Page 43 of The Final Diagnosis

The baby lay perfectly still, its eyes closed, only a slight regular movement of the tiny chest testifying to its breathing. Even in the incubator, designed for the smallest infants, the little helpless body appeared forlorn and lost. It seemed incredible that in such fragility life could exist at all.

The younger nurse had come outside to join them. Wilding asked, “What was the birth weight?”

“Three pounds eight ounces.” The young nurse turned to John. “Do you understand what’s happening, Mr. Alexander—how your baby is being cared for?”

He shook his head. He found it hard to tear his eyes away, even for a moment, from the tiny child.

The young nurse said practically, “Some people like to know. They seem to think it helps.”

John nodded. “Yes; if you’d tell me. Please.”

The nurse pointed to the incubator. “The temperature inside is always ninety-eight degrees. There’s oxygen added to the air—about 40 per cent. The oxygen makes it easier for the baby to breathe. His lungs are so small, you see. They weren’t really developed when he was born.”

“Yes. I understand.” His eyes were back on the faint pulsing movement in the chest. While it continued it meant there was life, that the tiny burdened heart was beating, the thread of survival still unbroken.

The nurse went on. “Your baby isn’t strong enough to suck, so we have to use intubation. You see the little tube?” She pointed to a plastic cord with a hollow center which ran from the top of the incubator into the infant’s mouth. “It goes directly into the stomach. He’ll be having dextrose and water through the tube every hour and a half.”

John hesitated. Then he asked, “You’ve seen a lot of these cases?”

“Yes.” The nurse nodded gravely, as if sensing the question which would follow. He noticed she was petite and pretty, with red hair tucked under her cap. She was surprisingly young, too; perhaps twenty, certainly no more. But she carried an air of professional competence.

“Do you think he’ll live?” He glanced down again through the paneled glass.

“You can never tell.” The younger nurse’s forehead was creased in a frown. He could sense that she was trying to be honest, not to destroy his hopes and yet not to raise them. “Some do; some don’t. Sometimes it seems as if some babies have a will to live. They fight for life.”

He asked her, “This one—is he fighting?”

She said carefully, “It’s too early to know. But those extra eight weeks would have made a lot of difference.” She added quietly, “This will be a hard fight.”

Once more he let his eyes stray back to the tiny figure. For the first time the thought occurred to him: This is my son, my own, a part of my life. Suddenly he was consumed by a sense of overwhelming love for this fragile morsel, fighting his lonely battle inside the warm little box below. He had an absurd impulse to shout through the glass: You’re not alone, son; I’ve come to help. He wanted to run to the incubator and say: These are my hands; take them for your strength. Here are my lungs; use them and let me breathe for you. Only don’t give up, son; don’t give up! There’s so much ahead, so much we can do together—if only you’ll live! Listen to me, and hold on! This is your father and I love you.

He felt Nurse Wilding’s hand on his arm. Her voice said gently, “We’d better go now.”

He nodded, unable to speak. Then with a last glance backward they moved away.

Lucy Grainger knocked and went into the pathology office. Joe Pearson was behind his desk, David Coleman on the far side of the room, studying a file. He turned as Lucy entered.

“I have the new X-rays,” Lucy said, “on Vivian Loburton.”

“What do they show?” Pearson was interested at once. He pushed some papers aside and got up.

“Very little, I’m afraid.” Lucy had moved to the X-ray viewer which hung on the office wall, and the two men followed her. Coleman reached out and snapped a switch; after a second or two the fluorescent lights in the viewer flickered on.

Two at a time, they studied the comparative films. Lucy pointed out, as Dr. Bell had done in Radiology, the area of periosteal reaction created by the biopsy. Otherwise, she reported, there had been no change.

At the end Pearson thoughtfully rubbed his chin with thumb and forefinger. Glancing at Coleman, he said, “I guess your idea didn’t work.”

“Apparently not.” Coleman kept his voice noncommittal. In spite of everything they were still left with a question—a division of opinion. He wondered what the older man would do.

“It was worth trying anyway.” Pearson had a way of making the most ordinary acknowledgment sound grudging, but Coleman guessed he was talking to gain time and to cover up his indecision.

Now the old man turned to Lucy. Almost sardonically, he said, “So Radiology bows out.”

She answered levelly, “I suppose you could say that.”

“And it leaves it up to me—to Pathology?”

“Yes, Joe,” she said quietly, waiting.

There was a ten-second silence before Pearson spoke again. Then he said clearly and confidently, “My diagnosis is that your patient has a malignant tumor—osteogenic sarcoma.”

Lucy met his eyes. She asked, “That’s quite definite?”

“Quite definite.” In the pathologist’s voice there was no hint of doubt or hesitation. He went on, “In any case, I’ve been sure from the beginning. I thought this”—he indicated the X-ray films—“would give some extra confirmation.”

“All right.” Lucy nodded her acceptance. Her mind was working now on immediate things to do.

Pearson asked matter-of-factly, “When shall you amputate?”

“Tomorrow morning, I expect.” Lucy gathered up the X-rays and went to the door. Her glance taking in Coleman, she said, “I suppose I’d better go and break the news.” She made a small grimace. “This is one of the hard ones.”

When the door had closed behind her, Pearson turned to Coleman. He said with surprising courtesy, “Someone had to decide. I didn’t ask your opinion then because I couldn’t take the chance of letting it be known that there was doubt. If Lucy Grainger knew, she would have no choice but to tell the girl and her parents. And once they heard, they would want to delay. People always do; you can’t blame them.” He paused, then added, “I don’t have to tell you what delay can do with osteogenic sarcoma.”

Coleman nodded. He had no quarrel with Pearson’s having made the decision. As the old man had said, someone had to do it. All the same, he wondered if the amputation to be performed tomorrow was necessary or not. Eventually, of course, they would know for sure. When the severed limb came down to the lab, dissection would show if the diagnosis of malignancy was right or wrong. Unfortunately, though, an error discovered then would be too late to do the patient any good. Surgery had learned many ways to amputate limbs effectively, but it had no procedures for putting them back.

The afternoon flight from Burlington landed at La Guardia Airport a little after four o’clock, and from the airport Kent O’Donnell took a taxi to Manhattan. On the way into town he leaned back, relaxing for the first time in several days. He always tried to relax in New York taxis, mainly because any attempt to watch the traffic, or his own progress through it, usually left him in a state of nervous tension. He had long ago decided that the correct attitude to adopt was one of fatalism; you resigned yourself to disaster, then, if it failed to happen, you congratulated yourself on abundant good luck.

Another reason for relaxing was that for the past week he had worked at full pressure, both in the hospital and outside. He had extended his office appointments and scheduled extra surgery to make possible the four-day absence from Three Counties he had now embarked on. As well, two days ago, he had presided at a special meeting of the hospital’s medical staff at which—aided by data prepared by Harry Tomaselli—he had revealed the suggested scale of donations to the hospital building fund for attending physicians and others. As he had expected, there had been plenty of grumbling, but he had no doubt that the pledges, and eventually the money, would be forthcoming.

Despite his mental withdrawal, O’Donnell was conscious of the activity of New York outside and of the familiar angled sky line of mid-town Manhattan, now growing closer. They were passing over Queensborough Bridge, the warm afternoon sun slanting lancelike through drab green girders, and down below he could see Welfare Island, its city hospitals squatting somberly and institutional midway in the gray East River. He reflected that on each occasion he saw New York its ugliness seemed greater, its disorder and grime more strikingly apparent. And yet, even to the non-New Yorker, after a while these things became comfortable and familiar, seeming to hold a welcome for the traveler, as though an old, worn garment were good enough between friends. He smiled, then chided himself for unmedical thinking—the kind that held back air-pollution control and slum removal. Sentimentality, he reflected, was an aid and comfort to the opponents of progress.

They moved off the bridge and along Sixtieth Street to Madison, then jogged a block, turning west on Fifty-ninth. At Seventh Avenue and Central Park they went left in the traffic and stopped four blocks down at the Park Sheraton Hotel.

He checked into the hotel and later, in his room, showered and changed. From his bag he took the program of the surgeons’ congress—ostensible reason for his presence in New York. He noted that there were three papers he wanted to hear—two on open heart surgery and a third on replacement of diseased arteries by grafts. But the first was not until eleven next morning, which gave him plenty of time tomorrow. He glanced at his watch. It was a little before seven—more than an hour before he was due to meet Denise. He took an elevator downstairs and strolled through the foyer to the Pyramid Lounge.

It was the cocktail hour and the place was beginning to fill with pre-dinner-and-theater groups, mostly, he guessed, like himself, from out of town. A headwaiter showed him to a table, and as they moved across he saw an attractive woman, sitting alone, glance at him interestedly. It was not a new experience, and in the past similar incidents had occasionally led to interesting results. But tonight he thought: Sorry, I have other plans. A waiter took his order for scotch and soda, and when the drink came he sipped it slowly, his mind coasting leisurely over random thoughts.

Moments like this, he reflected, were all too rare in Burlington. That was why it was good to get away for a while; it sharpened your sense of perspective, made you realize that some of the things you deemed important on your own home ground were a good deal less so when looked at from a distance. Just lately he had suspected that his own closeness to hospital business had thrown some of his thinking out of balance. He looked around him. Since he had come in the lounge had filled; waiters were hurrying to bring the drinks which three bartenders were dispensing; one or two of the earlier groups were moving out. How many of these people, he wondered—the man and the girl at the next table, the waiter by the door, the foursome just leaving—had ever heard of Three Counties Hospital and, if they had, would care what went on there? And yet, to himself just lately, the hospital’s affairs seemed almost to have become the breath of life. Was this a healthy symptom? Was it a good thing professionally? O’Donnell had always mistrusted dedicated people; they tended to become obsessed, their judgment undermined by enthusiasm for a cause. Was he in danger now of becoming one such himself?

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