Artropods and Human Disease 6 page

O’Donnell sipped his drink. “And your answer was ‘no’?”

“I wanted a career in medicine. At the time it seemed terribly important. That and marriage didn’t seem to go together.”

He asked casually, “Any regrets?”

Lucy considered. “Not really, I suppose. I’ve achieved what I wanted, and it’s been rewarding in many ways. Oh, sometimes one wonders how things would have turned out with a different decision, but after all, that’s human, isn’t it?”

“I suppose so.” O’Donnell was conscious of being strangely moved. There was a sense of depth and tenderness about Lucy, a feeling of peacefulness and coming home. She should have children, he thought. He had asked, “Do you still feel the same way about marriage and medicine—for you, that is?”

“I’m no longer dogmatic about anything.” She smiled. “That, at least, I’ve learned.”

O’Donnell wondered what, from his own point of view, marriage to Lucy would be like. Would there be love and mellowness? Or had each of their careers gone parallel too far and too long for change and adjustment now. If married, how might they spend their hours of leisure? Would the talk be intimate and domestic? Or would it be of hospital affairs, with charts on the table at dinner and diagnostic problems for dessert? Would he perhaps, instead of gaining sanctuary, find merely another offshoot of medicine and his daily work. Aloud he said, “I’ve always thought, you know, that we have a good deal in common.”

“Yes, Kent,” Lucy answered, “so have I.”

O’Donnell had finished his drink, then risen to leave. He realized they had both said a good deal more than had passed in words. Now he wanted time to think and to reason things through. Too much was involved for hasty decisions.

“There’s really no need to go, Kent. Stay if you wish.” Lucy had said it simply, and he knew if he stayed it would be up to him what happened next.

Part of his mind had told him to remain, but caution and habit won out. He took her hands. “Good night, Lucy. Let’s think about all this.”

When the elevator doors had closed she was still standing at the open apartment door.

Six

“I asked you here,” O’Donnell told the group around the board-room table, “because I’d like your support in something I want to do.” The others were listening attentively. Of those they had asked, all had come except Reubens, who had a herniorrhaphy scheduled. O’Donnell went on, “I think we all know there’s a problem in Pathology. I believe, too, you’ll agree it’s a personal problem as well as medical.”

“What kind of a problem?” It was Charlie Dornberger. As the elderly obstetrician talked he filled his pipe. “I’m not sure I know what you’re getting at, Kent.”

O’Donnell had expected something like this. He knew that Dornberger and Pearson were close friends. Politely he said, “I’d like you to hear me out, Charlie, if you will. I’ll try to make it clear.”

Methodically he went over the issues involved—the delays in surgical reports, the increasing service the hospital required from its pathology department, his own doubts that Joe Pearson could cope with them alone. He related the incident of Bill Rufus’ patient, turning to Rufus for confirmation, and followed it with the report he had had from Reubens that morning. He told them of his own interview with Pearson and the old man’s refusal to accept a second pathologist. He concluded: “I’m convinced we do need a new man to help Joe out. I want your support in seeing that one is brought in.”

“I’ve been concerned about Pathology too.” Promptly, as if to ensure the observance of protocol, Harvey Chandler, the chief of medicine, followed O’Donnell. His words held the suggestion of a judicial opinion weightily delivered; as usual, his simplest statements contained an air of mild pomposity. He continued, “But the situation may be difficult with Joe Pearson feeling the way he does. After all, he’s a department head, and we ought to avoid any suggestion of undermining his authority.”

“I agree,” O’Donnell responded, “and that’s why I want some help.” He drummed his fingers on the desk top for emphasis. “Some help in convincing Joe Pearson that changes are necessary.”

“I’m not sure I like the way we’re doing this,” Bill Rufus said.

“Why, Bill?” O’Donnell noticed that Rufus was wearing one of his more subdued neckties today. It had only three colors instead of the usual four.

“I don’t think a few of us, meeting like this, have any right to talk about a change in Pathology.” Rufus looked around at the others. “Certainly I’ve had some run-ins with Joe Pearson. I guess most of us have. But that doesn’t mean I’m going to join some hole-and-corner conspiracy to boot him out.”

O’Donnell was glad this had come up; he was ready for it. “Let me say emphatically,” he said, “there is no intention on my part or anybody else’s of—as you put it”—he glanced at Rufus—“booting Dr. Pearson out.” There was a murmur of assent.

“Look at it this way,” O’Donnell said. “There seems to be agreement that changes in Pathology are necessary. Take surgical reports alone. Every day’s delay where surgery is needed means danger to the patient. I know I don’t need to emphasize that.”

Harry Tomaselli interjected, “And don’t let us forget that these delays are tying up hospital beds we need badly. Our waiting list for admissions is still very long.”

O’Donnell took over again. “Of course, instead of handling things this way I could have called the executive committee together.” He paused. “I still will if I have to, but I think you know what might happen. Joe is a member of the executive himself and, knowing Joe as we all do, any discussion will mean a showdown. In that case, assuming we force the issue, what have we gained? We’ve proven to Joe Pearson that he’s no longer in charge of his own department. And medically, and every other way—just as Harvey said—we’ll have undermined ourselves and the hospital.” O’Donnell thought, too, of what he could not tell the others: that he was also weighing Pearson’s influence with the old guard on the hospital board and the political repercussions which a showdown might create.

“I’m not saying I go along with you, but what’s your suggestion?” The question came from Charlie Dornberger. He punctuated it with puffs of smoke as his pipe got going.

Rufus sniffed. “We’d better hurry this up. It won’t be fit to breathe in here soon. Do you import that camel dung, Charlie?”

As the others smiled, O’Donnell decided to lay it on the line. “My suggestion, Charlie, is that you approach Joe—on behalf of the rest of us.”

“Oh no!” The reaction from Dornberger was much what O’Donnell had anticipated. He settled in to be persuasive.

“Charlie, we know you’re a close friend of Joe’s and I had that in mind when I asked you here. You could persuade him about this.”

“In other words, you want me to carry your ax,” Dornberger said dryly.

“Charlie, it isn’t an ax, believe me.”

Dr. Charles Dornberger hesitated. He observed that the others were watching him, waiting for his answer. He debated: should he do as O’Donnell asked or not? He was torn by two conflicting feelings—his concern for the hospital’s good and his own relationship with Joe Pearson.

In a way the news of the state of affairs in Pathology was not entirely unexpected; it was a condition he had suspected for some time. Nevertheless the two incidents concerning Rufus and Reubens, which O’Donnell had revealed, had shocked him inexpressibly. Dornberger knew also that O’Donnell would not have called this meeting unless he had been seriously concerned, and he respected the chief of surgery’s judgment.

At the same time Charles Dornberger wanted to help Joe Pearson if he could, and at this moment he found himself resenting the tide of events which seemed to be engulfing the elderly pathologist. And yet O’Donnell had appeared to be sincere when he said there was no intention of booting Pearson out, and the others seemed to share this feeling. He decided that perhaps he could be the intermediary. Possibly this way he could help Joe best.

Dornberger looked around at the others. He asked, “Is this unanimous?”

Lucy Grainger said thoughtfully, “I’m very fond of Joe. I think we all are. But I do believe some changes in Pathology are necessary.” It was the first time Lucy had spoken. She too had wondered about this meeting with Kent O’Donnell. What had passed between them in her apartment last night had left her strangely disturbed in a way she had not remembered for years. Afterward she had wondered if she were in love with O’Donnell, then told herself—only half believing—that those kind of phrases were all very well for the young and ardent, but at her age—with maturity, independence, and a professional practice—one reasoned and rationalized, eschewing hastily conceived emotions. At this moment, though, she found herself able to separate personal and professional feelings and to think about the problem in Pathology. In medicine you learned to do that—to push things out of your mind when immediate concerns were more important.

O’Donnell looked at Rufus. “Bill?”

The surgeon nodded. “All right—if Charlie will approach Pearson, I agree.”

Harvey Chandler was next. The chief of medicine told Dornberger ponderously, “In my opinion this is the best way to handle the situation, Charlie. You will be doing all of us, as well as the hospital, a very real service.”

“Very well,” Dornberger said. “I’ll see what I can do.”

There was a momentary silence, and O’Donnell sensed a feeling of relief. He knew the problem had been understood and now, at least, something would be done. Then, if this approach failed, he would have to resort to more direct methods. Sometimes, he reflected, it might be simpler if medical protocol were less complicated. In industry, if a man was not doing his job adequately, you fired him. If you wanted him to take an assistant, you told him to do so and usually that was that. But in medicine and in a hospital it was less straightforward. The lines of authority were seldom clear-cut, and a medical-department head, once appointed, was pretty well master in his own domain. What was even more important—you hesitated to do really drastic things because you were dealing with more than just a job. You were questioning the ability of a man who, like yourself, was dependent on his professional reputation. It was a delicate issue in which a single decision could affect the entire future and livelihood of a fellow practitioner. That was why you proceeded warily, keeping things like this under wraps and carefully guarded from outside scrutiny.

Harry Tomaselli said softly, “I take it, then, we’re going to look for an available pathologist.”

“I think we should begin to look around.” O’Donnell answered the administrator, then glanced at the others. “I imagine most of us have contacts where we might pass the word along. If you hear of anyone—a good man who’s just finishing his residency perhaps—I’d like you to let me know.”

“Pathologists can be pretty choosy nowadays,” Bill Rufus said.

“I know. This may not be easy.” O’Donnell added, “It’s all the more reason for handling Joe carefully.”

Harry Tomaselli had reached into one of his desk drawers and removed a file folder. He said, “Something here may interest you.”

Harvey Chandler asked him, “What is it you have?”

“I’ve been receiving the ‘open list’ on pathologists lately,” Tomaselli answered. “Frankly, I anticipated something like this and asked for it. This name came in a week or two ago.”

“May I see?” O’Donnell reached for the paper Tomaselli had produced. He knew the so-called “open list” was circulated periodically to hospitals on request. It contained information on pathologists available for appointments, and the men concerned had given permission for their names to be used. There was also a “closed list,” but this was retained in confidence by the pathologists’ professional society. Mostly the “closed list” comprised men dissatisfied with their present appointments who were seeking discreetly to make a change. In this case a hospital would advise the society of its need for a pathologist and those on the “closed list” had this information passed along to them. If he chose, an individual could then approach a hospital direct. Yet with all this machinery in existence, O’Donnell knew that most pathology appointments were still made on the basis of personal contacts and recommendation.

He glanced over the sheet the administrator had given him. The listing was for a Dr. David Coleman, his age thirty-one. O’Donnell’s eyebrows went up as he noted Coleman’s record and experience. An N.Y.U. honors graduate. Intern at Bellevue. Two years in the Army, mostly in pathology. A five-year pathology residence spread over three good hospitals. Here was a man who plainly shopped for the best in education.

He passed the paper to Rufus. “I doubt very much if he’d look at us,” he told Tomaselli. “Not with those qualifications and what we could pay to begin with.” O’Donnell knew, from an earlier talk with the administrator, that salary level would have to be around ten thousand dollars a year.

Rufus glanced up. “I agree. This man can take his pick of the big city hospitals.” He passed the sheet to Harvey Chandler.

“Well, as a matter of fact . . .” Tomaselli paused; he sounded unusually diffident, as if weighing his words carefully.

O’Donnell asked curiously, “What is it, Harry?”

“Well, the fact is, Dr. Coleman is interested in this hospital.” Tomaselli paused. “I gather he’s heard something of our recent changes and plans for the future.”

O’Donnell broke the sudden stillness. “How do you know?”

“I know because we’ve had some correspondence.”

Rufus said, “Isn’t that a little unusual, Harry?”

“Perhaps I was being premature, but after this came”—Tomaselli indicated the paper which had now passed to Lucy—“I wrote to Dr. Coleman. I said nothing definite, of course. It was just a tentative approach, sounding him out.” He turned to O’Donnell. “It was after our conversation a couple of weeks ago. You may remember, Kent.”

“Yes, I do.” O’Donnell was wishing that Harry had briefed him about this beforehand. Of course, as administrator Tomaselli had a right to correspond with anyone he chose. He hadn’t committed the hospital in any way. The correspondence was presumably confidential. Possibly it might prove to have been a good move. He said to Tomaselli, “You say he’s interested?”

“Yes. He’d like to come and see us. If this had not come up today, I’d intended to speak to you about it.”

Dornberger had the paper now. He tapped it with a forefinger. “What do you want me to do about this?”

O’Donnell glanced at the others, seeking confirmation. “I think you should take it with you, Charlie,” he said. “And I suggest you show it to Joe Pearson.”

Seven

In an annex to the autopsy room Roger McNeil, the pathology resident, was almost ready for gross conference. All that was necessary to begin was the presence of Dr. Joseph Pearson.

At Three Counties, as at many hospitals, a gross conference was the second stage after autopsy. Half an hour ago George Rinne, diener of the morgue, had brought in the organs removed at three autopsies earlier in the week. Two sets of organs now stood neatly arrayed in white enameled pails, and alongside them, in glass jars, were three brains. Centerpiece of the gross-conference room was a stone table with a large sink let into it and with a water tap above. At present the tap was turned on and beneath it was the third pail of organs, the water washing out the formalin in which the organs had been preserved, as well as some of the more objectionable odor.

McNeil looked around, making a final check. Pearson was always irascible if everything was not ready at hand. McNeil reflected that the room in which they did their work was appropriately macabre—particularly when the organs were laid out, as they would be in a few minutes, making the place look somewhat like a butcher’s shop. He had been in hospital dissecting rooms where everything was gleaming stainless steel; but that was the modern way which had not touched Three Counties’ pathology department yet. Now he heard the familiar, half-shuffling footsteps, and Pearson came in, the inevitable cloud of cigar smoke with him.

“Can’t waste any time.” Pearson seldom bothered with preliminaries. “It’s a week and a half since I had that set-to with O’Donnell, and we’re still behind.” The cigar bobbed up and down. “When this is through I want a check on all surgicals outstanding. What’s the first case?” While he had been talking he had put on a black rubber apron and rubber gloves. Now he came to the center table and sat down at it. McNeil perched himself on a stool opposite and looked over the case notes.

“Fifty-five-year-old woman. Physician’s cause of death, carcinoma of the breast.”

“Let me see.” Pearson reached for the file. Sometimes he would sit patiently while the resident described a case; at other times he would want to read everything himself. In this, as in all things, he was unpredictable.

“Hm.” He put down the papers and turned off the running water. Then he reached into the pail and groped around until he found the heart. He opened it, using both hands.

“Did you cut this?”

The resident shook his head.

“I didn’t think so.” Pearson peered at the heart again. “Seddons?”

McNeil nodded a little reluctantly. He had noticed himself that the heart was badly cut.

“He left the mark of Zorro.” Pearson grinned. “Looks like he was dueling with it. By the way, where is Seddons?”

“I believe there was something in surgery. A procedure he wanted to see.”

“Tell him from me that while any resident is assigned to Pathology I expect him at all gross conferences. All right, let’s get on with it.”

McNeil balanced a clip board on his knee and prepared to write. Pearson dictated: “Heart shows a slight thickening and rolling of the mitral valve. See it there?” He held it out.

Leaning across, McNeil answered, “Yes, I do.”

Pearson continued, “The chordae tendineae are fused, shortened and thickened.” He added casually, “Looks as if she had an old rheumatic fever. It was not a cause of death though.”

He cut away a small portion of tissue and put it into a labeled jar about the size of an ink bottle. This was for microscopic examination later. Then with the ease of long practice he tossed the remainder of the heart accurately into a hole lower down the table. Beneath the hole was a metal bin. Later in the day this would be cleared and cleaned, the contents being burned to fine ash in a special incinerator.

Now Pearson had the lungs. He opened the first lung like the two big leaves of a book, then dictated to McNeil, “Lungs show multiple metastatic nodules.” Again he held out the tissue for the resident to see.

He had turned his attention to the second lung when a door behind him opened.

“You busy, Dr. Pearson?”

Pearson turned around irritably. The voice was that of Carl Bannister, senior lab technician in the pathology department. Bannister had his head around the door tentatively, and there was another figure behind him in the corridor.

“Of course I’m busy. What do you want?” It was the tone, half snarling, half bantering, Pearson habitually used to Bannister. Over the years the two of them had become accustomed to it; anything more cordial would probably have confused both.

Bannister was unperturbed. He beckoned to the figure behind him. “Come inside.” Then to Pearson he said, “This is John Alexander. You remember—our new lab technician. You hired him a week ago. He starts work today.”

“Oh yes. I’d forgotten this was the day. Come in.” Pearson sounded more cordial than he had been with Bannister. McNeil thought: Maybe he doesn’t want to scare a new employee first day out.

McNeil looked curiously at the newcomer. Twenty-two, he figured; later he was to learn he was exactly right. He knew from what he had heard that Alexander was fresh from college with a degree in medical technology. Well, they could do with someone like that around the place. Bannister, for sure, wasn’t any Louis Pasteur.

McNeil turned his eyes to the senior technician. As usual, Bannister’s appearance made him something of a minor league Pearson. His short, paunchy body was partially covered by a stained lab coat. The coat was not buttoned and the clothes beneath it appeared shabby and unpressed. Bannister was mostly bald, and such hair as was left looked as if it were permanently ignored.

McNeil knew something of Bannister’s history. He had come to Three Counties a year or two after Pearson’s arrival. He had a high-school education, and Pearson had hired him for odd jobs—stock clerk, messenger, washing glassware. Gradually, as the years passed, Bannister had learned a lot of practical things around the lab, becoming more and more a right hand to Pearson.

Officially Bannister’s work was in serology and biochemistry. But he had been in the department so long that he could fill La if necessary, and often did, for technicians in other sections of the lab. Because of this Pearson had pushed a good deal of administrative lab work onto Bannister, leaving him, in effect, in charge of all pathology technicians.

McNeil thought it likely that in Bannister’s heyday he had been a good technician who, with more education, might have risen to better things. As it was now, McNeil considered Bannister long on experience and short on theory. From observation the resident knew that much of Bannister’s work in the lab was from rote rather than reasoning. He could do serologic and chemical tests but without any real understanding of the science behind them. McNeil had often thought that one day this might prove dangerous.

Alexander, of course, was a different proposition. He had come the way of most lab technicians nowadays, with three years of college behind him, the last year in an approved school for medical technologists. The word “technologist” was sometimes a sore point with people like Bannister who only rated the styling “technician.”

Pearson waved his cigar at the remaining stool around the table. “Sit down, John.”

“Thank you, Doctor,” Alexander answered politely. In his spotless lab coat, with a recent crew cut, pressed pants, and shined shoes, he presented a contrast to Pearson as well as Bannister.

“Do you think you’ll like it here?” Pearson looked down at the lungs he was holding, continuing the examination while he talked.

“I’m sure I will, Doctor.”

Nice kid, this, McNeil thought. He sounds as if he means it.

“Well, John,” Pearson was saying, “you’ll discover we have certain ways of doing things. They may not always be the ways you’ve been used to, but we find they work pretty well for us.”

“I understand, Doctor.”

Do you? McNeil thought Do you understand what the old man is really telling you?—that he doesn’t want any changes around the place, that there’s to be no nonsense with ideas you may have picked up in school, that nothing in the department—no matter how trifling—is to be amended without his blessing.

“Some people might say we’re old-fashioned,” Pearson continued. He was being friendly enough in his way. “But we believe in tried and tested methods. Eh, Carl?”

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.”

Date: 2014-12-21; view: 755