The Final Diagnosis

Because of this by the mid-thirties, when American specialty boards were coming into being, Dornberger was already established in his own field. As a result, under the so-called “grandfather” clause, he had been given Board certification without examination. It was something he had always been proud of. If anything, it had made him keener still to remain up to date.

And yet he had never resented younger men. When he had felt them to be good and conscientious, he had gone out of his way to offer help and advice. He admired and respected O’Donnell. He considered the youthful chief of surgery one of the best things that had ever happened to Three Counties. His own morale had risen with O’Donnell’s changes and progress in the hospital.

He had made many friends, some among his own immediate colleagues, others in unlikely places. Joe Pearson might be called one of the unlikely ones. Professionally the two men looked at a lot of things in different ways. Dornberger knew, for example, that Joe did not read much these days. He suspected that in a few areas of knowledge the elderly pathologist had slipped behind the times, and, administratively, there was the problem which yesterday’s meeting had revealed. And yet, over the years, the bond between the two men had grown strong. To his own surprise sometimes he had found himself siding with Pearson at medical conferences and defending him occasionally when Pathology was criticized in private.

Dornberger’s interjection ten days ago at the mortality conference had been much like that. He supposed other people recognized the alliance between himself and Joe. What was it Gil Bartlett had said? “You’re a friend of his; and besides he doesn’t have a vendetta with obstetricians.” Until this moment he had forgotten the remark, but he realized now it had had an edge of bitterness and he was sorry about that. Bartlett was a good physician, and Dornberger made a mental note to be especially cordial next time they met.

But there was still his own problem. To quit or not to quit? And if he did quit, when? Just lately, despite his carefully guarded physical fitness, he had found himself tiring. And although he had spent a lifetime answering night calls, lately they had seemed harder to take. Yesterday at lunch he had heard Kersh, the dermatologist, telling a new intern, “You should join us in the skin game, son. Haven’t been called out at night in fifteen years.” Dornberger had laughed with the rest but harbored a little secret envy.

One thing he was sure of though. He would not hang on if he found himself weakening. Right now he knew he was as good as ever. His mind was clear, his hands steady and eyes sharp. He always watched himself carefully because he knew that at the first sign of failing he would not hesitate. He would clear his desk and go. He had seen too many others try to stay the course too long. That would never be for him.

But as for the present, well, maybe he would let things go another three months, then think it over.

By this time he had packed the tobacco tightly in his pipe and now he reached for a folder of matches. He was about to strike one when the telephone rang. Putting down pipe and matches, he answered it. “Dr. Dornberger speaking.”

It was one of his patients. She had begun labor pains an hour ago. Now her membranes had ruptured and she had discharged water. She was a young girl in her early twenties, and it would be her first baby. She sounded breathless, as if nervous but trying not to be.

As he had so many times before, Dornberger gave his instructions quietly. “Is your husband at home?”

“Yes, Doctor.”

“Then get your things together and have him drive you to the hospital. I’ll see you after you’ve arrived.”

“Very well, Doctor.”

“Tell your husband to drive carefully and stop at all the red lights. We’ve plenty of time. You’ll see.”

He could sense, even over the phone, that he had helped her to relax. It was something he did often, and he considered it as much a part of his job as any course of treatment. Nevertheless he felt his own senses quickening. A new case always had that effect. Logically, he thought, he should have lost the feeling long ago. As you grew older in medicine you were supposed to become impervious, mechanical and unsentimental. It had never worked that way for him, though—perhaps because, even now, he was doing what he loved to do most.

He reached for his pipe, then changed his mind and picked up the telephone again. He must let Obstetrics know that his patient was coming in.

Eight

“I’m not even sure that defeating polio was a good or necessary thing.”

The speaker was Eustace Swayne—founder of a department-store empire, millionaire philanthropist, and member of the board of directors of Three Counties Hospital. The background was the shadowed, oak-paneled library of Swayne’s aging but imposing mansion, set alone in fifty acres of parkland and near the eastern fringes of Burlington.

“Come now, you can’t be serious,” Orden Brown said lightly. The hospital-board chairman smiled at the two women in the room—his own wife, Amelia, and Swayne’s daughter, Denise Quantz.

Kent O’Donnell sipped the cognac which a soft-footed manservant had brought him and leaned back in the deep leather chair he had chosen on entering this room with the others after dinner. It occurred to him that the scene they made was almost medieval. He glanced around the softly lighted room, his eyes ranging over tiers of leather-bound books rising to the high-timbered ceiling, the dark and heavy oaken furniture, the cavernous fireplace laid with great logs—not burning now, this warm July evening, but ready to blaze to life at the touch of a servant’s torch; and, across from O’Donnell, Eustace Swayne, seated kinglike in a straight-backed, stuffed wing chair, the other four—almost as courtiers—formed in a semicircle, facing the old tycoon.

“I am serious.” Swayne put down his brandy glass and leaned forward to make his point. “Oh, I admit—show me a child in leg braces and I’ll cringe with the rest and reach for my checkbook. But I’m talking of the grand design. The fact is—and I challenge anyone to deny it—we’re busily engaged in weakening the human race.”

It was a familiar argument. O’Donnell said courteously, “Would you suggest that we should stop medical research, freeze our knowledge and techniques, not try to conquer any more diseases?”

“You couldn’t do it,” Swayne said. “You couldn’t do it any more than you could have stopped the Gadarene swine jumping off their cliff.”

O’Donnell laughed. “I’m not sure I like the analogy. But if that is so, then why the argument?”

“Why?” Swayne banged a fist on the arm of his chair. “Because you can still deplore something, even though there’s nothing you can do to force a change.”

“I see.” O’Donnell was not sure he wanted to get deeper into this discussion. Besides, it might not help relations with Swayne, either for himself or Orden Brown, which was really why they had come here. He glanced around at the others in the room. Amelia Brown, whom he had come to know well through his visits to the chairman’s home, caught his eye and smiled. As a wife who kept herself posted on all her husband’s activities, she was well informed about hospital politics.

Swayne’s married daughter, Denise Quantz, was sitting forward, listening intently.

At dinner O’Donnell had several times found his eyes traveling, almost involuntarily, in Mrs. Quantz’s direction. He had found it difficult to reconcile her as the daughter of the rugged, hard-bitten man who sat at the table’s head. At seventy-eight Eustace Swayne still exhibited much of the toughness he had learned in the competitive maelstrom of large-scale retail merchandising. At times he took advantage of his age to toss out barbed remarks to his guests, though O’Donnell suspected that most times their host was merely angling for an argument. O’Donnell had found himself thinking: The old boy still likes a fight, even if it’s only in words. In the same way he had an instinct now that Swayne was overstating his feelings about medicine, though perhaps in this case merely for the sake of being ornery. Watching the old man covertly, O’Donnell had suspected gout and rheumatism might be factors here.

But, in contrast, Denise Quantz was gentle and softly spoken. She had a trick of taking the edge from a remark of her father’s by adding a word or two to what he had said. She was beautiful too, O’Donnell thought, with the rare mature loveliness which sometimes comes to a woman at forty. He gathered that she was visiting Eustace Swayne and came to Burlington fairly frequently. Probably this was to keep an eye on her father; he knew that Swayne’s own wife had died many years before. It was evident from conversation, though, that most of the time Denise Quantz lived in New York. There were a couple of references made to children, but a husband was not mentioned. He gained the impression that she was either separated or divorced. Mentally O’Donnell found himself comparing Denise Quantz with Lucy Grainger. There was a world of difference, he thought, between the two women: Lucy with her professional career, at ease in the environment of medicine and the hospital, able to meet someone like himself on ground familiar to them both; and Denise Quantz, a woman of leisure and independence, a figure in society no doubt, and yet—he had the feeling—someone who would make a home a place of warmth and serenity. O’Donnell wondered which kind of woman was better for a man: one who was close to his working life, or someone separate and detached, with other interests beyond the daily round.

His thoughts were interrupted by Denise. Leaning toward him, she said, “Surely you’re not going to give up so easily, Dr. O’Donnell. Please don’t let my father get away with that.”

The old man snorted. “There’s nothing to get away with. It’s a perfectly clear situation. For years the natural balance of nature kept populations in check. When the birth rate became too great there were famines to offset it.”

Orden Brown put in, “But surely some of that was political. It wasn’t always a force of nature.”

“I’ll grant you that in some cases.” Eustace Swayne waved his hand airily. “But there was nothing political in the elimination of the weak.”

“Do you mean the weak or the unfortunate?” Very well, O’Donnell thought, if you want an argument I’ll give you one.

“I mean what I say—the weak.” The old man’s voice had a sharper tone, but O’Donnell sensed he was enjoying this. “When there was a plague or an epidemic, it was the weak who were wiped out and the strong survived. Other illnesses did the same thing; there was a level maintained—nature’s level. And because of this it was the strong who perpetuated themselves. They were the ones who sired the next generation.”

“Do you really think, Eustace, that mankind is so degenerate now?” Amelia Brown had asked the question, and O’Donnell saw she was smiling. She knows that Swayne’s enjoying this, he thought.

“We’re moving toward degeneracy,” the old man answered her, “at least in the Western world. We’re preserving the cripples, the weaklings, and the disease-ridden. We’re accumulating burdens on society, non-producers—the unfit, unable to contribute anything to the common good. Tell me—what purpose does a sanatorium or a home for incurables serve? I tell you, medicine today is preserving people who should be allowed to die. But we’re helping them to live, then letting them spawn and multiply, passing along their uselessness to their children and their children’s children.”