ah.thefinaldiagnosis-第38部分

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row　spaces　between　the　bone　spicules　。　。　。　There　was　no　blood…vessel　invasion　。　。　。　So　it　came　back　basically　to　examination　of　the　osteoblasts…the　new　bone　formation。　It　was　the　perennial　question　which　all　pathologists　had　to　face：　was　a　lesion　proliferating；　as　a　natural　process　to　fill　a　gap　in　the　body's　defenses？　Or　was　it　proliferating　because　it　was　a　neoplasm　and　therefore　malignant？　Malignant　or　benign？　It　was　so　easy　to　be　wrong；　but　all　one　could　do　was　to　weigh　the　evidence　and　judge　accordingly。
　〃I'm　afraid　I　disagree　with　you；〃　he　told　Pearson　politely。　〃I'd　still　say　this　tissue　was　benign。〃
　The　older　pathologist　stood　silent　and　thoughtful；　plainly　assessing　his　own　opinion　against　that　of　the　younger　man。　After　a　moment　he　said；　〃You'd　agree　there's　room　for　doubt；　I　suppose。　Both　ways。〃
　〃Yes；　there　is。〃　Coleman　knew　there　was　often　room　for　doubt　in　situations　like　this。　Pathology　was　no　exact　science；　there　were　no　mathematical　formulas　by　which　you　could　prove　your　answer　right　or　wrong。　All　you　could　give　sometimes　was　a　considered　estimate；　some　might　call　it　just　an　educated　guess。　He　could　understand　Pearson's　hesitation；　the　old　man　had　the　responsibility　of　making　a　final　decision。　But　decisions　like　this　were　part　of　a　pathologist's　job…something　you　had　to　face　up　to　and　accept。　Now　Coleman　added；　〃Of　course；　if　you're　right　and　it　is　osteogenic　sara；　it　means　amputation。〃
　〃I　know　that！〃　It　was　said　vehemently　but　without　antagonism。　Coleman　sensed　that　however　slipshod　other　things　might　be　in　the　department；　Pearson　was　too　experienced　a　pathologist　to　object　to　an　honest　difference　of　opinion。　Besides；　both　of　them　knew　how　delicate　were　the　premises　in　any　diagnosis。　Now　Pearson　had　crossed　the　room。　Turning；　he　said　fiercely；　〃Blast　these　borderline　cases！　I　hate　them　every　time　they　e　up！　You　have　to　make　a　decision；　and　yet　you　know　you　may　be　wrong。〃
　Coleman　said　quietly；　〃Isn't　that　true　of　a　lot　of　pathology？〃
　〃But　who　else　knows　it？　That's　the　point！〃　The　response　was　forceful；　almost　passionate；　as　if　the　younger　man　had　touched　a　sensitive　nerve。　〃The　public　doesn't　know…nothing's　surer　than　that！　They　see　a　pathologist　in　the　movies；　on　television！　He's　the　man　of　science　in　the　white　coat。　He　steps　up　to　a　microscope；　looks　once；　and　then　says　'benign'　or　'malignant'…just　like　that。　People　think　when　you　look　in　there〃…he　gestured　to　the　microscope　they　had　both　been　using…〃there's　some　sort　of　pattern　that　falls　into　place　like　building　bricks。　What　they　don't　know　is　that　some　of　the　time　we're　not　even　close　to　being　sure。〃
　David　Coleman　had　often　thought　much　the　same　thing　himself；　though　without　expressing　it　as　strongly。　The　thought　occurred　to　him　that　perhaps　this　outburst　was　something　the　old　man　had　bottled　up　for　a　long　time。　After　all；　it　was　a　point　of　view　that　only　another　pathologist　could　really　understand。　He　interjected　mildly；　〃Wouldn't　you　say　that　most　of　the　time　we're　right？〃
　〃All　right；　so　we　are。〃　Pearson　had　been　moving　around　the　room　as　he　talked；　now　they　were　close　together。　〃But　what　about　the　times　we're　not　right？　What　about　this　case；　eh？　If　I　say　it's　malignant；　Lucy　Grainger　will　amputate；　she　won't　have　any　choice。　And　if　I'm　wrong；　a　nineteen…year…old　girl　has　lost　a　leg　for　nothing。　And　yet　if　it　is　malignant；　and　there's　no　amputation；　she'll　probably　die　within　two　years。〃　He　paused；　then　added　bitterly；　〃Maybe　she'll　die　anyway。　Amputation　doesn't　always　save　them。〃
　This　was　a　facet　of　Pearson's　make…up　that　Coleman　had　not　suspected…the　deep　mental　involvement　in　a　particular　case。　There　was　nothing　wrong　in　it；　of　course。　In　Pathology　it　was　a　good　thing　to　remind　yourself　that　a　lot　of　the　time　you　were　dealing　not　merely　with　bits　of　tissue　but　with　people's　lives　which　your　own　decisions　could　change　for　good　or　ill。　Remembering　that　fact　kept　you　on　your　toes　and　conscientious；　that　is…provided　you　were　careful　not　to　allow　feelings　to　affect　scientific　judgment。　Coleman；　though　so　much　younger；　had　already　experienced　some　of　the　doubts　which　Pearson　was　expressing。　His　own　habit　was　to　keep　them　to　himself；　but　that　was　not　to　say　they　troubled　him　less。　Trying　to　help　the　older　man's　thinking；　he　said；　〃If　it　is　malignant；　there　isn't　any　time　to　spare。〃
　〃I　know。〃　Again　Pearson　was　thinking　deeply。
　〃May　I　suggest　we　check　some　past　cases；〃　Coleman　said；　〃cases　with　the　same　symptoms？〃
　The　old　man　shook　his　head。　〃No　good。　It　would　take　too　long。〃
　Trying　to　be　discreet；　Coleman　persisted；　〃But　surely　if　we　checked　the　cross　file　。　。　。〃　He　paused。
　〃We　haven't　got　one。〃　It　was　said　softly；　and　at　first　Coleman　wondered　if　he　had　heard　aright。　Then；　almost　as　if　to　anticipate　the　other's　incredulity；　Pearson　went　on；　〃It's　something　I've　been　meaning　to　set　up　for　a　long　time。　Just　never　got　around　to　it。〃
　Hardly　believing　what　he　had　heard；　〃You　mean　。　。　。　we　can't　study　any　previous　cases？〃
　〃It　would　take　a　week　to　find　them。〃　This　time　there　was　no　mistaking　Pearson's　embarrassment。　〃There　aren't　too　many　just　like　this。　And　we　haven't　that　much　time。〃
　Nothing　that　Pearson　might　have　said　could　have　shocked　David　Coleman　quite　so　much　as　this。　To　him；　and　to　all　pathologists　whom　he　had　trained　and　worked　with　until　now；　the　cross　file　was　an　essential　professional　tool。　It　was　a　source　of　reference；　a　means　of　teaching；　a　supplement　to　a　pathologist's　own　knowledge　and　experience；　a　detective　which　could　assimilate　clues　and　offer　solutions；　a　means　of　reassurance；　and　a　staff　to　lean　on　in　moments　of　doubt。
　It　was　all　of　this　and　more。　It　was　an　indication　that　a　pathology　department　was　doing　its　work　efficiently；　that；　as　well　as　giving　service　for　the　present；　it　was　storing　up　knowledge　for　the　future。　It　was　a　warranty　that　tomorrow's　hospital　patients　would　benefit　from　what　was　learned　today。　Pathology　departments　in　new　hospitals　considered　establishment　of　a　cross　file　a　priority　task。　In　older；　established　centers　the　type　of　cross　file　varied。　Some　were　straightforward　and　simple；　others　elaborate　and　plex；　providing　research　and　statistical　data　as　well　as　information　for　day…to…day　work。　But；　simple　or　elaborate；　all　had　one　thing　in　mon：　their　usefulness　in　paring　a　present　case　against　others　in　the　past。　To　David　Coleman　the　absence　of　a　cross　file　at　Three　Counties　could　be　described　with　only　one　word：　criminal。
　Until　this　moment；　despite　his　outward　impression　that　the　pathology　department　of　Three　Counties　was　seriously　in　need　of　changes；　he　had　tried　to　withhold　any　personal　opinion　on　Dr。　Joseph　Pearson。　The　old　man　had；　after　all；　been　operating　alone　for　a　long　time；　and　the　amount　of　work　involved　in　a　hospital　this　size　could　not　have　been　easy　for　one　pathologist　to　handle。　That　kind　of　pressure　could　account　for　the　inadequate　procedure　which　Coleman　had　already　discovered　in　the　lab；　and；　while　the　fault　was　not　excusable；　at　least　it　was　understandable。
　It　was　possible；　too；　that　Pearson　might　have　been　strong　in　other　ways。　In　David　Coleman's　opinion　good　administration　and　good　medicine　usually　went　together。　But；　of　the　two；　medicine…in　this　case　pathology…was　the　more　important。　He　knew　of　too　many　whited　sepulchers　where　gleaming　chrome　and　efficient　paper　work　ranked　first；　with　medicine　ing　in　a　poor　second。　He　had　considered　it　possible　that　the　situation　here　might　be　the　reverse…with　administration　poor　and　pathology　good。　This　was　the　reason　he　had　curbed　his　natural　tendency　to　judge　the　older　pathologist　on　the　basis　of　what　had　been　evident　so　far。　But　now　he　found　it　impossible　to　pretend　any　longer　to　himself。　Dr。　Joseph　Pearson　was　a　procrastinator　and　inpetent。
　Trying　to　keep　the　contempt　out　of　his　voice；　Coleman　asked；　〃What　do　you　propose？〃
　〃There's　one　thing　I　can　do。〃
　Pearson　had　gone　back　to　his　desk　and　picked　up　the　telephone。　He　pressed　a　button　labeled　〃Inter。〃　After　a　pause；　〃Tell　Bannister　to　e　in。〃
　He　replaced　the　phone；　then　turned　to　Coleman。　〃There　are　two　men　who　are　experts　in　this　field…Chollingham　in　Boston　and　Earnhart　in　New　York。〃
　Coleman　nodded。　〃Yes；　I've　heard　of　their　work。〃
　Bannister　entered。　〃Do　you　want　me？〃　He　glanced　at　Coleman；　then　pointedly　ignored　him。
　〃Take　these　slides。〃　Pearson　closed　the　folder　and　passed　it　across　the　desk。　〃Get　two　sets　off　tonight…air　mail；　special　delivery；　and　put　on　an　urgent　tag。　One　set　is　to　go　to　Dr。　Chollingham　at　Boston；　the　other　to　Dr。　Earnhart　in　New　York。　Get　the　usual　covering　notes　typed；　enclose　a　copy　of　the　case　history；　and　ask　both　of　them　to　telegraph　their　findings　as　quickly　as　possible。〃
　〃Okay。〃　The　slide　folder　under　his　arm；　Bannister　went　out。
　At　least；　Coleman　reflected；　the　old　man　had　handled　that　part　of　it　efficiently。　Getting　the　two　expert　opinions　in　this　case　was　a　good　idea；　cross　file　or　not。
　Pearson　said；　〃We　ought　to　get　an　answer　within　two　or　three　days。　Meanwhile　I'd　better　talk　to　Lucy　Grainger。〃　He　mused。　〃I　won't　tell　her　much。　Just　that　there's　a　slight　doubt　and　we're　getting〃…he　looked　sharply　at　Coleman…〃some　outside　confirmation。〃
　
　Thirteen
　
　Vivian　kept　very　still…bewildered；　unprehen