The Final Diagnosis

In the house-staff common room, off duty for half an hour, Mike Seddons lay back in one of the deep leather armchairs. He was doing exactly what Vivian had told him—thinking of what it would be like living with a wife who had only one leg.

Twenty-three

It was early afternoon. Four days had gone by since the initial cases of typhoid in Three Counties Hospital had been reported.

Now, in the administrator’s office, serious-faced and silent, Orden Brown, the board chairman, and Kent O’Donnell were listening to Harry Tomaselli speaking on the telephone.

“Yes,” the administrator said, “I understand.” There was a pause, then he continued, “If that becomes necessary we shall be ready with all arrangements. At five o’clock then. Good-by.” He replaced the phone.

“Well?” Orden Brown asked impatiently.

“The City Health Department is giving us until this evening,” Tomaselli said quietly. “If we’ve failed to locate the typhoid carrier by then we shall be required to close the kitchens.”

“But do they realize what that means?” O’Donnell had risen to his feet, his voice agitated. “Don’t they know it will practically have the same effect as closing the hospital. You’ve told them, haven’t you, that we can’t get outside catering for more than a handful of patients?”

Still quietly, Tomaselli said, “I’ve told them, but it doesn’t make any difference. The trouble is, the public-health people are afraid of an outbreak in the city.”

Orden Brown asked, “Is there any news at all from Pathology?”

“No.” O’Donnell shook his head. “They’re still working. I was in there half an hour ago.”

“I can’t understand it!” The board chairman was more disturbed than O’Donnell had ever seen him before. “Four days and ten typhoid cases right here in the hospital—four of them patients—and we still haven’t come up with the source!”

“There’s no question it’s a big job for the lab,” O’Donnell said, “and I’m sure they haven’t wasted any time.”

“No one’s blaming anyone,” Orden Brown snapped; “not at this stage anyway. But we’re got to show some results.”

“Joe Pearson told me they expect to be through with all their cultures by midmorning tomorrow. If the typhoid carrier is among the food handlers, they’ll have to have traced him by then.” O’Donnell appealed to Tomaselli. “Can’t you persuade the public-health people to hold off—at least until midday tomorrow?”

The administrator shook his head negatively. “I tried earlier. But they’ve given us four days already; they won’t wait any longer. The city health officer was here again this morning, and he’s returning at five o’clock. If there’s nothing to report by then I’m afraid we’ll have to accept their ruling.”

“And meanwhile,” Orden Brown asked, “what do you propose?”

“My department is already at work.” Harry Tomaselli’s voice held the sense of shock and unbelief that gripped them all. “We’re proceeding on the assumption that we shall have to close down.”

There was a silence, then the administrator asked, “Kent, could you come back here at five—to meet the health officer with me?”

“Yes,” O’Donnell said glumly. “I suppose I should be here.”

The tension in the lab was equaled only by the tiredness of the three men working there.

Dr. Joseph Pearson was haggard, his eye red-rimmed, and weariness written in the slowness of his movements. For the past four days and three nights he had remained at the hospital, snatching only a few hours of sleep on a cot which he had had moved into the pathology office. It was two days since he had shaved; his clothes were rumpled and his hair wild. Only for one period of several hours on the second day had he been missing from Pathology, with no one knowing where he had gone and Coleman unable to locate him despite several inquiries from the administrator and Kent O’Donnell. Subsequently Pearson had reappeared, offering no explanation for his absence, and had continued his supervision of the cultures and subcultures which occupied them still.

Now Pearson asked, “How many have we done?”

Dr. Coleman checked a list. “Eighty-nine,” he said. “That leaves another five in incubation which we’ll have tomorrow morning.”

David Coleman, though appearing fresher than the senior pathologist, and with none of the outward signs of personal neglect which Pearson exhibited, was conscious of an oppressive weariness which made him wonder if his own endurance would last as long as the older man’s. Unlike Pearson, Coleman had slept at his own apartment on each of the three nights, going there from the lab well after midnight and returning to the hospital around six the following morning.

Early as he had been, though, in arriving, only on one occasion had he preceded John Alexander, and then by a mere few minutes. The other times the young technologist had already been occupied at one of the lab benches, working—as he had since the beginning—like a precisely geared machine, his movements accurate and economic, his written record of each test stage painstakingly recorded in neat and legible lettering. Nor had it been necessary—after the initial start—to issue more instructions. Alexander was so obviously competent and aware of what he was doing that Dr. Pearson, after inspecting his progress briefly, had nodded approval and from that point had left him entirely alone.

Turning from Coleman to Alexander, Pearson asked now, “What are your figures on the subcultures?”

Reading from notes, Alexander answered, “Of the eighty-nine plates checked, forty-two have been separated for subculturing, and two hundred and eighty subcultures planted.”

Pearson calculated mentally. Half to himself he said, “That means another hundred and ten subcultures still to check, including tomorrow’s batch.”

Glancing across at John Alexander, David Coleman wondered what the younger man was feeling at this moment and whether the act of throwing himself so intensely into this endeavor was proving an outlet for at least some of his personal grief. It had been four days since the Alexander baby’s death. In that time the original sense of shock and desolation which the young technologist had shown had disappeared, at any rate superficially. Coleman suspected, though, that John Alexander’s emotions were still not far below the surface, and he had sensed something of their presence in Alexander’s announced intention to enroll in medical school. It was a subject which David Coleman had not pursued so far, but he had resolved, as soon as this present crisis was over, to have a long talk with Alexander. There was a good deal of advice and guidance which Coleman could offer the younger man, based on his own experiences. Certainly, as Alexander had said, it would not be easy for him—particularly financially—to give up a salaried job and become a student once more, but there were certain guideposts Coleman could point to and pitfalls which he might help Alexander to avoid.

The fourth member of the original lab team, Carl Bannister, was temporarily disqualified. The senior technician had worked through three days and most of the nights, handling routine lab work alone and assisting the others whenever he could. This morning, however, his speech had been slurred and he was so obviously near exhaustion that David Coleman, without consulting Pearson, had ordered him home. Bannister had departed gratefully and without argument.

The preparatory work on the stool samples arriving in the lab had gone on continuously. By the second day, however, those samples which had been dealt with first had been in incubation long enough for investigation. Once again Dr. Pearson had divided his forces in order to keep the work flowing, John Alexander and himself handling the new stage, while David Coleman continued to deal with the remaining stool samples still coining in.

Removed from the incubator, the pink-tinged surface of the prepared petri dishes showed small, moist bacteria colonies where the tiny amounts of human feces had been added the previous day. With every individual stool containing millions of bacteria, the next task was to separate those colonies which were obviously harmless from those which must be investigated further.

Pink-tinged colonies of bacteria were eliminated at once as harboring no typhoid. Pale colonies, where typhoid bacilli might conceivably lurk, had samples taken from them for subculture in sugar tubes with liquid media. There were ten sugar tubes to each original culture, each tube containing a different reagent. It was these reagents which, after further incubation, would finally show which stool sample, if any, contained the marauding and infectious typhoid germs.

Now, on the fourth day, all the stool samples were finally in. They had been obtained from everyone on the hospital staff involved in any way with the receiving, preparation, or distribution of food, and the task of processing them would continue until well into tomorrow. At the moment the 280 subcultures which John Alexander had referred to were distributed in racks around the lab and in incubators. But although on many of these the final checks were complete, none so far had revealed the individual—the suspected typhoid carrier—whom, anxiously and diligently, they had been seeking day and night.

The telephone bell rang and Pearson, nearest to the lab wall phone, answered it. “Yes?” He listened, then said, “No; nothing yet. I keep telling you—I’ll call as soon as we find anything.” He replaced the instrument.

John Alexander, succumbing to a sudden tiredness, completed an entry on a data sheet, then dropped into a straight-back lab chair. Momentarily he closed his eyes with relief at his own sudden inactivity.

From alongside David Coleman said, “Why don’t you take an hour or two off, John—maybe go upstairs and stay with your wife for a while?”

Alexander got to his feet again. He knew that if he remained seated too long he could easily fall asleep. “I’ll do one more series,” he said, “then I think I will.”

Taking a rack of subcultures from the incubator, he collected a fresh data sheet and began to line up the ten sugar tubes he was about to check. Glancing at the lab wall clock, he noted with surprise that another day was running out. The time was ten minutes to five.

Kent O’Donnell replaced the telephone. Answering Harry Tomaselli’s unspoken question, he said, “Joe Pearson says there’s nothing new.”

In the administrator’s birch-paneled office there was a silence, both men bleakly aware of the implications of this latest lack of news. Both knew, too, that around them, outside the administration suite, the work of the hospital was grinding to a halt.

Since early afternoon the plan for contraction of patient service, devised by Harry Tomaselli several days earlier and now made necessary by the impending shutdown of the hospital kitchens, had been going steadily into effect. Commencing with breakfast tomorrow, one hundred meals for patients on regular diet would be prepared by two local restaurants, combining forces for the occasion, and would be delivered to the hospital for seriously ill patients who could not be moved. Of the remaining patients, as many as possible were being discharged to their homes, while others, for whom hospital care was still essential, were being transferred to other institutions in and around Burlington, now mobilizing their own facilities to meet the emergency influx from Three Counties.