The Final Diagnosis (15 page)

Seddons had asked her, “Do you still feel that way?”

“Yes, I do,” she had said. “Oh, now and then—when you’re tired sometimes, and you’ve seen some of the things in the hospital, and you’re thinking about home—you wonder if it’s worth it, if there aren’t easier things to do; but I guess that happens to everybody. Most of the time, though, I’m quite sure.” She had smiled, then said, “I’m a very determined person, Mike, and I’ve made up my mind to be a nurse.”

Yes, he had thought, you are determined; I can believe that. Glancing at Vivian covertly while she talked, he could sense an inner strength—a toughness of character behind what seemed at first a facade of gentle femininity. Once more, as he had a day or two ago, Mike Seddons had felt his interest quicken, but again he warned himself: No involvements! Remember, anything you feel is basically biological!

It was close to midnight now, but Vivian had signed the late book and there was no problem about hurrying in. Some of the older nurses, who had done their training under spartan regimes, felt the students were allowed too much freedom nowadays. But in practice it was seldom abused.

Mike touched her arm. “Let’s go through the park.”

Vivian laughed. “That’s an old line I’ve heard before.” But she offered no resistance as he steered her to a gateway and into the park beyond. In the darkness she could make out a line of poplars on either side, and the grass was soft underfoot.

“I’ve a whole collection of old lines. It’s one of my specialties.” He reached down and took her hand. “Do you want to hear more?”

“Like what, for example?” Despite her self-assurance her voice held the slightest of tremors.

“Like this.” Mike stopped and took both her shoulders, turning her to face him. Then he kissed her fully on the lips.

Vivian felt her heart beat faster, but not so much that her mind could not weigh the situation. Should she stop at once or let this go on? She was well aware that if she took no action now, later it might not be so easy.

Vivian already knew that she liked Mike Seddons and believed she could come to like him a good deal more. He was physically attractive and they were both young. She felt the stirrings of desire within her. They were kissing again and she returned the pressure of his lips. The tip of his tongue came lightly into her mouth; she met it with her own and the contact set up a delicious tingling. Mike tightened his arms around her, and through the thin summer dress she felt his thighs pressing tighter. His hands were moving, caressing her back. The right dropped lower; it passed lightly over the back of her skirt, then more heavily, each caress pulling her closer to him. Against her own body she felt a bulkiness. It stirred, intoxicatingly, heavenly. She knew clearly, as if with a second mind, that if she were going to, this was the moment to break away. Just a moment longer, she thought; just a moment longer!

Then suddenly it seemed as if this were an intermission, a release from other things around. Closing her eyes she savored the seconds of warmth and tenderness; these past months there had been so few. So many times since coming to Three Counties she had had to use control and self-discipline, her emotions pent up and tears unshed. When you were young, inexperienced, and a little frightened, sometimes it was hard to do. There had been so many things—the shocks of ward duty, pain, disease, death, the autopsy—and yet no safety valve to release the pressures building up inside. A nurse, even a student nurse, had to see so much of suffering and give so much in care and sympathy. Was it wrong, then, to grasp a moment of tenderness for herself? For an instant, with Mike holding her, she felt the same solace and relief as when, years before, she had run as a little girl into her mother’s arms. Mike had released her a little now and was holding her slightly away. He said, “You’re beautiful.” Impulsively she buried her face in his shoulder. Then he put a hand under her chin and their lips were together again. She felt the same hand drop and, from outside her dress, move lightly over her breasts. From every part of her body the desire to love and be loved welled up, madly, uncontrollably.

His hand was at the neckline of her dress. It was made to open at the front, and a hook and eye secured the top. He was fumbling for it. She struggled. Breathlessly, “No, Mike! Please! No!” She failed even to convince herself. Her arms were around him tightly. He had the dress open a little way now and she felt his hand move, then gasped at the contact as it cupped her own young, soft flesh. He took the nipple gently between his fingers, and a shudder of ecstasy moved through her in a sensual wave. Now she knew that it was too late to stop. She wanted, craved him desperately. Her lips to his ear, she murmured, “Yes, oh yes.”

“Darling, darling Vivian.” He was equally excited; she could tell from his whispered, breathless voice.

Womanlike, a moment’s common sense came through. “Not here, Mike. There are people.”

“Let’s go through the trees.” He took her hand and they moved closely together. She felt a trembling excitement, a wondering curiosity to know what it would be like. She dismissed any consequence; it seemed unimportant. And Mike was a doctor; he would know how to be careful.

They had reached a small clearing surrounded by trees and shrubs. Mike kissed her again, and passionately she returned his kisses, her tongue darting and fighting his. So this is where it’s to be, she thought. The real thing. Vivian was not a virgin; she had ceased to be while in high school, and there had been another incident in her first year of college, but neither experience had been satisfactory. She knew this would be. “Hurry, Mike, please hurry.” She felt her own excitement transmit itself to him.

“Over here, darling,” he said, and they moved toward the far side of the clearing.

Suddenly she felt a searing pain. It was so intense at first she could not be sure where it was. Then she knew it was her left knee. Involuntarily she cried out.

“What is it? Vivian, what is it?” Mike turned to her. She could see he was puzzled, not knowing what to make of it. She thought: He probably thinks it’s a trick. Girls do this sort of thing to get out of these situations.

The first sharpness of pain had subsided a little. But it still returned in waves. She said, “Mike, I’m afraid it’s my knee. Is there a seat somewhere?” She flinched again.

“Vivian,” he said, “you don’t have to put on an act. If you want to go back to the hospital, just say so and I’ll take you.”

“Please believe me, Mike.” She took his arm. “It is my knee. It hurts me terribly. I have to sit down.”

“This way.” She could tell he was still skeptical, but he guided her back through the trees. There was a park bench nearby, and they made for it.

When she had rested, Vivian said, “I’m sorry, I didn’t do that on purpose.”

He said doubtfully, “Are you sure?”

She reached for his hand. “Mike—in there; I wanted to, as much as you. Then this.” Again the pain.

He said, “I’m sorry, Vivian. I thought . . .”

She said, “I know what you thought. But it wasn’t that. Honestly.”

“All right. Tell me what’s wrong.” He was the doctor now. Back in there he had forgotten.

“It’s my knee. All of a sudden—the sharpest pain.”

“Let me see.” He was down in front of her. “Which one?”

She lifted her skirt and indicated the left knee. He felt it carefully, his hands moving lightly. For the moment Mike Seddons dismissed the thought that this was a girl to whom, a few minutes earlier, he had been about to make love. His behavior now was professional, analytical. As he had been trained to do, his mind went methodically over the possibilities. He found Vivian’s nylons impeded his sense of touch.

“Roll down your stocking, Vivian.” She did so, and his probing fingers moved over the knee again. Watching him, she thought: He’s good; he’ll be a fine doctor; people will come to him for help and he’ll be kind and do the utmost that he can. She found herself wondering what it would be like—the two of them together always. As a nurse there would be so much she could do to help him and to understand his work. She told herself: This is ridiculous; we scarcely know each other. Then, momentarily, the pain returned and she winced.

Mike asked, “Has this happened before?”

For a moment the absurdity of the situation struck her and she giggled.

“What is it, Vivian?” Mike sounded puzzled.

“I was just thinking. A minute or two ago . . . And now here you are, just like in a doctor’s office.”

“Listen, kid.” He was serious. “Has this happened before?”

She said, “Just once. It wasn’t as bad as this though.”

“How long ago?”

She thought. “About a month.”

“Have you seen anybody about it?” He was all professional now.

“No. Should I have?”

Noncommittally he said, “Maybe.” Then he added, “You will tomorrow anyway. I think Dr. Grainger would be the best one.”

“Mike, is something wrong?” Now she felt an undercurrent of alarm.

“Probably not,” he reassured her. “But there’s a small lump there that shouldn’t be. Lucy Grainger will give us the word though. I’ll talk with her in the morning. Now we have to get you home.”

The earlier mood was gone. It could not be recaptured, not tonight anyway, and both of them knew it.

Mike helped her up. As his arm went around her, he had a sudden feeling of wanting to help and protect her. He asked, “Do you think you can walk?”

Vivian told him, “Yes. The pain’s gone now.”

“We’ll just go to the gate,” he said; “we can get a taxi there.” Then because she looked glum he added cheerfully, “That patient was a cheap skate. He didn’t send any cab fare.”

Nine

“Give me the details.”

Hunched over the binocular microscope, Dr. Joseph Pearson half grunted the words to Roger McNeil.

The pathology resident looked at his folder of notes. “Case was a forty-year-old man, admitted for appendicitis.” McNeil was seated opposite Pearson at the desk of the pathology office.

Pearson took out the slide he had been studying and substituted another. He asked, “What did the tissue look like at gross?”

McNeil, who had made the gross examination when the removed appendix came down from the operating room, said, “Grossly it looked normal enough to me.”

“Hm.” Pearson moved the slide around. Then he said, “Wait a minute; here’s something.” After a pause he slipped the second slide out and selected a third. Now he said, “Here it is—an acute appendicitis. It was just beginning in this section. Who was the surgeon?”

McNeil answered, “Dr. Bartlett.”

Pearson nodded. “He got it good and early. Take a look.” He made way at the microscope for McNeil.

Working with the resident, as the hospital’s teaching program required him to, Pearson was endeavoring to catch up on the pathology department’s surgical reports.

Despite his best efforts, though, both men knew they were seriously in arrears with work. The slides being studied now had been sectioned from a patient’s appendix removed several weeks earlier. The patient had long since been discharged, and in this case the report would merely confirm or deny the surgeon’s original diagnosis. In this instance Gil Bartlett had been entirely right, in fact, creditably so, since he had caught the disease in its early stages and before the patient could have had much distress.

“Next.” Pearson moved back to the microscope as McNeil returned to the other side of the desk.

The resident pushed over a slide folder and, as Pearson opened it, McNeil consulted a fresh set of notes. As they worked Bannister entered the room quietly. With a glance at the other two he passed behind them and began to file papers into a cabinet.

“This is a current one,” McNeil said. “It came down five days ago. They’re waiting to hear what we say.”

“You’d better give me any like this first,” Pearson said sourly, “otherwise there’ll be more bleating from upstairs.”

McNeil was on the point of saying that several weeks ago he had suggested changing their procedure in just that way, but Pearson had insisted on reviewing all specimens in the order they came into the department. However, the resident checked himself. Why bother? he thought. He told Pearson, “It’s a fifty-six-year-old woman. The specimen is a skin lesion—superficially a mole. Question is: Is it a malignant melanoma?”

Pearson put in the first slide and moved it around. Then he nipped over the highest-powered lens and adjusted the binocular eyepiece. “It could be.” He took the second slide, then two more. After that he sat back thoughtfully. “On the other hand it could be a blue nevus. Let’s see what you think.”

McNeil moved in. This one, he knew, was important. A malignant melanoma was a tumor that was viciously malignant. Its cells could spread rapidly and murderously in the body. If diagnosed as such from the small portion already removed, it would mean immediate major surgery for the woman patient. But a blue nevus tumor was entirely harmless. It could stay where it was in the body, doing no harm, for the rest of the woman’s life.

From his own studies McNeil knew that a malignant melanoma was not common, but he also knew that a blue nevus was extremely rare. Mathematically the odds were on this being malignant. But this was not mathematics. It was pathology at its purest.

As he had learned to do, McNeil ran over in his mind the comparative features of the two types of tumor. They were distressingly similar. Both were partly scarred, partly cellular, with a good deal of pigmentation in them. Again, in both, the cellular structure was very pronounced. Something else McNeil had been taught was to be honest. After looking at all the slides he said to Pearson, “I don’t know.” He added, “What about previous cases? Could we get any out? To compare them.”

“It’d take us a year to find any. I don’t remember when I last had a blue nevus.” Pearson was frowning. He said heavily, “One of these days we’ve got to set up a cross file. Then when a doubtful case like this comes up we can go back and compare it.”

“You’ve been saying that for five years.” Bannister’s dry voice came from behind, and Pearson wheeled. “What are you doing here?”