The Final Diagnosis

Seddons had said with a grin, “Well, that much we’ll have in common—anyway, until my practice gets going.”

That had been last night. This morning, after the visit with Vivian, he had felt for some reason a sense of lightness and relief. Perhaps he had been depressed unnaturally long and brighter spirits were seeking an outlet. But, whatever the cause, he felt himself seized by a cheerful conviction that everything would turn out well. The feeling was with him now—in the autopsy room where he was assisting Roger McNeil with the autopsy of an elderly woman patient who had died last night in the hospital. It had prompted him to begin telling humorous stories to McNeil; Mike Seddons had a fund of them—another reason for his reputation as a joker.

Pausing in the middle of the latest, he asked McNeil, “Have you any cigarettes?”

The pathology resident motioned with his head. He was sectioning the heart he had just removed from the body.

Seddons crossed the room, found the cigarettes in McNeil’s suit coat, and lighted one. Returning, he continued, “So she said to the undertaker, ‘Thank you for doing that, even though it must have been a lot of trouble.’ And the undertaker said, ‘Oh, it wasn’t any trouble really. All I did was change their heads.’ ”

Grim as the jest was in these surroundings, McNeil laughed aloud. He was still laughing as the autopsy-room door opened and David Coleman stepped inside.

“Dr. Seddons, will you put out that cigarette, please?” Coleman’s voice cut quietly across the room.

Mike Seddons looked around. He said amiably, “Oh, good morning, Dr. Coleman. Didn’t see you there for a minute.”

“The cigarette, Dr. Seddons!” There was ice in Coleman’s tone, his eyes steely.

Not quite understanding, Seddons said, “Oh . . . oh yes.” none, moved his hand toward the autopsy table with the body upon it.

“Not there!” Coleman rapped out the words, stopping the surgical resident short. After a moment Seddons moved across the room, found an ash tray, and deposited the cigarette.

“Dr. McNeil.”

“Yes, Dr. Coleman,” Roger McNeil answered quietly.

“Will you . . . drape the face, please?”

Uncomfortably, knowing what was going through Coleman’s mind, McNeil reached out for a towel. It was one they had used earlier; it had several big bloodstains. Still with the same soft intensity, Coleman said, “A clean towel, please. And do the same for the genitals.”

McNeil nodded to Seddons, who brought over two clean towels. McNeil placed one carefully across the face of the dead woman; the other he used to cover the external genitalia.

Now the two residents stood facing Coleman. Both showed traces of embarrassment. Both sensed what was coming next.

“Gentlemen, I think there is something I should remind you of.” David Coleman still spoke quietly—at no time since entering the room had he raised his voice—but there was no mistaking the underlying purpose and authority. Now he said deliberately, “When we perform an autopsy we do so with permission from the family of the one who has died. Without that permission there would be no autopsy. That is quite clear to you, I presume?”

“Quite clear,” Seddons said. McNeil nodded.

“Very well.” Coleman glanced at the autopsy table, then at the others. “Our own objective is to advance medical learning. The family of the deceased, for its part, gives us the body in trust, expecting that it will be treated with care, respect, and dignity.” As he paused there was silence in the room. McNeil and Seddons were standing very still.

“And that is the way we will treat it, gentlemen.” Coleman emphasized the words again, “With care, respect, and dignity.” He went on, “At all autopsies the face and genitals will be draped and there will be no smoking in the room at any time. As for your own demeanor, and particularly the use of humor”—at the word Mike Seddons flushed a deep red—“I think I can leave that to your imagination.”

Momentarily Coleman looked directly at each man in turn. Then, “Thank you, gentlemen. Will you carry on, please?” He nodded and went out.

For several seconds after the door had closed neither spoke. Then, softly, Seddons observed, “We appear to have been skillfully taken apart.”

Ruefully McNeil said, “With some reason, I think. Don’t you?”

As soon as they could afford it, Elizabeth Alexander decided, she would buy a vacuum cleaner. The old-fashioned carpet sweeper she was using now collected the superficial dirt, but that was about all. She pushed it back and forth a few more times over the rug and inspected the result critically. Not very good, but it would have to do. She must remember to have a talk with John tonight. Vacuum cleaners were not terribly expensive, and one extra monthly payment shouldn’t make all that difference. The trouble was, though, there were so many things they needed. It was a problem, deciding which should come first.

In a way, she supposed, John was right. It was all very well to talk of making sacrifices and doing without things so that John could go to medical school. But when you came right down to it, it was hard to manage on any reduced income once you became accustomed to a certain standard. Take John’s salary at the hospital, for example. It certainly did not put them in the big brackets, but it had made their life together comfortable and they were able to enjoy small luxuries which a few months ago had been out of reach. Could they surrender those things now? Elizabeth supposed so, but it would be difficult all the same. Medical school would mean another four years of struggling, and even after that there would be internship and perhaps residency, if John decided to specialize. Would it be worth it? Weren’t they perhaps better off taking their happiness as they found it at this moment, accepting a role—even if a modest one—in the here and now?

That made sense, didn’t it? And yet, somehow, Elizabeth was still unsure. Should she still continue to urge John to aim higher, to enter medical school, at whatever cost? Dr. Coleman obviously believed he should. What was it he had said to John?—If you feel like this, and don’t go to medical school while you have the chance, it may be something you’ll regret the rest of your life. At the time the words had made a deep impression on Elizabeth and, she suspected, on John too. Now, remembering, they seemed more significant than ever. She frowned; perhaps they had better talk over the whole subject again tonight. If she were convinced of what John really wanted, maybe she could force him into a decision. It would not be the first time Elizabeth had had her own way about things that concerned them both.

Elizabeth put the sweeper away and began to move around the apartment, tidying and dusting. Now, dismissing more serious thoughts for the time being, she sang as she worked. It was a beautiful morning. The warm August sun, shining brightly into the small but comfortable living room, showed off to advantage the new draperies she had made and had hung last night. Elizabeth stopped at the center table to rearrange a vase of flowers. She had removed two blooms which had faded and was about to cross to the tiny kitchen when the pain struck her. It came suddenly, without warning, like a blazing, searing fire and worse, much worse, than the day before in the hospital cafeteria. Drawing in her breath, biting her lip, trying not to scream aloud, Elizabeth sank into a chair behind her. Briefly the pain went away, then it returned, even—it seemed—more intensely. It was as if it were a cycle. Then the significance dawned upon her. Involuntarily she said, “Oh no! No!”

Dimly, through the enveloping anguish, Elizabeth knew she had to act quickly. The hospital number was on a pad by the telephone. Suddenly the instrument on the other side of the room became an objective. Biding her time between each onset of pain, grasping the table for support, Elizabeth eased out of the chair and moved across. When she had dialed and a voice answered, she said, gasping, “Dr. Dornberger . . . it’s urgent.”

There was a pause and he came on the line. “It’s . . . Mrs. Alexander,” Elizabeth said. “I’ve started . . . to have . . . my baby.”

David Coleman knocked once on the door of Dr. Pearson’s office, then went in. He found the senior pathologist seated behind the desk, Carl Bannister standing alongside. The lab technician’s face had a taut expression; after a first glance he studiously avoided looking Coleman’s way.

“You wanted to see me, I believe.” Coleman had been returning from doing a frozen section on the surgical floor when his name had been called on the public-address system.

“Yes, I did.” Pearson’s manner was cool and formal. “Dr. Coleman, I have received a complaint concerning you from a member of the staff. Carl Bannister here.”

“Oh?” Coleman raised his eyebrows. Bannister was still looking straight ahead.

Pearson went on, “I understand you two had a little brush this morning.”

“I wouldn’t call it exactly that.” Coleman kept his voice casual and unperturbed.

“What would you call it then?” There was no mistaking the acidity in the old man’s tone.

Coleman said levelly, “Frankly, I hadn’t planned to bring the matter to your attention. But, since Mr. Bannister has chosen to, I think you had better hear the whole story.”

“If you’re sure it’s not too much trouble.”

Ignoring the sarcasm, Coleman said, “Yesterday afternoon I told both serology technicians that I planned to make occasional spot checks of laboratory work. Early this morning I did make one such check.” Coleman glanced at Bannister. “I intercepted a patient’s specimen before delivery to the serology lab and divided the specimen into two. I then added the extra sample to the listing on the requisition sheet, showing it as an extra test. Later, when I checked, I found that Mr. Bannister had recorded two different test results when, of course, they should have been identical.” He added, “If you wish, we can get the details from the lab record now.”

Pearson shook his head. He had risen from his chair and was half turned away; he appeared to be thinking. Coleman wondered curiously what would happen next. He knew that he himself was on perfectly secure ground. The procedure he had followed was standard in most well-run hospital labs. It provided a protection for patients and was a safeguard against carelessness. Conscientious technicians accepted lab checks without resentment and as a part of their job. Moreover, Coleman had followed protocol in telling both Bannister and John Alexander yesterday that the checks would be made.

Abruptly Pearson wheeled on Bannister. “All right, what have you got to say?”

“I don’t like being spied on.” The answer was resentful and aggressive. “I’ve never had to work that way before and I don’t figure I should start now.”

“And I tell you you’re a fool!” Pearson shouted the words. “You’re a fool for making a damn silly mistake, and you’re an even bigger fool for coming to me when you get caught out.” He paused, his lips tight, his breathing heavy. Coleman sensed that part of the old man’s anger stemmed from his frustration at having no choice but to support what the younger pathologist had done, much as he might dislike it. Now, standing directly in front of Bannister, he snarled, “What did you expect me to do—pat you on the back and give you a medal?”

Bannister’s face muscles were working. For once he appeared to have no answer. Surveying him grimly, Pearson seemed about to go on, then abruptly he stopped. Turning partly away, he gestured with his hand. “Get out! Get out!”

Without a word, his face set, looking neither to right nor left, Bannister went out of the room and closed the door behind him.

Now Pearson turned sharply to Coleman. “What the devil do you mean by this?”

David Coleman could see the burning anger in the old man’s eyes. He realized that the affair with Bannister was merely a preliminary skirmish. Determined not to lose his own temper, he answered mildly, “What do I mean by what, Dr. Pearson?”

“You know damn well what I mean! I mean by making lab checks—without my authority.”

Coleman said coldly, “Do I really need your authority? For something routine like that?”

Pearson slammed his fist on the desk. “Any time I want lab checks I’ll order them!”

“If it’s of any interest,” Coleman said, still quietly, “I happen to have had your authority. As a matter of courtesy I mentioned to you yesterday that I would like to do standard lab checks in Serology, and you agreed.”

Suspiciously Pearson said, “I don’t remember.”

“I assure you the conversation took place. In any case, I’m not in the habit of making that kind of invention.” David Coleman felt his own anger rising; it was hard to conceal his contempt for this aged incompetent. He added, “I may say you seemed rather preoccupied at the time.”

He appeared to have checked Pearson, at least partially. Grumblingly the old man said, “If you say so, I’ll believe you. But it’ll be the last time you do something like that on your own. Understand?”

Coleman sensed that this was a critical moment, both for Pearson and himself. Icily he asked, “Do you mind telling me what kind of responsibility I’m to have in this department?”

“You’ll get whatever I choose to give you.”

“I’m afraid I don’t find that at all satisfactory.”

“You don’t, eh?” Pearson was directly in front of the younger man now, his head jutted forward. “Well, there happen to be a few things I don’t find satisfactory either.”

“For instance?” David Coleman had no intention of being intimidated. And if the old man wanted a showdown, he himself was quite willing to have it, here and now.

“For instance, I hear you’ve been laying down the law in the autopsy room,” Pearson said.

“You asked me to take charge of it.”

“I told you to supervise autopsies, not to set up a lot of fancy rules. No smoking, I understand. Is that supposed to include me?”

“I imagine that will be up to you, Dr. Pearson.”

“I’ll say it’ll be up to me!” The other’s calmness seemed to make Pearson angrier. “Now you listen to me, and listen good. You may have some pretty fancy qualifications, mister, but you’ve still got a lot to learn and I’m still in charge of this department. What’s more, there are good reasons I’m going to be around here for a long time yet. So now’s the time to decide—if you don’t like the way I run things, you know what you can do.”

Before Coleman could answer there was a knock on the door. Impatiently Pearson called out, “Yes?”

A girl secretary came in, glancing curiously from one to the other. It occurred to Coleman that Pearson’s voice, at least, must have been clearly audible in the corridor outside. The girl said, “Excuse me, Dr. Pearson. There are two telegrams for you. They just came.” Pearson took the two buff envelopes the girl held out.

When she had gone Coleman was about to reply. But Pearson stopped him with a gesture. Beginning to thumb open the first envelope, he said, “These will be the answers about the girl—Lucy Grainger’s patient.” His tone was quite different from that of a few moments before. He added, “They took long enough about it.”

Automatically David Coleman felt a quickening of interest. Tacitly he accepted Pearson’s view that their argument could be postponed; this was more important. As Pearson had the first flap open the telephone jangled sharply. With an exclamation of annoyance he put the two envelopes down to answer it.

“Yes?”

“Dr. Pearson, this is Obstetrics,” a voice said. “Dr. Dornberger is calling you. One moment, please.”

There was a pause, then Dornberger came on the line. He said urgently, “Joe, what’s wrong with you people in Pathology?” Without waiting for an answer, “Your technician’s wife—Mrs. Alexander—is in labor and the baby will be premature. She’s on the way here in an ambulance, and I haven’t got a blood-sensitivity report. Now get it up here fast!”

“Right, Charlie.” Pearson slammed the receiver down and reached for a pile of forms in a tray marked “Signature.” As he did, the two telegraph envelopes caught his eye. Quickly he passed them to Coleman. “Take these. See what they say.”

Pearson riffled through the forms. The first time, in his haste, he missed the one he wanted; the second time through he found it. He lifted the telephone again, listened, then said brusquely, “Send Bannister in.” Replacing the phone, he scribbled a signature on the form he had removed.

“You want me?” Bannister’s tone and expression made it plain that he was still smarting from the reprimand earlier.

“Of course I want you!” Pearson held out the form he had signed. “Get this up to Dr. Dornberger—fast. He’s in Obstetrics. John Alexander’s wife is in trouble. She’s going to have a premie.”

Bannister’s expression changed. “Does the kid know? He’s down in—”

Impatiently Pearson cut him off. “Get going, will you! Get going!” Hastily Bannister went out with the form.

Dimly David Coleman had been aware of what was going on around him. His mind, however, had not yet grasped the details. For the moment he was too concerned with the awesome significance of the two telegrams which he held, opened, in his hand.

Now Pearson turned to him. The old man said, “Well, does the girl lose her leg or not? Are they both definite?”

Coleman thought: This is where pathology begins and ends; these are the borderlands where we must face the truth of how little we really know; this is the limit of learning, the rim of the dark, swirling waters of the still unknown. He said quietly, “Yes, they’re both definite. Dr. Chollingham in Boston says, ‘Specimen definitely malignant.’ Dr. Earnhart in New York says, ‘The tissue is benign. No sign of malignancy.’ ”

There was a silence. Then Pearson said slowly, softly, “The two best men in the country, and one votes ‘for,’ the other ‘against.’ ” He looked at Coleman, and when he spoke there was irony but no antagonism. “Well, my young pathologist friend, Lucy Grainger expects an answer today. She will have to be given one, and it will have to be definite.” With a twisted smile, “Do you feel like playing God?”

Sixteen

A police patrolman on duty at Main and Liberty heard the ambulance’s siren six blocks away. Moving out from the sidewalk, and with the skill of long practice, he began to expedite the traffic flow so as to leave the intersection clear. As the siren grew louder and the flashing warning light became visible, threading its way toward him, the patrolman inflated his cheeks and blew two sharp whistle blasts. Then, signaling a halt to all traffic in the side roads, he authoritatively waved the ambulance driver through a red light. Pedestrians at the intersection, turning their heads curiously, caught a blurred glimpse of a young woman’s white face as the ambulance swept by.

Inside, Elizabeth was only dimly conscious of their progress through the busy city streets. She sensed they were moving fast, but the buildings and people outside were a confused pattern racing past the window near her head. Momentarily, between each onset of pain, she could see the driver up ahead, his two big hands nursing the wheel, turning quickly, first right, then left, taking advantage of every opening as it occurred. Then the pain came back and all she could think of was to cry out and to hold on.

“Hold my wrists! And hang on all you want.” It was the ambulance attendant, leaning over her. He had a stubble of beard and a cleft chin, and for a moment Elizabeth believed it was her father come here now to comfort her. But her father was dead; hadn’t he been killed at the railroad? Or perhaps he had not and he was in this ambulance along with her, being taken to some place they could be cared for together. Then her head cleared and she saw it was not her father but a stranger whose wrists were red with the gouge marks her nails had made.

She had time to touch the marks before the next pain came. It was a gesture, all she could do. The man shook his head. “Don’t worry. Just you hold on all you want. We’ll be there soon. Old Joe up front is the best wagon driver in the city.” Then the pain again, worse than before, the intervals between growing shorter, the sensation as if all her bones were being twisted beyond endurance with the agony centered in her back, the torture of it overflowing into a flame of red, yellow, purple in front of her eyes. Her nails dug deeper and she screamed.

“Can you feel the baby coming?” It was the attendant again; he had waited until the last pain subsided, then leaned close.

She managed to nod her head and gasp. “I . . . I think so.”

“All right.” He eased his hands gently away. “Hang on to this for a minute.” He gave her a towel he had rolled tight, then turned back the blanket over the stretcher and began to loosen her clothing. He talked softly while he worked. “We’ll do the best we can if we have to. It wouldn’t be the first one I’ve delivered in here. I’m a grandfather, you see, so I know what it’s all about.” His last words were drowned out by her cry; once more, at her back, flooding around her, blinding, overpowering, the crescendo of agony, crushing, unrelenting. “Please!” She grasped for his wrists again, and he gave them, faint lines of blood appearing as her nails ripped flesh. Turning his head, he called forward, “How are we doing, Joe?”

“Just went through Main and Liberty.” The big hands turned the wheel sharply right. “There was a cop there; he had it sorted. Saved us a good minute.” A swing to the left, then the head leaned back. “You a godfather yet?”

“Not quite, Joe. It’s getting pretty close though, I reckon.”

Again the wheel spinning; a sharp turn to the right. Afterward: “We’re on the home stretch, boy. Try to keep the cork in a minute more.”

All Elizabeth could think, through the miasma that engulfed her, was: My baby—he’ll be born too soon! He’ll die! Oh God, don’t let him die! Not this time! Not again!

In Obstetrics, Dr. Dornberger was scrubbed and gowned. Emerging from the scrub room into the busy interior hallway which separated the labor rooms from the delivery areas, he looked around him. Seeing him through the glass partitions of her office, Mrs. Yeo, the head nurse, got up and came toward him, holding a clip board.

“Here’s the blood-sensitivity report on your patient, Dr. Dornberger. It just came in from Pathology.” She held out the board so he could read without touching it.

“About time!” Unusual for him, it was almost a growl. Scanning the form on top of the clip board, he said, “Sensitivity negative, eh? Well, there’s no problem there. Is everything else ready?”

“Yes, Doctor.” Mrs. Yeo smiled. She was a tolerant woman who felt that every man, including her own husband, was entitled to be grouchy now and then.

“How about an incubator?”

“It’s here now.”

As Dornberger glanced around, a nurse held the outer doorway wide while a woman orderly wheeled in an Isolette incubator. Holding the trailing cord clear of the floor, the orderly glanced inquiringly at Mrs. Yeo.

“In number two, please.”

The orderly nodded and wheeled the incubator through a second swing door immediately ahead. As it closed behind her a girl clerk came toward them from the nursing office.

“Excuse me, Mrs. Yeo.”

“Yes?”

“Emergency just phoned.” The girl turned to Dornberger. “Your patient just arrived, Doctor, and she’s on the way up. They say she’s well advanced in labor.”

Ahead of the hospital stretcher, to which she had been transferred from the ambulance, Elizabeth could see the young intern who had received her on arrival. Moving forward at a steady but unhurried pace, he was clearing a way, calmly and methodically, through the groups of people in the busy main-floor corridor. “Emergency . . . emergency, please.” The words were quiet, almost casual, but their effect was immediate. Passers-by halted, groups moved back against the wall, to allow the small procession—intern, stretcher, and nurse propelling it—to go by. At the corridor’s end an elevator operator had seen them and was clearing the car.

“Next car, please. This car for an emergency.” Obediently the occupants moved out and the stretcher rolled in. The smooth, established drill of hospital procedure was functioning effortlessly to admit another supplicant.

Something of the calm seemed to transfer itself to Elizabeth. Though the pain was continuous now, and a new pressure in her uterus was building up, she found herself able to endure both better than before. She discovered that by biting her lower lip, and by gripping the edge of the sheet which covered her, it was possible not to cry out. She knew, though, that the final stage of birth had begun; involuntarily she began to bear down and, between her thighs, felt the first beginning of emergence.

Now they were in the elevator with the doors gliding closed and the nurse behind reaching down and holding her hand. “Just a minute or two more; that’s all it will be.” Then the doors were opened again and she saw Dr. Dornberger, gowned and waiting for her.

As if there were a hope that he had misread them earlier, Dr. Pearson picked up the two telegrams again. Looking at them, he put them down one at a time. “Malignant! Benign! And no doubt in either one. We’re back where we started.”

“Not quite,” David Coleman said quietly. “We’ve lost almost three days.”

“I know! I know!” Joe Pearson was beating a bulky fist into his palm, uncertainty around him like a mantle. “If it is malignant, the leg has to be amputated quickly; otherwise we’ll be too late.” He turned to face Coleman directly. “But the girl’s nineteen. If she were fifty I’d say malignant and never turn a hair. But nineteen!—and maybe have your leg off when you didn’t need to.”

Despite his feelings about Pearson, despite his own conviction that the tissue they were speaking of was benign and not malignant, Coleman felt his sympathy for Pearson grow. The old man did have the final responsibility in the case; it was understandable that he should be troubled; the decision was extremely tough. He said tentatively, “It takes a lot of courage to make this kind of diagnosis.”

As if he had touched a match to open flame, Pearson flared up. “Don’t give me any of your high-school cliches! I’ve been doing this for thirty years!” He glared at Coleman, eyes blazing, the earlier antagonism returning. At that moment the telephone rang.

“Yes?” Though Pearson had answered the phone brusquely, as he listened his expression softened. Then he said, “All right, Lucy. I think you’d better come down. I’ll wait for you here.” Replacing the phone, he stood looking down at a point in the center of his desk. Then, without raising his head, he said to Coleman, “Lucy Grainger’s on her way. You can stay if you want.”

Almost as if he had not heard, Coleman said thoughtfully, “You know, there’s one other thing might work, might give us a better pointer.”

“What?” Pearson raised his head abruptly.

“That X-ray that was done.” Coleman was still going slowly, the words keeping pace with his thoughts. “It was taken two weeks ago. If there is a tumor, and it’s developing, another X-ray might show it.”

Without a word Pearson reached down and once more picked up the telephone. There was a click and then he said, “Get me Dr. Bell in Radiology.” Waiting, the old man eyed Coleman strangely. Then, covering the mouthpiece, he said with grudging admiration, “I’ll say this for you: you’re thinking—all the time.”

In the room which the hospital staff jestingly referred to as “the expectant father’s sweatbox” John Alexander butted a half-smoked cigarette into an ash stand. Then he got up from the padded leather chair where he had sat for the last hour and a half, looking up each time the door opened and someone had come in from the corridor outside. On each occasion, though, the news had been for someone else, and now, of the five men who had occupied the room ninety minutes ago, only he and one other remained.

Crossing to the big windows which looked down on the hospital forecourt and across other buildings to the industrial heart of Burlington, he saw that the streets and roofs were wet. It must have rained since he had come here without his noticing it. Now the area surrounding the hospital looked its worst—squalid and depressing, the roofs of mean houses and tenements stretching away toward the factories and grimy smokestacks lining both banks of the river. Glancing down at the street on which the hospital fronted, he saw a group of children run from an alley, nimbly dodging the pools of water left by the rain or broken sidewalks. Watching them, he saw one of the bigger boys in the group halt and put out a foot to trip a child behind. It was a small girl, probably four or five, and she fell face forward into one of the larger puddles, dirty water splashing up around her. She arose crying, wiping streaks of mud from her face and attempting pathetically to wring the water from her soiled, soaked dress. By now the others had stopped and they formed a ring around her, dancing and, from their expressions, chanting derision.

“Kids!” The disgusted voice came from alongside, and John was aware for the first time that the other occupant of the room had joined him at the window. Glancing sideways, he saw that the man was tall and pencil thin; hollow cheeks made him appear gaunt, and he was in need of a shave. Probably twenty years older than John, he wore a stained corduroy jacket with soiled coveralls beneath. With him across the room he brought an odor of grease and stale beer.

“Kids! They’re all alike!” The man turned away from the window and began fumbling in his pockets. After a moment he produced paper and tobacco and began to roll a cigarette. Looking sharply at John, he asked, “This your first?”