The Final Diagnosis

“Yes,” O’Donnell said wonderingly. “John Alexander—he’s a laboratory technologist.”

“They lost a child?”

O’Donnell nodded.

“Joe Pearson asked that I pay the boy’s way through medical school. I can do it, of course—quite easily. Money at least has a few remaining uses.” Swayne reached for a thick manila envelope which had been lying on the quilt. “I have already instructed my lawyers. There will be a fund—enough to take care of fees and for him and his wife to live comfortably. Afterward, if he chooses to specialize, there will be money for that too.” The old man paused, as if tired by speaking. Then he continued, “What I have in mind now is something more permanent. Later there will be others—I suppose equally deserving. I would like the fund to continue and to be administered by the Three Counties’ medical board. I shall insist on only one condition.”

Eustace Swayne looked squarely at O’Donnell. He said defiantly, “The fund will be named the Joseph Pearson Medical Endowment. Do you object?”

Moved and ashamed, O’Donnell answered, “Sir, far from objecting, in my opinion it will be one of the finest things you have ever done.”

“Please tell me the truth, Mike,” Vivian said. “I want to know.”

They faced each other—Vivian in the hospital bed, Mike Seddons standing, apprehensively, beside it.

It was their first meeting following their time apart. Last night, after cancellation of Vivian’s transfer order, she had tried a second time to reach Mike by telephone, but without success. This morning he had come, without her calling, as they had arranged six days ago. Now her eyes searched his face, fear nudging her, instinct telling what her mind refused to know.

“Vivian,” Mike said, and she could see him trembling, “I’ve got to talk to you.”

There was no answer, only Vivian’s steady gaze meeting his own. His lips were dry; he moistened them with his tongue. He knew that his face was flushed, felt his heart pounding. His instinct was to turn and run. Instead he stood, hesitating, groping for words which refused to come.

“I think I know what you want to say, Mike.” Vivian’s voice was flat; it seemed drained of emotion. “You don’t want to marry me. I’d be a burden to you—now, like this.”

“Oh, Vivian darling—”

“Don’t, Mike!” she said. “Please don’t!”

He said urgently, imploringly, “Please listen to me, Vivian—hear me out! It isn’t that simple . . .” Again his speech faltered.

For three days he had sought the right words and phrases to meet this moment, yet knowing whatever form they took the effect would be the same. In the interval between their last meeting Mike Seddons had probed the inner chasms of his soul and conscience. What he had found there had left him with disgust and self-contempt, but he had emerged with truth. He knew with certainty that a marriage between himself and Vivian would never succeed—not because of her inadequacy, but through his own.

In moments of searching self-examination he had forced himself to consider situations the two of them might meet together. In a flood light of imagination he had seen them entering a crowded room—himself young, virile, unimpaired; but Vivian on his arm, moving slowly, awkwardly, perhaps with a cane, and only as an artificial limb allowed. He had seen himself dive through surf, or lie on a beach near-naked in the sun, but with Vivian dressed decorously, sharing none of it because a prothesis was ugly when exposed and, if removed, she would become a grotesque, immobile freak—an object for pitying or averted eyes.

And more than this.

Overcoming every reluctance and instinctive decency, he had let himself consider sex. He had pictured the scene at night, before bed. Would Vivian unstrap her synthetic leg alone, or would he help her? Could there be intimacies of undressing, knowing what lay beneath? And how would they make love—with the leg on or off? If on, how would it be—the hard, unyielding plastic pressing against his own urgent body? If off, how would the stump feel beneath him? Would there be fulfillment—in intercourse with a body no longer whole?

Mike Seddons sweated. He had plumbed the depths and found his own reflection.

Vivian said, “You needn’t explain, Mike.” This time her voice was choked.

“But I want to! I’ve got to! There are so many things we both have to think of.” Now the words came quickly, tumbling out in an eager effort to make Vivian understand, to know the agony of mind he had suffered before coming here. Even at this moment he needed her understanding.

He started to say, “Look, Vivian. I’ve thought about it and you’ll be better off . . .”

He found her eyes regarding him. He had never noticed before how steady and direct they were. “Please don’t lie, Mike,” she said. “I think you’d better go.”

He knew it was no good. All that he wanted now was to get away from here, not to have to meet Vivian’s eyes. But still he hesitated. He asked, “What will you do?”

“I really don’t know. To tell you the truth, I haven’t thought much about it.” Vivian’s voice was steady, but it betrayed the effort she was making. “Perhaps I’ll go on in nursing, if they’ll have me. Of course, I really don’t know if I’m cured, and if I’m not, how long I’ve got. That’s so, isn’t it, Mike?”

He had the grace to lower his eyes.

At the doorway he looked back for the last time. “Good-by, Vivian,” he said.

She tried to answer, but her self-control had been taxed too long.

From the second floor Mike Seddons used the stairway to reach Pathology. He entered the autopsy room and in the annex found David Coleman dissecting a leg. Seddons looked at the limb and saw it white and lifeless, the dark blood seeping out from Coleman’s knife cuts. For an instant of horror he pictured it nylon-sheathed, a high-heeled sandal upon the foot. Then, with an awful fascination, he crossed the room and read the name in the open case file.

When he had done so, Mike Seddons went into the corridor and vomited against the wall.

“Oh, Dr. Coleman! Do come in.”

Kent O’Donnell got up courteously from his office desk as the young pathologist entered the room. David Coleman had been cleaning up after the dissection when the message from the chief of surgery had reached him.

“Sit down, won’t you?” O’Donnell held out an engraved gold case. “Cigarette?”

“Thank you.” Coleman took a cigarette and accepted the light O’Donnell offered. He leaned back, relaxed, in one of the leather armchairs. An instinct told him that what was to follow would be a turning point in his life.

O’Donnell moved behind the desk to the office window. He stood with his back to it, the morning sun behind him. “I imagine you’ve heard,” he said, “that Dr. Pearson has resigned.”

“Yes, I’d heard.” Coleman answered quietly, then to his own surprise he heard himself saying, “You know, of course, these past few days he hasn’t spared himself. He’s been here day and night.”

“Yes, I know.” O’Donnell regarded the glowing tip of his cigarette. “But it doesn’t change anything. You realize that?”

Coleman knew that the chief of surgery was right. “No,” he said, “I don’t suppose it does.”

“Joe has expressed a wish to leave at once,” O’Donnell continued. “It means there will be an immediate vacancy here for a director of pathology. Shall you accept?”

For a second David Coleman hesitated. This was the thing he had coveted—a department of his own; freedom to reorganize, to mobilize the new aids of science, to practice good medicine, and to make pathology count as he knew it truly could. This was the cup he had sought. Kent O’Donnell had lifted it to his lips.

Then fear struck him. Suddenly he was appalled at the awesome responsibility he would have to hold. It occurred to him there would be no one senior to relieve him of decisions; the ultimate choice—the final diagnosis—would be his alone. Could he face it? Was he yet ready? He was still young; if he chose, he could continue as a second-in-command for several years more. After that there would be other openings—plenty of time to move ahead. Then he knew that there was no escaping, that this moment had been moving toward him since his own first arrival at Three Counties Hospital.

“Yes,” he said. “If it’s offered to me, I shall accept.”

“I can tell you that it will be offered.” O’Donnell smiled. He asked, “Would you tell me something?”

“If I can.”

The chief of surgery paused. In his mind he was choosing the right phrases for the question he wanted to put. He sensed that what was to be said next would be important to them both. Finally he asked, “Will you tell me what your attitude is—to medicine and to this hospital?”

“It’s hard to put into words,” Coleman said.

“Will you try?”

David Coleman considered. It was true there were things he believed, but even to himself he had seldom expressed them. Now, perhaps, was a time for definition.

“I suppose the real thing,” he said slowly, “is that all of us—physicians, the hospital, medical technology—exist only for one thing: for patients, for healing of the sick. I believe we forget this sometimes. I think we become absorbed in medicine, science, better hospitals; and we forget that all these things have only one reason for existence—people. People who need us, who come to medicine for help.” He stopped. “I’ve put it clumsily.”

“No,” O’Donnell said. “You’ve put it very well.” He had a sense of triumph and of hope. Instinct had not belied him; he had chosen well. He foresaw that the two of them—as chief of surgery and director of pathology—would be good together. They would go on and build and, with them, Three Counties would progress. Not all that they wrought would be perfect; it never was. There would be flaws and failures, but at least their aims were the same, their feelings shared. They would have to remain close; Coleman was younger than himself, and there were areas in which O’Donnell’s greater experience could be of help. In these past few weeks the chief of surgery himself had learned a good deal. He had learned that zeal could lead to complacency as surely as indifference, and that disaster could be reached by many routes. But from now on he would fight complacency on every front, and Pathology, with young Dr. Coleman at its head, could be a stout right arm.

A thought occurred to him. He asked, “One more thing. How do you feel about Joe Pearson and the way he’s leaving?”

“I’m not sure,” David Coleman said. “I’ve been wishing I knew.”

“It’s not such a bad thing to be unsure sometimes. It takes us away from rigid thinking.” O’Donnell smiled. “There are some things I think you should know though. I’ve been talking with some of the older men on staff; they’ve told me incidents, things I didn’t know about.” He paused. “Joe Pearson has done a great deal for this hospital in thirty-two years—things that are mostly forgotten now or that people like you and me don’t always get to hear about. He started the blood bank, you know. It’s strange to think of it, but there was a lot of opposition at the time. Then he worked for the formation of a tissue committee; I’m told a good many staff men fought him bitterly on that. But he got the committee and it did a lot to raise the standard of surgery here. Joe did some investigative work, too—on the cause and incidence of thyroid cancer. Most of it’s generally accepted now, but few people remember that it came from Joe Pearson.”