The Final Diagnosis

“If you’re sure it’s not too much trouble.”

Ignoring the sarcasm, Coleman said, “Yesterday afternoon I told both serology technicians that I planned to make occasional spot checks of laboratory work. Early this morning I did make one such check.” Coleman glanced at Bannister. “I intercepted a patient’s specimen before delivery to the serology lab and divided the specimen into two. I then added the extra sample to the listing on the requisition sheet, showing it as an extra test. Later, when I checked, I found that Mr. Bannister had recorded two different test results when, of course, they should have been identical.” He added, “If you wish, we can get the details from the lab record now.”

Pearson shook his head. He had risen from his chair and was half turned away; he appeared to be thinking. Coleman wondered curiously what would happen next. He knew that he himself was on perfectly secure ground. The procedure he had followed was standard in most well-run hospital labs. It provided a protection for patients and was a safeguard against carelessness. Conscientious technicians accepted lab checks without resentment and as a part of their job. Moreover, Coleman had followed protocol in telling both Bannister and John Alexander yesterday that the checks would be made.

Abruptly Pearson wheeled on Bannister. “All right, what have you got to say?”

“I don’t like being spied on.” The answer was resentful and aggressive. “I’ve never had to work that way before and I don’t figure I should start now.”

“And I tell you you’re a fool!” Pearson shouted the words. “You’re a fool for making a damn silly mistake, and you’re an even bigger fool for coming to me when you get caught out.” He paused, his lips tight, his breathing heavy. Coleman sensed that part of the old man’s anger stemmed from his frustration at having no choice but to support what the younger pathologist had done, much as he might dislike it. Now, standing directly in front of Bannister, he snarled, “What did you expect me to do—pat you on the back and give you a medal?”

Bannister’s face muscles were working. For once he appeared to have no answer. Surveying him grimly, Pearson seemed about to go on, then abruptly he stopped. Turning partly away, he gestured with his hand. “Get out! Get out!”

Without a word, his face set, looking neither to right nor left, Bannister went out of the room and closed the door behind him.

Now Pearson turned sharply to Coleman. “What the devil do you mean by this?”

David Coleman could see the burning anger in the old man’s eyes. He realized that the affair with Bannister was merely a preliminary skirmish. Determined not to lose his own temper, he answered mildly, “What do I mean by what, Dr. Pearson?”

“You know damn well what I mean! I mean by making lab checks—without my authority.”

Coleman said coldly, “Do I really need your authority? For something routine like that?”

Pearson slammed his fist on the desk. “Any time I want lab checks I’ll order them!”

“If it’s of any interest,” Coleman said, still quietly, “I happen to have had your authority. As a matter of courtesy I mentioned to you yesterday that I would like to do standard lab checks in Serology, and you agreed.”

Suspiciously Pearson said, “I don’t remember.”

“I assure you the conversation took place. In any case, I’m not in the habit of making that kind of invention.” David Coleman felt his own anger rising; it was hard to conceal his contempt for this aged incompetent. He added, “I may say you seemed rather preoccupied at the time.”

He appeared to have checked Pearson, at least partially. Grumblingly the old man said, “If you say so, I’ll believe you. But it’ll be the last time you do something like that on your own. Understand?”

Coleman sensed that this was a critical moment, both for Pearson and himself. Icily he asked, “Do you mind telling me what kind of responsibility I’m to have in this department?”

“You’ll get whatever I choose to give you.”

“I’m afraid I don’t find that at all satisfactory.”

“You don’t, eh?” Pearson was directly in front of the younger man now, his head jutted forward. “Well, there happen to be a few things I don’t find satisfactory either.”

“For instance?” David Coleman had no intention of being intimidated. And if the old man wanted a showdown, he himself was quite willing to have it, here and now.

“For instance, I hear you’ve been laying down the law in the autopsy room,” Pearson said.

“You asked me to take charge of it.”

“I told you to supervise autopsies, not to set up a lot of fancy rules. No smoking, I understand. Is that supposed to include me?”

“I imagine that will be up to you, Dr. Pearson.”

“I’ll say it’ll be up to me!” The other’s calmness seemed to make Pearson angrier. “Now you listen to me, and listen good. You may have some pretty fancy qualifications, mister, but you’ve still got a lot to learn and I’m still in charge of this department. What’s more, there are good reasons I’m going to be around here for a long time yet. So now’s the time to decide—if you don’t like the way I run things, you know what you can do.”

Before Coleman could answer there was a knock on the door. Impatiently Pearson called out, “Yes?”

A girl secretary came in, glancing curiously from one to the other. It occurred to Coleman that Pearson’s voice, at least, must have been clearly audible in the corridor outside. The girl said, “Excuse me, Dr. Pearson. There are two telegrams for you. They just came.” Pearson took the two buff envelopes the girl held out.

When she had gone Coleman was about to reply. But Pearson stopped him with a gesture. Beginning to thumb open the first envelope, he said, “These will be the answers about the girl—Lucy Grainger’s patient.” His tone was quite different from that of a few moments before. He added, “They took long enough about it.”

Automatically David Coleman felt a quickening of interest. Tacitly he accepted Pearson’s view that their argument could be postponed; this was more important. As Pearson had the first flap open the telephone jangled sharply. With an exclamation of annoyance he put the two envelopes down to answer it.

“Yes?”

“Dr. Pearson, this is Obstetrics,” a voice said. “Dr. Dornberger is calling you. One moment, please.”

There was a pause, then Dornberger came on the line. He said urgently, “Joe, what’s wrong with you people in Pathology?” Without waiting for an answer, “Your technician’s wife—Mrs. Alexander—is in labor and the baby will be premature. She’s on the way here in an ambulance, and I haven’t got a blood-sensitivity report. Now get it up here fast!”

“Right, Charlie.” Pearson slammed the receiver down and reached for a pile of forms in a tray marked “Signature.” As he did, the two telegraph envelopes caught his eye. Quickly he passed them to Coleman. “Take these. See what they say.”

Pearson riffled through the forms. The first time, in his haste, he missed the one he wanted; the second time through he found it. He lifted the telephone again, listened, then said brusquely, “Send Bannister in.” Replacing the phone, he scribbled a signature on the form he had removed.

“You want me?” Bannister’s tone and expression made it plain that he was still smarting from the reprimand earlier.

“Of course I want you!” Pearson held out the form he had signed. “Get this up to Dr. Dornberger—fast. He’s in Obstetrics. John Alexander’s wife is in trouble. She’s going to have a premie.”

Bannister’s expression changed. “Does the kid know? He’s down in—”

Impatiently Pearson cut him off. “Get going, will you! Get going!” Hastily Bannister went out with the form.

Dimly David Coleman had been aware of what was going on around him. His mind, however, had not yet grasped the details. For the moment he was too concerned with the awesome significance of the two telegrams which he held, opened, in his hand.

Now Pearson turned to him. The old man said, “Well, does the girl lose her leg or not? Are they both definite?”

Coleman thought: This is where pathology begins and ends; these are the borderlands where we must face the truth of how little we really know; this is the limit of learning, the rim of the dark, swirling waters of the still unknown. He said quietly, “Yes, they’re both definite. Dr. Chollingham in Boston says, ‘Specimen definitely malignant.’ Dr. Earnhart in New York says, ‘The tissue is benign. No sign of malignancy.’ ”

There was a silence. Then Pearson said slowly, softly, “The two best men in the country, and one votes ‘for,’ the other ‘against.’ ” He looked at Coleman, and when he spoke there was irony but no antagonism. “Well, my young pathologist friend, Lucy Grainger expects an answer today. She will have to be given one, and it will have to be definite.” With a twisted smile, “Do you feel like playing God?”

Sixteen

A police patrolman on duty at Main and Liberty heard the ambulance’s siren six blocks away. Moving out from the sidewalk, and with the skill of long practice, he began to expedite the traffic flow so as to leave the intersection clear. As the siren grew louder and the flashing warning light became visible, threading its way toward him, the patrolman inflated his cheeks and blew two sharp whistle blasts. Then, signaling a halt to all traffic in the side roads, he authoritatively waved the ambulance driver through a red light. Pedestrians at the intersection, turning their heads curiously, caught a blurred glimpse of a young woman’s white face as the ambulance swept by.

Inside, Elizabeth was only dimly conscious of their progress through the busy city streets. She sensed they were moving fast, but the buildings and people outside were a confused pattern racing past the window near her head. Momentarily, between each onset of pain, she could see the driver up ahead, his two big hands nursing the wheel, turning quickly, first right, then left, taking advantage of every opening as it occurred. Then the pain came back and all she could think of was to cry out and to hold on.

“Hold my wrists! And hang on all you want.” It was the ambulance attendant, leaning over her. He had a stubble of beard and a cleft chin, and for a moment Elizabeth believed it was her father come here now to comfort her. But her father was dead; hadn’t he been killed at the railroad? Or perhaps he had not and he was in this ambulance along with her, being taken to some place they could be cared for together. Then her head cleared and she saw it was not her father but a stranger whose wrists were red with the gouge marks her nails had made.

She had time to touch the marks before the next pain came. It was a gesture, all she could do. The man shook his head. “Don’t worry. Just you hold on all you want. We’ll be there soon. Old Joe up front is the best wagon driver in the city.” Then the pain again, worse than before, the intervals between growing shorter, the sensation as if all her bones were being twisted beyond endurance with the agony centered in her back, the torture of it overflowing into a flame of red, yellow, purple in front of her eyes. Her nails dug deeper and she screamed.