ah.thefinaldiagnosis-第29节

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　This　was　what　he　had　expected。　He　thought　for　a　moment；　then　said；　〃Let　me　put　it　as　simply　as　I　can。　All　of　us　have　certain　factors　in　our　blood。　And　when　you　speak　of　a　'factor'　you　might　say　that　it's　another　name　for　an　'ingredient。'　〃
　Elizabeth　nodded。　〃I　see。〃　She　found　herself　concentrating；　adjusting　mentally　to　take　in　what　Dr。　Dornberger　was　saying。　For　a　moment　she　was　reminded；　almost　nostalgically；　of　days　in　class。　At　school　she　had　always　taken　pride　in　her　capacity　to　understand　things；　to　focus　on　a　particular　problem…absorbing　facts　quickly　by　excluding　other　things　from　consciousness。　It　had　made　her　one　of　the　brighter　pupils。　She　was　curious　to　know　if　she　had　retained　the　ability。
　Dornberger　continued；　〃Different　human　beings　have　different　blood　factors。　The　last　time　anyone　counted　there　were　forty…nine　of　these　factors　known　to　medicine。　Most　people…you　and　I；　for　example…have　between　fifteen　and　twenty　of　them　in　our　own　blood　stream。〃
　Elizabeth's　brain　clicked：　question　one。　She　asked；　〃What　causes　people　to　be　born　with　different　factors？〃
　〃Mostly　we　inherit　them；　but　that　isn't　important　now。　What's　important　is　to　remember　that　some　factors　are　patible　and　some　are　not。〃
　〃You　mean　。　。　。〃
　〃I　mean　that　when　these　blood　factors　are　mixed　together；　some　will　get　along　quite　happily；　but　some　will　fight　one　another　and　won't　get　along　at　all。　That's　why　we　are　always　careful　in　blood　typing　when　we　give　a　transfusion。　We　have　to　be　sure　it's　the　right　kind　of　blood　for　the　person　receiving　it。〃
　Frowning　thoughtfully；　Elizabeth　said；　〃And　it's　the　factors　that　fight　each　other…the　inpatible　ones…that　cause　trouble？　When　people　have　babies；　I　mean。〃　Again　her　own　classroom　formula：　be　clear　on　each　point　before　going　on　to　the　next。
　Dornberger　answered；　〃Occasionally　they　do；　but　more　often　they　don't。　Let's　take　the　case　of　you　and　your　husband。　You　say　he's　Rh　positive？〃
　〃That's　right。〃
　〃Well；　that　means　his　blood　contains　a　factor　called　'big　D。'　And　because　you're　Rh　negative　you　don't　have　any　'big　D。'　〃
　Elizabeth　nodded　slowly。　Her　mind　was　registering：　Rh　negative…no　〃big　D。〃　Using　an　old　memory　trick；　she　quickly　made　up　a　mnemonic：
　
　If　you　haven't　got　〃big　D〃
　Your　blood's　a　minus　quantity。
　
　She　found　Dornberger　watching　her。　〃You　make　it　so　interesting；〃　she　said。　〃No　one's　ever　explained　it　like　this　before。〃
　〃Good。　Now　let's　talk　about　your　baby。〃　He　pointed　to　the　bulge　below　her　waist。　〃We　don't　know　yet　whether　Junior　here　has　Rh…negative　blood　or　Rh…positive。　In　other　words；　we　don't　know　if　he　has　any　'big　D。'　〃
　For　a　moment　Elizabeth　forgot　the　mental　game　she　was　playing。　With　a　trace　of　anxiety　she　asked；　〃What　happens　if　he　does？　Does　it　mean　that　his　blood　will　fight　with　mine？〃
　Dornberger　said　calmly；　〃There's　always　that　possibility。〃　He　told　her　with　a　smile；　〃Now　listen　very　carefully。〃
　She　nodded。　Her　attention　was　focused　again。　Briefly；　back　there；　she　had　let　her　mind　bee　sidetracked。
　He　said　deliberately；　〃A　baby's　blood　is　always　quite　separate　from　the　mother's。　Nevertheless；　in　pregnancy；　small　amounts　of　the　baby's　blood　often　escape　into　the　mother's　blood　stream。　Do　you　understand　that？〃
　Elizabeth　nodded。　〃Yes。〃
　〃Very　well　then。　If　the　mother　is　Rh　negative　and　the　baby　happens　to　be　Rh　positive；　sometimes　that　can　mean　our　old　friend　'big　D'　seeps　into　the　mother's　blood　stream；　and　he　isn't　wele　there。　Got　it？〃
　Again　Elizabeth　said；　〃Yes。〃
　He　said　slowly；　〃When　that　happens；　the　mother's　blood　usually　creates　something　we　call　antibodies；　and　those　antibodies　fight　the　'big　D'　and　eventually　destroy　it。〃
　Elizabeth　was　puzzled。　〃Then　where's　the　problem？〃
　〃There　never　is　any　problem…for　the　mother。　The　problem；　if　there　is　one；　begins　when　the　antibodies…the　'big　D'　fighters　which　the　mother　has　created…cross　over　the　placental　barrier　into　the　baby's　blood　stream。　You　see；　although　there's　no　regular　movement　of　blood　between　mother　and　baby；　the　antibodies　can；　and　do；　cross　over　quite　freely。〃
　〃I　see；〃　Elizabeth　said　slowly。　〃And　you　mean　the　antibodies　would　start　fighting　with　the　baby's　blood…and　destroying　it。〃　She　had　it　now…clearly　in　her　mind。
　Dornberger　looked　at　her　admiringly。　This　is　one　smart　girl；　he　thought。　She　hadn't　missed　a　thing。　Aloud　he　said；　〃The　antibodies　might　destroy　the　baby's　blood…or　part　of　it…if　we　let　them。　That's　a　condition　we　call　Erythroblastosis　Foetalis。〃
　〃But　how　do　you　stop　it　happening？〃
　〃If　it　happens　we　can't　stop　it。　But　we　can　bat　it。　In　the　first　place；　as　soon　as　there　are　any　antibodies　in　the　mother's　blood　we　get　a　warning　through　a　blood…sensitization　test。　That　test　will　be　done　on　your　blood…now　and　later　during　your　pregnancy。〃
　〃How　is　it　done？〃　Elizabeth　asked。
　〃You're　quite　a　girl　with　the　questions。〃　The　obstetrician　smiled。　〃I　couldn't　tell　you　the　lab　procedure。　Your　husband　will　know　more　about　that　than　I　do。〃
　〃But　what　else　is　done？　For　the　baby；　I　mean。〃
　He　said　patiently；　〃The　most　important　thing　is　to　give　the　baby　an　exchange　transfusion　of　the　right　kind　of　blood　immediately　after　birth。　It's　usually　successful。〃　He　deliberately　avoided　mention　of　the　strong　danger　of　an　erythroblastotic　child　being　born　dead　or　that　physicians　often　induced　labor　several　weeks　early　to　give　the　child　a　better　chance　of　life。　In　any　case　he　felt　the　discussion　had　gone　far　enough。　He　decided　to　sum　it　up。
　〃I've　told　you　all　this；　Mrs。　Alexander；　because　I　thought　you　had　something　on　your　mind　about　Rh。　Also；　you're　an　intelligent　girl；　and　I　always　believe　it's　better　for　someone　to　know　all　the　truth　than　just　a　part　of　it。〃
　She　smiled　at　that。　She　guessed　she　really　was　intelligent。　After　all；　she　had　proved　she　still　possessed　her　old　classroom　ability　to　understand　and　memorize。　Then　she　told　herself：　Don't　be　smug；　besides；　it's　a　baby　you're　having；　not　an　end…of…semester　exam。
　Dr。　Dornberger　was　talking　again。　〃But　just　let　me　remind　you　of　the　important　things。〃　He　was　serious　now；　leaning　toward　her。　〃Point　one：　you　may　never　have　an　Rh…positive　baby；　either　now　or　later。　In　that　case　there　can't　be　any　problem。　Point　two：　even　if　your　baby　happens　to　be　Rh　positive；　you　may　not　bee　sensitized。　Point　three：　even　if　your　baby　were　to　have　erythroblastosis；　the　chances　of　treatment　and　recovery　are　favorable。〃　He　looked　at　her　directly。　〃Now…how　do　you　feel　about　it　all？〃
　Elizabeth　was　beaming。　She　had　been　treated　like　an　adult　and　it　felt　good。　〃Dr。　Dornberger；〃　she　said；　〃I　think　you're　wonderful。〃
　Amusedly　Dornberger　reached　for　his　pipe　and　began　to　fill　it。　〃Yes；〃　he　said；　〃sometimes　I　feel　that　way　too。〃
　
　〃Joe；　can　I　talk　to　you？〃
　Lucy　Grainger　had　been　on　her　way　to　Pathology　when　Pearson's　bulky　figure　loomed　ahead　in　the　main…floor　corridor。　As　she　called　to　him　he　stopped。
　〃Got　a　problem；　Lucy？〃　It　was　his　usual　catarrhal；　rumbling　voice；　but　she　was　glad　to　notice　there　was　no　unfriendliness。　She　hoped　she　was　still　immune　from　his　bad　temper。
　〃Yes；　Joe。　I'd　like　you　to　see　a　patient　of　mine。〃
　He　was　busy　lighting　one　of　the　inevitable　cigars。　When　he　had　it　going　he　surveyed　the　red　tip。　〃What's　the　trouble？〃
　〃It's　one　of　our　own　student　nurses。　A　girl　named　Vivian　Loburton。　She's　nineteen。　Do　you　know　her？〃
　Pearson　shook　his　head。　Lucy　went　on。　〃The　case　is　worrying　me　a　little。　I　suspect　a　bone　tumor　and　I've　a　biopsy　scheduled　for　the　day　after　tomorrow。　The　tissue　will　be　ing　down　to　you；　of　course；　but　I　thought　perhaps　you'd　like　to　take　a　look　at　the　girl。〃
　〃All　right。　Where　is　she？〃
　〃I've　had　her　admitted　for　observation；〃　Lucy　said。　〃She's　on　the　second　floor。　Could　you　see　her　now？〃
　Pearson　nodded。　〃Might　as　well。〃　They　moved　toward　the　main　vestibule　and　the　passenger　elevators。
　Lucy's　request　to　Pearson　was　not　unusual。　In　a　case　like　this；　where　malignancy　was　a　possibility；　it　was　the　pathologist　who　would　give　a　final　opinion　on　the　patient's　condition。　In　the　diagnosis　of　any　tumor　there　were　many　factors…sometimes　conflicting…for　a　pathologist　to　weigh　in　balance。　But　determination　of　bone　tumors　was　even　more　difficult；　something　of　which　Lucy　was　aware。　Consequently　it　was　an　advantage　for　the　pathologist　to　be　involved　with　a　case　at　the　beginning。　In　that　way　he　could　know　the　patient；　discuss　symptoms；　and　hear　the　radiologist's　opinion；　all　of　which　added　to　his　knowledge　and　aided　diagnosis。
　As　they　moved　into　the　elevator　Pearson　paused　and　winced。　He　put　a　hand　to　his　back。
　Lucy　pressed　the　button　for　the　second　floor。　As　the　automatic　doors　slid　closed　she　asked；　〃Is　your　back　bothering　you？〃
　〃Sometimes　it　does。〃　With　an　effort　he　straightened　up。　〃Probably　too　much　hunching　over　a　microscope。〃
　She　looked　at　him　concernedly。　〃Why　don't　you　e　to　my　office？　I'll　take　a　look　at　it。〃
　He　puffed　his　cigar；　then　grinned。　〃I'll　tell　you；　Lucy。　I　can't　afford　your　fees。〃
　The　doors　opened　and　they　went　out　on　the　second　floor。　Walking　down　the　corridor；　she　said；　〃It'll　be　plimentary。　I　don't　believe　in　charging　my　colleagues。〃
　He　gave　her　an　amused　glance。　〃You're　not　like　the　psychiatrists　then？〃
　〃No；　I'm　not