The Final Diagnosis Arthur Hailey 7 page

Called on for endorsement, Bannister was quick to answer. “That’s right, Doctor.”

Pearson had finished with the lungs now and, dipping into the pail, somewhat like drawing a lottery, had come up with a stomach. He grunted, then held out an open section to McNeil. “See that?”

The resident nodded. “I saw it before. We have it listed.”

“All right.” Pearson motioned to the clip board, then he dictated, “There is a peptic ulcer lying just below the pyloric ring in the duodenum.”

Alexander had shifted slightly to get a better look. Pearson saw his movement and slid the organ across. “Are you interested in dissection, John?”

Alexander answered respectfully, “I’ve always been interested in anatomy, Doctor.”

“As well as lab work, eh?” McNeil sensed that Pearson was pleased. Pathological anatomy was the old man’s first love.

“Yes, sir.”

“Well, these are the organs of a fifty-five-year-old woman.” Pearson turned over the case-history pages in front of him. Alexander was raptly attentive. “Interesting history, this case. The patient was a widow, and the immediate cause of death was cancer of the breast. For two years before she died her children knew she had trouble but they couldn’t persuade her to see a physician. It seems she had a prejudice against them.”

“Some people do.” It was Bannister. He gave a high-pitched giggle which dried up as he caught Pearson’s eye.

“Just cut out the snide remarks. I’m giving John here some information. Might not do you any harm either.” Anyone but Bannister would have been crushed by Pearson’s rejoinder. As it was, the technician merely grinned.

“What happened, Doctor?” Alexander asked.

“It says here: ‘Daughter states that for the past two years the family has been noticing drainage from the mother’s left breast area. Fourteen months before admission bleeding was noticed from the same area. Otherwise she appeared in normal health.’ ”

Pearson turned a page. “It seems this woman went to a faith healer.” He chuckled grimly. “Guess she didn’t have enough faith, though, because she finally collapsed and they brought her to this hospital.”

“By then, I suppose, it was too late.”

This isn’t politeness, McNeil thought. This guy Alexander is really interested.

“Yeah,” Pearson answered. “But if she had gone to a doctor at the beginning she could have had a radical mastectomy—that’s removal of the breast.”

“Yes, sir. I know.”

“If she’d had that she might still be alive.” Pearson tossed the stomach neatly through the hole.

Something was troubling Alexander. He asked, “Didn’t you just say, though, she had a peptic ulcer?”

Good for you, McNeil thought. Pearson, it seemed, had the same reaction, for he turned to Bannister. “There you are, Carl. Here’s a boy who keeps his ears open. You watch out or he’ll be showing you up.”

Bannister was grinning, but McNeil suspected a little sourness. What had been said might prove uncomfortably true. “Well, John”—Pearson was really expansive now—“she might have had trouble with that. Then again she might not.”

“You mean she’d never have known about it?”

McNeil thought it was time he said something himself. “It’s surprising,” he told Alexander, “what people have wrong with them besides the things they die of. Things they never know about. You see a lot of that here.”

“That’s right.” Pearson nodded agreement. “You know, John, the remarkable thing about the human body is not what kills us but what we can have wrong inside and still go on living.” He paused, then abruptly changed the subject. “Are you married?”

“Yes, sir. I am.”

“Your wife here with you?”

“Not yet. She’s coming next week. I thought I’d find us a place to live first.”

McNeil remembered that Alexander had been one of the out-of-town applicants for the job at Three Counties. He seemed to recall that Chicago had been mentioned.

Alexander hesitated, then he added, “There was something I wanted to ask you, Dr. Pearson.”

“What’s that?” The old man sounded wary.

“My wife is pregnant, Doctor, and coming into a new town, we don’t know anyone.” Alexander paused. “This baby is pretty important to us. You see, we lost our first child. A month after she was born.”

“I see.” Pearson had stopped work now and was listening carefully.

“I was wondering, Doctor, if you could recommend an obstetrician my wife could go to.”

“That’s easy.” Pearson sounded relieved. Plainly he had wondered what was coming. “Dr. Dornberger’s a good man. He has an office right here in the hospital. Would you like me to call him?”

“If it’s not too much trouble.”

Pearson motioned to Bannister. “See if he’s in.”

Bannister picked up the telephone behind them and asked for an extension. After a pause he said, “He’s in,” and offered the instrument to Pearson.

With both hands gloved and wet, the old man motioned his head irritably. “Hold it! Hold it!”

Bannister moved in closer and held the receiver against Pearson’s ear.

“That you, Charlie?” The pathologist boomed into the mouthpiece. “I’ve got a patient for you.”

In his office three floors above Dr. Charles Dornberger smiled and moved the telephone slightly away from his ear. He asked, “What can obstetrics do for your kind of patients?” At the same time he reflected that this call was convenient. Since the meeting which O’Donnell had called yesterday, Charles Dornberger had speculated on the best method of approach to Joe Pearson. Now, it seemed, an opportunity was presenting itself.

Down in Pathology Pearson maneuvered the cigar to a corner of his mouth. He always enjoyed exchanges with Dornberger.

“This isn’t a dead patient, you old fool. It’s a live one. Wife of one of my lab boys here—Mrs. John Alexander. They’re new in town. Don’t know anybody.”

As Pearson mentioned the name Dornberger opened a file drawer and selected a blank card.

“Just a minute.” He cradled the phone in his shoulder and, using his left hand to hold the card, wrote in a fine script with the right, “Alexander, Mrs. John.” It was typical of Dornberger’s organized approach to his practice that this was the first thing he did. Now he said, “Be glad to oblige, Joe. Will you have them call me for an appointment?”

“All right. Be some time next week. Mrs. Alexander won’t be in town till then.” He grinned at Alexander, then added, still almost shouting, “And if they want twins, Charlie, it’s up to you to see they get them.”

Pearson listened to Dornberger’s answer and chuckled. A thought struck him. “And hey! Another thing! None of your fancy fees for this job. I don’t want the boy coming to me for a raise so he can pay his doctor’s bill.”

Dornberger smiled. He said, “Don’t worry.” On the card he made a notation, “Hospital employee.” It was a signal to himself that this was a patient he would charge no fee. Into the phone he said, “Joe, there’s something I want to talk to you about. When would be a convenient time to come and see you?”

“Can’t make it today, Charlie,” Pearson said. “Got a full schedule. How about tomorrow?”

Dornberger consulted his own appointment list. “I’m crowded tomorrow myself. Let’s make it the day after. How about around ten in the morning? I’ll come to your office.”

“That’ll be all right. Unless you want to tell me now—on the phone.” Pearson’s voice sounded curious.

“No, Joe,” Dornberger said, “I’d rather come and see you.”

In Pathology Pearson answered, “All right, Charlie. See you then. So long.” Impatiently he motioned the telephone away and Bannister replaced it.

To Alexander, Pearson said, “That’s all fixed. Your wife can be admitted to this hospital when she comes to term. Because you’re an employee you’ll get a twenty per cent discount on your bill.”

Alexander was beaming. McNeil thought: Yes, go ahead; enjoy it, my friend. This is one of the old man’s good moments. But make no mistake—there’ll be others, and those you won’t enjoy at all.

“I’ll only be a moment.” In his office Dornberger smiled at the student nurse who had come in while he was talking with Pearson. He motioned her to the chair alongside his desk.

“Thank you, Doctor.” Vivian Loburton had brought a patient’s chart that Dornberger had asked to see. Ordinarily physicians didn’t get this kind of service; they would have to walk to the ward and look at the chart there. But Dornberger was a favorite with the nurses; they were always doing little things for him, and when he had phoned a few minutes ago the staff nurse had sent Vivian off promptly.

“I like to do one thing at a time when I can.” Dornberger was writing in pencil now, noting on the card the new facts Joe Pearson had given him. Later, when he had more information from the patient, he would erase the pencil notes and complete the card in ink. Still writing, he asked the girl, “You’re new here, aren’t you?”

“Fairly new, Doctor,” Vivian said. “This is my fourth month in nursing school.”

He noticed she had a soft voice with a lilt. Pretty too. He wondered if she had slept yet with any of the interns or residents. Or had things changed since his own student years? He occasionally suspected that interns and residents nowadays were getting more conservative than they used to be. A pity. If true, they were missing a good deal. Aloud he said, “That was Dr. Pearson, our pathologist. Have you met him yet?”

“Yes,” Vivian said. “Our class went to an autopsy.”

“Oh dear. How did you . . .” He was going to say “like it” but changed it to, “How did you find it?”

Vivian considered. “At first it was rather a shock. Afterward I didn’t mind too much though.”

He nodded sympathetically. He had finished writing now and put the card away. This had been a quieter day than usual; it was a luxury to be able to clean up one piece of work before going on to another. He held out his hand for the chart. “Thank you.” He added, “I’ll only be a moment with this, if you’d like to wait.”

“All right, Doctor.” Vivian decided a few more minutes’ respite from the rush of ward work would be welcome. She settled back in the chair. It was cool in here with the air conditioning. There was no such luxury in the nurses’ home.

Vivian watched Dr. Dornberger as he studied the chart. He was probably about the same age as Dr. Pearson, she thought, but certainly a lot different to look at. While the pathologist was round-faced and heavy-jowled, Dr. Dornberger was lean and angular. In other ways, too, his appearance was a contrast, with the thatch of white hair carefully combed and parted. She noticed his hands were manicured, his white hospital jacket pressed and spotless.

Dornberger handed back the chart. “Thank you,” he said. “It was good of you to bring it.” He has a sparkle to him, Vivian thought. She had heard he was much beloved by his women patients. There was little need to wonder why.

“We’ll be seeing each other, I expect.” Dornberger had risen and opened the door courteously. “Good luck in your studies.”

“Good-by, Doctor.” She went out, leaving a trace of fragrance behind her, Dornberger thought. Not for the first time the contact with someone youthful left him wondering about himself. He returned to the swivel chair and leaned back meditatively. Almost absently he took out his pipe and began to fill it.

He had been in medicine now for almost thirty-two years; in a week or two he would being his thirty-third. They had been full years and rewarding ones. Financially he had no problems. His own four children were married, and he and his wife could live comfortably on the careful investments he had made. But would he be content to retire and rusticate? That was the rub.

In all his years in medicine Charles Dornberger had prided himself in keeping up to date. He had made up his mind long ago that no young newcomer was going to surpass him, either in technique or knowledge. As a result he had read avidly and still continued to do so. He subscribed to many of the medical journals which he read thoroughly and occasionally contributed articles himself. He was a regular attender at medical conventions and conscientiously took in most of the business sessions. Early in his career, long before the present boundary lines were drawn in medicine, he had foreseen the need for specialization. His own choice had been obstetrics and gynecology. It was a choice he had never regretted, and he often felt it had helped him to keep young in mind.

Because of this by the mid-thirties, when American specialty boards were coming into being, Dornberger was already established in his own field. As a result, under the so-called “grandfather” clause, he had been given Board certification without examination. It was something he had always been proud of. If anything, it had made him keener still to remain up to date.

And yet he had never resented younger men. When he had felt them to be good and conscientious, he had gone out of his way to offer help and advice. He admired and respected O’Donnell. He considered the youthful chief of surgery one of the best things that had ever happened to Three Counties. His own morale had risen with O’Donnell’s changes and progress in the hospital.

He had made many friends, some among his own immediate colleagues, others in unlikely places. Joe Pearson might be called one of the unlikely ones. Professionally the two men looked at a lot of things in different ways. Dornberger knew, for example, that Joe did not read much these days. He suspected that in a few areas of knowledge the elderly pathologist had slipped behind the times, and, administratively, there was the problem which yesterday’s meeting had revealed. And yet, over the years, the bond between the two men had grown strong. To his own surprise sometimes he had found himself siding with Pearson at medical conferences and defending him occasionally when Pathology was criticized in private.

Dornberger’s interjection ten days ago at the mortality conference had been much like that. He supposed other people recognized the alliance between himself and Joe. What was it Gil Bartlett had said? “You’re a friend of his; and besides he doesn’t have a vendetta with obstetricians.” Until this moment he had forgotten the remark, but he realized now it had had an edge of bitterness and he was sorry about that. Bartlett was a good physician, and Dornberger made a mental note to be especially cordial next time they met.

But there was still his own problem. To quit or not to quit? And if he did quit, when? Just lately, despite his carefully guarded physical fitness, he had found himself tiring. And although he had spent a lifetime answering night calls, lately they had seemed harder to take. Yesterday at lunch he had heard Kersh, the dermatologist, telling a new intern, “You should join us in the skin game, son. Haven’t been called out at night in fifteen years.” Dornberger had laughed with the rest but harbored a little secret envy.

One thing he was sure of though. He would not hang on if he found himself weakening. Right now he knew he was as good as ever. His mind was clear, his hands steady and eyes sharp. He always watched himself carefully because he knew that at the first sign of failing he would not hesitate. He would clear his desk and go. He had seen too many others try to stay the course too long. That would never be for him.

But as for the present, well, maybe he would let things go another three months, then think it over.

By this time he had packed the tobacco tightly in his pipe and now he reached for a folder of matches. He was about to strike one when the telephone rang. Putting down pipe and matches, he answered it. “Dr. Dornberger speaking.”

It was one of his patients. She had begun labor pains an hour ago. Now her membranes had ruptured and she had discharged water. She was a young girl in her early twenties, and it would be her first baby. She sounded breathless, as if nervous but trying not to be.

As he had so many times before, Dornberger gave his instructions quietly. “Is your husband at home?”

“Yes, Doctor.”

“Then get your things together and have him drive you to the hospital. I’ll see you after you’ve arrived.”

“Very well, Doctor.”

“Tell your husband to drive carefully and stop at all the red lights. We’ve plenty of time. You’ll see.”

He could sense, even over the phone, that he had helped her to relax. It was something he did often, and he considered it as much a part of his job as any course of treatment. Nevertheless he felt his own senses quickening. A new case always had that effect. Logically, he thought, he should have lost the feeling long ago. As you grew older in medicine you were supposed to become impervious, mechanical and unsentimental. It had never worked that way for him, though—perhaps because, even now, he was doing what he loved to do most.

He reached for his pipe, then changed his mind and picked up the telephone again. He must let Obstetrics know that his patient was coming in.

Eight

“I’m not even sure that defeating polio was a good or necessary thing.”

The speaker was Eustace Swayne—founder of a department-store empire, millionaire philanthropist, and member of the board of directors of Three Counties Hospital. The background was the shadowed, oak-paneled library of Swayne’s aging but imposing mansion, set alone in fifty acres of parkland and near the eastern fringes of Burlington.

“Come now, you can’t be serious,” Orden Brown said lightly. The hospital-board chairman smiled at the two women in the room—his own wife, Amelia, and Swayne’s daughter, Denise Quantz.

Kent O’Donnell sipped the cognac which a soft-footed manservant had brought him and leaned back in the deep leather chair he had chosen on entering this room with the others after dinner. It occurred to him that the scene they made was almost medieval. He glanced around the softly lighted room, his eyes ranging over tiers of leather-bound books rising to the high-timbered ceiling, the dark and heavy oaken furniture, the cavernous fireplace laid with great logs—not burning now, this warm July evening, but ready to blaze to life at the touch of a servant’s torch; and, across from O’Donnell, Eustace Swayne, seated kinglike in a straight-backed, stuffed wing chair, the other four—almost as courtiers—formed in a semicircle, facing the old tycoon.

“I am serious.” Swayne put down his brandy glass and leaned forward to make his point. “Oh, I admit—show me a child in leg braces and I’ll cringe with the rest and reach for my checkbook. But I’m talking of the grand design. The fact is—and I challenge anyone to deny it—we’re busily engaged in weakening the human race.”

It was a familiar argument. O’Donnell said courteously, “Would you suggest that we should stop medical research, freeze our knowledge and techniques, not try to conquer any more diseases?”

“You couldn’t do it,” Swayne said. “You couldn’t do it any more than you could have stopped the Gadarene swine jumping off their cliff.”

O’Donnell laughed. “I’m not sure I like the analogy. But if that is so, then why the argument?”

“Why?” Swayne banged a fist on the arm of his chair. “Because you can still deplore something, even though there’s nothing you can do to force a change.”

“I see.” O’Donnell was not sure he wanted to get deeper into this discussion. Besides, it might not help relations with Swayne, either for himself or Orden Brown, which was really why they had come here. He glanced around at the others in the room. Amelia Brown, whom he had come to know well through his visits to the chairman’s home, caught his eye and smiled. As a wife who kept herself posted on all her husband’s activities, she was well informed about hospital politics.

Swayne’s married daughter, Denise Quantz, was sitting forward, listening intently.

At dinner O’Donnell had several times found his eyes traveling, almost involuntarily, in Mrs. Quantz’s direction. He had found it difficult to reconcile her as the daughter of the rugged, hard-bitten man who sat at the table’s head. At seventy-eight Eustace Swayne still exhibited much of the toughness he had learned in the competitive maelstrom of large-scale retail merchandising. At times he took advantage of his age to toss out barbed remarks to his guests, though O’Donnell suspected that most times their host was merely angling for an argument. O’Donnell had found himself thinking: The old boy still likes a fight, even if it’s only in words. In the same way he had an instinct now that Swayne was overstating his feelings about medicine, though perhaps in this case merely for the sake of being ornery. Watching the old man covertly, O’Donnell had suspected gout and rheumatism might be factors here.

But, in contrast, Denise Quantz was gentle and softly spoken. She had a trick of taking the edge from a remark of her father’s by adding a word or two to what he had said. She was beautiful too, O’Donnell thought, with the rare mature loveliness which sometimes comes to a woman at forty. He gathered that she was visiting Eustace Swayne and came to Burlington fairly frequently. Probably this was to keep an eye on her father; he knew that Swayne’s own wife had died many years before. It was evident from conversation, though, that most of the time Denise Quantz lived in New York. There were a couple of references made to children, but a husband was not mentioned. He gained the impression that she was either separated or divorced. Mentally O’Donnell found himself comparing Denise Quantz with Lucy Grainger. There was a world of difference, he thought, between the two women: Lucy with her professional career, at ease in the environment of medicine and the hospital, able to meet someone like himself on ground familiar to them both; and Denise Quantz, a woman of leisure and independence, a figure in society no doubt, and yet—he had the feeling—someone who would make a home a place of warmth and serenity. O’Donnell wondered which kind of woman was better for a man: one who was close to his working life, or someone separate and detached, with other interests beyond the daily round.

His thoughts were interrupted by Denise. Leaning toward him, she said, “Surely you’re not going to give up so easily, Dr. O’Donnell. Please don’t let my father get away with that.”

The old man snorted. “There’s nothing to get away with. It’s a perfectly clear situation. For years the natural balance of nature kept populations in check. When the birth rate became too great there were famines to offset it.”

Orden Brown put in, “But surely some of that was political. It wasn’t always a force of nature.”

“I’ll grant you that in some cases.” Eustace Swayne waved his hand airily. “But there was nothing political in the elimination of the weak.”

“Do you mean the weak or the unfortunate?” Very well, O’Donnell thought, if you want an argument I’ll give you one.

“I mean what I say—the weak.” The old man’s voice had a sharper tone, but O’Donnell sensed he was enjoying this. “When there was a plague or an epidemic, it was the weak who were wiped out and the strong survived. Other illnesses did the same thing; there was a level maintained—nature’s level. And because of this it was the strong who perpetuated themselves. They were the ones who sired the next generation.”

“Do you really think, Eustace, that mankind is so degenerate now?” Amelia Brown had asked the question, and O’Donnell saw she was smiling. She knows that Swayne’s enjoying this, he thought.

“We’re moving toward degeneracy,” the old man answered her, “at least in the Western world. We’re preserving the cripples, the weaklings, and the disease-ridden. We’re accumulating burdens on society, non-producers—the unfit, unable to contribute anything to the common good. Tell me—what purpose does a sanatorium or a home for incurables serve? I tell you, medicine today is preserving people who should be allowed to die. But we’re helping them to live, then letting them spawn and multiply, passing along their uselessness to their children and their children’s children.”

O’Donnell reminded him, “The relationship between disease and heredity is far from clear.”

“Strength is of the mind as well as the body,” Eustace Swayne snapped back. “Don’t children inherit the mental characteristics of their parents—and their weaknesses?”

“Not all of the time.” This was between the old tycoon and O’Donnell now. The others sat back, listening.

“But a lot of the time they do. Well, don’t they?”

O’Donnell smiled. “There’s some evidence that way, yes.”

Swayne snorted. “It’s one of the reasons we’ve so many mental hospitals. And patients in them. And people running to psychiatrists.”

“It could also be that we’re more aware of mental health.”

Swayne mimicked him. “It could also be that we’re breeding people who are weak, weak, weak!”

The old man had almost shouted the last words. Now a bout of coughing seized him. I’d better go easily, O’Donnell thought. He probably has high blood pressure.

Just as if O’Donnell had spoken, Eustace Swayne glared across at him. The old man took a sip of brandy. Then, almost malevolently, he said, “Don’t try to spare me, my young medical friend. I can handle all your arguments and more.”

O’Donnell decided he would go on but more moderately. He said, quietly and reasonably, “I think there’s one thing you’re overlooking, Mr. Swayne. You say that illness and disease are nature’s levelers. But many of these things haven’t come to us in the natural course of nature. They’re the result of man’s own environment, conditions he’s created himself. Bad sanitation, lack of hygiene, slums, air pollution—those aren’t natural things; they’re man’s creation.”

“They’re part of evolution and evolution is a part of nature. It all adds up to the balancing process.”

Admiringly O’Donnell thought: You can’t shake the old son of a gun easily. But he saw the chink in the other’s argument. He said, “If you’re right, then medicine is a part of the balancing process too.”

Swayne snapped back, “How do you reason that?”

“Because medicine is a part of evolution.” Despite his good resolution O’Donnell felt his voice grow more intense. “Because every change of environment that man has had produced its problems for medicine to face and to try to solve. We never solve them entirely. Medicine is always a little behind, and as fast as we meet one problem there’s a new one appearing ahead.”

“But they’re problems of medicine, not nature.” Swayne’s eyes had a malicious gleam. “If nature were left alone it would settle its problems before they arose—by natural selection of the fittest.”

“You’re wrong and I’ll tell you why.” O’Donnell had ceased to care about the effect of his words. He felt only that this was something he had to express, to himself as well as to the others. “Medicine has only one real problem. It’s always been the same; it always will. It’s the problem of individual human survival.” He paused. “And survival is the oldest law of nature.”

“Bravo!” Impulsively Amelia Brown clapped her palms together. But O’Donnell had not quite finished.

“That’s why we fought polio, Mr. Swayne, and the black plague, and smallpox, and typhus, and syphilis. It’s why we’re still fighting cancer and tuberculosis and all the rest. It’s the reason we have those places you talked about—the sanatoria, the homes for incurables. It’s why we preserve people—all the people we can, the weak as well as the strong. Because it adds up to one thing—survival. It’s the standard of medicine, the only one we can possibly have.”

For a moment he expected Swayne to lash back as he had before. But the old man was silent. Then he looked over at his daughter. “Pour Dr. O’Donnell some more brandy, Denise.”

O’Donnell held out his glass as she approached with the decanter. There was a soft rustle to her dress, and as she leaned toward him he caught a faint, tantalizing waft of perfume. For a moment he had an absurd, boyish impulse to reach out and touch her soft dark hair. As he checked it she moved over to her father.

Replenishing the old man’s glass, she asked, “If you really feel the way you say, Father, what are you doing on a hospital board?”

Eustace Swayne chuckled. “Mostly I’m there because Orden and some others are hoping I won’t change my will.” He looked over at Orden Brown. “They reckon there can’t be long to wait in any case.”

“You’re doing your friends an injustice, Eustace,” Brown said. His tone contained the right mixture of banter and seriousness.

“And you’re a liar.” The old man was enjoying himself again. He said, “You asked a question, Denise. Well, I’ll answer it. I’m on the hospital board because I’m a practical man. The world’s the way it is and I can’t change it, even though I see what’s wrong. But what someone like me can be is a balancing force. Oh, I know what some of you think—that I’m just an obstructionist.”

Orden Brown interjected quickly, “Has anyone ever said that?”

“You don’t have to.” Swayne shot a half-amused, malicious glance at the board chairman. “But every activity needs a brake on it somewhere. That’s what I’ve been—a brake, a steadying force. And when I’m gone perhaps you and your friends will find you need another.”

Date: 2014-12-21; view: 677