The Final Diagnosis

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.”