The Final Diagnosis

Even as he spoke them the words sounded hollow and false. He thought: You could have let him down more lightly than that. Mentally he added a footnote to himself: You haven’t changed, my friend; you haven’t changed at all.

Momentarily Harry Tomaselli found himself wishing that Mrs. Straughan would go back to her kitchens and stay there. Then he checked himself: a good chief dietitian was a pearl to be prized. And Mrs. Straughan was good; of that fact the administrator was well aware.

But there were times when he wondered if Hilda Straughan ever thought of Three Counties Hospital as a unified whole. Most times when talking with her he gained the impression that the hospital’s heart consisted of kitchens, from which other and less important facilities radiated outward. He reflected, though—Harry Tomaselli was, above all, a fair-minded man—that this sort of attitude was often found in people who took their jobs seriously. And, if it were a failing, he certainly preferred it to slackness and indifference. Another thing: a good department head was always willing to fight and argue for something which he or she believed in, and Mrs. Straughan was a fighter and arguer in every ample cubic inch of her.

At this moment, her big bulk overflowing a chair in the administrator’s office, she was fighting hard.

“I wonder if you realize, Mr. T., how serious this is.” Mrs. Straughan invariably used the surname initial when addressing people she knew; she had a habit of referring to her own husband as “Mr. S.”

“I think so,” Harry Tomaselli said.

“The dishwashers I have now were obsolete at least five years ago. Every year since I’ve been here I’ve been told: Next year we’ll give you your new ones. And when next year comes, where are my dishwashers? I find they’re put off for another twelve months. It won’t do, Mr. T. It just won’t do.”

Mrs. Straughan always used the personal pronoun “my” when referring to equipment in her charge. Tomaselli had no objection to this. What he did object to was Hilda Straughan’s unwillingness to consider any problems other than her own. He prepared to cover, once more, the ground they had gone over just a week or two before.

“There’s no question, Mrs. Straughan, that the dishwashers are going to be replaced eventually. I know the problem you have down there in the kitchens, but those are big, expensive machines. If you remember, the last estimate we had ran a little under eleven thousand dollars, allowing for changes in the hot-water system.”

Mrs. Straughan leaned over the desk, her massive bosom brushing a file tray aside. “And the longer you leave it the more the cost will go up.”

“Unfortunately I’m aware of that too.” The rising cost of everything the hospital bought was a problem Tomaselli lived with daily. He added, “But right at this moment hospital money for capital expenditures is extremely tight. The building extension, of course, is partly responsible. It’s simply a question of allocating priorities, and some of the medical equipment has had to come first.”

“What good is medical equipment if your patients don’t have clean plates to eat their food from?”

“Mrs. Straughan,” he said firmly, “the situation is not as bad as that, and both of us know it.”

“It’s not very far removed from it.” The chief dietitian leaned forward and the file tray took another shove; Harry Tomaselli found himself wishing she would keep her breasts off his desk. She went on, “Several times lately whole loads of dishes going through my machines have still been dirty when they came out. We try to check as much as we can, but when there’s a rush it isn’t always possible.”

“Yes,” he said. “I can understand that.”

“It’s the danger of infection I’m worried about, Mr. T. There’s been a lot of intestinal flu among the hospital staff lately. Of course, when that happens everyone blames the food. But it wouldn’t surprise me if this was the cause of it.”

“We’d need considerably more evidence to be sure of that.” Harry Tomaselli’s patience was beginning to wear thin. Mrs. Straughan had come to him on an exceptionally busy morning. There was a board meeting this afternoon, and right now he had several pressing problems to consider in advance of it. Hoping to wind up the interview, he asked, “When did Pathology last run a bacteria test on the dishwashers?”

Hilda Straughan considered. “I could check, but I think it’s about six months ago.”

“We’d better have them do another. Then we’ll know exactly where we stand.”

“Very well, Mr. T.” Mrs. Straughan resigned herself to accomplishing nothing more today. “Shall I speak to Dr. Pearson?”

“No, I’ll do it.” The administrator made a penciled note. At least, he thought, I can save Joe Pearson a similar session to this.

“Thank you, Mr. T.” The chief dietitian eased herself upward and out of the chair. He waited until she had gone, then carefully moved the file tray back to its original position.

David Coleman was returning to Pathology from lunch in the cafeteria. Making his way through the corridors and down the basement stairway, he pondered over the time he had spent so far with Dr. Joseph Pearson. Up to this moment, he decided, it had been unsatisfactory and inconclusive.

Pearson had been cordial enough—later, if not at the beginning. On finding Coleman waiting in his office his first remark had been, “So you really meant what you said about starting right away.”

“There didn’t seem much point in waiting.” He had added politely, “I’ve been looking around the labs. I hope you don’t mind.”

“That’s your privilege.” Pearson had said it with a half-growl, as if it were an invasion he did not like but had to put up with. Then, as if realizing his own ungraciousness, he had added, “Well, I guess I should welcome you.”

When they had shaken hands the older man had said, “First thing I have to do is get some of this work cleared away.” He gestured at the untidy pile of slide folders, dockets, and loose memoranda on his desk. “After that maybe we can figure out what you’ll be doing around here.”

Coleman had sat, with nothing else to do but read a medical journal, while Pearson had plowed through some of the papers. Then a girl had come in to take dictation, and after that he had accompanied Pearson to a gross conference in the autopsy-room annex. Sitting beside Pearson with two residents—McNeil and Seddons—on the opposite side of the dissecting table, he had felt very much like a junior resident himself. There had been almost nothing for him to contribute; Pearson had conducted the gross conference with Coleman merely a spectator. Nor had the older man made any acknowledgment of Coleman’s status as the new assistant director of the entire department.

Later he and Pearson had gone to lunch together and, in the course of it, Pearson had introduced him to a few people on the medical staff. Then the older pathologist had excused himself and left the table, saying there was some urgent work he had to attend to. Now Coleman was returning to Pathology alone, weighing in his mind the problem which seemed to face him.

He had anticipated some slight resistance from Dr. Pearson, of course. From odd pieces of information which had come to him he had pieced together the fact that Pearson had not wanted a second pathologist, but he had certainly not expected anything quite like this.

He had assumed, at the very least, that there would be an office ready for him on arrival and a few clearly defined duties. Certainly David Coleman had not expected to take over a great number of major responsibilities at once. He had no objection to the senior pathologist checking on him for a while; in fact, in Pearson’s position, he himself would take the same precaution with a newcomer. But this situation went far beyond that. Apparently, despite his letter, no thought whatever had been given to what Coleman’s duties were to include. The idea seemed to be that he should sit around until Dr. Pearson could take enough time away from his mail and various other chores to hand out a few tasks. Well, if that were the case, some of the thinking would have to be changed—and soon.

David Coleman had long been aware of defects in his own character, but he was equally aware of a number of important qualities. Among the most significant was his own record and ability as physician and pathologist. Kent O’Donnell had stated nothing more than truth when he had referred to Coleman as highly qualified. Despite his youthfulness he already had qualifications and experience which many practicing pathologists would find it hard to match. Certainly there was no reason for him to stand in awe of Dr. Joseph Pearson and, while he was prepared to defer a little to the other man’s age and seniority, he had no intention of being treated, himself, like a raw and inexperienced hand.

There was another strength, too: a feeling which overrode all other considerations, whether of character, attempts at tolerance, or anything else. It was a determination to practice medicine uncompromisingly, cleanly, honestly—even exactly, as far as exactness was possible in medical affairs. For any who did less—and even in his own few years he had seen and known them—the compromisers, the politicians, the lazy, the at-any-cost ambitious—David Coleman had only anger and disgust.

If he had been asked from whence this feeling sprang, he would have found it hard to answer. Certainly he was no sentimentalist; nor had he entered medicine because of some overt urge to aid humanity. The influence of his own father might have had some effect but, David Coleman suspected, not too much. His father, he realized now, had been an averagely good physician, within the limits of general practice, but there had always been a striking difference between their two natures. The elder Coleman had been a warm, outgoing personality with many friends; his son was cool, hard to know, often aloof. The father had joked with his patients and casually given them his best. The son—as an intern, before pathology cut him off from patients—had never joked but carefully, exactly, skillfully, had given a little better than the best of many others. And even though, as a pathologist, his relationship with patients had changed, this attitude had not.

Sometimes, in his moments of honest self-examination, David Coleman suspected his approach would have been the same, whether his occupation had been medicine or something else. Basically, he supposed, it was a quality of exactitude combined with intolerance of mistake or failure—the feeling, too, that whoever and whatever you set out to serve was entitled, by right, to the utmost you had to give. In a way, perhaps, the two feelings were contradictory. Or possibly they had been summed up accurately by a medical classmate who had once drunk an ironic toast to “David Coleman—the guy with the antiseptic heart.”

Passing now through the basement corridor, his mind returned to the present and instinct told him that conflict lay very close ahead.

He entered the pathology office to find Pearson hunched over a microscope, a slide folder open in front of him. The older man looked up. “Come and take a look at these. See what you make of them.” He moved away from the microscope, waving Coleman toward it.

“What’s the clinical story?” Coleman slipped the first slide under the retaining clips and adjusted the binocular eyepiece.