The Final Diagnosis (22 page)

Alexander took the blood samples and put them in the lab refrigerator. Then, closing the refrigerator door, he paused thoughtfully.

“Carl, there’s something I’ve been meaning to ask you.”

Bannister was busily clearing up. He always liked to leave right on the dot of five. Without turning his head he asked, “What is it?”

“The blood-sensitization tests we’re doing here—I’ve been wondering about them.”

“Wondering what?”

Alexander chose his words carefully. Right from the beginning, because of his own college training, he had realized the possibility of arousing resentment in people like Bannister. He tried now, as he had before, to avoid giving offense. “I noticed we’re only doing two sensitization tests—one in saline, the other in high protein.”

“So?”

“Well,” Alexander said diffidently, “isn’t just doing the two tests alone . . . a bit out of date?”

Bannister had finished clearing up. He came around the center table, wiping his hands on a paper towel. He said sharply, “Suppose you tell me why.”

Alexander ignored the sharpness. This was important. He said, “Most labs nowadays are doing a third test—an indirect Coombs—after the test in saline.”

“A ‘what’ test?”

“An indirect Coombs.”

“What’s that?”

“Are you kidding?” The moment the words were out Alexander knew he had made a tactical mistake. But he had spoken impulsively, reasoning that no serology technician could fail to know of an indirect Coombs test.

The senior technician bridled. “You don’t have to get smart.”

Hastily trying to repair the damage, Alexander replied, “I’m sorry, Carl. I didn’t mean it to sound like that.”

Bannister crumpled the paper towel and threw it into a waste bin. “Well, that’s the way it did sound.” He leaned forward aggressively, his bald head reflecting a light bulb above. “Look, fella, I’ll tell you something for your own good. You’re fresh out of school, and one thing you haven’t found out is that some things they teach you there just don’t work out in practice.”

“This isn’t just theory, Carl.” Alexander was in earnest now, his blunder of a moment ago seeming unimportant. “It’s been proven that some antibodies in the blood of pregnant women can’t be detected either in a saline solution or high protein.”

“And how often does it happen?” Bannister put the question smugly, as if knowing the answer in advance.

“Very seldom.”

“Well, there you are.”

“But it’s enough to make the third test important.” John Alexander was insistent, trying to penetrate Bannister’s unwillingness to know. “Actually it’s very simple. After you’ve finished the saline test you take the same test tube——”

Bannister cut him off. “Save the lecture for some other time.” Slipping off his lab coat, he reached for the jacket of his suit behind the door.

Knowing it to be a losing argument, Alexander still went on. “It isn’t much more work. I’d be glad to do it myself. All that’s needed is Coombs serum. It’s true it makes the testing a little more expensive . . .”

This was familiar ground. Now Bannister could understand better what the two of them were talking about. “Oh, yeah!” he said sarcastically. “That would go great with Pearson. Anything that’s more expensive is sure to be a big hit.”

“But don’t you understand?—the other way isn’t foolproof.” Alexander spoke tensely; without realizing it he had raised his voice. “With the two tests we’re doing here you can get a negative test result, and yet a mother’s blood may still be sensitized and dangerous to the baby. You could kill a newborn child that way.”

“Well, it isn’t your job to worry about it.” This was Bannister at his crudest, the words almost snarled.

“But——”

“But nothing! Pearson isn’t keen on new ways of doing things—especially when they cost more money.” Bannister hesitated, and his manner became less aggressive. He was aware that it was one minute to five and he was anxious to wind this up and get away. “Look, kid, I’ll give you some advice. We’re not doctors, and you’d be smart to quit trying to sound like one. We’re lab assistants and we work in here the way we’re told.”

“That doesn’t mean to say I can’t think, does it?” It was Alexander’s turn to be aroused. “All I know is, I’d like to see my wife’s test done in saline,
and
in protein,
and
in Coombs serum. You may not be interested, but this baby happens to be important to us.”

At the door the older man surveyed Alexander. He could see clearly now what he had not realized before—this kid was a troublemaker. What was more, troublemakers had a habit of involving other people in uncomfortable situations. Maybe this smart-aleck college graduate should be allowed to hang himself right now. Bannister said, “I’ve told you what I think. If you don’t like it you’d better go see Pearson. Tell him you’re not satisfied with the way things are being run around here.”

Alexander looked directly at the senior technician. Then he said quietly, “Maybe I will.”

Bannister’s lip curled. “Suit yourself. But remember—I warned you.”

With a final glance at the clock he went out, leaving John Alexander in the laboratory alone.

Twelve

Outside the main entrance to Three Counties Hospital Dr. David Coleman paused to look around him. It was a few minutes after eight on a warm, mid-August morning, with promise already of a hot and sultry day ahead. At this moment there was little activity outside the hospital. Beside himself, the only other people in sight were a janitor, hosing some of yesterday’s dust from a section of the forecourt, and a middle-aged nurse who had just alighted from a bus on the opposite side of the street. The main stream of hospital business, he supposed, would not begin to flow for another hour or so.

David Coleman surveyed the block of buildings which comprised Three Counties. Certainly, he decided, the hospital’s builders could never be accused of having wasted money on aesthetic frills. The architecture was strictly utilitarian, the facings of plain brick unadorned by any other masonry. The effect was a succession of conventional rectangles: walls, doors, and windows. Only near the main doorway did the pattern vary, and here a single foundation stone announced, “Laid by His Honor Mayor Hugo Stouting, April 1918.” As he walked up the entry steps David Coleman found himself wondering what kind of a man that long-forgotten dignitary had been.

Carl Bannister was sorting papers on Dr. Pearson’s desk when Coleman knocked and entered the pathologist’s office.

“Good morning.”

Surprised, the senior lab technician looked up. It was unusual to have visitors this early. Most people around the hospital knew that Joe Pearson seldom arrived before ten o’clock, sometimes later.

“Good morning.” He returned the greeting, not too affably. Bannister was never at his best in the early morning. He asked, “Are you looking for Dr. Pearson?”

“In a way, yes. I’m starting work here today.” Seeing the other start, he added, “I’m Dr. Coleman.”

The effect, Coleman thought, was somewhat like letting off firecrackers under a hen. Bannister put down his papers hurriedly and came around the desk, almost at a run, his bald head gleaming. “Oh, excuse me, Doctor. I didn’t realize. I’d heard you were coming, but we had no idea it would be this soon.”

Coleman said calmly, “Dr. Pearson is expecting me. Is he in, by the way?”

Bannister seemed shocked. “You’re too early for him. He won’t be here for another two hours.” His face creased in a confidential man-to-man smile. It seemed to say: I expect you’ll keep the same kind of hours yourself as soon as the newness wears off.

“I see.”

As Coleman glanced around him Bannister remembered an omission. He said, “Oh, by the way, Doctor, I’m Carl Bannister—senior lab technician.” With careful geniality he added, “I expect we’ll be seeing a lot of each other.” Bannister made a habit of taking no chances with anybody senior to himself.

“Yes, I expect we will.” Coleman was not sure how much the idea appealed to him. But he shook hands with Bannister, then looked around for a place to hang the light raincoat he had brought; the morning forecast predicted thunder showers later in the day. Once again Bannister was alert to serve and please.

“Let me take your coat.” He found a wire hanger and carefully put coat and hanger on a rack near the door.

“Thank you,” Coleman said.

“That’s perfectly all right, Doctor. Now, would you like me to show you around the labs?”

Coleman hesitated. Perhaps he ought to wait for Dr. Pearson. On the other hand, two hours was a long time to sit around and he might as well be doing something in the meantime. The labs would be his domain anyway. What was the difference? He said, “I saw part of the labs with Dr. Pearson when I was here a few weeks ago. But I’ll take another look if you’re not too busy.”

“Well, of course, we’re always busy around here, Doctor. But I’ll be glad to take the time for you. In fact, it’ll be a pleasure.” The working of Bannister’s mind was incredibly transparent.

“This way, please.” Bannister had opened the door of the serology lab and stood back for Coleman to enter. John Alexander, who had not seen Bannister since their argument the night before, looked up from the centrifuge in which he had just placed a blood sample.

“Doctor, this is John Alexander. He just started work here.” Carl Bannister was warming to his role of showman. He added facetiously, “Still wet behind the ears from technology school, eh, John?”

“If you say so.” Alexander answered uncomfortably, resenting the condescension but not wanting to be rude.

Coleman moved forward, offering his hand. “I’m Dr. Coleman.”

As they shook hands Alexander said interestedly, “You mean you’re the new pathologist, Doctor?”

“That’s right.” Coleman glanced around him. As he had on the previous visit, he could see that a lot of changes would need to be made in here.

Bannister said expansively, “You just look around, Doctor—at anything you want.”

“Thank you.” Turning back to Alexander, Coleman asked, “What are you working on now?”

“It’s a blood sensitization.” He indicated the centrifuge. “This specimen happens to be from my wife.”

“Really.” Coleman found himself thinking this young lab assistant was a good deal more impressive than Bannister. In appearance anyway. “When is your wife having her child?” he asked.

“In just over four months, Doctor.” Alexander balanced the centrifuge and switched it on, then reached over to set a timing dial. Coleman noticed that all the movements were economical and quick. There was a sense of fluidity in the way this man used his hands. Politely Alexander asked, “Are you married, Doctor?”

“No.” Coleman shook his head.

Alexander seemed on the point of asking another question, then appeared to change his mind.

“Did you want to ask me something?”

For a moment there was a pause. Then John Alexander made up his mind. “Yes, Doctor,” he said. “I do.”

Whether this meant trouble or not, Alexander thought, at least he would bring his doubts out into the open. Last night, after the dispute with Bannister, he had been tempted to drop the whole subject of the extra test on blood samples coming to the lab. He remembered only too clearly the dressing down he had received from Dr. Pearson on the last occasion he had chosen to make a suggestion. This new doctor, though, certainly seemed easier to deal with. And even if he considered Alexander wrong, it didn’t seem likely there would be any big scene. He took the plunge. “It’s about the blood tests we’re doing—for sensitization.”

As they had been speaking he had become aware of Banister in the background, the older technician moving his bald head from side to side, intent on missing nothing that was said. Now he moved forward, annoyed and aggressive, to put Alexander in his place. “Now listen! If that’s what you were talking about last night, you leave it alone!”

Coleman asked curiously, “What was it you were talking about last night?”

Ignoring the question, Bannister continued to lecture Alexander. “I don’t want Dr. Coleman bothered with stuff like that five minutes after he gets here. Forget it! Understand?” He turned to Coleman, the automatic smile switched on. “It’s just some bee he’s got in his bonnet, Doctor. Now, if you’ll come with me, I’ll show you our histology setup.” He put a hand on Coleman’s arm to steer him away.

For the space of several seconds Coleman did nothing. Then, deliberately, he reached down and removed the hand from his sleeve. “Just a moment,” he said quietly. Then to Alexander, “Is this something medical? To do with the laboratory?”

Deliberately avoiding Bannister’s scowl, Alexander answered, “Yes, it is.”

“All right, let’s hear it.”

“It came up, really, because of this blood-sensitization test—the one for my wife,” Alexander said. “She’s Rh negative; I’m Rh positive.”

Coleman smiled. “Well, that applies to plenty of people. There’s no problem—that is, as long as the sensitization test shows a negative result.”

“But that’s the point, Doctor—the test.”

“What about it?” Coleman was puzzled. He was not at all clear about what this young lab assistant was getting at.

Alexander said, “I think we should be doing an indirect Coombs test on all these samples,
after
the tests in saline and high protein.”

“Of course.”

There was a silence which Alexander broke. “Would you mind saying that again, Doctor?”

“I said ‘of course.’ Naturally there should be an indirect Coombs.” Coleman still could see no point in this discussion. For a serology lab this sort of thing was elementary, basic.

“But we’re not doing an indirect Coombs.” Alexander shot a triumphal glance at Bannister. “Doctor, the Rh-sensitivity tests here are all being done just in a saline solution and in high protein. There’s no Coombs serum being used at all.”

At first Coleman was sure Alexander must be wrong. Apparently the young technologist had been working here only a short time; no doubt he had become confused. Then Coleman remembered the tone of conviction in which the statement had been made. He asked Bannister, “Is this true?”