The Final Diagnosis

“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.