Slowly his eyes swept the board room. They went the length of the table, then returned to its head. Looking directly at O’Donnell, Pearson said, “This epidemic should not have happened. Nor would it, if Pathology had been alert to a breakdown in hygiene precautions. It is the responsibility of my department, and therefore my own responsibility, that this neglect occurred.”
Again a silence. It was as if history had been made. In this room so many times Joe Pearson had charged others with error and misjudgment. Now he stood himself—accuser and accused.
O’Donnell wondered if he should interrupt. He decided not. Again Pearson looked around him. Then he said slowly, “Having allocated some of the blame, we must now prevent the outbreak going further.” He glanced across the table at Harry Tomaselli. “The administrator, the heads of departments, and I have formulated certain procedures to be carried out at once. I will tell you what they are.”
Now Pearson paused, and when he resumed there was a stronger note to his voice. It was almost, O’Donnell thought, as if in this single moment the old man were throwing off some of his years, as if providing a glimpse of what he had been like long ago as a younger practitioner—intense, earnest, and competent. The old sardonic humor, the air of borderline contempt, which all of them in this room had come to know so well, were gone. In their place were authority and know-how and the forthright frankness of one who accepts without question the fact that he is speaking with equals.
“The immediate problem,” Pearson said, “is to locate the source of infection. Because of the failure to check food handlers properly over the past six months it is logical that we should suspect food as a means of contamination and should begin our search there. For this reason there must be a medical inspection of all food handlers before the next hospital meal is served.” From his frayed woolen vest he extracted a watch and placed it on the table. “The time is now 2:15 p.m. That gives us two and three-quarter hours. In that time every employee who has any part in the preparation and serving of hospital food is to be given a thorough physical check. Facilities are being set up now in the outpatient clinics. I understand that all the internists and house staff were notified before this meeting.” He glanced around and there was a nodding of heads. “Very well. As soon as we are finished here Dr. Coleman”—Pearson glanced down at David Coleman beside him—“will give you your assignment to a specific room.”
Gesturing toward the chief dietitian, Pearson said, “Mrs. Straughan is arranging to assemble all the people concerned, and they will be reporting to Outpatients in batches of twelve. That means ninety-five people to be examined within the time we have.
“When you make these examinations, by the way, remember that the typhoid carrier—and we are assuming there is a carrier—probably has none of the symptoms Dr. Chandler described. What you should look for particularly is any lack of personal cleanliness. And anyone you have doubts about should be suspended from duty for the time being.”
Pearson stopped as if thinking. So far he had consulted no notes. Now he went on again. “Of course, we are all aware that physical checkups will not give us the whole story. We may be lucky and find the individual we’re looking for that way, but the chances are we won’t. Most likely the major work will come in the labs as soon as the medicals are completed. All the people you examine are to be told that stool cultures are required and stool samples must be in the hospital by tomorrow morning.” There was the ghost of a smile. “Constipation will not be taken as an excuse; and if anyone can come through with a sample today we will, of course, accept it gratefully.
“The labs are being set up now to cope with all the cultures we shall be doing. Of course, it will take us a few days—two or three at least—to handle all those stool samples.”
A voice—O’Donnell thought it was Gil Bartlett’s—said quietly, “Ninety-five people! That’s a lot of shit.” A ripple of laughter ran around the table.
Pearson turned. “Yes,” he said, “it is a lot. But we shall do our best.”
With that he sat down.
Lucy signaled with her hand, and O’Donnell nodded for her to speak. She asked, “If the source of infection is not found immediately, will we continue to use the hospital kitchens—to serve food here?”
“For the moment—yes,” O’Donnell answered.
The administrator added, “My office is checking now to see if there’s any outside caterer who could handle food supply if that were felt necessary. I doubt, though, if there’s anyone in town who has facilities—at short notice like this—to do it.”
Bill Rufus asked, “What’s our policy to be on admissions?”
“I’m sorry,” O’Donnell said. “I should have mentioned that. As of this moment we’ve stopped admissions. The admitting department has already been notified. But, of course, we’re hoping pathology can track down the source of infection quickly, and then we’ll review our admissions policy again. Anything else?”
There were no more questions. Looking down the table, O’Donnell asked, “Dr. Coleman, do you have anything to add?”
David Coleman shook his head. “No.”
O’Donnell closed the file which had been open in front of him. “Very well, ladies and gentlemen, I suggest we get started.” Then, as chairs scraped back and conversation began, he asked Pearson, “Joe, could I have a word with you?”
Together they crossed to a window, away from the others who were filing out through the door. O’Donnell said quietly, making sure his voice did not carry, “Joe, naturally you’ll remain in charge of Pathology during this outbreak. But I think I must make clear to you that, concerning other things, nothing has changed.”
Pearson nodded slowly. “Yes,” he said, “I’d already figured that.”
Twenty-two
Like a general appraising his forces ahead of battle, Dr. Joseph Pearson surveyed the pathology lab.
With him were David Coleman, the pathology resident Dr. McNeil, Carl Bannister, and John Alexander. Pearson, Coleman, and McNeil had come directly from the emergency staff meeting in the board room. The other two, acting on earlier instructions, had cleared the lab of all but immediate, essential work.
When Pearson had completed his inspection he addressed the other four. “Our problem,” he announced, “is one of detection. Out of a field of approximately ninety-five people—the food handlers—it is our business to track down a single individual whom we believe to be spreading typhoid germs within this hospital. It is also a problem of speed; the longer we take, the worse the epidemic will be. Our means of detection will be the stool specimens which will start coming in today, with the bulk of them arriving tomorrow.”
He addressed Roger McNeil. “Dr. McNeil, your job for the next few days will be to keep the lab clear of non-essential work. Check all routine requisitions coming in and decide how many of them should have priority and which can be postponed, at least for a day or two. The lab items which in your opinion are urgent can be handled by Carl Bannister. Work with him as much as you can, but don’t load him with any more than is essential; the rest of the time we’ll use him on our major project.” Pearson continued as McNeil nodded. “You yourself will have to take care of all surgical reports. Process those which appear urgent and accumulate anything that can wait. If there’s any diagnosis about which you’re not absolutely sure, call Dr. Coleman or myself.”
“Right. I’ll check with the office now.” McNeil went out.
To the others Pearson said, “We shall use a separate plate for each single stool culture. I don’t want to take the risk of putting several cultures together, then having one overgrow the others; it would mean we’d lose time and have to start again.” He asked Alexander, “Do we have sufficient MacConkey’s medium ready to handle close to a hundred cultures?”