ah.thefinaldiagnosis-第68章
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s throbbing； the room swirling。 Momentarily he closed his eyes； then opened them。 It was all right； things were back in focus； the dizziness almost gone。 But when he looked down at his hands he saw they were trembling。 He tried to control the movement and failed。
The incubator containing the Alexander baby was being wheeled in。 At the same moment he beard the intern ask； 〃Dr。 Dornberger…are you all right？〃
It was on the edge of his tongue to answer 〃yes。〃 He knew that if he did he could carry on； concealing what had happened； with no one but himself aware of it。 And then perhaps； even at this late moment； by exercise of skill and judgment he could save this child； salving； at least in some measure； his conscience and integrity。
Then； in the same moment； he remembered all that he had said and believed over the years…about old men clinging to power too long； the boast that when his own time came he would know it and make way； his conviction that he would never handle a case with his own facilities unpaired。 He thought of these things； then looked down at his shaking hands。
〃No；〃 he said； 〃I don't think I am all right。〃 He paused； and aware for the first time of a deep emotion which made it hard to control his voice； he asked； 〃Will someone please call Dr。 O'Donnell？ Tell him I'm unable to go on。 I'd like him to take over。〃
At that moment； in fact and in heart； Dr。 Charles Dornberger retired from the practice of medicine。
As the telephone bell rang Pearson snatched the instrument from its cradle。
〃Yes？〃 A pause。 〃This is Dr。 Pearson。〃 He listened。 〃Very well。 Thanks。〃
Without putting the receiver back he flashed the exchange and asked for an extension number。 There was a click； then an answer； and Pearson said； 〃Get me Dr。 Dornberger。 It's Dr。 Pearson calling。〃
A voice spoke briefly； then Pearson said； 〃All right； then give him a message。 Tell him I've just heard from the university。 The blood test on the Alexander baby is positive。 The child has erythroblastosis。〃
Pearson replaced the phone。 Then he looked up； to find David Coleman's eyes upon him。
Dr。 Kent O'Donnell was striding through the hospital's main floor on his way to Neurology。 He had arranged a consultation there to discuss a partial paralysis condition in one of his own patients。
It was O'Donnell's first day back at Three Counties after his return from New York the evening before。 He still felt a sense of exhilaration and freshness from his trip； a change of scene； he told himself； was what every physician needed now and then。 Sometimes the daily contact with medicine and sickness could bee a depressive； wearing you down after a while without your own awareness of its happening。 In the larger sense； too； a change was invigorating and broadening for the mind。 And akin to this； more and more since his New York meeting with Denise； the question of ending his own tenure at Three Counties； and of leaving Burlington for good； had kept ing back； to be assessed and weighed in mind； and each time the arguments in favor of a move had seemed more convincing。 He knew； of course； that he was strongly motivated by his feelings for Denise and that even until their latest meeting the thought of leaving Burlington had not occurred to him。 But he asked himself： was there anything wrong with an individual making a professional choice which weighed in favor of personal happiness？ It was not as if he would be quitting medicine； he would merely be changing his base of operations and giving of his best elsewhere。 After all； any man's life was the sum of all its parts； without love； if once he found it； the rest of him might wither and be worthless。 With love he could be a better man…zealous and devoted…because his life was whole。 Again he thought of Denise with a rising sense of excitement and anticipation。
〃Dr。 O'Donnell。 Dr。 O'Donnell。〃
The sound of his own name on the hospital P。A。 system brought him back to reality。 He stopped； looking around him for a telephone on which to acknowledge the call。 He saw one in a glass…enclosed accounting office a few yards away。 Going in to use it； he reported to the telephone exchange and a moment later was given Dornberger's message。 Responding promptly； he changed direction and headed for the elevators which would take him to the fourth floor and Obstetrics。
While Kent O'Donnell scrubbed； Dornberger； standing alongside； described what had happened in the case and his own reason for calling in the chief of surgery。 Dornberger neither dramatized nor held anything back； he related the scene in the pathology lab； as well as the events leading up to it； accurately and without emotion。 Only at two points did O'Donnell stop him to interject sharp questions； the remainder of the time he listened carefully； his expression growing grimmer as Dornberger's account proceeded。
O'Donnell's mood of elation was gone now； shattered suddenly and incredibly by what he had learned； by the knowledge that negligence and ignorance…for which； in a very real sense； he himself Was responsible…might snuff out the life of a patient in this hospital。 He thought bitterly： I could have fired Joe Pearson； there was plenty of reason to。 But no！ I dallied and procrastinated； playing politics； convincing myself I was behaving reasonably； while all the time I was selling medicine short。 He took a sterile towel and dried his hands； then plunged them into gloves which a nurse held out。 〃All right；〃 he told Dornberger。 〃Let's go in。〃
Entering the small operating room； O'Donnell ran his eye over the equipment which had been made ready。 He was familiar with exchange…transfusion technique…a fact which Dornberger had known in calling for the chief of surgery…having worked with the heads of Pediatrics and Obstetrics in establishing a standard procedure at Three Counties； based on experience in other hospitals。
The tiny； frail Alexander baby had been taken from its incubator and placed on the warm operating table。 Now the assisting nurse； with the intern helping her； was securing the infant in place； using diapers…one around each arm and leg…folded in long narrow strips and fastened with safety pins to the cover of the table。 O'Donnell noticed the baby lay very still； making only the slightest of responses to what was being done。 In a child so small it was not a hopeful sign。
The nurse unfolded a sterile sheet and draped it over the infant； leaving exposed only the head and navel； the latter area still in process of healing where the umbilical cord had been severed at birth。 A local anesthetic had already been administered。 Now the girl passed forceps to O'Donnell and； taking them； he picked up a gauze pad and began to prep the operative area。 The intern had taken up a clip board and pencil。 O'Donnell asked him； 〃You're going to keep score？〃
〃Yes； sir。〃
O'Donnell noticed the tone of respect and in other circumstances would have smiled inwardly。 Interns and residents…the hospital's house staff…were a notoriously independent breed； quick to observe shortings in the more senior attending physicians； and to be addressed as 〃sir〃 by any of their number was something of an accolade。
A few minutes ago two student nurses had slipped into the room and now； following a habit of instruction； O'Donnell began to describe procedure as he worked。
〃An exchange transfusion； as perhaps you know〃…O'Donnell glanced toward the student nurses…〃is actually a flushing…out process。 First we remove some blood from the child； then replace it with an equivalent amount of donor blood。 After that we do the same thing again and keep doing it until most of the original； unhealthy blood is gone。〃
The assisting nurse was inverting a pint bottle of blood on a stand above the table。 O'Donnell said； 〃The blood bank has already crossmatched the patient's blood with that of the donor to ensure that both are patible。 What we must be sure of also is that we replace exactly the amount of blood we remove。 That's the reason we keep a score sheet。〃 He indicated the intern's clip board。
〃Temperature ninety…six；〃 the assisting nurse announced。
O'Donnell said； 〃Knife； please；〃 and held out his hand。
Using the knife gently； he cut off the dry portion of the umbili
