ah.thefinaldiagnosis-第69章

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　〃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　umbilical　vein；　exposing　moist　tissue。　He　put　down　the　knife　and　said　softly；　〃Hemostat。〃
　The　intern　was　craning　over；　watching。　O'Donnell　said；　〃We've　isolated　the　umbilical　vein。　I'll　go　into　it　now　and　remove　the　clot。〃　He　held　out　his　hand　and　the　nurse　passed　forceps。　The　blood　clot　was　miniscule；　scarcely　visible；　and　he　drew　it　out；　painstakingly　and　gently。　Handling　a　child　this　small　was　like　working　with　a　tiny　doll。　What　were　the　chances　of　success；　O'Donnell　wondered…of　the　child's　survival。　Ordinarily　they　might　have　been　fair；　even　good。　But　now；　with　this　procedure　days　late；　the　hope　of　success　had　been　lessened　drastically。　He　glanced　at　the　child's　face。　Strangely　it　was　not　an　ugly　face；　as　the　faces　of　premature　children　so　often　were；　it　was　even　a　little　handsome；　with　a　firm　jaw　line　and　a　hint　of　latent　strength。　For　a　moment；　uncharacteristically　allowing　his　mind　to　wander；　he　thought：　What　a　shame　this　all　is　I…to　be　born　with　so　much　stacked　against　you。
　The　assisting　nurse　was　holding　a　plastic　catheter　with　a　needle　attached；　it　was　through　this　that　the　blood　would　be　drawn　off　and　replaced。　O'Donnell　took　the　catheter　and　with　utmost　gentleness　eased　the　needle　into　the　umbilical　vein。　He　said；　〃Check　the　venous　pressure；　please。〃
　As　he　held　the　catheter　vertical；　the　nurse　used　a　ruler　to　measure　the　height　of　the　column　of　blood。　She　announced；　〃Sixty　millimeters。〃　The　intern　wrote　it　down。
　A　second　plastic　tube　led　to　the　bottle　of　blood　above　them；　a　third　ran　to　one　of　the　two　Monel…metal　basins　at　the　foot　of　the　table。　Bringing　the　three　tubes　together；　O'Donnell　connected　them　to　a　twenty…milliliter　syringe　with　a　three…way　stopcock　at　one　end。　He　turned　one　of　the　stopcocks　through　ninety　degrees。　〃Now；〃　he　said；　〃we'll　begin　withdrawing　blood。〃
　His　fingers　sensitive；　he　eased　the　plunger　of　the　syringe　toward　him　gently。　This　was　always　a　critical　moment　in　an　exchange　transfusion；　if　the　blood　failed　to　flow　freely　it　would　be　necessary　to　remove　the　catheter　and　begin　the　early　preparation　all　over　again。　Behind　him；　O'Donnell　was　conscious　of　Dornberger　leaning　forward。　Then；　smoothly　and　easily；　the　blood　began　to　flow；　flooding　the　catheter　tube　and　entering　the　syringe。
　O'Donnell　said；　〃You'll　notice　that　I'm　suctioning　very　slowly　and　carefully。　We'll　also　remove　very　little　at　any　one　time　in　this　case…because　of　the　smallness　of　the　infant。　Normally；　with　a　term　baby；　we　would　probably　take　twenty　milliliters　at　once；　but　in　this　instance　I　shall　take　only　ten；　so　as　to　avoid　too　much　fluctuation　of　the　venous　pressure。〃
　On　his　score　sheet　the　intern　wrote；　10　ml。　out。〃
　Once　more　O'Donnell　turned　one　of　the　stopcocks　on　the　syringe；　then　pressed　hard　on　the　plunger。　As　he　did；　the　blood　withdrawn　from　the　child　was　expelled　into　one　of　the　metal　basins。
　Turning　the　stopcock　again；　he　withdrew　donor　blood　into　the　syringe；　then；　tenderly　and　slowly；　injected　it　into　the　child。
　On　his　score　sheet　the　intern　wrote；　10　ml。　in。
　Painstakingly　O'Donnell　went　on。　Each　withdrawal　and　replacement；　acplished　gradually　and　carefully；　took　five　full　minutes。　There　was　a　temptation　to　hurry；　particularly　in　a　critical　case　like　this；　but　O'Donnell　was　conscious　that　speed　was　something　to　be　shunned。　The　little　body　on　the　table　had　small　enough　resistance　already；　any　effect　of　shock　could　be　immediate　and　fatal。
　Then；　twenty…five　minutes　after　they　had　started；　the　baby　stirred　and　cried。
　It　was　a　frail；　thready　cry…a　weak　and　feeble　protest　that　ended　almost　as　soon　as　it　began。　But　it　was　a　signal　of　life；　and　above　the　masks　of　those　in　the　room　eyes　were　smiling；　and　somehow　hope　seemed　a　trifle　closer。
　O'Donnell　knew　better　than　to　jump　to　hasty　conclusions。　Nevertheless；　over　his　shoulder　to　Dornberger；　he　said；　〃Sounds　like　he's　mad　at　us。　Could　be　a　good　sign。〃
　Dornberger　too　had　reacted。　He　leaned　over　to　read　the　intern's　score　card；　then；　conscious　that　he　himself　was　not　in　charge；　he　ventured　tentatively；　〃A　little　calcium　gluconate；　do　you　think？〃
　〃Yes。〃　O'Donnell　unscrewed　the　syringe　from　the　double　stopcock　and　substituted　a　ten…cc。　syringe　of　calcium　gluconate　which　the　nurse　had　given　him。　He　injected　one　cc。；　then　handed　it　back。　The　nurse　returned　the　original　syringe　which；　in　the　meantime；　she　had　rinsed　in　the　second　metal　bowl。
　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　e　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　bee　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　e　about。
　The　mother；　Elizabeth　Alexander；　could；　of　cou