The Final Diagnosis

The young nurse in charge of the premature nursery—the same nurse whom John Alexander had seen a few days before—had been looking at Dornberger expectantly. She said, “His breathing was quite steady until an hour ago, then it became weak. That was when I called you.”

A student nurse around the other side of the incubator was following the conversation closely, her eyes above her gauze mask darting from Dornberger to the charge nurse and back again.

“No, he’s not breathing well,” Dornberger said slowly. He went on, thinking out loud, trying to be sure there was nothing he had missed, “There’s more jaundice than there should be, and the feet seem swollen. Tell me again—what was the blood count?”

The charge nurse consulted her clip board. “R.B.C. four point nine million. Seven nucleated red cells per hundred white.”

There was another pause, the two nurses watching while Dornberger digested the information. He was thinking: There’s altogether too much anemia, though of course it might be an exaggerated normal-type reaction. Aloud he said, “You know, if it weren’t for that sensitivity report I’d suspect this child had erythroblastosis.”

The charge nurse looked surprised. She said, “But surely, Doctor,” then checked herself.

“I know—it couldn’t happen.” He motioned to the clip board. “All the same, let me see that lab report—the original one on the mother’s blood.”

Turning over several sheets, the charge nurse found the form and extracted it. It was the report which Dr. Pearson had signed following the altercation with David Coleman. Dornberger studied it carefully, then handed it back. “Well, that’s definite enough—negative sensitivity.”

It should be definite, of course; but at the back of his mind was a nagging thought: Could the report be wrong? Impossible, he told himself; the pathology department would never make a mistake like that. All the same, he decided, he would drop in and talk with Joe Pearson after rounds.

To the charge nurse Dornberger said, “There’s nothing more we can do at the moment. Call me again, please, if there’s any change.”

“Yes, Doctor.”

When Dornberger had gone the student nurse asked, “What was it the doctor said—erythro . . . ?” She stumbled on the word.

“Erythroblastosis—it’s a blood disease in babies. It happens sometimes when the mother’s blood is Rh negative and the father’s Rh positive.” The young charge nurse with the red hair answered the question carefully but confidently, as she always did. The students liked being assigned to her; as well as having a reputation for being one of the most able nurses on staff, she was little more than twelve months away from her own student days, having graduated at the top of the senior class the year before. Knowing this, the student had no hesitation in extending her questioning.

“I thought when that happened they changed the baby’s blood at birth.”

“You mean by an exchange transfusion?”

“Yes.”

“That only happens in some cases.” The charge nurse went on patiently, “It may depend on the sensitization report on the mother’s blood. If the report is positive, it usually means the baby will be born with erythroblastosis and must be given an exchange transfusion immediately after birth. In this case the lab report was negative, so an exchange transfusion wasn’t necessary.” The charge nurse stopped. Then she added, thoughtfully, half to herself, “It’s strange, though, about those symptoms.”

Since their argument of several days ago on the subject of laboratory checks the senior pathologist had made no reference to David Coleman’s activities in the serology lab. Coleman had no idea what this silence implied—whether he had achieved his point and was to have direct charge of Serology, or if Pearson intended to return to the attack later. Meanwhile, though, the younger pathologist had fallen into the habit of dropping into the lab regularly and reviewing the work being done. As a result he had already formulated several ideas for changes in procedure, and some of the minor ones had been put into effect during the last day or two.

Between himself and Carl Bannister, the elderly lab technician, there was something with might be considered close to an armed truce. John Alexander, on the other hand, had made it plain that he welcomed Coleman’s attention to the lab and in the last two days already had made a few suggestions which Coleman had approved.

Alexander had returned to work the day after his wife had been brought to the hospital, despite a gruff but kindly suggestion from Pearson that he could take time off if he wished. Coleman had heard Alexander tell the old pathologist, “Thank you all the same, Doctor; but if I don’t work I’ll think too much, and it wouldn’t help.” Pearson had nodded and said that Alexander could do as he pleased and leave the lab to go upstairs and see his wife and baby whenever he wished.

Now David Coleman opened the door of the serology lab and went in.

He found John Alexander at the center lab bench, looking up from a microscope, and, facing him, a white-coated woman with extremely large breasts whom Coleman recalled vaguely having seen around the hospital several times since his own arrival.

As he entered Alexander was saying, “I think perhaps you should ask Dr. Pearson or Dr. Coleman. I’ll be making my report to them.”

“What report is that?” As Coleman asked casually, the heads of the other two turned toward him.

The woman spoke first. “Oh, Doctor!” She looked at him inquiringly. “You are Dr. Coleman?”

“That’s right.”

“I’m Hilda Straughan.” She offered him her hand and added, “Chief dietitian.”

“How do you do.” As she shook his hand he noticed, fascinated, that her magnificent breasts moved with her arm—an undulant, whalelike rolling motion. Checking his thoughts, he asked, “Is there some sort of problem we can help you with?” He knew from his own experience that pathologists and dietitians usually worked closely in matters of food hygiene.

“There’s been a lot of intestinal flu these past few weeks,” the dietitian said. She added, “Mostly among the hospital staff.”

Coleman laughed. “Tell me a hospital where it doesn’t happen now and again.”

“Oh, I know.” Mrs. Straughan gave the faintest hint of disapproval at the flippancy. “But if food is the reason—and it usually is—I like to pin down the cause if it’s possible. Then one can try to prevent the same thing occurring again.”

There was an earnestness about this woman which David Coleman found himself respecting. He asked politely, “Do you have any ideas?”

“Very definitely. I suspect my dishwashing machines, Dr. C.”

For a moment Coleman was startled at the form of address. Then, recovering, he asked, “Oh, why?” Out of the corner of his eye he saw Bannister enter the room. Now both lab technicians were listening to the conversation.

The dietitian said, “My hot-water booster system is quite inadequate.”

The phraseology tempted him to smile, but he resisted it and asked instead, “Has anyone ever pointed that out?”

“I certainly have, Dr. C.” Obviously this was a subject on which Mrs. Straughan had strong feelings. She went on, “I’ve talked to the administrator, Mr. Tomaselli, on several occasions. It was my last talk with Mr. T., in fact, which caused him to ask Dr. Pearson for new lab tests on the dishwashers.”

“I see.” Coleman turned to John Alexander. “Did you run some tests?”

“Yes, Doctor.”

“What did you find?”

“The water temperature isn’t high enough.” Alexander consulted a clip board holding several pages of notes. “I did three tests on each dishwasher, each at a different time of day, and the temperature range was 110 to 130 degrees.”

“You see?” The dietitian held up her hands expressively.

“Oh yes.” Coleman nodded. “That’s much too low.”

“That isn’t all, Doctor.” John Alexander had put the clip board down and taken a slide from the lab bench. “I’m afraid I’ve found gas formers of the fecal group. On the plates—after they’ve been through the dishwashers.”

“Let me see.” Coleman took the slide and moved to the microscope. When he had adjusted the eyepiece the characteristic worm-like bacteria were visible at once. He straightened up.

Mrs. Straughan asked, “What is it? What does it mean?”

Coleman said thoughtfully, “The slide shows gas-forming bacteria. Normally the hot water should destroy them, but as it is they’re getting through the dishwashers onto your clean plates.”

“Is that serious?”

He considered carefully before answering. “Yes and no. It probably accounts for some of the intestinal flu you spoke of, but that’s not too serious in itself. The way in which it might become dangerous is if we happened to get a disease carrier in the hospital.”

“A disease carrier?”

Coleman went on to explain. “It’s someone who carries disease germs in their body without having the clinical disease themselves. A carrier can be an apparently normal, healthy person. It happens more frequently than you’d think.”

“Yes, I see what you mean,” Mrs. Straughan said thoughtfully.

Coleman had turned to the two technicians. He asked, “I suppose we are doing regular lab checks on all food handlers in the hospital?”

Bannister answered, self-importantly, “Oh yes. Dr. Pearson’s very fussy about that.”

“Are we right up to date?”

“Yeah.” The senior technician thought, then added, “Don’t think we’ve had any for quite a while.”

“When was the last?” Coleman asked the question casually, as a matter of routine.

“Just a minute. I’ll look at the book.” Bannister crossed to the opposite side of the lab.

In his mind David Coleman was weighing the factors involved. If the dishwashers were inefficient—and they appeared to be—something needed to be done promptly; there was no question about that. On the other hand, as long as a careful check was being kept on food handlers—and, according to Bannister, it was—there was no real reason for alarm. Indifference, though, was something else again. He told John Alexander, “You’d better get your report to Dr. Pearson as soon as you can.”

“Yes, Doctor.” Alexander went back to his clip board of notes.

Across the room Bannister looked up from a ruled ledger he had spread open on a file cabinet. He called out, “February the twenty-fourth.”

Surprised, Coleman asked, “Did you say February?”

“That’s right.”

“That’s almost six months ago.” To the dietitian he observed, “You don’t appear to have much of a turnover in kitchen staff.”

“Oh yes, we do—unfortunately.” Mrs. Straughan shook her head emphatically. “We’ve taken on a lot of new people since February, Dr. C.”