The Final Diagnosis

Roger McNeil smiled inwardly at the thought, though he did not betray it on his face. People who had to deal with McNeil thought he was dour, which he often was, and sometimes lacking in a sense of humor, which he was not. Actually he did not make friends easily with men; but women found him attractive, a fact he had discovered early and turned to advantage. When he was an intern his colleagues had found this puzzling. McNeil, the gloomy, brooding figure of the common room, had had uncanny success in whisking a succession of student nurses into bed, frequently where others who fancied their ability as paramours had failed.

The autopsy-room door swung open and Mike Seddons breezed in. Seddons was a surgical resident, temporarily assigned to Pathology, and he always breezed. His red hair stood up in odd places as though a self-created wind would never leave it static. His boyish, open face seemed creased permanently in an amiable grin. McNeil considered Seddons an exhibitionist, though in his favor the kid had taken to pathology a lot more readily than some of the other surgical residents McNeil had seen.

Seddons looked over at the body on the table. “Ah, more business!”

McNeil gestured to the case papers and Seddons picked them up. He asked, “What did he die of?” Then, as he read on, “Coronary, eh?”

McNeil answered, “That’s what it says.”

“You doing this one?”

The resident shook his head. “Pearson’s coming.”

Seddons looked up quizzically. “The boss man himself? What’s special about this case?”

“Nothing special.” McNeil snapped a four-page autopsy form onto a clip board. “Some of the student nurses are coming in to watch. I think he likes to impress them.”

“A command performance!” Seddons grinned. “This I must see.”

“In that case you may as well work.” McNeil passed over the clip board. “Fill in some of this stuff, will you?”

“Sure.” Seddons took the clip board and began to make notes on fee condition of the body. He talked to himself as he worked. “That’s a nice clean appendix scar. Small mole on the left arm.” He moved the arm to one side. “Excuse me, old man.” He made a note, “Slight rigor mortis.” Lifting the eyelids, he wrote, “Pupils round, 0.3 cm. diameter.” He pried the already stiff jaw open, “Let’s have a look at the teeth.”

From the corridor outside there was the sound of feet. Then the autopsy-room door opened, and a nurse, whom McNeil recognized as a member of the nursing school’s teaching staff, looked in. She said, “Good morning, Dr. McNeil.” Behind her was a group of young student nurses.

“Good morning.” The resident beckoned. “You can all come in.”

The students filed through the doorway. There were six, and as they entered all glanced nervously at the body on the table. Mike Seddons grinned. “Hurry up, girls. You want the best seats; we have ’em.”

Seddons ran his eye appraisingly over the group. There were a couple of new ones here he had not seen previously, including the brunette. He took a second look. Yes indeed; even camouflaged by the spartan student’s uniform, it was obvious that here was something special. With apparent casualness he crossed the autopsy room, then, returning, managed to position himself between the girl he had noticed and the rest of the group. He gave her a broad smile and said quietly, “I don’t remember seeing you before.”

“I’ve been around as long as the other girls.” She looked at him with a mixture of frankness and curiosity, then added mockingly, “Besides, I’ve been told that doctors never notice first-year nursing students anyway.”

He appeared to consider. “Well, it’s a general rule. But sometimes we make exceptions—depending on the student, of course.” His eyes candidly admiring, he added, “By the way, I’m Mike Seddons.”

She said, “I’m Vivian Loburton,” and laughed. Then, catching a disapproving eye from the class instructor, she stopped abruptly. Vivian had liked the look of this redheaded young doctor, but it did seem wrong somehow to be talking and joking in here. After all, the man on the table was dead. He had just died, she had been told upstairs; that was the reason she and the other student nurses had been taken from their work to watch the autopsy. The thought of the word “autopsy” brought her back to what was to happen here. Vivian wondered how she was going to react; already she felt uneasy. She supposed, as a nurse, she would grow used to seeing death, but at the moment it was still new and rather frightening.

There were footsteps coming down the corridor. Seddons touched her arm and whispered, “We’ll talk again—soon.” Then the door was flung open and the student nurses moved back respectfully as Dr. Joseph Pearson strode inside. He greeted them with a crisp “Good morning.” Then, without waiting for the murmured acknowledgments, he strode to a locker, slipped off his white coat, and thrust his arms into a gown which he had taken from the shelf. Pearson gestured to Seddons, who stepped over and tied the gown strings at the back. Then, like a well-drilled team, the two moved over to a washbasin where Seddons shook powder from a can over Pearson’s hands, afterward holding out a pair of rubber gloves into which the older man thrust his fingers. All this had been accomplished in silence. Now Pearson shifted his cigar slightly and grunted a “Thanks.”

He crossed to the table and, taking the clip board which McNeil held out to him, began to read it, apparently oblivious of everything else. So far Pearson had not even glanced at the body on the table. Watching the performance covertly, as he, too, moved across, it occurred to Seddons that it was like the entry of a maestro before a symphony. All that was missing was applause.

Now that Pearson had digested the case history he, too, inspected the body, comparing his findings with the notes Seddons had written. Then he put the clip board down and, removing his cigar, faced the nurses across the table. “This is your first experience of an autopsy, I believe.”

The girls murmured, “Yes, sir,” or, “Yes, Doctor.”

Pearson nodded. “Then I will explain that I am Dr. Pearson, the pathologist of this hospital. These gentlemen are Dr. McNeil, the resident in pathology, and Dr. Seddons, a resident in surgery, in his third year . . .” He turned to Seddons. “Am I right?”

Seddons smiled. “Quite right, Dr. Pearson.”

Pearson continued, “In his third year of residency, and who is favoring us with a spell of duty in Pathology.” He glanced at Seddons. “Dr. Seddons will shortly qualify to practice surgery and be released upon an unsuspecting public.”

Two of the girls giggled; the others smiled. Seddons grinned; he enjoyed this. Pearson never missed an opportunity to take a dig at surgeons and surgery, probably with good reason—in forty years of pathology the old man must have uncovered a lot of surgical bloopers. He glanced across at McNeil. The resident was frowning. He doesn’t approve, Seddons thought. Mac likes his pathology straight. Now Pearson was talking again.

“The pathologist is often known as the doctor the patient seldom sees. Yet few departments of a hospital have more effect on a patient’s welfare.”

Here comes the sales pitch, Seddons thought, and Pearson’s next words proved him right.

“It is pathology which tests a patient’s blood, checks his excrements, tracks down his diseases, decides whether his tumor is malignant or benign. It is pathology which advises the patient’s physician on disease and sometimes, when all else in medicine fails”—Pearson paused, looked down significantly at the body of George Andrew Dunton, and the eyes of the nurses followed him—“it is the pathologist who makes the final diagnosis.”

Pearson paused again. What a superb actor the old man is, Seddons thought. What an unabashed, natural ham!

Now Pearson was pointing with his cigar. “I draw your attention,” he was saying to the nurses, “to some words you will find on the wall of many autopsy rooms.” Their eyes followed his finger to the framed maxim thoughtfully provided by a scientific supply house—Mortui Vivos Docent. Pearson read the Latin aloud, then translated. “The dead teach the living.” He looked down again at the body. “That is what will happen now. This man apparently”—he emphasized the word “apparently”—“died of coronary thrombosis. By autopsy we shall discover if that is true.”

At this Pearson took a deep draw on his cigar, and Seddons, knowing what was coming, moved nearer. He himself might be only a bit player in this scene, but he had no intention of missing a cue. As Pearson exhaled a cloud of blue smoke, he handed the cigar to Seddons who took it and placed it down, away from the table. Now Pearson surveyed the instruments laid out before him and selected a knife. With his eye he calculated where he would cut, then swiftly, cleanly, deeply, applied the sharp steel blade.

McNeil was watching the student nurses covertly. An autopsy, he reflected, would never be recommended viewing for the fainthearted, but even to the experienced the first incision is sometimes hard to take. Until this point the body on the table has at least borne physical resemblance to the living. But after the knife, he thought, no illusions are possible. This was not a man, a woman, a child, but merely flesh and bone, resembling life, yet not of life. This was the ultimate truth, the end to which all must come. This was the fulfillment of the Old Testament, “For dust thou art, and unto dust shalt thou return.”

Using the skill, ease, and speed of long experience, Pearson began the autopsy with a deep “Y” incision. With three strong knife strokes he brought the top two branches of the “Y” from each shoulder of the body to meet near the bottom of the chest. Then from this point he cut downward, opening the belly all the way from chest to genitals. There was a hissing, almost a tearing sound, as the knife moved and the flesh parted, revealing a layer of yellow fat beneath the surface.

Still watching the student nurses, McNeil saw that two were deathly white, a third had gasped and turned away; the other three were stoically watching. The resident kept his eye on the pale ones; it was not unusual for a nurse to keel over at her first autopsy. But these six looked as if they were going to be all right; the color was coming back to the two he had noticed, and the other girl had turned back, though with a handkerchief to her mouth. McNeil told them quietly: “If any of you want to go out for a few minutes, that’s all right. The first time’s always a bit hard.” They looked at him gratefully, though no one moved. McNeil knew that some pathologists would never admit nurses to an autopsy until the first incision had been made. Pearson, though, did not believe in shielding anyone. He felt they should see the whole thing from the beginning, and it was something McNeil agreed with. A nurse had to witness a lot of things that were tough to take—sores, mangled limbs, putrefaction, surgery; the sooner she learned to accept the sights and smells of medicine, the better for everyone, including herself.

Now McNeil slipped on his own gloves and went to work with Pearson. By this time, moving swiftly, the older man had peeled back the chest flap and, hacking the flesh loose with a larger knife, exposed the ribs. Next, using the sharp levered rib cutters, he cut his way into the rib cage, exposing pericardium and lungs. The gloves, instruments, and table were now beginning to be covered with blood. Seddons, gloved also, on his side of the table, was cutting back the lower flaps of flesh and opening the abdomen. He crossed the room for a pail and began to remove stomach and intestines, which he put into the pail after studying them briefly. The odor was beginning to be noticeable. Now Pearson and Seddons together tied off and cut the arteries so the undertaker would have no trouble when it came to embalming. Taking a small tube from a rack above the table, Seddons turned on a tap and began to siphon blood that had escaped into the abdomen and, after a nod from Pearson, did the same thing for the chest.