The Final Diagnosis

Yet he was never able to play without a feeling of indifference to games, which he carefully concealed. And he never cheered without an inward uneasiness that he was behaving childishly. It was this which made him believe that, though he had humbled pride, he had never banished it.

His relationship with people had gone much the same way. In the old days, on meeting someone whom he considered intellectually inferior, he had never bothered to conceal his boredom or disinterest. But now, as part of his plan, he went out of his way to be cordial to such people. As a result, in college he had taken on the reputation of a friendly sage. It had become a password among those in academic difficulties to say, “Let’s have a bull session with David Coleman. He’ll straighten us out.” And invariably he did.

By all normal thinking the process should have shaped his feelings for people into a kindlier mold. Time and experience should have made him sympathetic to those less gifted than himself. But he was never sure that it had. Within himself Coleman found he still had the old contempt for mental incompetence. He concealed it, fought it with iron discipline and good acting, but, it seemed, it would never go away.

He had gone into medicine partly because his father, now dead, had been a country doctor and partly because it was something he had always wanted to do himself. But in entering a specific field he had chosen pathology because it was generally considered the least glamorous of the specialties. It was part of his own deliberate process of beating down the inevitable pride.

For a while he believed he had succeeded. Pathology is at times a lonely specialty, cut off as it is from the excitements and pressures of direct contact with hospital patients. But later, as interest and knowledge grew, he found the old contempt returning for those who knew less than he of the hidden mysteries a high-powered microscope revealed. Not to the same extent, though, because inevitably in medicine he met minds which were a match for his own. And still later he found he could relax, lowering some of the iron self-discipline with which he had clad himself. He still met those whom he considered fools—even in medicine there were some. But he never showed it and found occasionally that contact with such people disturbed him less. With such relaxation he began to wonder if at last he had beaten down his old enemy.

He was still wary though. A program of deliberate self-adjustment which had lasted fifteen years was not easy to shake off suddenly. And at times he found it hard to decide whether his motives came from pure choice or were from the habit of sackcloth he had worn so patiently and for so long.

Thus the question to himself on his choice of Three Counties Hospital. Had he chosen it because this was what he really wanted—a medium-size, second-line hospital, without reputation or glamor? Or had it been an old subconscious feeling that here was where his pride would suffer most?

As he mailed the two letters he knew these were questions that only time could answer.

On the seventh floor of the Burlington Medical Arts Building, Elizabeth Alexander dressed herself in the examining room adjoining Dr. Dornberger’s office. In the last half-hour Charles Dornberger had given her his usual thorough physical examination, and now he had gone back to his desk. Through the partly opened door she heard him say, “Come and sit down when you’re ready, Mrs. Alexander.”

Pulling a slip over her head, she answered cheerfully, “I’ll just be a minute, Doctor.”

Seated at his desk, Dornberger smiled. He liked to have patients who were obviously enjoying pregnancy, and Elizabeth Alexander was. She’ll be a good no-nonsense mother, he thought. She seemed an attractive girl, not pretty in the conventional sense, but with a lively personality which more than compensated for it. He glanced at the notes he had recorded earlier; she was twenty-three. When he was a younger man he always took the precaution of having a nurse present when he did physicals on women patients. He had heard of physicians failing to do this and later having nasty accusations hurled at them by unbalanced women. Nowadays, though, he seldom bothered. That, at least, was one advantage of being old.

He called out, “Well, I’d say you’re going to have a normal, healthy baby. There don’t seem to be any complications.”

“That’s what Dr. Crossan said.” Fastening the belt of a summer green-print dress, Elizabeth emerged from the other room. She seated herself in a chair alongside the desk.

Dornberger checked his notes again. “He was your doctor in Chicago. Is that right?”

“Yes.”

“Did he deliver your first child?”

“Yes.” Elizabeth opened her purse and took out a slip of paper. “I have his address here, Doctor.”

“Thank you. I’ll write him for your medical history.” Dornberger clipped the paper to his notes. He said matter-of-factly, “What did your first baby die of, Mrs. Alexander?”

“Bronchitis. When she was a month old.” Elizabeth said it normally. A year ago the words would have been hard to bring out and she would have had to fight back tears. Now, with another baby coming, the loss seemed easier to accept. But this time her baby would live—of that she was determined.

Dr. Dornberger asked, “Was the delivery normal?”

“Yes,” she answered.

He returned to his notes. As if to counter any distress the questions might have caused, he said conversationally, “I understand you’ve just arrived in Burlington.”

“That’s right,” she said brightly, then added, “My husband is working at Three Counties.”

“Yes, Dr. Pearson was telling me.” Still writing, he asked, “How does he like it there?”

Elizabeth considered. “John hasn’t said too much. But I think he likes it. He’s very keen on his work.”

Dornberger blotted what he had written. “That’s a help. Particularly in pathology.” He looked up and smiled. “The rest of us depend very much on the work of the laboratories.”

There was a pause while the obstetrician reached in a drawer of his desk. Then, extracting a pad of forms, he said, “Talking of the lab, we must send you for a blood test.”

As he wrote on the top form Elizabeth said, “I meant to tell you, Doctor. I’m Rh negative and my husband is Rh positive.”

He laughed. “I should have remembered you were the wife of a technologist. We’ll have to make it a very thorough check.” He tore off the form and gave it to her. “You can take this to the outpatients’ department at Three Counties any time.”

“Thank you, Doctor.” She folded the form and put it in her purse.

On the point of ending the interview Dornberger hesitated. He knew, as most physicians did, that patients frequently had incomplete or wrong ideas about medical matters. When that happened with one of his own patients he was usually at pains to set them straight, even if it meant taking time to do so. In this case the girl had lost her first baby; therefore this second pregnancy was doubly important to her. It was Dornberger’s business to see that she had no anxieties.

She had mentioned Rh factors, and obviously the subject was on her mind. Yet he doubted if she had any real understanding of what was involved. He decided to take the time to reassure her.

“Mrs. Alexander,” he said, “I want you to be quite clear that, even though you and your husband have differing Rh blood types, it doesn’t mean there will necessarily be any problem with the baby. You do understand that?”

“I think so, Doctor.” He knew he had been right. In her voice there was a trace of doubt.

Patiently he asked, “Do you understand exactly what is meant by the terms Rh positive and Rh negative?”

She hesitated. “Well, I suppose not. Not exactly anyway.”

This was what he had expected. He thought for a moment, then said, “Let me put it as simply as I can. All of us have certain factors in our blood. And when you speak of a ‘factor’ you might say that it’s another name for an ‘ingredient.’ ”

Elizabeth nodded. “I see.” She found herself concentrating, adjusting mentally to take in what Dr. Dornberger was saying. For a moment she was reminded, almost nostalgically, of days in class. At school she had always taken pride in her capacity to understand things, to focus on a particular problem—absorbing facts quickly by excluding other things from consciousness. It had made her one of the brighter pupils. She was curious to know if she had retained the ability.

Dornberger continued, “Different human beings have different blood factors. The last time anyone counted there were forty-nine of these factors known to medicine. Most people—you and I, for example—have between fifteen and twenty of them in our own blood stream.”

Elizabeth’s brain clicked: question one. She asked, “What causes people to be born with different factors?”

“Mostly we inherit them, but that isn’t important now. What’s important is to remember that some factors are compatible and some are not.”

“You mean . . .”

“I mean that when these blood factors are mixed together, some will get along quite happily, but some will fight one another and won’t get along at all. That’s why we are always careful in blood typing when we give a transfusion. We have to be sure it’s the right kind of blood for the person receiving it.”

Frowning thoughtfully, Elizabeth said, “And it’s the factors that fight each other—the incompatible ones—that cause trouble? When people have babies, I mean.” Again her own classroom formula: be clear on each point before going on to the next.

Dornberger answered, “Occasionally they do, but more often they don’t. Let’s take the case of you and your husband. You say he’s Rh positive?”

“That’s right.”

“Well, that means his blood contains a factor called ‘big D.’ And because you’re Rh negative you don’t have any ‘big D.’ ”

Elizabeth nodded slowly. Her mind was registering: Rh negative—no “big D.” Using an old memory trick, she quickly made up a mnemonic:

If you haven’t got “big D”

Your blood’s a minus quantity.

She found Dornberger watching her. “You make it so interesting,” she said. “No one’s ever explained it like this before.”

“Good. Now let’s talk about your baby.” He pointed to the bulge below her waist. “We don’t know yet whether Junior here has Rh-negative blood or Rh-positive. In other words, we don’t know if he has any ‘big D.’ ”

For a moment Elizabeth forgot the mental game she was playing. With a trace of anxiety she asked, “What happens if he does? Does it mean that his blood will fight with mine?”

Dornberger said calmly, “There’s always that possibility.” He told her with a smile, “Now listen very carefully.”

She nodded. Her attention was focused again. Briefly, back there, she had let her mind become sidetracked.

He said deliberately, “A baby’s blood is always quite separate from the mother’s. Nevertheless, in pregnancy, small amounts of the baby’s blood often escape into the mother’s blood stream. Do you understand that?”