The Final Diagnosis

Still not understanding, Coleman asked Bannister, “Are you sure about that date?”

“That’s the last one.” Bannister was cockily sure of himself. It was a pleasing change to be able to tell something to this know-all young doctor. He added, “See for yourself if you like.”

Ignoring the suggestion, Coleman said, “But what about the new employees—those who’ve been taken on since then?”

“There’s nothing else here.” Bannister shrugged. “If the health office doesn’t send us specimens for test, we’ve no way of knowing about new food handlers.” His attitude was one of complete indifference, almost contempt.

A slow burn was rising in Coleman. Controlling it, he said evenly to the dietitian, “I think this is a matter you should look into.” For the first time he had begun to realize that something, somewhere, was seriously wrong.

Mrs. Straughan appeared to have had the same thought. She said, “I will—immediately. Thank you, Dr. C.” Her breasts bouncing with each step, she went out of the lab.

There was a moment’s silence. For the first time Coleman sensed a feeling of unease in Bannister. As their eyes met he asked the technician icily, “Had it occurred to you to wonder why no tests for food handlers were coming in?”

“Well . . .” Bannister fidgeted, his earlier confidence evaporated. “I guess I would have—sooner or later.”

Coleman surveyed the other with disgust. He said angrily, “I’d say later, wouldn’t you?—especially if it meant that you would have had to do some thinking.” At the door he turned. “I’ll be with Dr. Pearson.”

The color drained from his face, the older technician still stood, looking at the door through which Coleman had gone. His lips framed words—bitter and defeated. “He knows it all, don’t he? Everything in the book. Every perishing thing.”

At this moment around Bannister was an aura of failure and downfall. His own familiar world—the world he had believed inviolate and therefore had done nothing to protect—was crumbling. A new order was emerging, and in the new order, through his own shortcoming, there was no room for himself. Crestfallen, out of place, he appeared only a weak, pathetic figure whom time was passing by.

Joe Pearson looked up from his desk as Coleman came in.

Without preliminary the younger pathologist announced, “John Alexander has found gas-forming bacteria—on clean plates which have been through the dishwasher.”

Pearson seemed unsurprised. He said dourly, “It’s the hot-water system.”

“I know.” David Coleman tried, but failed, to keep sarcasm from his voice. “Has anyone ever tried to do something about it?”

The old man was looking at him quizzically. He said, with surprising quietness, “I suppose you think things are run pretty poorly around here.”

“Since you ask me—yes.” Coleman’s own lips were tight. He wondered how long the two of them could continue working together in this kind of atmosphere.

Pearson had flung open a lower drawer of his desk, fumbling among files and papers, talking as he searched. He seemed to be speaking with a strange mixture of anger and sorrow. “You’re so young and green and full of lofty ideas. You come here, and it happens to be a time when there’s a new administration, when money is freer than it has been in years. So you figure that whatever’s wrong is because nobody has thought of changing it. Nobody’s tried!” He had found what he wanted and flung a bulging file of papers on the desk.

“I didn’t say that.” The words were snapped out, almost defensively.

Pearson pushed the file toward him. “This is a record of correspondence about the kitchen hot-water supply. If you’ll take the trouble to read it, you’ll find I’ve been pleading for a new system for years.” Pearson’s voice rose. He said challengingly, “Go ahead—take a look!”

Opening the file, Coleman read the top memo. He turned a page, then another, then skimmed the other pages beneath. At once he realized how much in error he had been. The memos contained a damning condemnation by Pearson of hospital kitchen hygiene, couched in even stronger terms than he would have used himself. The correspondence appeared to go back several years.

“Well?” Pearson had been watching as he read.

Without hesitation Coleman said, “I’m sorry. I owe you an apology—about that anyway.”

“Never mind.” Pearson waved his hand irritably, then as the words sank in, “You mean there’s something else?”

Coleman said evenly, “In finding out about the dishwashers I also discovered there haven’t been any lab tests of food handlers for more than six months.”

“Why?” The question rapped out like a sharp explosion.

“Apparently none were sent down from the health office. The chief dietitian is checking on that now.”

“And you mean we didn’t query it? Nobody in Pathology asked why none were coming?”

“Apparently not.”

“That fool Bannister! This is serious.” Pearson was genuinely concerned, his earlier hostility to Coleman forgotten.

Coleman said quietly, “I thought you’d want to know.”

Pearson had picked up the telephone. After a pause he said, “Get me the administrator.”

The conversation which followed was brief and to the point. At the end Pearson replaced the phone and stood up. To Coleman he said, “Tomaselli is on his way down. Let’s meet him in the lab.”

It took only a few minutes in the lab to run over, for a second time, what David Coleman had already learned. With Pearson and Harry Tomaselli listening, John Alexander recapped his notes and Pearson inspected the slides. As he straightened up from the microscope the chief dietitian entered the lab. The administrator turned to her. “What did you find out?”

“It’s incredible but true.” Mrs. Straughan shook her head in a gesture of unbelief. She addressed Pearson. “Earlier this year the health office hired a new clerk, Dr. P. Nobody told her about lab tests on food handlers. That’s the reason none were sent down.”

Tomaselli said, “So there have been no tests now for—how long?”

“Approximately six and a half months.”

Coleman noticed Carl Bannister standing dourly away from the group, apparently occupied, but he sensed the senior technician was missing nothing of what was going on.

The administrator asked Pearson, “What do you suggest?”

“There should be a checkup first on all the new employees—as quickly as possible.” This time the elder pathologist was incisive and brisk. “After that there will have to be re-examination of all the others. That means stool culture, chest X-ray, and a physical. And it should include all the kitchen workers and anyone else who has anything to do with food at all.”

“Will you arrange that, Mrs. Straughan?” Tomaselli said. “Work with the health office; they’ll handle most of the detail.”

“Yes, Mr. T. I’ll get onto it right away.” She undulated out of the lab.

“Is there anything else?” Tomaselli had returned his attention to Pearson.

“We need a new steam booster system for those dishwashers—either that or rip them right out and put new ones in.” Pearson’s voice rose heatedly. “I’ve been telling everybody that for years.”

“I know.” Tomaselli nodded. “I inherited the file, and it’s on our list. The trouble is, we’ve had so many capital expenditures.” He mused. “I wonder what the comparative cost would be.”

Unreasonably, irritably, Pearson said, “How should I know? I’m not the plumber.”

“I know a little about plumbing; perhaps I can help.” At the softly spoken words the others turned their heads. It was Dr. Dornberger, his hands, inevitably, busy with his pipe. He had come into the lab quietly and unnoticed. Seeing Harry Tomaselli, he asked, “Am I interrupting something?”

Pearson said gruffly, “No. It’s all right.”

Dornberger saw John Alexander watching him. He said, “I was with your baby awhile ago, son. I’m afraid he’s not doing too well.”

“Is there any hope, Doctor?” Alexander asked the question quietly. The others had turned, their expressions softening. Bannister put down a glass pipette and moved closer.

“Not very much, I’m afraid,” Dornberger said slowly. There was a silence, then, as if remembering something, he turned to Pearson. “I suppose, Joe, there couldn’t be any doubt about that blood-sensitization test on Mrs. Alexander?”

“Doubt?”

“I mean, that it could be wrong.”

Pearson shook his head. “No doubt at all, Charlie. Matter of fact, I did it myself—very carefully.” He added curiously, “Why did you ask?”

“Just checking.” Dornberger puffed at his pipe. “For a while this morning I suspected the child might have had erythroblastosis. It was only a long shot though.”

“Be highly unlikely.” Pearson was emphatic.

Dornberger said, “Yes, that’s what I thought.”

Again the silence, their eyes turning to Alexander. David Coleman felt he wanted to say something—anything to divert attention, to make things easier for the young technologist. He told Dornberger, almost without thinking, “There used to be some doubt about sensitization tests—when labs were using just the saline and high-protein methods. Sometimes then a few positive cases would get recorded as negative. Nowadays, though, with an indirect Coombs test as well, it’s pretty well foolproof.” As he finished speaking, he realized that this lab had only made the change since his own arrival. He had not meant to take a dig at Pearson; at this moment he found himself hoping the old man would not notice. There had been enough quarreling between them without adding to it needlessly.

“But, Dr. Coleman . . .” Alexander’s mouth was gaping, his eyes alarmed.

“Yes? What is it?” Coleman was puzzled. Nothing he had said was enough to produce this reaction.

“We didn’t do an indirect Coombs test.”

Despite his concern for Alexander, Coleman found himself becoming annoyed. Because of Pearson he had wanted to avoid pursuing this subject. Now he was being given no choice. “Oh yes, you did,” he said offhandedly. “I remember signing the requisition for Coombs serum.”

Alexander was looking at him despairingly, his eyes pleading. He said, “But Dr. Pearson said it wasn’t necessary. The test was done just in saline and high protein.”

It took Coleman several seconds to absorb what had been said. He saw that Harry Tomaselli, not understanding, was watching the scene curiously. Dornberger’s attention had suddenly perked up.

Pearson appeared uncomfortable. He said to Coleman, with a trace of unease, “I meant to tell you at the time. It slipped my mind.”

David Coleman’s brain was now ice-clear. But before going further he wanted to establish one fact. “Do I understand correctly,” he asked Alexander, “that there was no indirect Coombs test whatever?”