The Final Diagnosis

As Alexander nodded Dr. Dornberger cut in abruptly. “Wait a minute! Let me get this straight. You mean the mother—Mrs. Alexander—may have sensitized blood after all?”

“Of course she may!” Not caring, Coleman lashed out, his voice rising in pitch. “The saline and high-protein tests are good in a lot of cases but not in all. Anybody who’s kept reasonably up to date in hematology should be aware of that.” He glanced sideways at Pearson, who appeared not to have stirred. To Dornberger he went on, “That’s why I ordered an indirect Coombs.”

The administrator was still trying to grasp the medical significance. “This test you’re talking about; if you ordered it, why wasn’t it done?”

Coleman wheeled on Bannister. His eyes merciless, he asked, “What happened to the requisition I signed—the requisition for Coombs serum?” As the technician hesitated, “Well?”

Bannister was shaking. Barely audible, he mumbled, “I tore it up.”

Dornberger said incredulously, “You tore up a doctor’s requisition—and without telling him?”

Relentlessly Coleman said, “On whose instructions did you tear it up?”

Bannister was looking at the floor. He said reluctantly, “On Dr. Pearson’s instructions.”

Dornberger was thinking quickly now. To Coleman he said, “This means the child may have erythroblastosis; everything points to it, in fact.”

“Then you’ll do an exchange transfusion?”

Dornberger said bitterly, “If it was necessary at all, it should have been done at birth. But there may be a chance, even this late.” He looked at the young pathologist as if, by implication, only Coleman’s opinion could be trusted. “But I want to be sure. The child hasn’t any strength to spare.”

“We need a direct Coombs test of the baby’s blood.” Coleman’s reaction was fast and competent. This scene was between himself and Dornberger now; Pearson was standing still, as if dazed by the swiftness of what had happened. To Bannister, Coleman rapped out, “Is there any Coombs serum in the hospital?”

The technician swallowed. “No.”

This was something within the administrator’s orbit. He asked tersely, “Where do we get it then?”

“There isn’t time.” Coleman shook his head. “We’ll have to get the test done somewhere else—where they’ve facilities.”

“University will do it; they’ve a bigger lab than ours anyway.” Harry Tomaselli had crossed to the telephone. He told the operator, “Get me University Hospital, please.” To the others he said, “Who’s in charge of pathology there?”

Dornberger said, “Dr. Franz.”

“Dr. Franz, please.” Tomaselli asked, “Who’ll talk with him?”

“I will.” Coleman took the phone. The others heard him say, “Dr. Franz? This is Dr. Coleman—assistant pathologist at Three Counties. Could you handle an emergency Coombs test for us?” There was a pause, Coleman listening. Then he said, “Yes, we’ll send the sample immediately. Thank you, Doctor. Good-by.” He turned back to the room. “We’ll need the blood sample quickly.”

“I’ll help you, Doctor.” It was Bannister, a tray of equipment in his hands.

About to reject the offer, Coleman saw the mute appeal in the other man’s eyes. He hesitated, then said, “Very well. Come with me.”

As they left the administrator called after them. “I’ll get a police cruiser. They’ll get the sample over there faster.”

“Please! I’d like to take it—to go with them.” It was John Alexander.

“All right.” The administrator had the telephone to his ear. Into it he snapped, “Get me the City Police.” To Alexander he said, “Go with the others, then bring the blood sample to the emergency entrance. I’ll have the cruiser waiting there.”

“Yes, sir.” Alexander went out quickly.

“This is the administrator, Three Counties Hospital.” Tomaselli was talking into the phone again. “We’d like a police car to deliver an urgent blood sample.” He listened briefly. “Yes; our people will be waiting at the emergency entrance. Right.” Hanging up the phone, he said, “I’d better make sure they all get together.” He went out, leaving Pearson and Dornberger alone.

Within the past few moments a ferment of thoughts had been seething in the elderly obstetrician’s mind. Inevitably, in his long years of medical practice, Charles Dornberger had had patients die. Sometimes about their deaths there had seemed almost a predestination. But always he had fought for their lives, at times savagely, and never giving up until the end. And in all occasions—successes as well as failures—he could tell himself truthfully that he had behaved with honor, his standards high, nothing left to chance, the utmost of his skill expended always. There were other physicians, he knew, who were sometimes less exacting. But never, to the best of his own knowledge and belief, had Charles Dornberger failed a patient through inadequacy or neglect.

Until this moment.

Now, it seemed, near the close of his own career, he was to share the sad and bitter harvest of another man’s incompetence; and worse—a man who was a friend.

“Joe,” he said, “there’s something I’d like you to know.”

Pearson had lowered himself to a lab stool, his face drained of color, his eyes unfocused. Now he looked up slowly.

“This was a premature baby, Joe; but it was normal, and we could have done an exchange transfusion right after birth.” Dornberger paused, and when he went on the turmoil of his own emotions was in his voice. “Joe, we’ve been friends a long time, and sometimes I’ve covered up for you, and I’ve helped you fight your battles. But this time, if this baby dies, so help me God!—I’ll take you before the medical board and I’ll break you in two.”

Twenty

“For Christ sake, what are they doing over there? Why haven’t we heard yet?”

Dr. Joseph Pearson’s fingers drummed a nervous tattoo upon his office desk. It was an hour and a quarter since the blood sample had been taken from the Alexander baby and promptly dispatched to University Hospital. Now the elder pathologist and David Coleman were alone in the office.

Coleman said quietly, “I called Dr. Franz a second time. He said he’ll phone the moment they have a result.”

Pearson nodded dully. He asked, “Where’s the boy—Alexander?”

“The police drove him back. He’s with his wife.” Coleman hesitated. “While we’re waiting—do you think we should check with the health office about the kitchen situation, make sure the foodhandler checks are being started?”

Pearson shook his head. “Later—when all this is over.” He said intensely, “I can’t think of anything else until this thing is settled.”

For the first time since this morning’s events, which had erupted so explosively in the lab, David Coleman found himself wondering about Pearson and what the older man was feeling. There had been no argument about the validity of Coleman’s statements concerning the sensitization test, and Pearson’s silence on the subject seemed a tacit admission that his younger colleague was better informed than himself, at any rate in this area. Coleman thought: It must be a bitter thing to face; and for the first time he felt a stirring of sympathy for the other man.

Pearson stopped drumming and slammed his hand hard on the table. “For Pete’s sake,” he said, “why don’t they call?”

“Is there any news from Pathology?”

Dr. Charles Dornberger, scrubbed and waiting in a small operating room which adjoined Obstetrics, asked the question of the charge nurse who had entered.

The girl shook her head. “No, Doctor.”

“How close are we to being ready?”

The nurse filled two rubber hot-water bottles and placed them beneath a blanket on the tiny operating table that was used for infants. She answered, “Just a few minutes more.”

An intern had joined Dornberger. The intern asked, “Do you intend to go ahead with an exchange transfusion—even if you don’t have the Coombs test result?”

“Yes,” Dornberger answered. “We’ve lost enough time already and I don’t want to add to it.” He considered, then went on, “In any case, the anemia in the child now is sufficiently marked to justify a blood exchange even without the test.”

The nurse said, “By the way, Doctor, the baby’s umbilical cord has been cut short. I wondered if you knew that.”

“Yes, thank you, I did.” To the intern Dornberger explained, “When we know in advance that an exchange transfusion will be necessary, we leave the umbilical cord long at birth. It makes a convenient point of connection. Unfortunately in this case we didn’t know, so the cord was cut.”

“How will you proceed?” the intern asked.

“I’ll use a local anesthetic and cut down just above the umbilical vein.” Turning back to the nurse, Dornberger asked, “Is the blood being warmed?”

She nodded. “Yes, Doctor.”

Dornberger told the intern, “It’s important to make sure the new blood is close to body temperature. Otherwise it increases the danger of shock.”

In a separate compartment of his mind Dornberger was aware that he was talking as much for his own benefit as for the instruction of the intern. Talking at least prevented him from thinking too deeply, and for the moment deep thinking was something Charles Dornberger wanted to avoid. Since he had left Pearson after the showdown in the lab his own mind had been engaged in a torment of anxiety and recrimination. The fact that, technically, he himself was not to blame for what had happened seemed unimportant. It was his patient who was in jeopardy, his patient that might die because of the worst kind of medical negligence, and the ultimate responsibility was his alone.

About to continue talking, Dornberger checked himself abruptly. Something was wrong; he had a feeling of dizziness; his head was throbbing, the room swirling. Momentarily he closed his eyes, then opened them. It was all right; things were back in focus, the dizziness almost gone. But when he looked down at his hands he saw they were trembling. He tried to control the movement and failed.

The incubator containing the Alexander baby was being wheeled in. At the same moment he beard the intern ask, “Dr. Dornberger—are you all right?”

It was on the edge of his tongue to answer “yes.” He knew that if he did he could carry on, concealing what had happened, with no one but himself aware of it. And then perhaps, even at this late moment, by exercise of skill and judgment he could save this child, salving, at least in some measure, his conscience and integrity.

Then, in the same moment, he remembered all that he had said and believed over the years—about old men clinging to power too long; the boast that when his own time came he would know it and make way; his conviction that he would never handle a case with his own facilities unpaired. He thought of these things, then looked down at his shaking hands.