forward, offering his hand. “I’m Dr. Coleman.”

As they shook hands Alexander said interestedly, “You mean you’re the new pathologist, Doctor?”

“That’s right.” Coleman glanced around him. As he had on the previous visit, he could see that a lot of changes would need to be made in here.

Bannister said expansively, “You just look around, Doctor—at anything you want.”

“Thank you.” Turning back to Alexander, Coleman asked, “What are you working on now?”

“It’s a blood sensitization.” He indicated the centrifuge. “This specimen happens to be from my wife.”

“Really.” Coleman found himself thinking this young lab assistant was a good deal more impressive than Bannister. In appearance anyway. “When is your wife having her child?” he asked.

“In just over four months, Doctor.” Alexander balanced the centrifuge and switched it on, then reached over to set a timing dial. Coleman noticed that all the movements were economical and quick. There was a sense of fluidity in the way this man used his hands. Politely Alexander asked, “Are you married, Doctor?”

“No.” Coleman shook his head.

Alexander seemed on the point of asking another question, then appeared to change his mind.

“Did you want to ask me something?”

For a moment there was a pause. Then John Alexander made up his mind. “Yes, Doctor,” he said. “I do.”

Whether this meant trouble or not, Alexander thought, at least he would bring his doubts out into the open. Last night, after the dispute with Bannister, he had been tempted to drop the whole subject of the extra test on blood samples coming to the lab. He remembered only too clearly the dressing down he had received from Dr. Pearson on the last occasion he had chosen to make a suggestion. This new doctor, though, certainly seemed easier to deal with. And even if he considered Alexander wrong, it didn’t seem likely there would be any big scene. He took the plunge. “It’s about the blood tests we’re doing—for sensitization.”

As they had been speaking he had become aware of Banister in the background, the older technician moving his bald head from side to side, intent on missing nothing that was said. Now he moved forward, annoyed and aggressive, to put Alexander in his place. “Now listen! If that’s what you were talking about last night, you leave it alone!”

Coleman asked curiously, “What was it you were talking about last night?”

Ignoring the question, Bannister continued to lecture Alexander. “I don’t want Dr. Coleman bothered with stuff like that five minutes after he gets here. Forget it! Understand?” He turned to Coleman, the automatic smile switched on. “It’s just some bee he’s got in his bonnet, Doctor. Now, if you’ll come with me, I’ll show you our histology setup.” He put a hand on Coleman’s arm to steer him away.

For the space of several seconds Coleman did nothing. Then, deliberately, he reached down and removed the hand from his sleeve. “Just a moment,” he said quietly. Then to Alexander, “Is this something medical? To do with the laboratory?”

Deliberately avoiding Bannister’s scowl, Alexander answered, “Yes, it is.”

“All right, let’s hear it.”

“It came up, really, because of this blood-sensitization test—the one for my wife,” Alexander said. “She’s Rh negative; I’m Rh positive.”

Coleman smiled. “Well, that applies to plenty of people. There’s no problem—that is, as long as the sensitization test shows a negative result.”

“But that’s the point, Doctor—the test.”

“What about it?” Coleman was puzzled. He was not at all clear about what this young lab assistant was getting at.

Alexander said, “I think we should be doing an indirect Coombs test on all these samples, after the tests in saline and high protein.”

“Of course.”

There was a silence which Alexander broke. “Would you mind saying that again, Doctor?”

“I said ‘of course.’ Naturally there should be an indirect Coombs.” Coleman still could see no point in this discussion. For a serology lab this sort of thing was elementary, basic.

“But we’re not doing an indirect Coombs.” Alexander shot a triumphal glance at Bannister. “Doctor, the Rh-sensitivity tests here are all being done just in a saline solution and in high protein. There’s no Coombs serum being used at all.”

At first Coleman was sure Alexander must be wrong. Apparently the young technologist had been working here only a short time; no doubt he had become confused. Then Coleman remembered the tone of conviction in which the statement had been made. He asked Bannister, “Is this true?”

“The way we do all our tests are according to Dr. Pearson’s instructions.” The elderly technician made it plain that in his opinion the entire discussion was a waste of time.

“Perhaps Dr. Pearson doesn’t know you’re doing the Rh tests that way.”

“He knows all right.” This time Bannister let his surliness come through. It was always the same with new people. They weren’t inside a place five minutes before they started making trouble. He had tried to be pleasant with this new doctor, and look what you got for it. Well, one thing was for sure—Joe Pearson would soon put this fellow in his place. Bannister just hoped he was around to see it happen.

Coleman decided to ignore the senior technician’s tone. Whether he liked it or not he was going to have to work with this man for a while. All the same, this thing had to be cleared up now. He said, “I’m afraid I don’t quite understand. Surely you know that some antibodies in the blood of pregnant women will get past a saline test and a high-protein test, whereas they won’t if you go on and do a further test in Coombs serum.”

Alexander interjected, “That’s what I’ve been saying.”

Bannister made no answer. Coleman went on, “Anyway, I’ll mention it to Dr. Pearson sometime. I’m sure he wasn’t aware of it.”

“What shall we do about this test?” Alexander asked. “And the others from here on?”

Coleman answered, “Do them in all three mediums, of course—saline, high protein, and Coombs serum.”

“We haven’t any Coombs serum in the lab, Doctor.” Alexander was very glad now that he had brought this up. He liked the look of this new pathologist. Maybe he’d change some other things around the place. Goodness knows, he thought, there’s plenty that can stand it.

“Then let’s get some.” Coleman was deliberately brisk. “There’s no shortage anywhere.”

“We can’t just go out and get lab supplies,” Bannister said. “There has to be a purchase requisition.” He wore a superior smile. There were some things, after all, these Johnny-come-latelys didn’t know.

Coleman carefully kept his feelings in check. Sometime soon it might be necessary to have a showdown with this man Bannister; he certainly had no intention of taking this kind of behavior permanently. But the first day of arrival was obviously not the time. He said pleasantly enough, but firmly, “Let me have the form then. I imagine I can sign it. That’s one of the reasons I’m here.”

Briefly the older technician hesitated. Then he opened a drawer and produced a pad of forms which he handed to Coleman.

“A pencil, please?”

With the same reluctance Bannister produced one. Handing it over, he said pettishly, “Dr. Pearson likes to order all lab supplies himself.”

Date: 2014-12-21; view: 788