The Final Diagnosis

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.”

Coleman scribbled the order and signed it. With a tight, cool smile, “I expect to have a good deal more responsibility here than just ordering fifteen dollars’ worth of rabbit serum,” he said. “There you are.” As he handed back the pad and pencil the phone rang on the other side of the lab.

It was an excuse for Bannister to turn his back. His face red with anger and frustration, he crossed to the wall phone to answer it. After listening briefly he gave a curt answer and replaced the instrument. “Gotta go down to Outpatients.” The words, almost mumbled, were addressed to Coleman.

He answered icily, “You can go ahead.”

With the incident closed Coleman found himself more angry than he had realized. What kind of discipline existed which allowed insolence like this from a lab technician? The inadequate procedure was serious enough. But having to correct it over the objections of someone like this man Bannister was intolerable. If this were the general order of things, it seemed probable that the entire pathology department was even more run-down than he had believed at first.

With Bannister gone he began to take a more careful look at the rest of the lab. The worn equipment, some of it inadequate, had already been evident. Now he saw how deplorably sloppy and disorganized the whole place was. The tables and benches were cluttered untidily with an assortment of apparatus and supplies. He noticed a heap of dirty glassware, a pile of yellowed papers. Moving across the lab, he observed a section of a worktable with fungus growing from it. From the other side of the room Alexander was uncomfortably watching the inspection.

“Is this the way the lab is usually kept?” Coleman asked.

“It isn’t very tidy, is it?” Alexander felt a surge of shame that anyone should see this place the way it was. What he could not say was that he had already offered to reorganize it but Bannister had emphatically told him to leave things the way they were.

“I’d put it a little stronger than that.” Coleman ran one of his fingers over a shelf. It came away grimed with dust. He thought disgustedly: All this is something to be changed. On second thought, though, it might have to wait awhile. He knew he was going to have to be cautious in his dealings with people here, and his own experience had already taught him that there were limits to what you could accomplish quickly. All the same, he knew it would be hard to curb his own natural impatience, especially with this sort of mess visible right under his nose.

For the past few moments John Alexander had been watching Coleman closely. Ever since this new doctor had first come in with Bannister there had been something vaguely familiar about him. He was young—probably not much older than Alexander himself. But it was not that alone. Now Alexander said, “Doctor, excuse my mentioning it, but I have a feeling we’ve met somewhere before.”

“It’s possible.” Coleman was elaborately casual. Because he had supported this man in one incident, he did not want him to get any impression there was some sort of alliance between them. Then it occurred to him that perhaps he had been a little too curt. He added, “I interned at Bellevue, then I was at Walter Reed and Massachusetts General.”

“No.” Alexander shook his head. “It must have been before then. Have you ever been in Indiana? New Richmond?”

“Yes,” Coleman said, startled, “I was born there.”

John Alexander beamed. “I should have remembered the name, of course. Your father would be . . . Dr. Byron Coleman?”

“How do you know that?” It had been a long time since someone other than himself had recalled his father’s name.

“I’m from New Richmond too,” Alexander said. “So is my wife.”

“Really?” Coleman asked. “Did I know you there?”

“I don’t think so, though I remember seeing you a couple of times.” In the social life of New Richmond, John Alexander had been several stages removed from the orbit of the doctor’s son. As the thought occurred to him, there was a “ping” from the centrifuge timer. He paused to remove the blood sample which had been spun down, then went on, “My father was a truck farmer. We lived a few miles outside town. You may remember my wife though. Her family had the hardware store. She was Elizabeth Johnson.”

Coleman said thoughtfully, “Yes, I believe I do.” Memory stirred. “Wasn’t there something about her . . . she was in an accident of some sort?”

“That’s right; she was,” John Alexander said. “Her father was killed in his car at the rail crossing. Elizabeth was with him.”

“I remember hearing about it.” David Coleman’s mind flew back over the years—to the country doctor’s office in which his father had healed so many bodies until in the end his own had failed him. He said, “I was away at college at the time, but my father told me afterward.”

“Elizabeth almost died. But they gave her blood transfusions and she made it. I think that was the first time I was ever in a hospital. I almost lived there for a week.” Alexander paused. Then, still pleased at his discovery, “If you happen to be free one evening, Dr. Coleman, I’m sure my wife would enjoy meeting you. We have a small apartment . . .” He hesitated, sensing the truth: though both had moved on from New Richmond, there was still a social gulf between them.

Coleman was aware of it too. His brain clicked out a warning: be cautious of alliances with subordinates—even one like this. He rationalized: It isn’t snobbery; it’s just a matter of hospital discipline and common sense. Aloud he said, “Well, I’m going to be working quite hard for a while. Let’s leave it, shall we, and see how things go?”