ah.thefinaldiagnosis-第32部分

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he　seemed　an　attractive　girl；　not　pretty　in　the　conventional　sense；　but　with　a　lively　personality　which　more　than　pensated　for　it。　He　glanced　at　the　notes　he　had　recorded　earlier；　she　was　twenty…three。　When　he　was　a　younger　man　he　always　took　the　precaution　of　having　a　nurse　present　when　he　did　physicals　on　women　patients。　He　had　heard　of　physicians　failing　to　do　this　and　later　having　nasty　accusations　hurled　at　them　by　unbalanced　women。　Nowadays；　though；　he　seldom　bothered。　That；　at　least；　was　one　advantage　of　being　old。
　He　called　out；　〃Well；　I'd　say　you're　going　to　have　a　normal；　healthy　baby。　There　don't　seem　to　be　any　plications。〃
　〃That's　what　Dr。　Crossan　said。〃　Fastening　the　belt　of　a　summer　green…print　dress；　Elizabeth　emerged　from　the　other　room。　She　seated　herself　in　a　chair　alongside　the　desk。
　Dornberger　checked　his　notes　again。　〃He　was　your　doctor　in　Chicago。　Is　that　right？〃
　〃Yes。〃
　〃Did　he　deliver　your　first　child？〃
　〃Yes。〃　Elizabeth　opened　her　purse　and　took　out　a　slip　of　paper。　〃I　have　his　address　here；　Doctor。〃
　〃Thank　you。　I'll　write　him　for　your　medical　history。〃　Dornberger　clipped　the　paper　to　his　notes。　He　said　matter…of…factly；　〃What　did　your　first　baby　die　of；　Mrs。　Alexander？〃
　〃Bronchitis。　When　she　was　a　month　old。〃　Elizabeth　said　it　normally。　A　year　ago　the　words　would　have　been　hard　to　bring　out　and　she　would　have　had　to　fight　back　tears。　Now；　with　another　baby　ing；　the　loss　seemed　easier　to　accept。　But　this　time　her　baby　would　live…of　that　she　was　determined。
　Dr。　Dornberger　asked；　〃Was　the　delivery　normal？〃
　〃Yes；〃　she　answered。
　He　returned　to　his　notes。　As　if　to　counter　any　distress　the　questions　might　have　caused；　he　said　conversationally；　〃I　understand　you've　just　arrived　in　Burlington。〃
　〃That's　right；〃　she　said　brightly；　then　added；　〃My　husband　is　working　at　Three　Counties。〃
　〃Yes；　Dr。　Pearson　was　telling　me。〃　Still　writing；　he　asked；　〃How　does　he　like　it　there？〃
　Elizabeth　considered。　〃John　hasn't　said　too　much。　But　I　think　he　likes　it。　He's　very　keen　on　his　work。〃
　Dornberger　blotted　what　he　had　written。　〃That's　a　help。　Particularly　in　pathology。〃　He　looked　up　and　smiled。　〃The　rest　of　us　depend　very　much　on　the　work　of　the　laboratories。〃
　There　was　a　pause　while　the　obstetrician　reached　in　a　drawer　of　his　desk。　Then；　extracting　a　pad　of　forms；　he　said；　〃Talking　of　the　lab；　we　must　send　you　for　a　blood　test。〃
　As　he　wrote　on　the　top　form　Elizabeth　said；　〃I　meant　to　tell　you；　Doctor。　I'm　Rh　negative　and　my　husband　is　Rh　positive。〃
　He　laughed。　〃I　should　have　remembered　you　were　the　wife　of　a　technologist。　We'll　have　to　make　it　a　very　thorough　check。〃　He　tore　off　the　form　and　gave　it　to　her。　〃You　can　take　this　to　the　outpatients'　department　at　Three　Counties　any　time。〃
　〃Thank　you；　Doctor。〃　She　folded　the　form　and　put　it　in　her　purse。
　On　the　point　of　ending　the　interview　Dornberger　hesitated。　He　knew；　as　most　physicians　did；　that　patients　frequently　had　inplete　or　wrong　ideas　about　medical　matters。　When　that　happened　with　one　of　his　own　patients　he　was　usually　at　pains　to　set　them　straight；　even　if　it　meant　taking　time　to　do　so。　In　this　case　the　girl　had　lost　her　first　baby；　therefore　this　second　pregnancy　was　doubly　important　to　her。　It　was　Dornberger's　business　to　see　that　she　had　no　anxieties。
　She　had　mentioned　Rh　factors；　and　obviously　the　subject　was　on　her　mind。　Yet　he　doubted　if　she　had　any　real　understanding　of　what　was　involved。　He　decided　to　take　the　time　to　reassure　her。
　〃Mrs。　Alexander；〃　he　said；　〃I　want　you　to　be　quite　clear　that；　even　though　you　and　your　husband　have　differing　Rh　blood　types；　it　doesn't　mean　there　will　necessarily　be　any　problem　with　the　baby。　You　do　understand　that？〃
　〃I　think　so；　Doctor。〃　He　knew　he　had　been　right。　In　her　voice　there　was　a　trace　of　doubt。
　Patiently　he　asked；　〃Do　you　understand　exactly　what　is　meant　by　the　terms　Rh　positive　and　Rh　negative？〃
　She　hesitated。　〃Well；　I　suppose　not。　Not　exactly　anyway。〃
　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。
　Dorn