The Final Diagnosis

“Damn and hellfire!” She addressed the zipper with an expression much favored by her father, who had made a comfortable fortune felling tall trees and saw no reason to have one language for the woods and another at home.

Vivian, at nineteen, sometimes provided an interesting contrast between her father’s robustness and her mother’s innate New England delicacy which close contact with Oregon lumbering had never changed. Now, in her fourth month of training as a nurse, Vivian had already found something of the traits of both parents in her own reaction to the hospital and nursing. At one and the same time she was awed and fascinated, repulsed and disgusted. She supposed that close contact with sickness and disease was always a shock for anyone new. But knowing that did not help much when your stomach was ready to do flip-flops and it took all the will you possessed not to turn and run away.

It was after moments like this that she felt the need for a change of scene, a cleansing antidote; and to some extent she had found it in an old love—music. Surprisingly, for a city of its size, Burlington had an excellent symphony, and, discovering this, Vivian had become one of its supporters. She found the switch in tempo, the balm of good music, helped to steady and reassure her. She had been sorry when concerts had ended for the summer, and there had been moments recently when she had felt the need of something to replace them.

There was no time now, though, for odd, stray thoughts; the gap between morning classes and reporting to a ward for duty had been short enough. Now this zipper! . . . She tugged again, and suddenly the teeth meshed, the zipper closed. Relieved, she ran for the door, then paused to mop her face. Jeepers, it was hot! And all that effort had made her sweat like crazy.

So it went—that morning as all mornings—through the hospital. In the clinics, the nurseries, laboratories, operating rooms; in Neurology, Psychiatry, Pediatrics, Dermatology; in Orthopedics, Ophthalmology, Gynecology, Urology; in the charity wards and the private patients’ pavilion; in the service departments—administration, accounting, purchasing, housekeeping; in the waiting rooms, corridors, halls, elevators; throughout the five floors, basement, and sub-basement of Three Counties Hospital the tides and currents of humanity and medicine ebbed and flowed.

It was eleven, o’clock on the fifteenth of July.

Two

Two blocks from Three Counties Hospital the clock-tower bell of the Church of the Redeemer was chiming the hour as Kent O’Donnell made his way from the surgical floor down to Administration. The sound of the bell, off-key as always from a flaw in its long-ago casting, drifted in through an open stairway window. Automatically O’Donnell checked his wrist watch, then moved aside as a group of interns passed him hurriedly on the staff stairway, their feet sounding noisily on the metal treads. The interns quietened a little when they saw the medical-board president and offered a respectful “Good morning, Doctor,” as each went by. On the second floor O’Donnell halted to let a nurse with a wheel chair pass. In it was a girl of about ten with a bandage over one eye, a woman, plainly the mother, hovering protectively alongside.

The nurse, whom he smiled at but failed to recognize, appraised him covertly. In his early forties, O’Donnell still rated second glances from women. He had retained the build which had made him an outstanding quarterback in his college years—a tall, erect figure with big, broad shoulders and muscular arms. Even nowadays he had a trick of squaring his shoulders when ready to do something difficult or make a decision—as if readying instinctively to stop the charge of a red-dogging tackle. Yet despite his bulk—mostly bone and muscle with less than a pound of overweight—he still moved lightly; and regular sport—tennis in summer, skiing in winter—had kept him robust and lithe.

O’Donnell had never been handsome in the Adonic sense, but he had a rugged, creased irregularity of face (his nose still carried the scar of an old football injury) which women so often, and perversely, find attractive in men. Only his hair showed the real trace of years; not so long ago jet black, now it was graying swiftly as if the color pigments had suddenly surrendered and were marching out.

Now, from behind, O’Donnell heard his name called. He stopped and saw the caller was Bill Rufus, one of the seniors on surgical staff.

“How are you, Bill?” O’Donnell liked Rufus. He was conscientious, dependable, a good surgeon with a busy practice. His patients trusted him because of a forthright integrity which came through when he talked. He was respected by the house staff—interns and residents—who found Dr. Rufus to have a painless, pleasant way of imparting sound instruction while treating them as equals—a condition not always prevailing with other surgeons.

His only peculiarity, if you could call it that, was a habit of wearing impossibly gaudy neckties. O’Donnell shuddered inwardly as he noticed the creation his colleague was sporting today—turquoise circles and vermilion zigzags on a background of mauve and lemon yellow. Bill Rufus took a good deal of ribbing about his ties. One of the psychiatrists on staff had suggested recently that they represented “a pus crater from an inner seething below a conservative surface.” But Rufus had merely laughed good-naturedly. Today, though, he seemed troubled.

“Kent, I want to talk to you,” Rufus said.

“Shall we go to my office?” O’Donnell was curious now. Rufus was not the type to come to him unless it were something important.

“No; here’s as good as anywhere. Look, Kent, it’s about surgical reports from Pathology.”

They moved over to a window to avoid the traffic in the corridor, and O’Donnell thought: I was afraid of this. To Rufus he said, “What’s on your mind, Bill?”

“The reports are taking too long. Much too long.”

O’Donnell was well aware of the problem. Like other surgeons, Rufus would frequently operate on a patient with a tumor. When the tumor was exposed he would remove it for examination by the hospital’s pathologist, Dr. Joseph Pearson. The pathologist would then make two studies of the tissue. First, working in a small lab adjoining the operating room, and with the patient still under anesthetic, he would freeze a small portion of tissue and examine it under a microscope. From this procedure could come one of two verdicts—“malignant,” meaning the presence of cancer and indicating the need for major surgery on the patient; or “benign,” a reprieve which usually meant that nothing more need be done once the tumor was out. If a frozen section produced a “malignant” verdict, surgery would continue at once. On the other hand, the opinion “benign” from the pathologist was a signal for the surgeon to make his closure and send the patient to the recovery room.

“There’s no delay in frozen sections, is there?” O’Donnell had not heard of any, but he wanted to be sure.

“No,” Rufus said. “You’d hear plenty of howling if there were. But it’s the full tissue report that’s taking so long.”

“I see.” O’Donnell was maneuvering for time while he marshaled his thoughts. His mind ran over procedures. After a frozen section any removed tumor went to the pathology lab where a technician prepared several slides, more carefully and working under better conditions. Later the pathologist would study the slides and give his final opinion. Sometimes a tumor which had seemed benign or doubtful at frozen section would prove malignant during this subsequent, more close examination, and it was not considered abnormal for a pathologist to reverse his opinion in this way. If this happened the patient would be returned to the operating room and the necessary surgery done. But obviously it was important for the pathologist’s second report to be prompt. O’Donnell had already realized that this was the nub of Rufus’ complaint.

“If it were just once,” Rufus was saying, “I wouldn’t object. I know Pathology’s busy, and I’m not trying to get at Joe Pearson. But it isn’t just once, Kent. It’s all the time.”

“Let’s get specific, Bill,” O’Donnell said crisply. He had no doubt, though, that Rufus would have facts to back up a complaint like this.

“All right. I had a patient in here last week, Mrs. Mason—breast tumor. I removed the tumor, and at frozen section Joe Pearson said benign. Afterward, though, on surgical report he had it down as malignant.” Rufus shrugged. “I won’t quarrel with that; you can’t call them all the first time.”

“But?” Now that he knew what it was about, O’Donnell wanted to get this over with.

“Pearson took eight days to make the surgical report. By the time I got it the patient had been discharged.”

“I see.” This was bad all right, O’Donnell thought. He couldn’t duck this one.

“It isn’t easy,” Rufus was saying quietly, “to call a woman back and tell her you were wrong—that she does have cancer after all, and that you’ll have to operate again.”

No, it wasn’t easy; O’Donnell knew that too well. Once, before he had come to Three Counties, he had had to do the same thing himself. He hoped he never would again.

“Bill, will you let me handle this my way?” O’Donnell was glad it was Rufus. Some of the other surgeons might have made things more difficult.

“Sure. As long as something definite is done.” Rufus was within his rights to be emphatic. “This isn’t just an isolated case, you know. It just happens to be a bad one.”

Again O’Donnell knew this was true. The trouble was, Rufus was not aware of some of the other problems which went with it.

“I’ll talk to Joe Pearson this afternoon,” he promised. “After the surgical-mortality conference. You’ll be there?”

Rufus nodded. “I’ll be there.”

“See you then, Bill. Thanks for letting me know about this. Something will be done, I promise you.”

Something, O’Donnell reflected as he moved down the corridor. But what exactly? He was still thinking about it as he turned into the Administration suite and opened the door to Harry Tomaselli’s office.

O’Donnell did not see Tomaselli at first, then the administrator called to him. “Over here, Kent.” On the far side of the birch-paneled room, away from the desk at which he spent most of his working hours, Tomaselli was leaning over a table. Unrolled before him were whiteprints and sketches. O’Donnell crossed the thick pile carpet and looked down at them too.

“Daydreaming, Harry?” He touched one of the sketches. “You know, I’m sure we could put you a fancy penthouse there—on top of the East Wing.”

Tomaselli smiled. “I’m agreeable, providing you’ll convince the board it’s necessary.” He took off his rimless glasses and began to polish them. “Well, there it is—the New Jerusalem.”

O’Donnell studied the architect’s profile of Three Counties Hospital as it would appear with the magnificent new extension, now in the advanced stages of planning. The new buildings were to comprise an entire wing and a new nurses’ home. “Any more news?” He turned to Tomaselli.