ah.thefinaldiagnosis-第9章

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a　scientific　supply　house…Mortui　Vivos　Docent。　Pearson　read　the　Latin　aloud；　then　translated。　〃The　dead　teach　the　living。〃　He　looked　down　again　at　the　body。　〃That　is　what　will　happen　now。　This　man　apparently〃…he　emphasized　the　word　〃apparently〃…〃died　of　coronary　thrombosis。　By　autopsy　we　shall　discover　if　that　is　true。〃
　At　this　Pearson　took　a　deep　draw　on　his　cigar；　and　Seddons；　knowing　what　was　ing；　moved　nearer。　He　himself　might　be　only　a　bit　player　in　this　scene；　but　he　had　no　intention　of　missing　a　cue。　As　Pearson　exhaled　a　cloud　of　blue　smoke；　he　handed　the　cigar　to　Seddons　who　took　it　and　placed　it　down；　away　from　the　table。　Now　Pearson　surveyed　the　instruments　laid　out　before　him　and　selected　a　knife。　With　his　eye　he　calculated　where　he　would　cut；　then　swiftly；　cleanly；　deeply；　applied　the　sharp　steel　blade。
　McNeil　was　watching　the　student　nurses　covertly。　An　autopsy；　he　reflected；　would　never　be　remended　viewing　for　the　fainthearted；　but　even　to　the　experienced　the　first　incision　is　sometimes　hard　to　take。　Until　this　point　the　body　on　the　table　has　at　least　borne　physical　resemblance　to　the　living。　But　after　the　knife；　he　thought；　no　illusions　are　possible。　This　was　not　a　man；　a　woman；　a　child；　but　merely　flesh　and　bone；　resembling　life；　yet　not　of　life。　This　was　the　ultimate　truth；　the　end　to　which　all　must　e。　This　was　the　fulfillment　of　the　Old　Testament；　〃For　dust　thou　art；　and　unto　dust　shalt　thou　return。〃
　Using　the　skill；　ease；　and　speed　of　long　experience；　Pearson　began　the　autopsy　with　a　deep　〃Y〃　incision。　With　three　strong　knife　strokes　he　brought　the　top　two　branches　of　the　〃Y〃　from　each　shoulder　of　the　body　to　meet　near　the　bottom　of　the　chest。　Then　from　this　point　he　cut　downward；　opening　the　belly　all　the　way　from　chest　to　genitals。　There　was　a　hissing；　almost　a　tearing　sound；　as　the　knife　moved　and　the　flesh　parted；　revealing　a　layer　of　yellow　fat　beneath　the　surface。
　Still　watching　the　student　nurses；　McNeil　saw　that　two　were　deathly　white；　a　third　had　gasped　and　turned　away；　the　other　three　were　stoically　watching。　The　resident　kept　his　eye　on　the　pale　ones；　it　was　not　unusual　for　a　nurse　to　keel　over　at　her　first　autopsy。　But　these　six　looked　as　if　they　were　going　to　be　all　right；　the　color　was　ing　back　to　the　two　he　had　noticed；　and　the　other　girl　had　turned　back；　though　with　a　handkerchief　to　her　mouth。　McNeil　told　them　quietly：　〃If　any　of　you　want　to　go　out　for　a　few　minutes；　that's　all　right。　The　first　time's　always　a　bit　hard。〃　They　looked　at　him　gratefully；　though　no　one　moved。　McNeil　knew　that　some　pathologists　would　never　admit　nurses　to　an　autopsy　until　the　first　incision　had　been　made。　Pearson；　though；　did　not　believe　in　shielding　anyone。　He　felt　they　should　see　the　whole　thing　from　the　beginning；　and　it　was　something　McNeil　agreed　with。　A　nurse　had　to　witness　a　lot　of　things　that　were　tough　to　take…sores；　mangled　limbs；　putrefaction；　surgery；　the　sooner　she　learned　to　accept　the　sights　and　smells　of　medicine；　the　better　for　everyone；　including　herself。
　Now　McNeil　slipped　on　his　own　gloves　and　went　to　work　with　Pearson。　By　this　time；　moving　swiftly；　the　older　man　had　peeled　back　the　chest　flap　and；　hacking　the　flesh　loose　with　a　larger　knife；　exposed　the　ribs。　Next；　using　the　sharp　levered　rib　cutters；　he　cut　his　way　into　the　rib　cage；　exposing　pericardium　and　lungs。　The　gloves；　instruments；　and　table　were　now　beginning　to　be　covered　with　blood。　Seddons；　gloved　also；　on　his　side　of　the　table；　was　cutting　back　the　lower　flaps　of　flesh　and　opening　the　abdomen。　He　crossed　the　room　for　a　pail　and　began　to　remove　stomach　and　intestines；　which　he　put　into　the　pail　after　studying　them　briefly。　The　odor　was　beginning　to　be　noticeable。　Now　Pearson　and　Seddons　together　tied　off　and　cut　the　arteries　so　the　undertaker　would　have　no　trouble　when　it　came　to　embalming。　Taking　a　small　tube　from　a　rack　above　the　table；　Seddons　turned　on　a　tap　and　began　to　siphon　blood　that　had　escaped　into　the　abdomen　and；　after　a　nod　from　Pearson；　did　the　same　thing　for　the　chest。
　Meanwhile　McNeil　had　applied　himself　to　the　head。　First　he　made　an　incision　across　the　vertex　of　the　skull；　starting　slightly　behind　each　ear　and　cutting　above　the　hairline　so　the　mark　would　not　be　visible　if　the　body　were　placed　on　view　by　the　dead　man's　family。　Then；　using　all　the　strength　in　his　fingers；　he　peeled　the　scalp　forward　in　one　piece；　so　that　all　the　flesh　from　the　head　was　bunched　over；　the　front　of　the　face；　covering　the　eyes。　The　entire　skull　was　now　exposed；　and　McNeil　picked　up　the　portable　electric　saw　which　was　already　plugged　in。　Before　he　switched　it　on　he　looked　over　at　the　student　nurses　to　find　them　watching　him　with　a　mixture　of　incredulity　and　horror。　Take　it　easy；　girls；　he　thought；　in　a　few　minutes　you'll　have　seen　it　all。
　Pearson　was　carefully　removing　the　heart　and　lungs　when　McNeil　applied　the　saw　to　bone。　The　metallic　〃scrunch〃　of　the　oscillating　steel　teeth　biting　into　the　skull　cut　grimly　across　the　quiet　room。　Glancing　up；　he　saw　the　girl　with　the　handkerchief　flinch；　if　she　was　going　to　vomit　he　hoped　it　wouldn't　be　in　here。　He　kept　the　blade　cutting　until　the　top　of　the　skull　was　severed。　He　put　down　the　saw。　George　Rinne　would　remove　the　blood　from　it　when　he　cleaned　all　the　instruments　later。　Now　McNeil　carefully　pried　loose　the　skull；　exposing　the　soft　membrane　covering　the　brain　beneath。　Again　he　glanced　at　the　nurses。　They　were　standing　up　to　it　well；　if　they　could　take　this　they　could　take　anything。
　With　the　bony　portion　of　the　skull　removed；　McNeil　took　sharp　scissors　and　opened　the　large　vein…the　superior　sagittal　sinus…which　ran　from　front　to　rear　along　the　center　of　the　membrane。　The　blood　poured　out；　spilling　over　the　scissors　and　his　fingers。　It　was　fluid　blood；　he　noted；　there　was　no　sign　of　thrombosis。　He　inspected　the　membrane　carefully；　then　cut　and　lifted　it　clear　to　expose　the　mass　of　brain　beneath。　Using　a　knife；　he　carefully　severed　the　brain　from　the　spinal　cord　and　eased　it　out。　Seddons　joined　him；　holding　a　glass　jar　half　full　of　formalin；　and　McNeil　gently　lowered　the　brain　into　it。
　Watching　McNeil；　his　hands　steady　and　petent；　Seddons　found　himself　wondering　again　what　went　on　in　the　pathology　resident's　mind。　He　had　known　McNeil　for　two　years；　first　as　a　fellow　resident；　though　senior　to　himself　in　the　hospital's　pyramid　system；　and　then　more　closely　during　his　own　few　months　in　Pathology。　Pathology　had　interested　Seddons；　he　was　glad；　though；　it　was　not　his　own　chosen　specialty。　He　had　never　had　second　thoughts　about　his　personal　choice　of　surgery　and　would　be　glad　when　he　went　back　to　it　in　a　few　weeks'　time。　In　contrast　to　this　domain　of　the　dead　the　operating　room　was　a　territory　of　the　living。　It　was　pulsing　and　alive；　there　was　a　poetry　of　motion；　a　sense　of　achievement　he　knew　he　could　never　find　here。　Each　to　his　own；　he　thought；　and　pathology　for　the　pathologists。
　There　was　something　else　about　pathology。　You　could　lose　your　sense　of　reality；　your　awareness　that　medicine　was　of　and　for　human　beings。　This　brain　now　。　。　。　Seddons　found　himself　acutely　aware　that　just　a　few　hours　ago　it　was　the　thinking　center　of　a　man。　It　had　been　coordinator　of　the　senses…touch；　smell；　sight；　taste。　It　had　held　thoughts；　known　love；　fear；　triumph。　Yesterday；　possibly　even　today；　it　could　have　told　the　eyes　to　cry；　the　mouth　to　drool。　He　had　noticed　the　dead　man　was　listed　as　a　civil　engineer。　This；　then；　was　a　brain　that　had　used　mathematics；　understood　stresses；　devised　construction　methods；　perhaps　had　built　houses；　a　highway；　a　water　works；　a　cathedral…legacies　from　this　brain　for　other　humans　to　live　with　and　use。　But　what　was　the　brain　now？…just　a　mass　of　tissue；　beginning　to　be　pickled　and　destined　only　to　be　sliced；　examined；　then　incinerated。
　Seddons　did　not　believe　in　God　and　he　found　it　hard　to　understand　how　educated　people　could。　Knowledge；　science；　thought…the　more　these　advanced；　the　more　improbable　all　religions　became。　But　he　did　believe　in　what；　for　lack　of　better　phrases；　he　thought　of　as　〃the　spark　of　humanity；　the　credo　of　the　individual。〃　As　a　surgeon；　of　course；　he　would　not　always　deal　with　individuals；　nor　would　he　always　know　his　patients；　and　e