The Final Diagnosis (10 page)

Now Harry Tomaselli was in love with his work. He shared Kent O’Donnell’s views about the standards of good medicine and respected the business acumen and caginess of the board chairman, Orden Brown. As administrator, it was Tomaselli’s business to see that all hospital services—nursing, housekeeping, engineering, building, accounting, and their subsidiaries—measured up to the standards the other two men required.

He did this by delegation—he had a happy faculty of appointing good department heads—and also by an intense personal interest in everything that went on within the hospital. Almost nothing of importance escaped Harry Tomaselli. Each day his short, stocky figure could be seen bustling along the corridors but pausing frequently while he talked with nurses, patients, janitors, clerks, cooks—anyone who could tell him something about the hospital or make a suggestion on how to run it better. New ideas excited him; his own enthusiasm engendered more in others. Sometimes, head thrust forward, eyes gleaming behind his big black-rimmed glasses, he would talk volubly, his thoughts moving at a gallop, his hands underscoring points as he made them.

In all his peregrinations Harry Tomaselli seldom made a written note. His lawyer’s training enabled him to carry assorted facts readily in his head. But after each inspection tour he fired off a barrage of staccato memoranda on all points, big and little, where he felt the administration of Three Counties could be improved.

Yet, for all this, he had a diplomat’s sense of tone and language that seldom gave offense. Verbally he would hand out a reprimand, then talk cheerfully of something else. And though he never wasted words, his written memos were always gracious. He hated to fire a hospital employee unless the provocation were really strong. He frequently told his department heads, “If anyone has worked here more than a month, we have an investment in their experience. It’s to our advantage to mold them if we can, rather than try for someone new who may have other faults we haven’t thought of.” Because this policy was known and respected, employee morale was high.

There were still things about the organization that worried him. Some departments, he knew, could be made more efficient. There were areas where service to patients could be improved. A good deal of old equipment needed junking and replacement. There was newly developed equipment—the cine-radiography unit was an example—which, under ideal conditions, the hospital should have. The new building program would make good some of these deficiencies but not all. Like O’Donnell, he knew there were years of work ahead and that some objectives perhaps would remain beyond reach. But, after all, that was the road to achievement; you always tried for a little more than you knew you could accomplish.

His thoughts were brought back to the present by Orden Brown. The chairman was telling O’Donnell, “There’ll be a good deal of social activity, of course, once the campaign gets going. Oh, and something else. I believe it would be a good thing, Kent, if we put you in as a speaker at the Rotary Club. You could tell them what the new building will do, our plans for the future, and so on.”

O’Donnell, who disliked public meetings, especially the regimented bonhomie of service clubs, had been about to grimace but checked himself. Instead he said, “If you think it will help.”

“One of my people is on Rotary executive,” Orden Brown said. “I’ll have him fix it up. That had better be the opening week of the campaign. Then the following week we might do the same thing with Kiwanis.”

O’Donnell considered suggesting that the chairman leave him some time for surgery, otherwise he might have trouble meeting his own quota. But he thought better of it.

“By the way,” Orden Brown was saying, “are you free for dinner the day after tomorrow?”

“Yes, I am,” O’Donnell answered promptly. He always enjoyed the quiet, formal dignity of dinner at the house on the hill.

“I’d like you to come with me to Eustace Swayne’s.” Seeing O’Donnell’s surprise, the chairman added, “It’s all right—you’re invited. He asked me if I’d tell you.”

“Yes, I’ll be glad to come.” All the same, the invitation to the home of the board of directors’ most die-hard member was unexpected. Naturally O’Donnell had met Swayne a few times but had not come to know him well.

“As a matter of fact, it’s my suggestion,” Brown said. “I’d like you to talk with him about the hospital generally. Let him absorb some of your ideas if you can. Frankly, at times he’s a problem on the board, but you know that, of course.”

“I’ll do what I can.” Now that he knew what was involved, O’Donnell did not relish the thought of getting close to board politics. So far he had managed to steer clear of them. But he could not say no to Orden Brown.

The chairman picked up his brief case and prepared to leave. Tomaselli and O’Donnell rose with him.

“It will be just a small party,” Orden Brown said. “Probably half a dozen people. Why don’t we pick you up on the way across town? I’ll phone before we leave.”

O’Donnell murmured his thanks as, nodding pleasantly, the chairman went out.

The door had scarcely closed on Orden Brown when tall, slim Kathy Cohen, Tomaselli’s secretary, came in. “I’m sorry to interrupt,” she said.

“What is it, Kathy?”

She told the administrator, “There’s a man on the phone who insists on talking to you. A Mr. Bryan.”

“I’m busy with Dr. O’Donnell now. I’ll call him back.” Tomaselli sounded surprised. Normally he would not have to tell Kathy anything so elementary.

“I told him that, Mr. Tomaselli.” She sounded doubtful. “But he’s very insistent. He says he’s the husband of a patient. I thought you ought to know.”

“Maybe you should talk with him, Harry.” O’Donnell smiled at the girl. “Take him off Kathy’s mind. I don’t mind waiting.”

“All right.” The administrator reached for one of his two telephones.

“It’s line four.” The girl waited until the connection was made, then went back to the outer office.

“Administrator speaking.” Tomaselli’s tone was friendly. Then he frowned slightly, listening to what was coming from the other end of the line.

O’Donnell could hear the receiver diaphragm rattling sharply. He caught the words, “Disgraceful situation . . . imposition on a family . . . should be an inquiry.”

Tomaselli put his hand over the phone’s mouthpiece. He told O’Donnell, “He’s really boiling. Something about his wife. I can’t quite make put . . .” He listened for a moment more, then said, “Now, Mr. Bryan, supposing you start at the beginning. Tell me what this is all about.” He reached for a pad and pencil, then said, “Yes, sir.” A pause. “Now tell me, please, when was your wife admitted to hospital?” The phone rattled again and the administrator made a swift note. “And who was your physician?” Again a note. “And the date of discharge?” A pause. “Yes, I see.”

O’Donnell heard the words, “Can’t get any satisfaction,” then Tomaselli was talking again.

“No, Mr. Bryan, I don’t remember the particular case. But I will make some inquiries. I promise you that.” He listened, then answered, “Yes, sir, I do know what a hospital bill means to a family. But the hospital doesn’t make any profit, you know.”

O’Donnell could still hear the voice on the telephone, but it sounded calmer, responding to Tomaselli’s conciliatory approach. Now the administrator said, “Well, sir, it’s the physician who decides how long a patient remains in hospital. I think you should have another talk with your wife’s physician, and what I’ll do meanwhile is have our treasurer go over your bill, item by item.” He listened briefly, then, “Thank you, Mr. Bryan. Good-by.”

He hung up the phone, tore off the page of notes, and put it in a tray marked “Dictation.”

“What was the trouble?” O’Donnell asked the question casually. In a busy hospital complaints about service and charges were not unique.

“He claims his wife was kept in too long. Now he has to go into debt to pay the bill.”

O’Donnell said sharply, “How does he know she was in too long?”

“He says he’s checked around—whatever that means.” Tomaselli said thoughtfully, “It may have been necessary, of course, but she
was
here nearly three weeks.”

“So?”

“Normally I wouldn’t think much about it. But we’ve had an unusual number of these complaints. They’re not always as strong as this—but on the same lines.”

Something flashed through O’Donnell’s mind: the word Pathology. Aloud he said: “Who was the attending physician?”

Tomaselli glanced at his notes. “Reubens.”

“Let’s see if we can get him and clear this up now.”

Tomaselli touched an intercom set. “Kathy,” he said, “see if you can locate Dr. Reubens.”

They waited in silence. From the corridor outside they could hear a soft voice on the hospital public-address system. “Dr. Reubens. Dr. Reubens.” After a moment the phone buzzed. Tomaselli lifted the receiver and listened. Then he passed it to O’Donnell.

“Reub? It’s Kent O’Donnell.”

“What can I do for you?” O’Donnell could hear the thin, precise voice of Reubens, one of the senior surgeons, at the other end of the line.

“Do you have a patient”—he looked at Tomaselli’s notes which the administrator had pushed toward him—“a Mrs. Bryan?”

“That’s right. What’s the matter? Has her husband been complaining?”

“You know about it then?”

“Of course I know about it.” Reubens sounded annoyed. “Personally I think he has good reason to complain.”

“What’s the story, Reub?”

“The story is that I admitted Mrs. Bryan for possible carcinoma of the breast. I removed a tumor. It turned out to be benign.”

“Then why keep her here for three weeks?” As he asked, O’Donnell remembered that you always had to go through this question-and-answer performance with Reubens. The other man seldom volunteered information.

Now he answered, “You’d better ask Joe Pearson that!”

“Be simpler if you told me, Reub.” O’Donnell was quietly insistent. “After all, she’s your patient.”

There was a silence. Then the thin, clipped voice said, “All right. I told you the tumor was benign. But it was two and a half weeks before I found out. That’s how long it took Pearson to get it under his microscope.”

“Did you remind him about it?”

“If I called him once I called him half a dozen times. He’d probably have been longer if I hadn’t kept after it.”

“And that’s why you kept Mrs. Bryan in—for three weeks?”

“Naturally.” The voice on the phone took on a note of sarcasm. “Or are you suggesting I should have discharged her?”

There was reason for Reubens to be sour on the subject, O’Donnell thought. Unquestionably he had been put in a difficult position. If he had discharged the patient, he might have had to call her back for more surgery, as had happened to Bill Rufus. On the other hand, every additional day in hospital meant an extra financial burden for the family. He answered noncommittally, “I’m not suggesting anything, Reub. Just making some inquiries.”

The thing had obviously been on Reubens’ mind. “Then you’d better talk to some of the other men,” he said. “I’m not the only one this has happened to. You know about Bill Rufus?”

“Yes, I know. Frankly, I thought things had been improving a little.”

“If they have, it’s not so’s you’d notice it. What do you propose to do about Bryan’s bill?”

“I doubt if we can do anything. After all, his wife was here for three weeks. Hospital money is tight, you know.” O’Donnell wondered what Reubens’ reaction would be when he heard he was being asked to give six thousand dollars himself to the hospital building fund.

“It’s too bad. Husband’s a decent little guy—a carpenter or something like that, works for himself. He didn’t have any insurance. This’ll set ’em back for a long time.” O’Donnell made no answer. His mind was already running ahead, thinking of what came next. Again the thin voice on the phone: “Well, is that all?”

“Yes, Reub; that’s all. Thanks.” He handed the telephone back to Harry Tomaselli.

“Harry, I want a meeting this afternoon.” O’Donnell had made up his mind what had to be done. “Let’s try to get half a dozen of the senior people on staff. We’ll meet here, if that’s convenient, and I’d like you to be here too.”

Tomaselli nodded. “Can do.”

O’Donnell was checking over names in his mind. “We’ll want Harvey Chandler, of course, as chief of medicine. Better have Bill Rufus, and Reubens should be included, I think.” He paused. “Oh yes, and Charlie Dornberger. He might be useful. How many is that?”

The administrator checked the names he had written. “Six with you and me. How about Lucy Grainger?”

Briefly O’Donnell hesitated. Then he said, “All right. Let’s make it seven then.”

“Agenda?” Tomaselli had his pencil poised.

O’Donnell shook his head. “We won’t need one. There’s just one subject—changes in Pathology.”

When the administrator had mentioned Lucy Grainger’s name, O’Donnell had hesitated for one reason only: it had reminded him of a meeting between himself and Lucy the night before.

They had met for dinner—the outcome of O’Donnell’s invitation to Lucy the day of the mortality conference—and in the Palm Court of the Roosevelt Hotel they had had cocktails, then a leisurely meal. It had been a pleasant, relaxed occasion, and they had talked lightly of themselves, of people they had known, and their own experiences in and out of medicine.

Afterward O’Donnell had driven Lucy home. She had recently moved into Benvenuto Grange, a large, fashionable apartment block on the north side of town. She had said, “You’ll come in for a nightcap, of course?”

He had left his car for the uniformed doorman to park and followed her. They rode the gleaming, silent elevator to the fifth floor, then turned down a birch-paneled corridor, their footsteps silenced in deep broadloom. He had raised his eyebrows and Lucy smiled. “It is a little awesome, isn’t it? I’m still impressed myself.”

She had used her key to open a door and inside touched a switch. Tasteful, subdued lighting sprang up around an elegant interior lounge. He could see the partly opened door of a bedroom directly ahead. “I’ll mix us a drink,” she said.

Her back was to him. Ice clinked in glasses. O’Donnell said, “Lucy, you’ve never married?”