Seated at his desk, Dornberger smiled. He liked to have patients who were obviously enjoying pregnancy, and Elizabeth Alexander was. She’ll be a good no-nonsense mother, he thought. She seemed an attractive girl, not pretty in the conventional sense, but with a lively personality which more than compensated 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 complications.”
“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 coming, 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 incomplete 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 compatible 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 incompatible 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 become 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 welcome 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.”