The Final Diagnosis Arthur Hailey 9 page

The laughter had simmered down. “What is it you’re looking for?” Bell asked.

“I want you to take some films of the left knee,” Lucy answered. Then she added, “There’s some sort of growth there. I don’t like the look of it.”

Back in his own office, Dr. Charles Dornberger had telephoned Kent O’Donnell to report the outcome of the talk with Pearson. At the end he had told the chief of surgery, “I’ve let Joe know about the man you people have been corresponding with.”

O’Donnell had asked, “How did he take it?”

“I wouldn’t say he was enthusiastic,” Dornberger said. “But I think if you want to have this fellow . . . what’s his name—Coleman? . . . if you want to have him come here for a talk, Joe won’t be difficult. But I’d suggest you keep Joe posted on everything you do from here on in.”

“You can be sure of that,” O’Donnell had said. Then, “Thanks, Charlie. Thank you very much.”

Afterward Dornberger had made another telephone call. It was to Mrs. John Alexander, who had phoned earlier that morning and left a message. Before calling he had looked up his record card and was reminded that this was the wife of the pathology technologist, referred to him by Joe Pearson. Talking with Mrs. Alexander, he learned that she had just arrived in town to join her husband. They made an appointment for her to come to Dornberger’s downtown office the following week.

About the same time that Mrs. Alexander was talking with Dornberger her husband was receiving his first tongue-lashing from Dr. Joseph Pearson. It happened this way.

After Pearson’s outburst that morning about the poor-quality surgical slides, Bannister had come back to the serology lab where John Alexander was working and had told him the whole story. By this time Bannister was seething, and later he had taken out some of his own bad humor on the two girl technicians and their male helper who worked in the histology lab next door. Alexander had heard what was said through the doorway which Bannister had left open behind him.

Alexander, though, knew that not all the blame for the bad slides lay with the histology technicians. Even in the short time he had been at the hospital he had sensed the real problem, and afterward he had told Bannister, “You know, Carl, I don’t believe it’s all their fault. I think they have too much to do.”

Bannister had answered sourly, “We’ve all got too much to do.” Then with clumsy sarcasm he had added, “Maybe if you know so much about it you can do your own work and part of theirs as well.”

Alexander had declined to be provoked. “I don’t think so. But I do think they’d be a lot better off with a tissue-processing machine instead of having to do everything by hand—the old-fashioned way.”

“Forget it, kid. It isn’t your problem.” Bannister had been loftily condescending. “And, besides, anything that means spending money around here is a dead duck before it starts.”

Alexander had not argued. But he resolved to raise the subject, the first chance he got, with Dr. Pearson.

He had had to go into Pearson’s office that afternoon to leave some lab reports for signature, and he had found the pathologist going through a pile of mail with obvious impatience. Glancing up at Alexander, Pearson had motioned him to put the papers on the desk and had gone on with his reading. Alexander had hesitated, and the old man had barked, “What is it? What is it?”

“Dr. Pearson, I was wondering if I could make a suggestion.”

“Now?”

A more experienced hand would have known the tone of voice meant: Leave me alone. Alexander answered, “Yes, sir.”

Resignedly Pearson said, “Well?”

A little nervously Alexander began, “It’s about speeding up the surgical reports, Doctor.” As he mentioned surgical reports, Pearson had put down his letter and looked up sharply. Alexander went on, “I was wondering if you’d ever thought of getting a tissue-processing machine.”

“What do you know about tissue processors?” There was an ominous note in Pearson’s voice. “And anyway, I thought we put you to work in Serology.”

Alexander reminded him, “I did a full course in histology at technologists’ school, Doctor.” There was a pause. Pearson said nothing, so Alexander went on. “I’ve used a tissue processor and it’s a good machine, sir. It would save us at least a day in preparing slides. Instead of processing tissue by hand through all the solutions, you set the machine overnight and automatically by morning——”

Abruptly Pearson cut in. “I know how it works. I’ve seen them.”

Alexander said, “I see, sir. Then don’t you think——”

“I said I’ve seen these so-called tissue processors and I’m not impressed.” Pearson’s Voice was harsh and grating. “There’s not the quality in the slides that there is with the old hand method. What’s more, the machines are expensive. You see these?” He riffled through a stack of typed yellow forms in a tray on his desk.

“Yes, sir.”

“They’re purchase requisitions. For things I need in this department. And every time I put a bunch through I have a fight with the administrator. He says we’re spending too much money.”

Alexander had made his first mistake in broaching the suggestion when Pearson had not wanted to hear. Now he made a second error. He mistook Pearson’s statement as an invitation to continue the discussion.

He said placatingly, “But surely, if it would save a whole day, maybe two . . .” He became more earnest. “Dr. Pearson, I’ve seen slides made with a processor and they’re good. Perhaps the one you saw wasn’t being used properly.”

Now the older man had risen from his chair. Whatever the provocation, Alexander had overstepped the bounds between physician and technologist. Head forward, Pearson shouted, “That’ll do! I said I’m not interested in a tissue processor, and that’s what I meant, and I don’t want any argument about it.” He came around the desk until he was directly in front of Alexander, his face close to the younger man’s. “And there’s something else I want you to remember: I’m the pathologist here and I’m running this department. I don’t mind suggestions if they’re reasonable. But don’t get stepping out of line. Understand?”

“Yes, sir. I understand.” Crestfallen and miserable, not really understanding at all, John Alexander went back to his work in the lab.

Mike Seddons had been preoccupied all day; several times he had had to check himself and make a conscious effort to pull back his mind to the work he happened to be doing. Once, during an autopsy, McNeil had been forced to warn him, “There’s a piece of your hand under that section you’re about to slice. We like people to leave here with all the fingers they came with.” Seddons had changed his grip hastily; it would not have been the first time that some inexperienced learner had lopped off a gloved finger with one of the razor-edged knives of pathology.

All the same his attention still kept wandering, the question recurring: What was it about Vivian that disturbed him so? She was attractive and desirable, and he was anxious to take her to bed as quickly as possible—Mike Seddons was under no illusions about that. She seemed amenable, too, assuming the pain in her knee the night before had been genuine, and he now believed it was. He hoped she would still feel the same way, though there was no guarantee she would, of course. Some girls were inconsistent like that—you could have the most exotic intimacies with them one day, then the next time round they would reject even the most basic advance, pretending that the earlier incident had never even happened.

But was there something more to Vivian and himself than merely sex? Mike Seddons was beginning to wonder. Certainly none of the earlier episodes—and there had been several—had caused him to do half so much thinking as he was doing right now. A new thought occurred to him: Perhaps if he could get the sex bit out of his system other things might become clearer. He decided to ask Vivian to meet him again; and tonight—assuming she would be free—was as good a time as any.

Vivian had found the note from Mike Seddons when she finished her last class of the day and went back to the student nurses’ residence. It had been delivered by hand and was waiting for her in the mail rack under “L.” It asked her to be on the hospital’s fourth floor near Pediatrics at 9:45 that night. At first she had not intended to go, knowing she would have no reason officially to be in the hospital and she might be in trouble if she ran into any of the nursing supervisors. But she found herself wanting to go, and at 9:40 she crossed the wooden boardwalk between the nurses’ home and the main hospital buildings.

Mike was waiting, strolling in the corridor, apparently preoccupied. But as soon as he saw her he motioned to a door and they went inside. It led to an interior stair well, with a metal stairway leading up and down. At this time of night it was quiet and deserted and there would be plenty of warning of anyone’s approach. Mike went down half a flight onto the next landing, leading her by the hand. Then he turned, and it seemed the most natural thing in the world that she should go into his arms.

As they kissed she felt Mike’s arms tightening and the magic of the night before came sweeping back. At this moment she knew why she had wanted so much to come here. This man with the wild red hair had suddenly become indispensable to her. She wanted him in every way—to be close to him, talk with him, make love with him. It was an electric, exciting feeling she had never known before. He was kissing her cheeks now, her eyes, her ears. His face in her hair, he whispered, “Vivian darling, I’ve been thinking about you all day. I haven’t been able to stop.” With both hands he took her face and looked into it. “Do you know what you’re doing?” She shook her head. “You’re undermining me.”

She reached out for him again. “Oh, Mike darling!”

It was hot on the stairway. Vivian felt the warmth of his body against the fire of her own. Now his hands were questing, seeking. She whispered, trembling, “Mike, isn’t there somewhere else?”

She felt his hands pause and knew he was considering. He said, “I share a room with Frank Worth. But he’s out tonight, won’t be back till late. Do you want to take a chance and come to the residents’ quarters?”

She hesitated. “What would happen? If we got caught.”

“We’d both get thrown out of the hospital.” He kissed her again. “At this moment I couldn’t care.” He took her hand. “Come on.”

They went down one flight of stairs and along a corridor. They passed another resident who grinned as he saw them but made no comment. Then more stairs, another corridor. This time a white figure turned out of a doorway just ahead. Vivian’s heart leaped as she recognized the night nursing supervisor. But the supervisor did not turn around and went in another doorway before they passed. Then they were in a narrower, quieter corridor with closed doors on each side. There were lights beneath some of the doors, and from one she could hear music. She recognized it as Chopin’s Prelude in E Minor; the Burlington Symphony had played it a month or two before.

“In here.” Mike had opened a door, and quickly they moved inside. It was dark, but she could make out the shape of bunk beds and an armchair. Behind her she heard the lock click as Mike fastened the catch.

They reached for each other demandingly, urgently. His fingers were at the buttons of her uniform. When they hesitated she helped him. Now she was standing in her slip. For a moment he held her tightly, together savoring the torture of delay. Then, his hands moving gently, tenderly, and with exquisite promise, he lifted the slip over her head. As she moved to the bed she kicked off her shoes. There was a swift movement and then he was with her, his hands helping her again. “Vivian, darling Vivian!”

She scarcely heard him. “Mike, don’t wait! Please don’t wait!” She felt the contours of his body pressing madly, abandonedly, into her. She responded wildly, fought fiercely to bring him tighter, nearer, deeper. Then suddenly there was nothing else in the world, nothing but a peak of tempestuous ecstasy, now sweeping, searing, surging . . . coming closer, closer, closer.

As they lay quietly together afterward, Vivian could hear the music again, coming faintly from down the hall. It was still Chopin, this time the Etude in E Major. It seemed strange, at this moment, to be identifying a musical composition, but the liquid, haunting melody, heard softly in the darkness, fitted her mood of completion.

Mike reached over and kissed her gently. Then he said, “Vivian dearest, I want to marry you.”

She asked him softly, “Mike darling, are you sure?”

The impetuousness of his own words had surprised even himself. Mike had spoken them on impulse, hut suddenly, deeply, he knew them to be true. His objective in avoiding entanglements seemed pointless and shallow; this was an entanglement he wanted, to the exclusion of all others. He knew now what had troubled him today and earlier; at this moment it troubled him no more. Characteristically he answered Vivian’s questions with a touch of humor. “Sure I’m sure. Aren’t you?”

As her arms went around him Vivian murmured, “I’ve never been more sure of anything.”

“Hey!” Mike broke away and he propped himself on an elbow, facing her. “All this put it out of my mind. What about your knee?”

Vivian smiled mischievously. “It wasn’t any trouble tonight, was it?”

After he had kissed her again he asked, “Tell me what Lucy Grainger said.”

“She didn’t. She had Dr. Bell take some X-rays this afternoon. She said she’d send for me in a couple of days.”

Mike said, “I’ll be glad when it’s cleared up.”

Vivian said, “Don’t be silly, darling. How could a little bump like that be anything serious?”

Ten

Boston, Mass.

August 7

Mr. H. N. Tomaselli,

Administrator,

Three Counties Hospital

Burlington, Pa.

Dear Mr. Tomaselli:

Since my visit to Burlington a week ago I have thought a great deal about the appointment in pathology at Three Counties Hospital.

This letter is to advise you that, subject, of course, to your still feeling the same way about me, I have decided to accept the appointment on the terms we discussed.

You mentioned that you were anxious for whoever accepted the post to begin work as soon as possible. There is really nothing to delay me here, and after clearing up a few minor things I could be in Burlington ready to begin on August 15—that is, in just over a week from now. I trust this will be a convenient arrangement.

In talking with Dr. O’Donnell he mentioned knowing of some bachelor apartments which will be completed soon and are quite near the hospital. I wonder if you have any more information on this subject and, if so, I would be interested to know of it. Meanwhile, perhaps you would be good enough to make a reservation for me at one of the local hotels for arrival August 14.

On the subject of the work I shall be doing at the hospital, there is one point which I felt we did not clear up entirely, and I am mentioning it now in the hope that perhaps you may be able to discuss it with Dr. Pearson sometime before my arrival.

It is my feeling that it would be advantageous, both for the hospital and myself, if there were some clearly defined areas of responsibility where I could have a reasonably free hand, both in general supervision of the day-to-day work and also the carrying-out of any changes of organization and technique which, of course, are always necessary from time to time.

My own wishes in this regard would be to have direct responsibility, within the pathology department, for Serology, Hematology, and Biochemistry, though, of course, assisting Dr. Pearson in pathological anatomy and other matters at any time he might see fit.

As I say, I have raised this point now in the hope that it may be possible for you and Dr. Pearson to consider it before August 15. But please be assured that at all times I will seek to co-operate fully with Dr. Pearson and to serve Three Counties Hospital to the best of my ability.

Yours very truly,

David Coleman, M.D.

Coleman read through the neatly typed letter once more, put it in an envelope, and sealed it. Then, going back to his portable typewriter, he tapped out a similar but slightly shorter note to Dr. Joseph Pearson.

David Coleman left the furnished apartment which he had rented on a short lease for the few months he had been in Boston and walked to a mailbox with both letters. Thinking over what he had written, he still was not sure why he had chosen Three Counties in preference to the seven other posts he had been offered within recent weeks. Certainly it was not the most remunerative. Thought of in financial terms, it was more than halfway down the list. Nor was it a “name” hospital. Two of the other medical centers in which he had been offered employment had names that were internationally renowned. But Three Counties was scarcely known outside the immediate area it served.

Why then? Was it because he was afraid of being lost, swallowed up, in a bigger center? Scarcely, because his own record already showed he could hold his own in that kind of environment. Was it because he felt he would be freer for research in a small place? He certainly hoped to do some research, but if that were what he wanted most he could have chosen a research institute—there had been one on his list—and done nothing else. Was it because of the challenge that he had made his choice? Maybe. There were certainly a lot of things wrong in pathology at Three Counties Hospital. He had seen that just in the two brief days he had spent there last week, following the phone call from the administrator inviting him to visit the hospital and look the situation over. And working with Dr. Pearson was not going to be easy. He had sensed resentment in the older man when they had met, and the administrator had admitted under Coleman’s questioning that Pearson had a reputation for being hard to get along with.

So was it because of the challenge? Was that why he had picked Three Counties? Was it? Or was it something else, something quite different? Was it . . . self-mortification? Was it that still—the old specter that had haunted him so long?

Of all his traits of character David Coleman had long suspected pride to be the strongest, and it was a defect he feared and hated most. In his own opinion he had never been able to conquer pride; he spurned it, rejected it, yet always it came back—seemingly strong and indestructible.

Mostly his pride stemmed from an awareness of his own superior intellect. In the company of others he frequently felt himself to be mentally far out front, usually because he was. And, intellectually, everything he had done so far in his life proved this to be true.

As far back as David Coleman could remember, the fruits of scholarship had come to him easily. Learning had proved as simple as breathing. In public school, high school, college, medical school, he had soared above others, taking the highest honors almost as a matter of course. He had a mind which was at once absorbent, analytical, understanding. And proud.

He had first learned about pride in his early years of high school. Like anyone who is naturally brilliant, he was regarded initially by his fellow students with some suspicion. Then, as he made no attempt to conceal his feelings of mental superiority, suspicion turned to dislike and finally to hate.

At the time he had sensed this, but he had not consciously cared until one day the school principal, himself a brilliant scholar and an understanding man, had taken him aside. Even now David Coleman remembered what the other man had said.

“I think you’re big enough to take this, so I’m going to spell it out. In these four walls, aside from me, you haven’t a single friend.”

At first he had not believed it. Then because, above all, he was supremely honest, he had admitted to himself that the fact was true.

Then the principal had said, “You’re a brilliant scholar. You know it and there’s no reason why you shouldn’t. As to what’s ahead, you can be anything you choose. You have a remarkably superior mind, Coleman—I may say, unique in my experience. But I warn you: if you want to live with others, sometimes you’ll have to seem less superior than you are.”

It was a daring thing to say to a young, impressionable man. But the master had not underrated his pupil. Coleman went away with the advice, digested it, analyzed it, and finished up despising himself.

From then on he had worked harder than ever—to rehabilitate himself with a planned program almost of self-mortification. He had begun with games. From as far back as he could remember David Coleman had disliked sports of every kind. At school, so far, he had never participated, and he inclined to the opinion that people who went to sports events and cheered were rather stupid juveniles. But now he turned up at practice—football in winter, baseball in summer. Despite his own first feelings he became expert. At college he found himself in the first teams. And when not playing, as a supporter in college and high school he attended every game, cheering as loudly as the rest.

Yet he was never able to play without a feeling of indifference to games, which he carefully concealed. And he never cheered without an inward uneasiness that he was behaving childishly. It was this which made him believe that, though he had humbled pride, he had never banished it.

His relationship with people had gone much the same way. In the old days, on meeting someone whom he considered intellectually inferior, he had never bothered to conceal his boredom or disinterest. But now, as part of his plan, he went out of his way to be cordial to such people. As a result, in college he had taken on the reputation of a friendly sage. It had become a password among those in academic difficulties to say, “Let’s have a bull session with David Coleman. He’ll straighten us out.” And invariably he did.

By all normal thinking the process should have shaped his feelings for people into a kindlier mold. Time and experience should have made him sympathetic to those less gifted than himself. But he was never sure that it had. Within himself Coleman found he still had the old contempt for mental incompetence. He concealed it, fought it with iron discipline and good acting, but, it seemed, it would never go away.

He had gone into medicine partly because his father, now dead, had been a country doctor and partly because it was something he had always wanted to do himself. But in entering a specific field he had chosen pathology because it was generally considered the least glamorous of the specialties. It was part of his own deliberate process of beating down the inevitable pride.

For a while he believed he had succeeded. Pathology is at times a lonely specialty, cut off as it is from the excitements and pressures of direct contact with hospital patients. But later, as interest and knowledge grew, he found the old contempt returning for those who knew less than he of the hidden mysteries a high-powered microscope revealed. Not to the same extent, though, because inevitably in medicine he met minds which were a match for his own. And still later he found he could relax, lowering some of the iron self-discipline with which he had clad himself. He still met those whom he considered fools—even in medicine there were some. But he never showed it and found occasionally that contact with such people disturbed him less. With such relaxation he began to wonder if at last he had beaten down his old enemy.

He was still wary though. A program of deliberate self-adjustment which had lasted fifteen years was not easy to shake off suddenly. And at times he found it hard to decide whether his motives came from pure choice or were from the habit of sackcloth he had worn so patiently and for so long.

Thus the question to himself on his choice of Three Counties Hospital. Had he chosen it because this was what he really wanted—a medium-size, second-line hospital, without reputation or glamor? Or had it been an old subconscious feeling that here was where his pride would suffer most?

As he mailed the two letters he knew these were questions that only time could answer.

On the seventh floor of the Burlington Medical Arts Building, Elizabeth Alexander dressed herself in the examining room adjoining Dr. Dornberger’s office. In the last half-hour Charles Dornberger had given her his usual thorough physical examination, and now he had gone back to his desk. Through the partly opened door she heard him say, “Come and sit down when you’re ready, Mrs. Alexander.”

Pulling a slip over her head, she answered cheerfully, “I’ll just be a minute, Doctor.”

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?”

Date: 2014-12-21; view: 781