The Final Diagnosis

The Final Diagnosis Page 23

It was early afternoon. Four days had gone by since the initial cases of typhoid in Three Counties Hospital had been reported.

Now, in the administrator's office, serious-faced and silent, Orden Brown, the board chairman, and Kent O'Donnell were listening to Harry Tomaselli speaking on the telephone.

"Yes," the administrator said, "I understand." There was a pause, then he continued, "If that becomes necessary we shall be ready with all arrangements. At five o'clock then. Good-by." He replaced the phone.

"Well?" Orden Brown asked impatiently.

"The City Health Department is giving us until this evening," Tomaselli said quietly. "If we've failed to locate the typhoid carrier by then we shall be required to close the kitchens."

"But do they realize what that means?" O'Donnell had risen to his feet, his voice agitated. "Don't they know it will practically have the same effect as closing the hospital. You've told them, haven't you, that we can't get outside catering for more than a handful of patients?"

Still quietly, Tomaselli said, "I've told them, but it doesn't make any difference. The trouble is, the public-health people are afraid of an outbreak in the city."

Orden Brown asked, "Is there any news at all from Pathology?"

"No." O'Donnell shook his head. "They're still working. I was in there half an hour ago."

"I can't understand it!" The board chairman was more disturbed than O'Donnell had ever seen him before. "Four days and ten typhoid cases right here in the hospital - four of them patients - and we still haven't come up with the source!"

"There's no question it's a big job for the lab," O'Donnell said, "and I'm sure they haven't wasted any time."

"No one's blaming anyone," Orden Brown snapped; "not at this stage anyway. But we're got to show some results."

"Joe Pearson told me they expect to be through with all their cultures by midmorning tomorrow. If the typhoid carrier is among the food handlers, they'll have to have traced him by then." O'Donnell appealed to Tomaselli. "Can't you persuade the public-health people to hold off - at least until midday tomorrow?"

The administrator shook his head negatively. "I tried earlier. But they've given us four days already; they won't wait any longer. The city health officer was here again this morning, and he's returning at five o'clock. If there's nothing to report by then I'm afraid we'll have to accept their ruling."

"And meanwhile," Orden Brown asked, "what do you propose?"

"My department is already at work." Harry Tomaselli's voice held the sense of shock and unbelief that gripped them all. "We're proceeding on the assumption that we shall have to close down."

There was a silence, then the administrator asked, "Kent, could you come back here at five - to meet the health officer with me?"

"Yes," O'Donnell said glumly. "I suppose I should be here."

The tension in the lab was equaled only by the tiredness of the three men working there.

Dr. Joseph Pearson was haggard, his eye red-rimmed, and weariness written in the slowness of his movements. For the past four days and three nights he had remained at the hospital, snatching only a few hours of sleep on a cot which he had had moved into the pathology office. It was two days since he had shaved; his clothes were rumpled and his hair wild. Only for one period of several hours on the second day had he been missing from Pathology, with no one knowing where he had gone and Coleman unable to locate him despite several inquiries from the administrator and Kent O'Donnell. Subsequently Pearson had reappeared, offering no explanation for his absence, and had continued his supervision of the cultures and subcultures which occupied them still.

Now Pearson asked, "How many have we done?"

Dr. Coleman checked a list. "Eighty-nine," he said. "That leaves another five in incubation which we'll have tomorrow morning."

David Coleman, though appearing fresher than the senior pathologist, and with none of the outward signs of personal neglect which Pearson exhibited, was conscious of an oppressive weariness which made him wonder if his own endurance would last as long as the older man's. Unlike Pearson, Coleman had slept at his own apartment on each of the three nights, going there from the lab well after midnight and returning to the hospital around six the following morning.

Early as he had been, though, in arriving, only on one occasion had he preceded John Alexander, and then by a mere few minutes. The other times the young technologist had already been occupied at one of the lab benches, working - as he had since the beginning - like a precisely geared machine, his movements accurate and economic, his written record of each test stage painstakingly recorded in neat and legible lettering. Nor had it been necessary - after the initial start - to issue more instructions. Alexander was so obviously competent and aware of what he was doing that Dr. Pearson, after inspecting his progress briefly, had nodded approval and from that point had left him entirely alone.

Turning from Coleman to Alexander, Pearson asked now, "What are your figures on the subcultures?"

Reading from notes, Alexander answered, "Of the eighty-nine plates checked, forty-two have been separated for subculturing, and two hundred and eighty subcultures planted."

Pearson calculated mentally. Half to himself he said, "That means another hundred and ten subcultures still to check, including tomorrow's batch."

Glancing across at John Alexander, David Coleman wondered what the younger man was feeling at this moment and whether the act of throwing himself so intensely into this endeavor was proving an outlet for at least some of his personal grief. It had been four days since the Alexander baby's death. In that time the original sense of shock and desolation which the young technologist had shown had disappeared, at any rate superficially. Coleman suspected, though, that John Alexander's emotions were still not far below the surface, and he had sensed something of their presence in Alexander's announced intention to enroll in medical school. It was a subject which David Coleman had not pursued so far, but he had resolved, as soon as this present crisis was over, to have a long talk with Alexander. There was a good deal of advice and guidance which Coleman could offer the younger man, based on his own experiences. Certainly, as Alexander had said, it would not be easy for him - particularly financially - to give up a salaried job and become a student once more, but there were certain guideposts Coleman could point to and pitfalls which he might help Alexander to avoid.

The fourth member of the original lab team, Carl Bannister, was temporarily disqualified. The senior technician had worked through three days and most of the nights, handling routine lab work alone and assisting the others whenever he could. This morning, however, his speech had been slurred and he was so obviously near exhaustion that David Coleman, without consulting Pearson, had ordered him home. Bannister had departed gratefully and without argument.

The preparatory work on the stool samples arriving in the lab had gone on continuously. By the second day, however, those samples which had been dealt with first had been in incubation long enough for investigation. Once again Dr. Pearson had divided his forces in order to keep the work flowing, John Alexander and himself handling the new stage, while David Coleman continued to deal with the remaining stool samples still coining in.

Removed from the incubator, the pink-tinged surface of the prepared petri dishes showed small, moist bacteria colonies where the tiny amounts of human feces had been added the previous day. With every individual stool containing millions of bacteria, the next task was to separate those colonies which were obviously harmless from those which must be investigated further.

Pink-tinged colonies of bacteria were eliminated at once as harboring no typhoid. Pale colonies, where typhoid bacilli might conceivably lurk, had samples taken from them for subculture in sugar tubes with liquid media. There were ten sugar tubes to each original culture, each tube containing a different reagent. It was these reagents which, after further incubation, would finally show which stool sample, if any, contained the marauding and infectious typhoid germs.

Now, on the fourth day, all the stool samples were finally in. They had been obtained from everyone on the hospital staff involved in any way with the receiving, preparation, or distribution of food, and the task of processing them would continue until well into tomorrow. At the moment the 280 subcultures which John Alexander had referred to were distributed in racks around the lab and in incubators. But although on many of these the final checks were complete, none so far had revealed the individual - the suspected typhoid carrier - whom, anxiously and diligently, they had been seeking day and night.

The telephone bell rang and Pearson, nearest to the lab wall phone, answered it. "Yes?" He listened, then said, "No; nothing yet. I keep telling you - I'll call as soon as we find anything." He replaced the instrument.

John Alexander, succumbing to a sudden tiredness, completed an entry on a data sheet, then dropped into a straight-back lab chair. Momentarily he closed his eyes with relief at his own sudden inactivity.

From alongside David Coleman said, "Why don't you take an hour or two off, John - maybe go upstairs and stay with your wife for a while?"

Alexander got to his feet again. He knew that if he remained seated too long he could easily fall asleep. "I'll do one more series," he said, "then I think I will."

Taking a rack of subcultures from the incubator, he collected a fresh data sheet and began to line up the ten sugar tubes he was about to check. Glancing at the lab wall clock, he noted with surprise that another day was running out. The time was ten minutes to five.

Kent O'Donnell replaced the telephone. Answering Harry Tomaselli's unspoken question, he said, "Joe Pearson says there's nothing new."

In the administrator's birch-paneled office there was a silence, both men bleakly aware of the implications of this latest lack of news. Both knew, too, that around them, outside the administration suite, the work of the hospital was grinding to a halt.

Since early afternoon the plan for contraction of patient service, devised by Harry Tomaselli several days earlier and now made necessary by the impending shutdown of the hospital kitchens, had been going steadily into effect. Commencing with breakfast tomorrow, one hundred meals for patients on regular diet would be prepared by two local restaurants, combining forces for the occasion, and would be delivered to the hospital for seriously ill patients who could not be moved. Of the remaining patients, as many as possible were being discharged to their homes, while others, for whom hospital care was still essential, were being transferred to other institutions in and around Burlington, now mobilizing their own facilities to meet the emergency influx from Three Counties.

An hour ago, knowing that the process of transfer would have to continue far into the night, Harry Tomaselli had given the order for evacuation to begin. Now a line of ambulances, summoned by telephone from all available points, had begun to assemble outside the emergency entrance. Meanwhile, in the wards and private pavilion, nurses and doctors were working briskly, moving patients from beds to stretchers and wheel chairs in readiness for their unexpected journey. For those with time for thinking it was a sad and somber moment. For the first time in its forty-year history Three Counties Hospital was turning the sick and the injured away from its doors.

There was a light tap, and Orden Brown entered the administrator's office. He listened attentively while Harry Tomaselli reported what had been done since their meeting four hours earlier. At the end the board chairman asked, "The city health authorities - have they been here again?"

"Not yet," Tomaselli answered. "We're expecting them now."

Orden Brown said quietly, "Then if you don't mind, I'll wait with you."

After a pause the board chairman turned to O'Donnell. "Kent, this isn't important now, but I'll tell you while I think of it. I've had a call from Eustace Swayne. When all this is over he would like you to go and see him."

For an instant the effrontery of the request left O'Donnell speechless. It was obvious why Eustace Swayne wanted to talk with him; there could be only one reason - despite everything the old man intended to use his money and influence in an attempt to intercede for his friend, Dr. Joseph Pearson. After all that had happened over the past few days it seemed unbelievable that such blindness and presumption could exist. A boiling fury seethed within O'Donnell. He said explosively, "To hell with Eustace Swayne and all his works!"

"May I remind you," Orden Brown said icily, "that you happen to be speaking of a member of the hospital board. Whatever your disagreements, he at least is entitled to be treated with courtesy."

O'Donnell faced Orden Brown, his eyes blazing. Very well, he thought, if this is the showdown, then let's have it. I've finished with hospital politics - for good and as of now.

At the same moment a buzzer sounded on the administrator's desk. "Mr. Tomaselli," a girl's voice said on the intercom, "the public-health officers have just arrived."

It was three minutes to five.

As they had on a morning six weeks earlier - the day on which, as he realized now, Kent O'Donnell had received his first warning of impending disruption in the hospital - the chimes of the Church of the Redeemer announced the hour as the small group threaded its way through the corridors of Three Counties. Led by O'Donnell, it included Orden Brown, Harry Tomaselli, and Dr. Norbert Ford, city health officer of Burlington. Behind them were Mrs. Straughan, the chief dietitian, who had arrived at the administration suite as they were leaving, and a young assistant health officer whose name O'Donnell had missed in the flurry of introductions.

Now that his initial anger was over, the chief of surgery was relieved that the interruption of a few minutes ago had prevented what could have become a major quarrel between himself and Orden Brown. He realized that all of them, himself included, had become unnaturally tense over the past few days, and the board chairman had, after all, done no more than relay a message. O'Donnell's real quarrel was with Eustace Swayne, and he had already resolved to meet the old tycoon face to face as soon as this present business was over. Then, whatever overtures Swayne chose to make, O'Donnell planned to respond with plain, blunt words, no matter what the consequences might be.

It had been Kent O'Donnell's suggestion that the group should visit the pathology department. He had told the city health officer, "At least you'll see we're doing everything possible to trace the source of infection."

Dr. Ford had at first demurred. "There's been no suggestion that you're not, and I doubt if I could add anything to what your pathologists are doing," he had said. But at O'Donnell's insistence he had agreed to go, and now they were en route to the basement pathology lab.

John Alexander glanced up as the group entered, then continued with the sugar test he was carrying out. Pearson, on seeing O'Donnell and Orden Brown, moved forward to meet them, wiping both hands on his already soiled lab coat. At a signal from Harry Tomaselli, David Coleman followed him.

O'Donnell handled the introductions. As Pearson and Dr. Norbert Ford shook hands the health officer asked, "Have you come up with anything?"

"Not yet." Pearson gestured around the lab. "As you can see, we're still working."

O'Donnell said, "Joe, I thought you should know. Dr. Ford has ordered the closing of our kitchens."

"Today?" There was disbelief in Pearson's voice.

The health officer nodded gravely. "I'm afraid so."

"But you can't do that! It's ridiculous!" This was the old aggressive Pearson, his voice belligerent, eyes flashing behind the mask of tiredness. He stormed on, "Why, man alive, we'll be working all night, and every subculture will be finished by midday tomorrow. If there's a carrier, all the chances are we'll have learned who it is."

"I'm sorry." The health officer shook his head. "We can't take that chance."

"But closing the kitchens means closing the hospital." Pearson fumed. "Surely you can wait until morning - at least until then."

"I'm afraid not." Dr. Ford was polite but firm. "In any case, the decision is not entirely mine. The city simply cannot afford the possibility of a wider epidemic. At the moment your outbreak is within these walls, but at any point it could spread outside. It's that we're thinking of."

Harry Tomaselli put in, "We're serving the evening meal, Joe, and that will be the last. We're sending home all the patients we can and transferring most of the others."

There was silence. Pearson's face muscles were working. His deep-set, red-rimmed eyes seemed close to tears. His voice near a whisper, he said, "I never thought I'd see the day . . ."

As the group turned away O'Donnell added quietly, "To tell the truth, Joe, neither did I."

They had reached the door when John Alexander announced, "I have it."

As a unit the group turned. Pearson asked sharply, "You have what?"

"A definite typhoid." Alexander pointed to the row of sugar tubes on which he had been working.

"Let me see!" Almost at a run, Pearson crossed the lab. The others had turned back into the room.

Pearson looked at the row of tubes. Nervously his tongue touched his lips. If Alexander were right, this was the moment they had worked for. "Call off the list," he said.

John Alexander picked up a textbook open at a double page. It was a tabulated chart of biochemical reactions of bacteria in sugar tubes. Putting a finger on the column headed "Salmonella typhi," he prepared to read down.

Pearson picked up the first of the ten tubes. He called out, "Glucose."

Checking the list, Alexander answered, "Acid formation, but no gas."

Pearson nodded. He replaced the tube and selected a second. "Lactose."

"No acid, no gas," Alexander read.

"Right." A pause. "Dulcitol."

Again Alexander read, "No acid, no gas."

"Sucrose."

"No acid, no gas." Once more the correct reaction for typhoid bacilli. The tension in the room was mounting.

Pearson took another tube. "Mannitol."

"Acid formation, but no gas."

"Correct." Another. "Maltose."

"Acid, but no gas."

Pearson nodded. Six down, four to go. Now he said, "Xylose."

Once more Alexander read, "Acid, but no gas."

Seven.

"Arabinose."

John Alexander said, "Either acid but no gas or no reaction at all."

Pearson announced, "No reaction."

Eight. Two more.

"Rhamnose?"

"No reaction."

Pearson looked at the tube. He said softly, "No reaction."

One to go.

From the last tube Pearson read, "Indole production."

"Negative," Alexander said, and replaced the book.

Pearson turned to the others. He said, "There's no question. This is the typhoid carrier."

"Who is it?" The administrator was first to ask.

Pearson turned over a petri dish. He read off, Number seventy-two."

David Coleman had already reached for a ledger. There was a list with entries in his own handwriting. He announced, "Charlotte Burgess."

"I know her!" Mrs. Straughan said quickly. "She works on the serving counter."

As if by instinct, all eyes swung to the clock. It was seven minutes after five.

Mrs. Straughan said urgently, "The dinner! They're beginning to serve the evening meal!"

"Let's get to the dining room fast!" As he spoke, Harry Tomaselli was already at the door.

On the hospital's second floor the nursing supervisor entered Vivian's room with a harassed air, glancing at the door number as she came in.

"Oh yes, you're Miss Loburton." She consulted a clip board and made a penciled notation. "You'll be transferred to the West Burlington Clinic."

Vivian asked, "When will it be, please?" She had already learned, earlier in the afternoon, of the impending move and the reason for it.

"The ambulances are very busy now," the supervisor said. "I expect it will be several hours - probably about nine o'clock tonight. Your own nurse will be in to help you with your things in plenty of time."

"Thank you," Vivian said.

Her mind back with the clip board, the supervisor nodded and went out.

This was the time, Vivian decided, to call Mike. Their five days of separation were not due to end until tomorrow, but neither of them had contemplated anything like this. Besides, she had already come to regret the whole idea of having a period of time apart; she saw it now as a stupid and unnecessary notion which she wished had never occurred to her.

Her hand went out for the bedside telephone, and this time there was no hesitation. When the operator answered Vivian said, "Dr. Michael Seddons, please."

"One moment."

There was a wait of several minutes, then the operator came on the line. "Dr. Seddons is away from the hospital with one of the transfer ambulances. Can someone else help?"

"No, thank you," Vivian said. "I'd like to leave a message though."

The operator asked, "Is this a medical matter?"

She hesitated. "Well, not really."

"We can only take urgent medical messages now. Will you make your call later, please." There was a click as the line went dead. Slowly Vivian replaced the telephone.

Outside in the hallway she could hear commotion and raised voices. She sensed an undercurrent of excitement; there was a sharp order given, then a clatter as an object fell to the floor, and someone laughed. It all sounded commonplace, and yet at this moment her mind clamored to share in it, to be a part of whatever was going on. Then her eyes fell to the bedclothes, to where the coverlet went flat at the point where her left leg ended. Suddenly, for the first time, Vivian felt fearfully and desperately alone.

"Oh, Mike!" she whispered. "Mike darling - wherever you are, please come to me soon!"

Nurse Penfield was about to enter the cafeteria when she saw the group bearing down toward her. She recognized the administrator and the chief of surgery. Behind them, her big breasts bouncing with the effort of keeping up, was Mrs. Straughan, the chief dietitian.

Passing through the cafeteria entrance, Harry Tomaselli slowed his pace. He told Mrs. Straughan, "I want this done quickly and quietly."

The dietitian nodded, and together they entered the kitchens through a service doorway.

O'Donnell beckoned Nurse Penfield. "Come with me, please. I'd like you to help us."

What happened next was done with swiftness and precision. One moment a middle-aged woman was serving at the cafeteria counter. The next, Mrs. Straughan had taken her arm and had steered her into the diet office at the rear. O'Donnell told the bewildered woman, "One moment, please," and motioned Nurse Penfield to remain with her.

"Take the food she was serving and incinerate it," he instructed Mrs. Straughan. "Get back any you can that's already been served. Remove any dishes she may have touched and boil them."

The chief dietitian went out to the serving counter. In a few minutes O'Donnell's instructions had been followed and the cafeteria line was moving once more. Only a few individuals closest to the scene were aware of what had occurred.

In the office at the rear O'Donnell told the woman kitchen worker, "Mrs. Burgess, I must ask you to regard yourself as a patient in the hospital." He added kindly, "Try not to be alarmed; everything will be explained to you."

To Nurse Penfield he said, "Take this patient to the isolation ward. She's to have contact with no one. I'll call Dr. Chandler and he'll issue instructions."

Gently Elaine Penfield led the frightened woman away.

Afterward Mrs. Straughan asked curiously, "What happens to her now, Dr. O.?"

"She'll be well looked after," O'Donnell said. "She'll stay in isolation, and the internists will study her for a while. Sometimes, you know, a typhoid carrier may have an infected gall bladder, and if that's the case she'll probably be operated on." He added, "There'll be follow-up checks, of course, on all the other people who have been affected. Harvey Chandler will see to that."

On the diet-office telephone Harry Tomaselli was telling an assistant, "That's what I said: cancel everything - transfers, discharges other than normal, catered meals, the whole works. And when you've done that you can call the admitting office." The administrator grinned across the desk at O'Donnell. "Tell them that Three Counties Hospital is back in business."

Tomaselli hung up the phone and accepted the cup of coffee which the chief dietitian had poured him from her private percolator.

"By the way, Mrs. Straughan," he said, "there hasn't been time to tell you before, but you're getting your new dishwashers. The board has approved the expenditure and the contract has been let. I expect the work will begin next week."

The dietitian nodded; obviously the information was something she had anticipated. Now her mind had moved ahead to other things. "There's something else I'd like to show you while you're here, Mr. T. I need my refrigerator enlarged." She eyed the administrator sternly. "I hope this time it won't require an epidemic to prove my point."

The administrator sighed and rose to his feet. He asked O'Donnell, "Do you have any more problems today?"

"Not today," O'Donnell answered. "Tomorrow, though, there's one item of business I intend to deal with personally."

He was thinking of Eustace Swayne.