"Sounds like pneumonia," I offered. "What did you treat him with?"

"Timentin and gentamicin, one dose ... He was in the hospital just a few weeks ago ... We couldn't be sure what we were treating ... . "

"Fever, pleuritic pain, rust-tinged sputum, lobar infiltrate-sounds like strep pneumoniae to me. Penicillin is still a wonder drug against strep pneumoniae, and it's so inexpensive. Why not do a Gram stain and be sure of what you're treating?"

My resident leaped to his intern's defense.

"Dr. Fournier, they don't let us do Gram stains any more. It's against the law. They throw us out of the micro lab." Sarcastically, he added, "They don't trust our judgment."

"Yeah, I know that law ... CLIA [Clinical Laboratory Improvement Amendments]." I screwed up my face, trying to decide whether I should tell them what I really thought of these regulations. "No patient with pneumonia should be started on antibiotics without the physician first looking at a Gram stain."

"But Dr. Fournier, what can we do?"

"Civil disobedience!" My eyes grew wide, and the veins in my neck stuck out. "Follow me!"

I picked up a sputum specimen from the patient and an alcohol pledget from a crash cart. We left the emergency department and crossed a corridor to an unmarked door. I turned the handle. It was unlocked. I led the team into one of the old house officers' laboratories. Dust layered the counters, coating the microscope, the staining bottles, and the laboratory paraphernalia. Cobwebs stretched from the microscope's objectives to the stage mount.

"The Holy Grail," I whispered reverently. The housestaff stared at me as if I'd lost it.

I brushed away the cobwebs and cleaned the eyepiece and objectives with a scrap of lenspaper. I teased a specimen of thick, green sputum from the cup and spread it on a slide.

"How will you heat-fix it, Dr. Fournier? They've shut off the gas on the Bunsen burner."

I was too excited to answer. I opened the alcohol pledget and twisted the foil so it could stand on end. I placed it in the sink, lit the exposed edge with a safety match, and watched nostalgically as the yellow flame with its blue center rose about 2 inches above the pledget.

"Behold the Boston City Hospital Bunsen burner," I pronounced. The team stared, transfixed like moths by the flame. After three passes through the flame, the slide was ready for staining. Crystal violet, Gram's iodine, acetone, and safranin. How many times had I repeated this litany? My thumb and index finger received first the purple and then the red stigmata.

"Once upon a time, we could tell which housestaff had been on call by whose fingers were stained," I said to no one in particular.

Then I entered yesteryear, that timeless world of purple and red, the bizarre denatured shapes of stained nuclei and cytoplasms. I could be an intern again. Once upon a time, every patient that was admitted to the hospital had peripheral smears and microscopic urinalyses examined by an admitting intern. Any possibly infected body fluid was always Gram-stained. It was part of the physical exam. Now, scanning past the squamous cells, looking for good sputum, I went in for a closer look.

"There! The enemy!" I exclaimed to the third-year student at my shoulder. "Look, right in the poly in the center of the field ... those pairs of blue dots with the haloes around them ... strep pneumoniae ... . "

The young student took off her glasses and squinted as she adjusted the fine focus. She paused.

"Cool!"