The Final Diagnosis by Arthur Hailey Page B

of the abdomen only.
    Pearson had turned his attention back to the body.
    “We’ll go on now to examine . . .” Pearson stopped and peered down. He reached for a knife and probed gingerly. Then he let out a grunt of interest.
    “McNeil, Seddons, take a look at this.”
    Pearson moved aside, and the pathology resident leaned over the area that Pearson had been studying. He nodded. The pleura, normally a transparent, glistening membrane covering the lungs, had a thick coating of scarring—a dense, white fibrous tissue. It was a signal of tuberculosis; whether old or recent they would know in a moment. He moved aside for Seddons.
    “Palpate the lungs, Seddons.” It was Pearson. “I imagine you’ll find some evidence there.”
    The surgical resident grasped the lungs, probing with his fingers. The cavities beneath the surface were detectable at once. He looked up at Pearson and nodded. McNeil had turned to the case-history papers. He used a clean knife to lift the pages so he would not stain them.
    “Was there a chest X-ray on admission?” Pearson asked.
    The resident shook his head. “The patient was in shock. There’s a note here it wasn’t done.”
    “We’ll take a vertical slice to see what’s visible.” Pearson was talking to the nurses again as he moved back to the table. He removed the lungs and cut smoothly down the center of one. It was there unmistakably—fibrocaseous tuberculosis, well advanced. The lung had a honeycombed appearance, like ping-pong balls fastened together, then cut through the center—a festering, evil growth that only the heart had beaten to the kill.
    “Can you see it?”
    Seddons answered Pearson’s question. “Yes. Looks like it was a tossup whether this or the heart would get him first.”
    “It’s always a tossup what we die of.” Pearson looked across at the nurses. “This man had advanced tuberculosis. As Dr. Seddons observed, it would have killed him very soon. Presumably neither he nor his physician were aware of its presence.”
    Now Pearson peeled off his gloves and began to remove his gown. The performance is over, Seddons thought. The bit players and stagehands will do the cleaning up. McNeil and the resident would put the essential organs into a pail and label it with the case number. The remainder would be put back into the body, with linen waste added if necessary to fill the cavities out. Then they would stitch up roughly, using a big baseball stitch—over and under—because the area they had been working on would be covered decorously with clothing in the coffin; and when they had finished the body would go in refrigeration to await the undertaker.
    Pearson had put on the white lab coat with which he entered the autopsy room and was lighting a new cigar. It was a characteristic that he left behind him through the hospital a trail of half-smoked cigar butts, usually for someone else to deposit in an ash tray. He addressed himself to the nurses.
    “There will be times in your careers,” he said, “when you will have patients die. It will be necessary then to obtain permission for an autopsy from the next of kin. Sometimes this will fall to the physician, sometimes to you. When that happens you will occasionally meet resistance. It is hard for any person to sanction—even after death—the mutilation of someone they have loved. This is understandable.”
    Pearson paused. For a moment Seddons found himself having second thoughts about the old man. Was there some warmth, some humanity, in him after all?
    “When you need to muster arguments,” Pearson said, “to convince some individual of the need for autopsy, I hope you will remember what you have seen today and use it as an example.”
    He had his cigar going now and waved it at the table. “This man has been tuberculous for many months. It is possible he may have infected others around him—his family, people he worked with, even some in this hospital. If there had been no autopsy, some of these