The Final Diagnosis

As Pearson spoke his bitterness came through—the bitterness against all who were younger, who were interfering, trying to deprive him of authority—absolute and unquestioned—which until now had been his. In a different mood, and at another time, he might have handled this more tolerantly. Now, coming as it did, he had plainly decided, once and for all, to put this upstart lab assistant in his place.

“Listen to me and get this straight! I told you this once before and I don’t aim to do it again.” This was Authority speaking, the head of a department, heavy-handed, making it clear to a minor employee that there would be no more warnings, merely action, from this point on. His face close to Alexander’s, Pearson said, “I’m the one in charge of this department, and if you or anybody else have any queries, they come to me. Do you understand?”

“Yes, sir.” At this instant all Alexander wanted was for this to end. He already knew he had made his last suggestion. If this was what you got for thinking, from here on he would do his work and keep his thoughts to himself. Let other people do the worrying—and let them have the responsibility too.

But Pearson had not finished. “Don’t go running around behind my back,” he said, “and taking advantage of Dr. Coleman because he’s new.”

Briefly Alexander’s spirit flared. “I didn’t take advantage . . .”

“And I say you did! And I’m telling you to cut it out!” The old man shouted angrily, his face muscles working, his eyes fiery.

Alexander stood, crushed and silent.

For a moment or two Pearson surveyed the younger man grimly. Then, as if satisfied that his point was made, he went on to speak again. “Now I’ll tell you something else.” His tone this time, if not cordial, was at least less harsh. “As far as that blood test is concerned, a test in saline and high protein will give us all the information we need. And let me remind you I happen to be a pathologist and I know what I’m talking about. Have you got that?”

Dully Alexander answered, “Yes, sir.”

“All right. I’ll tell you what I’ll do.” Pearson’s voice became more moderate; it was almost as if he were offering a truce. “Since you’re so keen on this test being right, I’ll do it myself. Here and now. Where’s the blood specimen?”

“In the refrigerator,” Bannister said.

“Get it.”

Crossing the lab, Bannister decided this scene had not turned out exactly the way he would have liked. It was true the Alexander kid had needed to be taken down a peg, but, all the same, the old man had laid it on the kid a bit hard. Bannister would have liked to see some of the storm move in the direction of that snide young doctor. But maybe the old man was saving that for later. He selected the blood specimen marked “Alexander, Mrs. E.” and closed the refrigerator door.

Pearson took the blood sample, which already had the clot removed. As he did, Bannister noticed the purchase order which had been the cause of the trouble; it had fallen to the floor. He bent down and picked it up.

He asked Pearson, “What shall I do with this?”

The old pathologist had taken two clean test tubes. Now he was aspirating a portion of the blood serum into each. Without looking up he said irritably, “What is it?”

“It’s the purchase requisition—for Coombs serum.”

“We won’t need it now. Tear it up.” Pearson was scrutinizing the label of a small bottle containing Rh-positive cells. Prepared by a drug house, the solution was used as a reagent in testing Rh-negative blood.

Bannister hesitated. Much as he objected to Coleman, he knew there was a question of medical protocol involved. “You ought to let Dr. Coleman know,” he said doubtfully. “Do you want me to tell him?”

Pearson was having trouble with the cork of the bottle. He said impatiently, “No, I’ll tell him myself.”

Bannister shrugged. He had pointed something out; if there were any trouble now, it would not be his responsibility. He took the purchase requisition and tore it up, allowing the pieces to flutter down into a wastebasket below.

Roger McNeil, the pathology resident, suspected that no matter how many years he stayed in medicine he would never become hardened to performing autopsies on children. He had just completed one, and now, in the autopsy room, the red-gaping body of the four-year-old boy lay open, pathetically, before him. The sight disturbed McNeil as much as ever. He knew, as always, there would be little sleep for him tonight. This scene would keep recurring in his mind—particularly when he remembered, as inevitably he would, how unnecessary and futile this particular death had been.

Looking up, he saw Mike Seddons watching him. The surgical resident said, “Poor little bastard.” Then, bitterly, “How stupid can people get!”

McNeil asked, “Are the police still waiting?”

Seddons nodded. “Yes—and the others.”

“You’d better call Pearson.”

“All right.” There was a telephone in the autopsy-room annex, and Seddons went to it.

McNeil wondered if he were being cowardly in avoiding this responsibility. But this was a case the old man should be told of anyway. Then he could make the decision on who would break the news outside this room.

Seddons had returned from the phone. “Pearson was in Serology,” he said. “He’s coming across now.”

The two men waited silently. Then they heard Pearson’s shuffling footsteps, and the old man came in. He glanced at the body as McNeil recited the details of the case. An hour or two earlier the child had been struck by an automobile outside his own home. He had been brought to the hospital by ambulance but was dead on arrival. Notified, the coroner had ordered an autopsy. McNeil told Pearson what they had discovered.

The old man said, “You mean that’s all?” He seemed incredulous.

McNeil answered, “That’s all that killed him. Nothing else.”

Pearson moved toward the body, then stopped. He knew McNeil well enough to be aware that the resident would have made no mistake. He said, “Then they must have just stood there . . . and watched.”

Seddons put in, “Most likely nobody knew what was happening.”

Pearson nodded slowly. Seddons wondered what the old man was thinking. Then Pearson asked, “How old was the child?”

“Four,” McNeil answered. “Nice-looking kid too.”

All of them glanced at the autopsy table and the still, small figure. The eyes were closed, the fair, tousled hair pulled back in place now that the brain had been removed. Pearson shook his head, then turned toward the door. Over his shoulder he said, “All right; I’ll go up and tell them.”

The three occupants of the hospital anteroom looked up as Pearson entered. One was a uniformed patrolman of the city police, and near him was a tall man whose eyes were red-rimmed. The third occupant—dejected and sitting alone in the far corner—was a mousy little man with a straggling mustache.

Pearson introduced himself. The patrolman said, “I’m Stevens, sir. Fifth Precinct.” He produced a notebook and pencil.

Pearson asked him, “Were you at the scene of the accident?”

“I arrived just after it happened.” He indicated the tall man. “This is the father of the boy. The other gentleman was the driver of the car.”

The mousy man looked up. Appealing to Pearson, he said, “He ran straight out—straight out from the side of the house. I’m not a careless driver. I’ve got kids of my own. I wasn’t going fast. I was almost stopped when it happened.”

“And I say you’re a lousy liar.” It was the father, his voice choked with emotion and bitterness. “You killed him, and I hope you go to jail for it.”

Pearson said quietly, “Just a moment, please.” There was silence, the others watching him. He motioned to the policeman’s notebook. “There’ll be a full report for the coroner, but I can tell you the preliminary findings now.” He paused. “The autopsy has shown it was not the car that killed the boy.”

The patrolman looked puzzled. The father said, “But I was there! I tell you . . .”

“I wish there were some other way to tell you this,” Pearson said, “but I’m afraid there isn’t.” He addressed the father. “The blow your boy received knocked him to the road, and there was a mild concussion which rendered him unconscious. He also sustained a small fracture of the nose—quite minor, but unfortunately it caused his nose to bleed profusely.” Pearson turned to the patrolman. “The boy was left lying on his back, I believe—where he fell.”

The officer said, “Yes, sir, that’s right. We didn’t want to move him until the ambulance came.”

“And how long was that?”

“I’d say about ten minutes.”

Pearson nodded slowly. It was more than enough time; five minutes would have been sufficient. He said, “I’m afraid that that was the cause of death. The blood from the nosebleed ran back into the boy’s throat. He was unable to breathe and he aspirated blood into the lungs. He died of asphyxiation.”

The father’s face revealed horror, incredulity. He said, “You mean . . . if we’d only turned him over . . .”

Pearson raised his hands expressively. “I meant what I said—I wish there were some other way to tell you this. But I can only report the truth: the original injuries to your boy were minor.”

The patrolman said, “Then the blow from the car . . . ?”

“One can’t be sure, of course, but my own opinion is that it was glancing and comparatively light.” Pearson gestured to the mousy man, now standing close beside them. “I imagine this man is telling the truth when he says the car was moving slowly.”

“Mother of God!” It came from the father—a despairing, tortured wail. He was sobbing, his hands to his face. After a moment the mousy man led him to a settee, his arm around the other’s shoulders, his own eyes glistening.

The patrolman’s face was white. He said, “Doctor, I was there all the time. I could have moved the boy . . . but I didn’t know.”

“I don’t think you should blame yourself.”

The man appeared not to have heard. He went on as if in a daze. “I took a first-aid course. I got a badge for it. All the time they taught us—don’t move anybody; whatever you do, don’t move them!”

“I know.” Pearson touched the patrolman’s arm gently. He said slowly, “Unfortunately there are some exceptions to the rule—one of them is when someone is bleeding in the mouth.”

In the main-floor corridor on his way to lunch David Coleman saw Pearson emerge from the anteroom. At first Coleman wondered if the senior pathologist were ill. He seemed distracted, unaware of his surroundings. Then he caught sight of Coleman and moved toward him. The younger man halted.

“Oh yes . . . Dr. Coleman . . . There was something I had to tell you.” Coleman sensed that for some reason Pearson was having trouble marshaling his thoughts. Now he reached out absently and grasped the lapel of Coleman’s white lab coat. Coleman noticed that the old man’s hands were nervous and fumbling. He disengaged his coat.