ah.thefinaldiagnosis-第27章

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ondering　what　it　would　be　like…the　two　of　them　together　always。　As　a　nurse　there　would　be　so　much　she　could　do　to　help　him　and　to　understand　his　work。　She　told　herself：　This　is　ridiculous；　we　scarcely　know　each　other。　Then；　momentarily；　the　pain　returned　and　she　winced。
　Mike　asked；　〃Has　this　happened　before？〃
　For　a　moment　the　absurdity　of　the　situation　struck　her　and　she　giggled。
　〃What　is　it；　Vivian？〃　Mike　sounded　puzzled。
　〃I　was　just　thinking。　A　minute　or　two　ago　。　。　。　And　now　here　you　are；　just　like　in　a　doctor's　office。〃
　〃Listen；　kid。〃　He　was　serious。　〃Has　this　happened　before？〃
　She　said；　〃Just　once。　It　wasn't　as　bad　as　this　though。〃
　〃How　long　ago？〃
　She　thought。　〃About　a　month。〃
　〃Have　you　seen　anybody　about　it？〃　He　was　all　professional　now。
　〃No。　Should　I　have？〃
　Nonmittally　he　said；　〃Maybe。〃　Then　he　added；　〃You　will　tomorrow　anyway。　I　think　Dr。　Grainger　would　be　the　best　one。〃
　〃Mike；　is　something　wrong？〃　Now　she　felt　an　undercurrent　of　alarm。
　〃Probably　not；〃　he　reassured　her。　〃But　there's　a　small　lump　there　that　shouldn't　be。　Lucy　Grainger　will　give　us　the　word　though。　I'll　talk　with　her　in　the　morning。　Now　we　have　to　get　you　home。〃
　The　earlier　mood　was　gone。　It　could　not　be　recaptured；　not　tonight　anyway；　and　both　of　them　knew　it。
　Mike　helped　her　up。　As　his　arm　went　around　her；　he　had　a　sudden　feeling　of　wanting　to　help　and　protect　her。　He　asked；　〃Do　you　think　you　can　walk？〃
　Vivian　told　him；　〃Yes。　The　pain's　gone　now。〃
　〃We'll　just　go　to　the　gate；〃　he　said；　〃we　can　get　a　taxi　there。〃　Then　because　she　looked　glum　he　added　cheerfully；　〃That　patient　was　a　cheap　skate。　He　didn't　send　any　cab　fare。〃
　
　Nine
　
　〃Give　me　the　details。〃
　Hunched　over　the　binocular　microscope；　Dr。　Joseph　Pearson　half　grunted　the　words　to　Roger　McNeil。
　The　pathology　resident　looked　at　his　folder　of　notes。　〃Case　was　a　forty…year…old　man；　admitted　for　appendicitis。〃　McNeil　was　seated　opposite　Pearson　at　the　desk　of　the　pathology　office。
　Pearson　took　out　the　slide　he　had　been　studying　and　substituted　another。　He　asked；　〃What　did　the　tissue　look　like　at　gross？〃
　McNeil；　who　had　made　the　gross　examination　when　the　removed　appendix　came　down　from　the　operating　room；　said；　〃Grossly　it　looked　normal　enough　to　me。〃
　〃Hm。〃　Pearson　moved　the　slide　around。　Then　he　said；　〃Wait　a　minute；　here's　something。〃　After　a　pause　he　slipped　the　second　slide　out　and　selected　a　third。　Now　he　said；　〃Here　it　is…an　acute　appendicitis。　It　was　just　beginning　in　this　section。　Who　was　the　surgeon？〃
　McNeil　answered；　〃Dr。　Bartlett。〃
　Pearson　nodded。　〃He　got　it　good　and　early。　Take　a　look。〃　He　made　way　at　the　microscope　for　McNeil。
　Working　with　the　resident；　as　the　hospital's　teaching　program　required　him　to；　Pearson　was　endeavoring　to　catch　up　on　the　pathology　department's　surgical　reports。
　Despite　his　best　efforts；　though；　both　men　knew　they　were　seriously　in　arrears　with　work。　The　slides　being　studied　now　had　been　sectioned　from　a　patient's　appendix　removed　several　weeks　earlier。　The　patient　had　long　since　been　discharged；　and　in　this　case　the　report　would　merely　confirm　or　deny　the　surgeon's　original　diagnosis。　In　this　instance　Gil　Bartlett　had　been　entirely　right；　in　fact；　creditably　so；　since　he　had　caught　the　disease　in　its　early　stages　and　before　the　patient　could　have　had　much　distress。
　〃Next。〃　Pearson　moved　back　to　the　microscope　as　McNeil　returned　to　the　other　side　of　the　desk。
　The　resident　pushed　over　a　slide　folder　and；　as　Pearson　opened　it；　McNeil　consulted　a　fresh　set　of　notes。　As　they　worked　Bannister　entered　the　room　quietly。　With　a　glance　at　the　other　two　he　passed　behind　them　and　began　to　file　papers　into　a　cabinet。
　〃This　is　a　current　one；〃　McNeil　said。　〃It　came　down　five　days　ago。　They're　waiting　to　hear　what　we　say。〃
　〃You'd　better　give　me　any　like　this　first；〃　Pearson　said　sourly；　〃otherwise　there'll　be　more　bleating　from　upstairs。〃
　McNeil　was　on　the　point　of　saying　that　several　weeks　ago　he　had　suggested　changing　their　procedure　in　just　that　way；　but　Pearson　had　insisted　on　reviewing　all　specimens　in　the　order　they　came　into　the　department。　However；　the　resident　checked　himself。　Why　bother？　he　thought。　He　told　Pearson；　〃It's　a　fifty…six…year…old　woman。　The　specimen　is　a　skin　lesion…superficially　a　mole。　Question　is：　Is　it　a　malignant　melanoma？〃
　Pearson　put　in　the　first　slide　and　moved　it　around。　Then　he　nipped　over　the　highest…powered　lens　and　adjusted　the　binocular　eyepiece。　〃It　could　be。〃　He　took　the　second　slide；　then　two　more。　After　that　he　sat　back　thoughtfully。　〃On　the　other　hand　it　could　be　a　blue　nevus。　Let's　see　what　you　think。〃
　McNeil　moved　in。　This　one；　he　knew；　was　important。　A　malignant　melanoma　was　a　tumor　that　was　viciously　malignant。　Its　cells　could　spread　rapidly　and　murderously　in　the　body。　If　diagnosed　as　such　from　the　small　portion　already　removed；　it　would　mean　immediate　major　surgery　for　the　woman　patient。　But　a　blue　nevus　tumor　was　entirely　harmless。　It　could　stay　where　it　was　in　the　body；　doing　no　harm；　for　the　rest　of　the　woman's　life。
　From　his　own　studies　McNeil　knew　that　a　malignant　melanoma　was　not　mon；　but　he　also　knew　that　a　blue　nevus　was　extremely　rare。　Mathematically　the　odds　were　on　this　being　malignant。　But　this　was　not　mathematics。　It　was　pathology　at　its　purest。
　As　he　had　learned　to　do；　McNeil　ran　over　in　his　mind　the　parative　features　of　the　two　types　of　tumor。　They　were　distressingly　similar。　Both　were　partly　scarred；　partly　cellular；　with　a　good　deal　of　pigmentation　in　them。　Again；　in　both；　the　cellular　structure　was　very　pronounced。　Something　else　McNeil　had　been　taught　was　to　be　honest。　After　looking　at　all　the　slides　he　said　to　Pearson；　〃I　don't　know。〃　He　added；　〃What　about　previous　cases？　Could　we　get　any　out？　To　pare　them。〃
　〃It'd　take　us　a　year　to　find　any。　I　don't　remember　when　I　last　had　a　blue　nevus。〃　Pearson　was　frowning。　He　said　heavily；　〃One　of　these　days　we've　got　to　set　up　a　cross　file。　Then　when　a　doubtful　case　like　this　es　up　we　can　go　back　and　pare　it。〃
　〃You've　been　saying　that　for　five　years。〃　Bannister's　dry　voice　came　from　behind；　and　Pearson　wheeled。　〃What　are　you　doing　here？〃
　〃Filing。〃　The　senior　lab　technician　answered　laconically。　〃Something　the　clerks　should　be　doing　if　we　had　some　proper　help。〃
　And　probably　a　lot　better；　McNeil　thought。　He　knew　the　department　badly　needed　more　clerical　staff　and　the　filing　methods　used　now　were　hopelessly　archaic。　The　reference　to　a　cross　file；　too；　had　reminded　him　of　a　gaping　hole　in　their　administrative　system。　There　were　few　good　hospitals　now　whose　pathology　departments　did　not　have　one。　Some　called　them　organ…lesion　files；　but；　whatever　the　name；　one　purpose　of　the　system　was　to　help　resolve　the　kind　of　problem　they　were　facing　at　this　moment。
　Pearson　was　studying　the　slides　again。　He　mumbled；　as　a　lot　of　pathologists　did　when　they　were　mentally　crossing　off　some　factors　and　confirming　others。　McNeil　heard；　〃It's　a　little　small　。　。　。　absence　of　hemorrhage　。　。　。　no　necrosis　of　the　tissue　。　。　。　negative　but　no　indication　。　。　。　yes；　I'm　satisfied。〃　Pearson　straightened　up　from　the　microscope；　replaced　the　last　slide；　and　closed　the　slide　folder。　Motioning　to　the　resident　to　write；　he　said；　〃Diagnosis…a　blue　nevus。〃　Courtesy　of　Pathology；　the　woman　patient　had　been　reprieved。
　Methodically；　for　McNeil's　benefit；　Pearson　ran　over　the　reasons　for　his　decision　again。　As　he　passed　the　slide　folder　he　added；　〃You'd　better　study　these。　It's　a　specimen　you　won't　see　often。〃
　McNeil　had　no　doubt　that　the　old　man's　finding　was　right。　This　was　one　place　where　years　of　experience　paid　off；　and　he　had　e　to　respect　Pearson's　judgment　in　matters　of　pathological　anatomy。　But　when　you've　gone；　he　thought；　looking　at　the　old　man；　that's　when　this　place　will　need　a　cross　file…badly。
　They　studied　two　more　cases；　both　fairly　straightforward；　then　Pearson　slipped　in　the　first　slide　from　the　next　series。　He　took　one　look　through　the　microscope　eyepiece；　straightened　up；　and　told　McNeil　explosively；　〃Get　Bannister！〃
　〃I'm　still　here。〃　It　was　Bannister；　calmly；　behind　them　at　the　file　cabinets。
　Pearson　wheeled。　〃Look　at　this！〃　He　was　using　his　loudest；　hectoring　vo