The Final Diagnosis

Looking toward the door, O’Donnell saw Lucy Grainger come in; she caught his eye and smiled slightly. Seeing Lucy was a reminder of the personal decision about his own future which, when all this was settled and done, he had still to face. Then suddenly he realized that since this morning he had not once thought of Denise. The hospital activity had driven all awareness of her from his mind, and he knew that for the next day or two, anyway, there would be other occasions when the same thing would be true. O’Donnell wondered how Denise herself would react about taking second place to medical affairs. Would she be understanding? As understanding, say, as Lucy would be? Fleeting as the thought was, it made him uncomfortable, as if by the mental comparison he had been disloyal. For the moment he preferred to think of present things. Now, he decided, it was time the meeting began.

O’Donnell rapped for silence, then waited until the talk stilled and those who had been standing had slipped into their seats. He began quietly. “Ladies and gentlemen, I think all of us are aware that epidemics in hospitals are not unique and, in fact, are a good deal more frequent than most members of the public realize. In a way, I suppose, one might say that epidemics are a hazard of our existence. When one considers how many diseases we harbor inside these walls, it’s surprising, really, there are not more.” All eyes in the room were upon him. He paused for a moment, then continued. “I have no wish to minimize what has happened, but I want us to keep a sense of proportion. Dr. Chandler, perhaps you’d be kind enough to lead off.”

As O’Donnell sat down the chief of medicine rose to his feet.

“To begin with, let’s summarize.” Harvey Chandler was holding his page of notes, and his glance moved theatrically around the room. Harvey’s enjoying this, O’Donnell thought; but then he always does enjoy attention. The medical chieftain went on, “The picture so far is that we have two definite cases of typhoid and four suspected. All of the cases are hospital employees, and we may count ourselves fortunate that no patients are affected—yet. Because of the number of cases I’m sure it’s evident to you, as it is to me, that we have a typhoid carrier somewhere in the hospital. Now, I may say I’m as shocked as everyone else must have been to learn that examination of food handlers here hasn’t been done for . . .”

At the mention of food handlers O’Donnell had jolted to attention. Now he cut in, quietly, as politely as he could.

“Excuse me, Doctor.”

“Yes?” Chandler’s tone made it plain the interruption was not appreciated.

Gently O’Donnell said, “We’re going to be dealing with that phase very shortly, Harvey. I wonder if, for the moment, you would outline the clinical aspects.”

He could sense the other man’s resentment. Harvey Chandler, who was virtually equal to O’Donnell in the hospital hierarchy, did not like this at all. Moreover, Dr. Chandler enjoyed talking at length; he had a reputation for never employing one word where it was possible to use two or three. Now he grumbled, “Well, if you wish, but . . .”

Suavely, but firmly, O’Donnell put in, “Thank you.”

Chandler shot him a glance which said: We’ll discuss this later in private. Then, after a barely perceptible pause, he went on, “For the benefit of those of you who are not familiar with typhoid—and I realize there will be some, because there isn’t too much of it around nowadays—I’ll run over the principal early-stage symptoms. Generally speaking, there’s a rising fever, chills, and a slow pulse. There’s also a low blood count and, naturally, the characteristic rose spots. In addition to all that a patient will probably complain of a dull headache, no appetite, and general aching. Some patients may say they’re drowsy in the daytime and that they’re restless at night. One thing to look out for also is bronchitis; that’s quite common with typhoid, and you may encounter nosebleed too. And, of course, a tender, swollen spleen.”

The chief of medicine sat down. O’Donnell asked, “Any questions?”

Lucy Grainger asked, “I take it that typhoid shots are being arranged.”

“Yes,” Chandler said, “for all employees and staff, also patients who are well enough to have them.”

“What about kitchen arrangements?” The question was from Bill Rufus.

O’Donnell said, “If you don’t mind, we’ll come to that shortly. At this point is there anything more medically?” He looked around; there was a shaking of heads, “Very well, then. We’ll hear from Pathology.” He announced quietly, “Dr. Pearson.”

Until this moment there had been background noises in the room—fidgeting, the movement of chairs, murmurs of conversation aside from the main discussion. But now there was a hush as eyes turned curiously to where, halfway down the long table, Joe Pearson sat. Since entering he had not spoken but had remained quite still, his eyes fixed directly ahead. For once he had no cigar lighted, and the effect was like the absence of a familiar trade-mark. Even now, as his name was called, he made no move.

O’Donnell waited. He was about to repeat the announcement when Pearson stirred. As his chair went back the old pathologist rose to his feet.

Slowly his eyes swept the board room. They went the length of the table, then returned to its head. Looking directly at O’Donnell, Pearson said, “This epidemic should not have happened. Nor would it, if Pathology had been alert to a breakdown in hygiene precautions. It is the responsibility of my department, and therefore my own responsibility, that this neglect occurred.”

Again a silence. It was as if history had been made. In this room so many times Joe Pearson had charged others with error and misjudgment. Now he stood himself—accuser and accused.

O’Donnell wondered if he should interrupt. He decided not. Again Pearson looked around him. Then he said slowly, “Having allocated some of the blame, we must now prevent the outbreak going further.” He glanced across the table at Harry Tomaselli. “The administrator, the heads of departments, and I have formulated certain procedures to be carried out at once. I will tell you what they are.”

Now Pearson paused, and when he resumed there was a stronger note to his voice. It was almost, O’Donnell thought, as if in this single moment the old man were throwing off some of his years, as if providing a glimpse of what he had been like long ago as a younger practitioner—intense, earnest, and competent. The old sardonic humor, the air of borderline contempt, which all of them in this room had come to know so well, were gone. In their place were authority and know-how and the forthright frankness of one who accepts without question the fact that he is speaking with equals.

“The immediate problem,” Pearson said, “is to locate the source of infection. Because of the failure to check food handlers properly over the past six months it is logical that we should suspect food as a means of contamination and should begin our search there. For this reason there must be a medical inspection of all food handlers before the next hospital meal is served.” From his frayed woolen vest he extracted a watch and placed it on the table. “The time is now 2:15 p.m. That gives us two and three-quarter hours. In that time every employee who has any part in the preparation and serving of hospital food is to be given a thorough physical check. Facilities are being set up now in the outpatient clinics. I understand that all the internists and house staff were notified before this meeting.” He glanced around and there was a nodding of heads. “Very well. As soon as we are finished here Dr. Coleman”—Pearson glanced down at David Coleman beside him—“will give you your assignment to a specific room.”

Gesturing toward the chief dietitian, Pearson said, “Mrs. Straughan is arranging to assemble all the people concerned, and they will be reporting to Outpatients in batches of twelve. That means ninety-five people to be examined within the time we have.

“When you make these examinations, by the way, remember that the typhoid carrier—and we are assuming there is a carrier—probably has none of the symptoms Dr. Chandler described. What you should look for particularly is any lack of personal cleanliness. And anyone you have doubts about should be suspended from duty for the time being.”

Pearson stopped as if thinking. So far he had consulted no notes. Now he went on again. “Of course, we are all aware that physical checkups will not give us the whole story. We may be lucky and find the individual we’re looking for that way, but the chances are we won’t. Most likely the major work will come in the labs as soon as the medicals are completed. All the people you examine are to be told that stool cultures are required and stool samples must be in the hospital by tomorrow morning.” There was the ghost of a smile. “Constipation will not be taken as an excuse; and if anyone can come through with a sample today we will, of course, accept it gratefully.

“The labs are being set up now to cope with all the cultures we shall be doing. Of course, it will take us a few days—two or three at least—to handle all those stool samples.”

A voice—O’Donnell thought it was Gil Bartlett’s—said quietly, “Ninety-five people! That’s a lot of shit.” A ripple of laughter ran around the table.

Pearson turned. “Yes,” he said, “it is a lot. But we shall do our best.”

With that he sat down.

Lucy signaled with her hand, and O’Donnell nodded for her to speak. She asked, “If the source of infection is not found immediately, will we continue to use the hospital kitchens—to serve food here?”

“For the moment—yes,” O’Donnell answered.

The administrator added, “My office is checking now to see if there’s any outside caterer who could handle food supply if that were felt necessary. I doubt, though, if there’s anyone in town who has facilities—at short notice like this—to do it.”

Bill Rufus asked, “What’s our policy to be on admissions?”

“I’m sorry,” O’Donnell said. “I should have mentioned that. As of this moment we’ve stopped admissions. The admitting department has already been notified. But, of course, we’re hoping pathology can track down the source of infection quickly, and then we’ll review our admissions policy again. Anything else?”

There were no more questions. Looking down the table, O’Donnell asked, “Dr. Coleman, do you have anything to add?”

David Coleman shook his head. “No.”

O’Donnell closed the file which had been open in front of him. “Very well, ladies and gentlemen, I suggest we get started.” Then, as chairs scraped back and conversation began, he asked Pearson, “Joe, could I have a word with you?”

Together they crossed to a window, away from the others who were filing out through the door. O’Donnell said quietly, making sure his voice did not carry, “Joe, naturally you’ll remain in charge of Pathology during this outbreak. But I think I must make clear to you that, concerning other things, nothing has changed.”

Pearson nodded slowly. “Yes,” he said, “I’d already figured that.”