Page 51 of The Final Diagnosis

O’Donnell was conscious of a lessening of tension in the room. He began to wonder if, after everything, this baby would pull through. He had seen stranger things happen, had learned long ago that nothing was impossible, that in medicine the unexpected was just as often on your side as against you.

“All right,” he said, “let’s keep going.”

He withdrew ten milliliters, then replaced it. He withdrew another ten and replaced that. Then another ten—in and out. And another.

Then, fifty minutes after they had begun, the nurse announced quietly, “The patient’s temperature is falling, Doctor. It’s ninety-four point three.”

He said quickly, “Check the venous pressure.”

It was thirty-five—much too low.

“He’s not breathing well,” the intern said. “Color isn’t good.”

O’Donnell told him, “Check the pulse.” To the nurse he said, “Oxygen.”

She reached for a rubber mask and held it over the infant’s face. A moment later there was a hiss as the oxygen went on.

“Pulse very slow,” the intern said.

The nurse said, “Temperature’s down to ninety-three.”

The intern was listening with a stethoscope. He looked up. “Respiration’s failing.” Then, a moment later, “He’s stopped breathing.”

O’Donnell took the stethoscope and listened. He could hear a heartbeat, but it was very faint. He said sharply, “Coramine—one cc.”

As the intern turned from the table O’Donnell ripped off the covering sheets and began artificial respiration. In a moment the intern was back. He had wasted no time; in his hand was a hypodermic, poised.

“Straight in the heart,” O’Donnell said. “It’s our only chance.”

In the pathology office Dr. David Coleman was growing restless. He had remained, waiting with Pearson, ever since the telephone message had come announcing the blood-test result. Between them they had disposed of some accumulated surgical reports, but the work had gone slowly, both men knowing that their thoughts were elsewhere. Now close to an hour had gone by and there was still no word.

Fifteen minutes ago Coleman had got up and said tentatively, “Perhaps I should see if there’s anything in the lab . . .”

The old man had looked at him, his eyes doglike. Then, almost pleadingly, he had asked, “Would you mind staying?”

Surprised, Coleman had answered, “No; not if you wish,” and after that they had gone back to their task of time filling.

For David Coleman, too, the waiting was hard. He knew himself to be almost as tense as Pearson, although at this moment the older man was showing his anxiety more. For the first time Coleman realized how mentally involved he had become in this case. He took no satisfaction from the fact that he had been right and Pearson wrong about the blood test. All he wanted, desperately now, for the sake of the Alexanders, was for their child to live. The force of his own feeling startled him; it was unusual for anything to affect him so deeply. He recalled, though, that he had liked John Alexander right from the beginning at Three Counties; then later, meeting his wife, knowing that all three of them had had their origins in the same small town, there had seemed to spring up a sense of kinship, unspoken but real.

The time was going slowly, each successive minute of waiting seeming longer than the last. He tried to think of a problem to keep his mind busy; that always helped when you had time to kill. He decided to concentrate on some of the aspects of the Alexander case. Point one, he thought: The fact that the baby’s Coombs test now shows positive means that the mother has Rh-sensitized blood also. He speculated on how this might have come about.

The mother, Elizabeth Alexander, could, of course, have become sensitized during her first pregnancy. David Coleman reasoned: It need not have affected their first child; that was the one who had died of—what was it they had told him?—oh yes, bronchitis. It was much more common to find the effect of Rh sensitization during a second pregnancy.

Another possibility, of course, was that Elizabeth might have been given a transfusion of Rh-positive blood at some time or other. He stopped; at the back of his mind was a nagging, unformed thought, an uneasy feeling that he was close to something but could not quite reach it. He concentrated, frowning. Then suddenly the pieces were in place; what he had been groping for was there—vivid and sharply in focus. His mind registered: Transfusions! The accident at New Richmond! The railroad crossing at which Elizabeth’s father had been killed, where she herself had been injured but had survived.

Once more Coleman concentrated. He was trying to remember what it was John Alexander had said about Elizabeth that day. The words came back to him: Elizabeth almost died. But they gave her blood transfusions and she made it. I think that was the first time I was ever in a hospital. I almost lived there for a week.

It could never be proved, of course, not after all this time; but he was willing to wager everything he had that that was the way it happened. He thought: Existence of the Rh factor only became known to medicine in the 1940s; after that it took another ten years before Rh testing was generally adopted by all hospitals and doctors. In the meantime, there were plenty of places where blood transfusions were given without an Rh cross match; New Richmond was probably one. The time fitted. The accident involving Elizabeth would have been in 1949; he remembered his father telling him about it afterward.

His father! A new thought came to him: it was his own father—Dr. Byron Coleman—who had taken care of the Alexander family, who would have ordered the transfusions Elizabeth Alexander had received. If she had had several transfusions they would have come from more than one donor; the chance of at least some of the blood being Rh positive was almost inevitable. That was the occasion, then, when Elizabeth had become sensitized; he was sure of it now. At the time, of course, there would have been no apparent effect. None, that is, except that her own blood would be building antibodies—antibodies to lurk hidden and unsuspected until, nine years later, they rose in anger, virulent and strong, to destroy her child.

Naturally David Coleman’s father could not be blamed, even if the hypothesis were true. He would have prescribed in good faith, using the medical standards of his day. It was true that at the time the Rh factor had been known and in some places Rh cross matching was already in effect. But a busy country G.P. could scarcely be expected to keep up with everything that was new. Or could he? Some physicians of the time—G.P.’s included—were aware of the new horizons opened up by modern blood grouping. They had acted promptly to enforce the latest standards. But possibly, David Coleman reasoned, these were younger men. His father at that time was growing old; he worked too hard and long to do much reading. But was that an adequate excuse? Was it an excuse that he himself—David Coleman—would accept from others? Or was there perhaps a double standard—a more lenient set of rules when it came to judging your own kin, even a father who was dead? The thought troubled him. He sensed uneasily that a feeling of personal loyalty was obtruding across some of his own most cherished views. David Coleman wished he had not thought of this. It gave him an uneasy feeling of doubt, of not being absolutely sure . . . of anything at all.

Pearson was looking across at him. He asked, “How long is it now?”

Coleman checked his watch, then answered, “Just over an hour.”

“I’m going to call them.” Impetuously Pearson reached for the telephone. Then he hesitated and drew his hand away. “No,” he said, “I suppose I’d better not.”

In the serology lab John Alexander, too, was conscious of the time. An hour ago he had come back from visiting Elizabeth, and since then he had made several halfhearted attempts to work. But it was obvious to himself that his mind was far removed from what he was doing and he had desisted, rather than risk mistakes. Now, taking up a test tube, he prepared to begin again, but Bannister came over and took it from him.

Looking at the requisition sheet, the older technician said kindly, “I’ll do that.”

He protested halfheartedly, then Bannister said, “Go on, kid; leave it to me. Why don’t you go up with your wife?”

“Thanks all the same, but I think I’ll stay. Dr. Coleman said as soon as he heard . . . he’d come and tell me.” Alexander’s eyes turned to the wall clock again. He said, his voice strained, “They can’t be much longer now.”

Bannister turned away. “No,” he said slowly, “I guess not.”

Elizabeth Alexander was in her hospital room alone. She was lying still, head back on the pillows, her eyes open, when Nurse Wilding came in. Elizabeth asked, “Is there any news?”

The elderly, gray-haired nurse shook her head. “I’ll tell you just as soon as we hear.” Putting down the glass of orange juice she had brought, she said, “I can stay with you for a few minutes if you like.”

“Yes, please.” Elizabeth smiled faintly, and the nurse pulled a chair near the bed and sat down. Wilding felt relieved to rest her feet; just lately they had been giving her a good deal of pain, and she suspected they would probably force her to quit nursing soon, whether she wanted to or not. Well, she had a feeling she was pretty close to being ready to go.

Wilding wished, though, that she could do something for these two young people. She had taken a fancy to them from the beginning; to her the two of them—husband and wife—seemed almost children. In a way, taking care of this girl, who, it seemed now, was likely to lose her baby, had been almost like caring for the daughter that long ago Wilding had wanted but never had. Wasn’t that silly now?—she, with all her years of nursing, getting sentimental at this late day. She asked Elizabeth, “What were you thinking about—when I came in just then?”

“I was thinking about children—fat, roly-poly children scrambling on green grass in afternoon sunshine.” Elizabeth’s voice had a dreamlike quality. “It was like that in Indiana when I was a little girl—in the summers. Even then I used to think that someday I would have children and that I would sit beside them while they rolled on the grass in the sunshine, just as I had.”

“It’s a funny thing about children,” Wilding said. “Sometimes things turn out so different from the way you thought they would. I had a son, you know. He’s a man now.”

“No,” Elizabeth said, “I didn’t know.”

“Don’t misunderstand me,” Wilding said. “He’s a fine man—a naval officer. He got married a month or two ago; I had a letter from him telling me.”

Elizabeth found herself wondering—what it would be like to bear a son and then have a letter, telling about his getting married.

“I never did feel we got to know one another very well,” Wilding was saying. “I expect that was my fault in a way—getting divorced and never giving him a real home.”

“But you’ll go and see him sometimes?” Elizabeth said. “And there’ll be grandchildren, I expect.”

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