The Final Diagnosis (5 page)

The autopsy-room door swung open and Mike Seddons breezed in. Seddons was a surgical resident, temporarily assigned to Pathology, and he always breezed. His red hair stood up in odd places as though a self-created wind would never leave it static. His boyish, open face seemed creased permanently in an amiable grin. McNeil considered Seddons an exhibitionist, though in his favor the kid had taken to pathology a lot more readily than some of the other surgical residents McNeil had seen.

Seddons looked over at the body on the table. “Ah, more business!”

McNeil gestured to the case papers and Seddons picked them up. He asked, “What did he die of?” Then, as he read on, “Coronary, eh?”

McNeil answered, “That’s what it says.”

“You doing this one?”

The resident shook his head. “Pearson’s coming.”

Seddons looked up quizzically. “The boss man himself? What’s special about this case?”

“Nothing special.” McNeil snapped a four-page autopsy form onto a clip board. “Some of the student nurses are coming in to watch. I think he likes to impress them.”

“A command performance!” Seddons grinned. “This I must see.”

“In that case you may as well work.” McNeil passed over the clip board. “Fill in some of this stuff, will you?”

“Sure.” Seddons took the clip board and began to make notes on fee condition of the body. He talked to himself as he worked. “That’s a nice clean appendix scar. Small mole on the left arm.” He moved the arm to one side. “Excuse me, old man.” He made a note, “Slight rigor mortis.” Lifting the eyelids, he wrote, “Pupils round, 0.3 cm. diameter.” He pried the already stiff jaw open, “Let’s have a look at the teeth.”

From the corridor outside there was the sound of feet. Then the autopsy-room door opened, and a nurse, whom McNeil recognized as a member of the nursing school’s teaching staff, looked in. She said, “Good morning, Dr. McNeil.” Behind her was a group of young student nurses.

“Good morning.” The resident beckoned. “You can all come in.”

The students filed through the doorway. There were six, and as they entered all glanced nervously at the body on the table. Mike Seddons grinned. “Hurry up, girls. You want the best seats; we have ’em.”

Seddons ran his eye appraisingly over the group. There were a couple of new ones here he had not seen previously, including the brunette. He took a second look. Yes indeed; even camouflaged by the spartan student’s uniform, it was obvious that here was something special. With apparent casualness he crossed the autopsy room, then, returning, managed to position himself between the girl he had noticed and the rest of the group. He gave her a broad smile and said quietly, “I don’t remember seeing you before.”

“I’ve been around as long as the other girls.” She looked at him with a mixture of frankness and curiosity, then added mockingly, “Besides, I’ve been told that doctors never notice first-year nursing students anyway.”

He appeared to consider. “Well, it’s a general rule. But sometimes we make exceptions—depending on the student, of course.” His eyes candidly admiring, he added, “By the way, I’m Mike Seddons.”

She said, “I’m Vivian Loburton,” and laughed. Then, catching a disapproving eye from the class instructor, she stopped abruptly. Vivian had liked the look of this redheaded young doctor, but it did seem wrong somehow to be talking and joking in here. After all, the man on the table was dead. He had just died, she had been told upstairs; that was the reason she and the other student nurses had been taken from their work to watch the autopsy. The thought of the word “autopsy” brought her back to what was to happen here. Vivian wondered how she was going to react; already she felt uneasy. She supposed, as a nurse, she would grow used to seeing death, but at the moment it was still new and rather frightening.

There were footsteps coming down the corridor. Seddons touched her arm and whispered, “We’ll talk again—soon.” Then the door was flung open and the student nurses moved back respectfully as Dr. Joseph Pearson strode inside. He greeted them with a crisp “Good morning.” Then, without waiting for the murmured acknowledgments, he strode to a locker, slipped off his white coat, and thrust his arms into a gown which he had taken from the shelf. Pearson gestured to Seddons, who stepped over and tied the gown strings at the back. Then, like a well-drilled team, the two moved over to a washbasin where Seddons shook powder from a can over Pearson’s hands, afterward holding out a pair of rubber gloves into which the older man thrust his fingers. All this had been accomplished in silence. Now Pearson shifted his cigar slightly and grunted a “Thanks.”

He crossed to the table and, taking the clip board which McNeil held out to him, began to read it, apparently oblivious of everything else. So far Pearson had not even glanced at the body on the table. Watching the performance covertly, as he, too, moved across, it occurred to Seddons that it was like the entry of a maestro before a symphony. All that was missing was applause.

Now that Pearson had digested the case history he, too, inspected the body, comparing his findings with the notes Seddons had written. Then he put the clip board down and, removing his cigar, faced the nurses across the table. “This is your first experience of an autopsy, I believe.”

The girls murmured, “Yes, sir,” or, “Yes, Doctor.”

Pearson nodded. “Then I will explain that I am Dr. Pearson, the pathologist of this hospital. These gentlemen are Dr. McNeil, the resident in pathology, and Dr. Seddons, a resident in surgery, in his third year . . .” He turned to Seddons. “Am I right?”

Seddons smiled. “Quite right, Dr. Pearson.”

Pearson continued, “In his third year of residency, and who is favoring us with a spell of duty in Pathology.” He glanced at Seddons. “Dr. Seddons will shortly qualify to practice surgery and be released upon an unsuspecting public.”

Two of the girls giggled; the others smiled. Seddons grinned; he enjoyed this. Pearson never missed an opportunity to take a dig at surgeons and surgery, probably with good reason—in forty years of pathology the old man must have uncovered a lot of surgical bloopers. He glanced across at McNeil. The resident was frowning. He doesn’t approve, Seddons thought. Mac likes his pathology straight. Now Pearson was talking again.

“The pathologist is often known as the doctor the patient seldom sees. Yet few departments of a hospital have more effect on a patient’s welfare.”

Here comes the sales pitch, Seddons thought, and Pearson’s next words proved him right.

“It is pathology which tests a patient’s blood, checks his excrements, tracks down his diseases, decides whether his tumor is malignant or benign. It is pathology which advises the patient’s physician on disease and sometimes, when all else in medicine fails”—Pearson paused, looked down significantly at the body of George Andrew Dunton, and the eyes of the nurses followed him—“it is the pathologist who makes the final diagnosis.”

Pearson paused again. What a superb actor the old man is, Seddons thought. What an unabashed, natural ham!

Now Pearson was pointing with his cigar. “I draw your attention,” he was saying to the nurses, “to some words you will find on the wall of many autopsy rooms.” Their eyes followed his finger to the framed maxim thoughtfully provided by 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 coming, 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 recommended 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 come. 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 coming 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 competent, 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.