The Final Diagnosis

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.”