“Right. I’ll check with the office now.” McNeil went out.
To the others Pearson said, “We shall use a separate plate for each single stool culture. I don’t want to take the risk of putting several cultures together, then having one overgrow the others; it would mean we’d lose time and have to start again.” He asked Alexander, “Do we have sufficient MacConkey’s medium ready to handle close to a hundred cultures?”
John Alexander was pale and his eyes red-rimmed. He had returned from Elizabeth only a half-hour before. Nevertheless he responded promptly, “No,” he said, “I doubt if we’ve more than a couple of dozen. Normally that’s several days’ supply.”
When he had spoken, realizing that his reaction to a question about the lab had sprung from habit, John Alexander wondered what his own feelings were toward Dr. Pearson. He found he could not define them. He supposed he should hate this old man whose negligence had caused his own son’s death, and perhaps later on he would. But for now there was only a dull, deep aching and a sense of melancholy. Maybe it was as well for the time being that a great deal of work appeared to be facing them all. At least he could try to lose himself in some of it.
“I understand,” Pearson said. “Well, then, will you work in the media kitchen and stay with it until all the plates are ready for use? We must have them all by the end of today.”
“I’ll get started.” Alexander followed McNeil out.
Now Pearson was thinking aloud. “We shall have ninety-five cultures, say a hundred. Assume that 50 per cent will be lactose positive, leaving the other 50 per cent to be investigated further; it shouldn’t be more than that.” He glanced at Coleman for confirmation.
“I’d agree.” Coleman nodded.
“All right then; we shall need ten sugar tubes to a culture. Fifty cultures—that means five hundred subcultures.” Turning to Bannister, Pearson asked, “How many sugar tubes are ready—clean and sterilized?”
Bannister considered. “Probably two hundred.”
“Are you sure?” Pearson looked at him searchingly.
Bannister colored. Then he said, “A hundred and fifty anyway.”
“Then order three hundred and fifty more. Call the supply house and say we want them delivered today, and no excuses. Tell them we’ll take care of the paper work later.” Pearson went on. “When you’ve done that, begin preparing the tubes in sets of ten. Use those on hand first, then the others when they come. Check your sugar supplies too. Remember you’ll need glucose, lactose, dulcitol, sucrose, mannitol, maltose, xylose, arabinose, rhamnose, and one tube for indole production.”
Pearson had rattled off the names without hesitation. With the ghost of a smile he said to Bannister, “You’ll find the list and table of reactions for Salmonella typhi on page sixty-six of laboratory standing orders. All right, get moving.”
Hastily Bannister scurried to the telephone.
Turning to David Coleman, Pearson asked, “Can you think of anything I’ve forgotten?”
Coleman shook his head. The old man’s grasp of the situation, as well as his celerity and thoroughness, had left Coleman both surprised and impressed. “No,” he said, “I can’t think of a thing.”
For a moment Pearson regarded the younger man. Then he said, “In that case, let’s go and have coffee. It may be the last chance we’ll have for quite a few days.”
Now that Mike Seddons had gone, it came to Vivian just how big a gap his absence left behind and how long-drawn-out the next few days were going to seem without him. She believed, though, she had been right in asking Mike to remain away for a time. It would give them both a chance to adjust and to think clearly about the future. Not that Vivian needed any time to think herself; she was quite sure of her own feelings, but it was faker to Mike this way. Or was it? For the first time it occurred to her that by acting as she had perhaps she was asking Mike to prove his love for her, while accepting her own without question.
But that was not what she had intended. Vivian wondered uneasily, though, if Mike had taken it that way—if she had appeared to him untrusting and unwilling to accept his devotion at face value. He hadn’t seemed to, it was true; but perhaps after thinking things over, as she herself was doing at this moment, he might decide that was the way it was. She speculated on whether she should call him or send a note explaining what she had really intended—that is, if she were sure herself. Was she sure though—even now? At times it was so difficult to think clearly; you started out doing what you thought was right, then you wondered if someone else might misinterpret, might look for hidden meanings that you had never considered yourself. How could you be really sure what was the best thing to do about anything . . . anywhere . . . ever . . . ?
There was a light tap on the door and Mrs. Loburton came in. Seeing her, suddenly Vivian forgot that she was all of nineteen, adult, able to decide things for herself. She held out her arms. “Oh, Mother,” she said, “I’m so terribly mixed up.”
The physical checkups on food handlers were proceeding briskly. In a small consulting room—the first of a row of similar rooms in the outpatients’ department—Dr. Harvey Chandler was concluding his examination of one of the male cooks. “All right,” he said, “you may get dressed.”
At first the chief of medicine had not been sure whether it would be dignified for him to handle some of the physicals himself or not. But eventually he had decided to, his attitude being somewhat that of a commanding officer who feels morally bound to position himself at the head of his troops during a beach-head assault.
Actually Dr. Chandler had been inclined to resent the dominance of the situation up to this point by Drs. O’Donnell and Pearson. O’Donnell was, of course, the medical-board president and entitled to be concerned with the over-all welfare of the hospital. All the same, Chandler reasoned, he was merely a surgeon and typhoid was essentially a matter for internal medicine.
In a sense the chief of medicine felt deprived of a starring role in the present crisis. In some of his more ultimate thoughts Dr. Chandler sometimes pictured himself as a man of destiny, but opportunities to prove the point were all too rare. Now, with an opportunity at hand, he was being relegated, if not to a minor role, at least to a secondary one. He had to admit, however, that the arrangements made by O’Donnell and Pearson appeared to be working well, and at least they all had the common aim of ending this deplorable outbreak of typhoid. Frowning slightly, he told the cook who had now dressed, “Remember to be especially careful about hygiene. And practice absolute cleanliness when you’re working in the kitchen.”
“Yes, Doctor.”
As the man went out Kent O’Donnell came in. “Hi,” he said. “How’s it going?”
Chandler’s first inclination was to reply huffily. Then, he decided, perhaps there was not really that much to be concerned about. And apart from the minor fault of O’Donnell’s being—in Chandler’s opinion—a little too democratic at times, he was a good man to have at the head of the board and certainly a big improvement over his predecessor. Therefore, amiably enough, he answered, “I lost count some time ago. I suppose we’re getting through them. But there’s nothing to show so far.”
“What’s the news of the typhoid patients?” O’Donnell asked. “And the four suspected cases?”
“You can make it four definite now,” Chandler said, “and scratch two of the suspects.”
“Anyone in danger?”
“I don’t think so. Thank God for antibiotics! Fifteen years ago we’d have been in a lot more trouble than we are.”
“Yes, I suppose so.” O’Donnell knew better than to inquire about isolation procedure. For all his pompousness Chandler could always be relied on to do the correct thing medically.
“Two of the patients are nurses,” Chandler said. “One’s from Psychiatry, the other from Urology. The other two are men—a generator-room worker and a clerk from the records office.”
“All from widely separated parts of the hospital,” O’Donnell said thoughtfully.
“Exactly! There’s no common denominator except hospital food. All four took their meals in the hospital cafeteria. I don’t think there’s any question that we’re on the right track.”
“Then I won’t hold you up,” O’Donnell said. “You’ve two more people waiting outside, but some of the other men have more, and we’re shifting them around.”
“Very well,” Chandler said. “I’ll just keep going until we’re clear; nothing must stop us—no matter how long it takes.” He sat in his chair a little straighter. He had the feeling that there was a touch of derring-do and a ring of Old Glory to his own forthright words.
“Right you are,” O’Donnell said. “I’ll leave you to it.”
A little piqued by the casual reaction, the chief of medicine said stiffly, “You might ask the nurse to send in the next one, will you?”
“Sure.”
O’Donnell went out, and a moment later a girl kitchen worker entered. She was holding a card.
Chandler said, “I’ll take that. Sit down, please.” He put the card in front of him and selected a blank case-history sheet.
“Yes, sir,” the girl said.
“Now, first I want your medical history—yourself and your family—as far back as we can go. Let’s start with your parents.”
With the girl responding to his careful questioning, Chandler’s rapidly written notes began to fill the sheet in front of him. As always, when he was finished the result would be a model of good case-history reporting, suitable for inclusion in any medical textbook. One of the reasons Dr. Chandler was chief of medicine at Three Counties was because he was an extremely precise and conscientious clinician.
Walking away from the commandeered outpatients’ department, Kent O’Donnell permitted himself to think, for the first time with any degree of perspective, of some of the day’s events so far. It was now midafternoon, and since this morning so much had happened that it had been impossible to grasp the implications of it all.
In swift and unexpected succession had come, first, the incident of the mis-diagnosed child and, shortly afterward, its death. Then there had followed: Pearson’s firing, Charlie Dornberger’s retirement, the discovery that an elementary hygiene precaution had been neglected in the hospital for more than six months, and now the occurrence of typhoid, with the threat of an even graver epidemic hanging over Three Counties like an avenging sword.
So much, it seemed, had broken loose at once. Why? How had it happened? Was it a sudden symptom of a malaise that, undetected until now, had gripped the hospital? Was there more to come perhaps? Was this the signal of a general disintegration soon to follow? Had they all been guilty of a sense of complacency—of which O’Donnell himself might be the instigator?
He thought: We were all sure, so sure, that this regime was better than the last. We worked to make it so. We believed we were creating and progressing, building a temple of healing, a place where good medicine would be learned and practiced. But have we failed—ignominiously and blindly—through the very goodness of our own intentions? Have we been stupid and unseeing—our eyes on the cloud tops, uplifted by the glister of ideals, yet ignoring the plain earthy warning of everyday events? What have we built here? O’Donnell searched his mind. Is it, in truth, a place of healing? Or have we raised, in folly, a whited sepulcher—an empty, antiseptic shrine?
Preoccupied, his thoughts burning and intense, O’Donnell had strode through the hospital instinctively, unconscious of his surroundings. Now he came to his office and went inside.
He crossed to the window and stood looking down at the hospital forecourt. As always, there was a movement of people, coming and going. He saw a man limping, a woman holding his arm; they passed beneath and out of sight. A car drew up; a man jumped out and helped a woman into it. A nurse appeared, handing the woman a baby. The doors slammed; the car moved on. A boy on crutches came into view; he moved quickly, swinging his body with the ease of practice. He was stopped by an old man in a raincoat; the old man seemed uncertain where to go. The boy pointed. They moved together toward the hospital doors.
O’Donnell thought: They come to us in supplication, holding faith. Are we worthy of it? Do our successes mitigate our failures? Can we, in time, by devotion atone for error? Shall we ever know?
More practically, he reasoned: After today there must be many changes. They must plug gaps—not only those already exposed, but others they would uncover by diligent searching. They must probe for weaknesses—among themselves and in the hospital fabric. There must be greater self-criticism, more self-examination. Let today, he thought, stand as a bright and shining beacon—a cross of sorrow, a signal for a new beginning.
There was much to do, a great deal of work ahead. They would begin with Pathology—the weak spot where tribulation had begun. After that there must be reorganization elsewhere—there were several departments which he suspected were in need of it. It was definite now that work on the new buildings would begin in the spring, and the two programs could merge together. O’Donnell began to plan, his brain functioning swiftly.
The telephone rang sharply.
The operator announced, “Dr. O’Donnell, long distance is calling.”
It was Denise. Her voice had the same soft huskiness that had attracted him before. When they had exchanged greetings she said, “Kent darling, I want you to come to New York this next weekend. I’ve invited some people for Friday night and I intend to show you off.”
He hesitated only a moment. Then he said, “I’m terribly sorry, Denise—I won’t be able to make it.”
“But you must come.” Her voice was insistent. “I’ve sent out the invitations and I can’t possibly cancel them.”
“I’m afraid you don’t understand.” He felt himself struggling awkwardly to find the right words. “We have an epidemic here. I have to stay until it’s cleared up, then for a while at least there’ll be other things that must be done.”
“But you said you’d come, dearest—whenever I called you.” There was the slightest hint of petulance. He found himself wishing he were with Denise. He was sure then that he could make her understand. Or could he?
He answered, “Unfortunately I didn’t know that this would happen.”
“But you’re in charge of the hospital. Surely, just for a day or two, you can make someone else responsible.” It was obvious that Denise had no intention of understanding.
He said quietly, “I’m afraid not.”
There was a silence at the other end of the line. Then Denise said lightly, “I did warn you, Kent—I’m a very possessive person.”
He started to say, “Denise dear, please—” then stopped.
“Is that really your final answer?” The voice on the phone was still soft, almost caressing.
“It has to be,” he said. “I’m sorry.” He added, “I’ll call you, Denise—just as soon as I can get away.”
“Yes,” she said, “do that, Kent. Good-by.”
“Good-by,” he answered, then thoughtfully replaced the phone.
It was midmorning—the second day of the typhoid outbreak.
As Dr. Pearson had predicted, while a few stool samples had reached the lab yesterday afternoon, the bulk had arrived within the past hour.
The samples, contained in small cardboard cups with lids, were set out in rows on the center table of the pathology lab. Each was identified as to source, and Pearson, seated on a wooden chair at one end of the table, was adding a lab serial number and preparing report sheets on which the culture results would be recorded later.
As Pearson completed the preliminary paper work, he passed each specimen behind him to where David Coleman and John Alexander, working side by side, were preparing the culture plates.
Bannister, alone at a side table, was handling other orders on the lab which McNeil—now enthroned in the pathology office—had decided could not be delayed.
The lab stank.
With the exception of David Coleman all in the room were smoking, Pearson sending forth great clouds of cigar smoke to combat the odor as lids were lifted from the stool-specimen cups. Earlier Pearson had silently offered Coleman a cigar and the younger pathologist had lighted it for a while. But he had found the cigar almost as unpleasant as the undiluted air and had allowed it to go out.
The youthful hospital messenger who was Bannister’s avowed enemy had derived great satisfaction from bringing the specimens in, and with each new batch he had a fresh line of banter to accompany it. On his first trip he had looked at Bannister and announced, “They certainly found the right place to send this stuff.” Later he had told Coleman, “Got six new flavors for you, Doctor.” Now, setting a series of cartons in front of Pearson, he had asked, “You like cream and sugar in yours, sir?” Pearson grunted and went on writing.
John Alexander was working methodically, his mind concentrated on the work in hand. With the same fluidity of movement which David Coleman had noted at their first meeting he reached for a specimen cup and removed the cardboard lid. He pulled a petri dish toward him and, using a crayon pencil, copied the number from the lid onto the dish. Now he took a small platinum loop fixed to the end of a wooden handle and sterilized it in a burner flame. Next he passed the loop through the stool specimen, transferring a small portion of it to a tube of sterile saline. He repeated the process, then, using the platinum loop again, planted some of the solution on the culture plate, moving the loop in even, steady strokes.
Now he labeled the saline tube and placed it in a rack. The petri dish, with its culture plate, he carried across the lab to an incubator. There it would remain until the following day when subcultures, if necessary, could be begun. The process was one which could not be hurried.
He turned away to find David Coleman close behind him. On impulse Alexander said quietly, conscious of Pearson across the room, “Doctor, there’s something I wanted to tell you.”
“What is it?” Coleman added a petri dish himself to the incubator and closed the door.
“I . . . that is, we . . . have decided to take your advice. I’m going to apply for medical school.”
“I’m glad.” Coleman spoke with genuine feeling. “I’m sure it will turn out well.”
“What will turn out well?” It was Pearson, his head lifted, watching.
Coleman went back to his work position, seated himself, and opened a new specimen. He said matter-of-factly, “John’s just told me he’s decided to apply for medical school. I advised him some time ago that he should.”
“Oh.” Pearson looked at Alexander sharply. He asked, “How will you afford it?”
“My wife can work, for one thing, Doctor. And then I thought I might get some lab work out of school hours; a lot of medical students do.” Alexander paused, then, glancing at Coleman, he added, “I don’t imagine it will be easy. But we think it will be worth it.”
“I see.” Pearson had blown out smoke; now he put down his cigar. He seemed about to say something else, then hesitated. Finally he asked, “How is your wife?”
Quietly Alexander answered, “She’ll be all right. Thank you.”
For a moment there was silence. Then Pearson said slowly, “I wish there was something I could say to you.” He paused. “But I don’t suppose words would do very much good.”
Alexander met the old man’s eyes. “No, Dr. Pearson,” he said, “I don’t believe they would.”
Alone in her hospital room, Vivian had been trying to read a novel which her mother had brought, but her mind would not register the words. She sighed and put the book down. At this moment she wished desperately that she had not forced Mike into promising to stay away. She wondered: should she send for him? Her eyes went to the telephone; if she called he would come, probably within minutes. Did it really matter—this silly idea of hers of a few days’ separation for them both to think things over? After all, they were in love; wasn’t that enough? Should she call? Her hand wavered. She was on the point of picking up the receiver when her sense of purpose won out. No! She would wait. This was already the second day. The other three would go quickly, then she would have Mike to herself—for good and all.
In the house-staff common room, off duty for half an hour, Mike Seddons lay back in one of the deep leather armchairs. He was doing exactly what Vivian had told him—thinking of what it would be like living with a wife who had only one leg.
Twenty-three
To the others Pearson said, “We shall use a separate plate for each single stool culture. I don’t want to take the risk of putting several cultures together, then having one overgrow the others; it would mean we’d lose time and have to start again.” He asked Alexander, “Do we have sufficient MacConkey’s medium ready to handle close to a hundred cultures?”
John Alexander was pale and his eyes red-rimmed. He had returned from Elizabeth only a half-hour before. Nevertheless he responded promptly, “No,” he said, “I doubt if we’ve more than a couple of dozen. Normally that’s several days’ supply.”
When he had spoken, realizing that his reaction to a question about the lab had sprung from habit, John Alexander wondered what his own feelings were toward Dr. Pearson. He found he could not define them. He supposed he should hate this old man whose negligence had caused his own son’s death, and perhaps later on he would. But for now there was only a dull, deep aching and a sense of melancholy. Maybe it was as well for the time being that a great deal of work appeared to be facing them all. At least he could try to lose himself in some of it.
“I understand,” Pearson said. “Well, then, will you work in the media kitchen and stay with it until all the plates are ready for use? We must have them all by the end of today.”
“I’ll get started.” Alexander followed McNeil out.
Now Pearson was thinking aloud. “We shall have ninety-five cultures, say a hundred. Assume that 50 per cent will be lactose positive, leaving the other 50 per cent to be investigated further; it shouldn’t be more than that.” He glanced at Coleman for confirmation.
“I’d agree.” Coleman nodded.
“All right then; we shall need ten sugar tubes to a culture. Fifty cultures—that means five hundred subcultures.” Turning to Bannister, Pearson asked, “How many sugar tubes are ready—clean and sterilized?”
Bannister considered. “Probably two hundred.”
“Are you sure?” Pearson looked at him searchingly.
Bannister colored. Then he said, “A hundred and fifty anyway.”
“Then order three hundred and fifty more. Call the supply house and say we want them delivered today, and no excuses. Tell them we’ll take care of the paper work later.” Pearson went on. “When you’ve done that, begin preparing the tubes in sets of ten. Use those on hand first, then the others when they come. Check your sugar supplies too. Remember you’ll need glucose, lactose, dulcitol, sucrose, mannitol, maltose, xylose, arabinose, rhamnose, and one tube for indole production.”
Pearson had rattled off the names without hesitation. With the ghost of a smile he said to Bannister, “You’ll find the list and table of reactions for Salmonella typhi on page sixty-six of laboratory standing orders. All right, get moving.”
Hastily Bannister scurried to the telephone.
Turning to David Coleman, Pearson asked, “Can you think of anything I’ve forgotten?”
Coleman shook his head. The old man’s grasp of the situation, as well as his celerity and thoroughness, had left Coleman both surprised and impressed. “No,” he said, “I can’t think of a thing.”
For a moment Pearson regarded the younger man. Then he said, “In that case, let’s go and have coffee. It may be the last chance we’ll have for quite a few days.”
Now that Mike Seddons had gone, it came to Vivian just how big a gap his absence left behind and how long-drawn-out the next few days were going to seem without him. She believed, though, she had been right in asking Mike to remain away for a time. It would give them both a chance to adjust and to think clearly about the future. Not that Vivian needed any time to think herself; she was quite sure of her own feelings, but it was faker to Mike this way. Or was it? For the first time it occurred to her that by acting as she had perhaps she was asking Mike to prove his love for her, while accepting her own without question.
But that was not what she had intended. Vivian wondered uneasily, though, if Mike had taken it that way—if she had appeared to him untrusting and unwilling to accept his devotion at face value. He hadn’t seemed to, it was true; but perhaps after thinking things over, as she herself was doing at this moment, he might decide that was the way it was. She speculated on whether she should call him or send a note explaining what she had really intended—that is, if she were sure herself. Was she sure though—even now? At times it was so difficult to think clearly; you started out doing what you thought was right, then you wondered if someone else might misinterpret, might look for hidden meanings that you had never considered yourself. How could you be really sure what was the best thing to do about anything . . . anywhere . . . ever . . . ?
There was a light tap on the door and Mrs. Loburton came in. Seeing her, suddenly Vivian forgot that she was all of nineteen, adult, able to decide things for herself. She held out her arms. “Oh, Mother,” she said, “I’m so terribly mixed up.”
The physical checkups on food handlers were proceeding briskly. In a small consulting room—the first of a row of similar rooms in the outpatients’ department—Dr. Harvey Chandler was concluding his examination of one of the male cooks. “All right,” he said, “you may get dressed.”
At first the chief of medicine had not been sure whether it would be dignified for him to handle some of the physicals himself or not. But eventually he had decided to, his attitude being somewhat that of a commanding officer who feels morally bound to position himself at the head of his troops during a beach-head assault.
Actually Dr. Chandler had been inclined to resent the dominance of the situation up to this point by Drs. O’Donnell and Pearson. O’Donnell was, of course, the medical-board president and entitled to be concerned with the over-all welfare of the hospital. All the same, Chandler reasoned, he was merely a surgeon and typhoid was essentially a matter for internal medicine.
In a sense the chief of medicine felt deprived of a starring role in the present crisis. In some of his more ultimate thoughts Dr. Chandler sometimes pictured himself as a man of destiny, but opportunities to prove the point were all too rare. Now, with an opportunity at hand, he was being relegated, if not to a minor role, at least to a secondary one. He had to admit, however, that the arrangements made by O’Donnell and Pearson appeared to be working well, and at least they all had the common aim of ending this deplorable outbreak of typhoid. Frowning slightly, he told the cook who had now dressed, “Remember to be especially careful about hygiene. And practice absolute cleanliness when you’re working in the kitchen.”
“Yes, Doctor.”
As the man went out Kent O’Donnell came in. “Hi,” he said. “How’s it going?”
Chandler’s first inclination was to reply huffily. Then, he decided, perhaps there was not really that much to be concerned about. And apart from the minor fault of O’Donnell’s being—in Chandler’s opinion—a little too democratic at times, he was a good man to have at the head of the board and certainly a big improvement over his predecessor. Therefore, amiably enough, he answered, “I lost count some time ago. I suppose we’re getting through them. But there’s nothing to show so far.”
“What’s the news of the typhoid patients?” O’Donnell asked. “And the four suspected cases?”
“You can make it four definite now,” Chandler said, “and scratch two of the suspects.”
“Anyone in danger?”
“I don’t think so. Thank God for antibiotics! Fifteen years ago we’d have been in a lot more trouble than we are.”
“Yes, I suppose so.” O’Donnell knew better than to inquire about isolation procedure. For all his pompousness Chandler could always be relied on to do the correct thing medically.
“Two of the patients are nurses,” Chandler said. “One’s from Psychiatry, the other from Urology. The other two are men—a generator-room worker and a clerk from the records office.”
“All from widely separated parts of the hospital,” O’Donnell said thoughtfully.
“Exactly! There’s no common denominator except hospital food. All four took their meals in the hospital cafeteria. I don’t think there’s any question that we’re on the right track.”
“Then I won’t hold you up,” O’Donnell said. “You’ve two more people waiting outside, but some of the other men have more, and we’re shifting them around.”
“Very well,” Chandler said. “I’ll just keep going until we’re clear; nothing must stop us—no matter how long it takes.” He sat in his chair a little straighter. He had the feeling that there was a touch of derring-do and a ring of Old Glory to his own forthright words.
“Right you are,” O’Donnell said. “I’ll leave you to it.”
A little piqued by the casual reaction, the chief of medicine said stiffly, “You might ask the nurse to send in the next one, will you?”
“Sure.”
O’Donnell went out, and a moment later a girl kitchen worker entered. She was holding a card.
Chandler said, “I’ll take that. Sit down, please.” He put the card in front of him and selected a blank case-history sheet.
“Yes, sir,” the girl said.
“Now, first I want your medical history—yourself and your family—as far back as we can go. Let’s start with your parents.”
With the girl responding to his careful questioning, Chandler’s rapidly written notes began to fill the sheet in front of him. As always, when he was finished the result would be a model of good case-history reporting, suitable for inclusion in any medical textbook. One of the reasons Dr. Chandler was chief of medicine at Three Counties was because he was an extremely precise and conscientious clinician.
Walking away from the commandeered outpatients’ department, Kent O’Donnell permitted himself to think, for the first time with any degree of perspective, of some of the day’s events so far. It was now midafternoon, and since this morning so much had happened that it had been impossible to grasp the implications of it all.
In swift and unexpected succession had come, first, the incident of the mis-diagnosed child and, shortly afterward, its death. Then there had followed: Pearson’s firing, Charlie Dornberger’s retirement, the discovery that an elementary hygiene precaution had been neglected in the hospital for more than six months, and now the occurrence of typhoid, with the threat of an even graver epidemic hanging over Three Counties like an avenging sword.
So much, it seemed, had broken loose at once. Why? How had it happened? Was it a sudden symptom of a malaise that, undetected until now, had gripped the hospital? Was there more to come perhaps? Was this the signal of a general disintegration soon to follow? Had they all been guilty of a sense of complacency—of which O’Donnell himself might be the instigator?
He thought: We were all sure, so sure, that this regime was better than the last. We worked to make it so. We believed we were creating and progressing, building a temple of healing, a place where good medicine would be learned and practiced. But have we failed—ignominiously and blindly—through the very goodness of our own intentions? Have we been stupid and unseeing—our eyes on the cloud tops, uplifted by the glister of ideals, yet ignoring the plain earthy warning of everyday events? What have we built here? O’Donnell searched his mind. Is it, in truth, a place of healing? Or have we raised, in folly, a whited sepulcher—an empty, antiseptic shrine?
Preoccupied, his thoughts burning and intense, O’Donnell had strode through the hospital instinctively, unconscious of his surroundings. Now he came to his office and went inside.
He crossed to the window and stood looking down at the hospital forecourt. As always, there was a movement of people, coming and going. He saw a man limping, a woman holding his arm; they passed beneath and out of sight. A car drew up; a man jumped out and helped a woman into it. A nurse appeared, handing the woman a baby. The doors slammed; the car moved on. A boy on crutches came into view; he moved quickly, swinging his body with the ease of practice. He was stopped by an old man in a raincoat; the old man seemed uncertain where to go. The boy pointed. They moved together toward the hospital doors.
O’Donnell thought: They come to us in supplication, holding faith. Are we worthy of it? Do our successes mitigate our failures? Can we, in time, by devotion atone for error? Shall we ever know?
More practically, he reasoned: After today there must be many changes. They must plug gaps—not only those already exposed, but others they would uncover by diligent searching. They must probe for weaknesses—among themselves and in the hospital fabric. There must be greater self-criticism, more self-examination. Let today, he thought, stand as a bright and shining beacon—a cross of sorrow, a signal for a new beginning.
There was much to do, a great deal of work ahead. They would begin with Pathology—the weak spot where tribulation had begun. After that there must be reorganization elsewhere—there were several departments which he suspected were in need of it. It was definite now that work on the new buildings would begin in the spring, and the two programs could merge together. O’Donnell began to plan, his brain functioning swiftly.
The telephone rang sharply.
The operator announced, “Dr. O’Donnell, long distance is calling.”
It was Denise. Her voice had the same soft huskiness that had attracted him before. When they had exchanged greetings she said, “Kent darling, I want you to come to New York this next weekend. I’ve invited some people for Friday night and I intend to show you off.”
He hesitated only a moment. Then he said, “I’m terribly sorry, Denise—I won’t be able to make it.”
“But you must come.” Her voice was insistent. “I’ve sent out the invitations and I can’t possibly cancel them.”
“I’m afraid you don’t understand.” He felt himself struggling awkwardly to find the right words. “We have an epidemic here. I have to stay until it’s cleared up, then for a while at least there’ll be other things that must be done.”
“But you said you’d come, dearest—whenever I called you.” There was the slightest hint of petulance. He found himself wishing he were with Denise. He was sure then that he could make her understand. Or could he?
He answered, “Unfortunately I didn’t know that this would happen.”
“But you’re in charge of the hospital. Surely, just for a day or two, you can make someone else responsible.” It was obvious that Denise had no intention of understanding.
He said quietly, “I’m afraid not.”
There was a silence at the other end of the line. Then Denise said lightly, “I did warn you, Kent—I’m a very possessive person.”
He started to say, “Denise dear, please—” then stopped.
“Is that really your final answer?” The voice on the phone was still soft, almost caressing.
“It has to be,” he said. “I’m sorry.” He added, “I’ll call you, Denise—just as soon as I can get away.”
“Yes,” she said, “do that, Kent. Good-by.”
“Good-by,” he answered, then thoughtfully replaced the phone.
It was midmorning—the second day of the typhoid outbreak.
As Dr. Pearson had predicted, while a few stool samples had reached the lab yesterday afternoon, the bulk had arrived within the past hour.
The samples, contained in small cardboard cups with lids, were set out in rows on the center table of the pathology lab. Each was identified as to source, and Pearson, seated on a wooden chair at one end of the table, was adding a lab serial number and preparing report sheets on which the culture results would be recorded later.
As Pearson completed the preliminary paper work, he passed each specimen behind him to where David Coleman and John Alexander, working side by side, were preparing the culture plates.
Bannister, alone at a side table, was handling other orders on the lab which McNeil—now enthroned in the pathology office—had decided could not be delayed.
The lab stank.
With the exception of David Coleman all in the room were smoking, Pearson sending forth great clouds of cigar smoke to combat the odor as lids were lifted from the stool-specimen cups. Earlier Pearson had silently offered Coleman a cigar and the younger pathologist had lighted it for a while. But he had found the cigar almost as unpleasant as the undiluted air and had allowed it to go out.
The youthful hospital messenger who was Bannister’s avowed enemy had derived great satisfaction from bringing the specimens in, and with each new batch he had a fresh line of banter to accompany it. On his first trip he had looked at Bannister and announced, “They certainly found the right place to send this stuff.” Later he had told Coleman, “Got six new flavors for you, Doctor.” Now, setting a series of cartons in front of Pearson, he had asked, “You like cream and sugar in yours, sir?” Pearson grunted and went on writing.
John Alexander was working methodically, his mind concentrated on the work in hand. With the same fluidity of movement which David Coleman had noted at their first meeting he reached for a specimen cup and removed the cardboard lid. He pulled a petri dish toward him and, using a crayon pencil, copied the number from the lid onto the dish. Now he took a small platinum loop fixed to the end of a wooden handle and sterilized it in a burner flame. Next he passed the loop through the stool specimen, transferring a small portion of it to a tube of sterile saline. He repeated the process, then, using the platinum loop again, planted some of the solution on the culture plate, moving the loop in even, steady strokes.
Now he labeled the saline tube and placed it in a rack. The petri dish, with its culture plate, he carried across the lab to an incubator. There it would remain until the following day when subcultures, if necessary, could be begun. The process was one which could not be hurried.
He turned away to find David Coleman close behind him. On impulse Alexander said quietly, conscious of Pearson across the room, “Doctor, there’s something I wanted to tell you.”
“What is it?” Coleman added a petri dish himself to the incubator and closed the door.
“I . . . that is, we . . . have decided to take your advice. I’m going to apply for medical school.”
“I’m glad.” Coleman spoke with genuine feeling. “I’m sure it will turn out well.”
“What will turn out well?” It was Pearson, his head lifted, watching.
Coleman went back to his work position, seated himself, and opened a new specimen. He said matter-of-factly, “John’s just told me he’s decided to apply for medical school. I advised him some time ago that he should.”
“Oh.” Pearson looked at Alexander sharply. He asked, “How will you afford it?”
“My wife can work, for one thing, Doctor. And then I thought I might get some lab work out of school hours; a lot of medical students do.” Alexander paused, then, glancing at Coleman, he added, “I don’t imagine it will be easy. But we think it will be worth it.”
“I see.” Pearson had blown out smoke; now he put down his cigar. He seemed about to say something else, then hesitated. Finally he asked, “How is your wife?”
Quietly Alexander answered, “She’ll be all right. Thank you.”
For a moment there was silence. Then Pearson said slowly, “I wish there was something I could say to you.” He paused. “But I don’t suppose words would do very much good.”
Alexander met the old man’s eyes. “No, Dr. Pearson,” he said, “I don’t believe they would.”
Alone in her hospital room, Vivian had been trying to read a novel which her mother had brought, but her mind would not register the words. She sighed and put the book down. At this moment she wished desperately that she had not forced Mike into promising to stay away. She wondered: should she send for him? Her eyes went to the telephone; if she called he would come, probably within minutes. Did it really matter—this silly idea of hers of a few days’ separation for them both to think things over? After all, they were in love; wasn’t that enough? Should she call? Her hand wavered. She was on the point of picking up the receiver when her sense of purpose won out. No! She would wait. This was already the second day. The other three would go quickly, then she would have Mike to herself—for good and all.
In the house-staff common room, off duty for half an hour, Mike Seddons lay back in one of the deep leather armchairs. He was doing exactly what Vivian had told him—thinking of what it would be like living with a wife who had only one leg.
Twenty-three
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.
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.