The Final Diagnosis (16 page)

“Filing.” The senior lab technician answered laconically. “Something the clerks should be doing if we had some proper help.”

And probably a lot better, McNeil thought. He knew the department badly needed more clerical staff and the filing methods used now were hopelessly archaic. The reference to a cross file, too, had reminded him of a gaping hole in their administrative system. There were few good hospitals now whose pathology departments did not have one. Some called them organ-lesion files, but, whatever the name, one purpose of the system was to help resolve the kind of problem they were facing at this moment.

Pearson was studying the slides again. He mumbled, as a lot of pathologists did when they were mentally crossing off some factors and confirming others. McNeil heard, “It’s a little small . . . absence of hemorrhage . . . no necrosis of the tissue . . . negative but no indication . . . yes, I’m satisfied.” Pearson straightened up from the microscope, replaced the last slide, and closed the slide folder. Motioning to the resident to write, he said, “Diagnosis—a blue nevus.” Courtesy of Pathology, the woman patient had been reprieved.

Methodically, for McNeil’s benefit, Pearson ran over the reasons for his decision again. As he passed the slide folder he added, “You’d better study these. It’s a specimen you won’t see often.”

McNeil had no doubt that the old man’s finding was right. This was one place where years of experience paid off, and he had come to respect Pearson’s judgment in matters of pathological anatomy. But when you’ve gone, he thought, looking at the old man, that’s when this place will need a cross file—badly.

They studied two more cases, both fairly straightforward, then Pearson slipped in the first slide from the next series. He took one look through the microscope eyepiece, straightened up, and told McNeil explosively, “Get Bannister!”

“I’m still here.” It was Bannister, calmly, behind them at the file cabinets.

Pearson wheeled. “Look at this!” He was using his loudest, hectoring voice. “How many times do I have to give instructions about the way I want slides made? What’s wrong with the technicians in Histology? Are they deaf or just plain stupid?”

McNeil had heard the same kind of outburst before. He sat back and watched as Bannister asked, “What’s the trouble?”

“I’ll tell you what’s the trouble.” Pearson ripped the slide from his microscope and tossed it across the table. “How can I give a proper diagnosis with this kind of tissue section?”

The senior lab technician picked up the slide and held it to the light. “Too thick, eh?”

“Of course it’s too thick.” Pearson picked out a second slide from the same set. “Look at this one. If I had some bread I could scrape off the meat and make a sandwich.”

Bannister grinned. “I’ll check the microtome. We’ve been having trouble with it.” He pointed to the slide folder. “Do you want me to take these away?”

“No. I’ll have to make do with them.” The explosiveness had gone now; the old man was merely growling. “Just do a better job in supervising Histology.”

Bannister, disagreeable himself by this time, grumbled on his way to the door. “Maybe if I didn’t have so much else . . .”

Pearson shouted after him, “All right. I’ve heard that record before.”

As Bannister reached the door, there was a light tap and Dr. Charles Dornberger appeared. He asked, “May I come in, Joe?”

“Sure.” Pearson grinned. “You might even learn something, Charlie.”

The obstetrician nodded pleasantly to McNeil, then said casually to Pearson, “This was the morning I arranged to come down. Had you forgotten?”

“Yes, I had.” Pearson pushed the slide folder away from him. He asked the resident, “How many more in this batch?”

McNeil counted the slide folders remaining. “Eight.”

“We’ll finish later.”

The resident began to gather up the case papers already completed.

Dornberger took out his pipe and leisurely filled it. Looking around the big drab room, he shivered. He said, “This place feels damp, Joe. Every time I come here I feel like I’m going to get a chill.”

Pearson gave a deep chuckle. He said, “We spray flu germs around—every morning. It discourages visitors.” He watched McNeil cross the room and go out of the door. Then he asked, “What’s on your mind?”

Dornberger wasted no time. He said, “I’m a deputation. I’m supposed to handle you tactfully.” He put the pipe in his mouth, his tobacco pouch away.

Pearson looked up. “What is this? More trouble?”

Their eyes met. Dornberger said quietly, “That depends.” After a pause he added, “But it looks as if you may get a new assistant pathologist.”

Dornberger had expected an outburst, but Pearson was strangely quiet. He said thoughtfully, “Whether I want one or not, eh?”

“Yes, Joe.” Dornberger made it definite; there was no point in holding back. He had thought a good deal about this since the meeting of several days ago.

“I suppose O’Donnell is back of this.” Pearson said it with a touch of bitterness but still quietly. As always, he was being unpredictable.

Dornberger answered, “Partly but not entirely.”

Again surprisingly, “What do you think I should do?” It was a question asked by one friend of another.

Dornberger laid his pipe, unlighted, in an ash tray on Pearson’s desk. He was thinking: I’m glad he’s taking it this way. It means I was right. I can help him accept this, adjust to it. Aloud he said, “I don’t believe you’ve much choice, Joe. You
are
behind with surgical reports, aren’t you? And a few other things?”

For a moment he thought he had gone too far. This was a sensitive area. He saw the other man brace up and waited for the storm to break. But again it did not. Instead, more strongly than before, but reasonably, Pearson said, “Sure, a few things need straightening out. I’ll admit that to you. But there’s nothing I can’t handle myself—if I can just get the time to do it.”

He
has
accepted it, Dornberger thought. He’s sounding off now. But he has accepted it just the same. He said casually, “Well, maybe you’ll get the time—with another pathologist.” With equal casualness he pulled from his inside pocket the paper which the administrator had given him.

Pearson asked, “What’s that?”

“There’s nothing definite about this, Joe. It’s a name that Harry Tomaselli had—apparently some young fellow who might be interested in coming here.”

Pearson took the single sheet. He said, “They sure didn’t waste any time.”

Dornberger said lightly, “Our administrator is a man of action.”

Pearson was scanning the paper. He read aloud, “Dr. David Coleman.” There was a pause. Then with bitterness, frustration, and envy the old man added, “Age thirty-one.”

It was twenty minutes after midday, and the hospital cafeteria was at its busiest. Most of the doctors, nurses, and hospital employees usually took their lunch about this time, and a line-up was beginning to form at the point where newcomers collected trays before passing counters and steam tables where the food was served.

Mrs. Straughan, as usual at this period, had her eye on proceedings, ensuring that as fast as one batch of food was used up another was brought from the kitchens to keep the line out front moving briskly. Today there was a choice of Irish stew, lamb chops, and broiled halibut. The chief dietitian noticed that the lamb chops were moving slowly. She decided to try some herself in a few minutes to see if there were any reason. Perhaps the meat was not as succulent as it might be; word of something like that was often passed to those arriving in the cafeteria by others who were leaving. Mrs. Straughan noticed a dish at the top of a pile on the servery that appeared to have a mark on it. She stepped forward and removed it quickly; sure enough, it still bore traces of an earlier meal. The dishwashing machines again! she thought. Their inadequacy was a recurring problem, and she decided to broach the subject with the administrator again very soon.

Over at the tables reserved for the medical staff there was the sound of noisy laughter. It came from a group of which Dr. Ralph Bell, the radiologist, was the center.

Gil Bartlett, who had come from the serving counter with a tray, put it down and went over with extended hand. “Congratulations, Ding Dong,” he said. “I just heard.”

“Heard what?” It was Lewis Toynbee, the internist, also with a tray, behind him. Then as Bell, beaming, passed a cigar to Bartlett, Toynbee exclaimed, “My God! Not again?”

“Certainly again. Why not?” The radiologist held out another cigar. “Join us, Lewis. It’s exactly eight Bells.”

“Eight! When was this?”

Bell said calmly, “This morning. Another boy for the ball team.”

Bill Rufus put in, “Don’t sound critical, Lewis. He’s doing his best. After all, he’s only been married eight years.”

Lewis Toynbee offered his hand. “Don’t squeeze it too tight, Ding Dong. I’m afraid some of that fertility might rub off.”

“I’m impervious to jealousy,” Bell said good-naturedly. He had been through all this before.

Lucy Grainger asked, “How is your wife?”

Bell answered, “She’s fine, thanks.”

“How does it feel to be a sex fiend?” The question was from Harvey Chandler, the chief of medicine, lower down the table.

Bell said, “I’m not a sex fiend. At our house we have intercourse once a year. I’m just a dead shot.”

Lucy Grainger joined in the ensuing laughter, then she said, “Ralph, I’m sending you a patient this afternoon. It’s one of our student nurses—Vivian Loburton.”

The laughter had simmered down. “What is it you’re looking for?” Bell asked.

“I want you to take some films of the left knee,” Lucy answered. Then she added, “There’s some sort of growth there. I don’t like the look of it.”

Back in his own office, Dr. Charles Dornberger had telephoned Kent O’Donnell to report the outcome of the talk with Pearson. At the end he had told the chief of surgery, “I’ve let Joe know about the man you people have been corresponding with.”

O’Donnell had asked, “How did he take it?”

“I wouldn’t say he was enthusiastic,” Dornberger said. “But I think if you want to have this fellow . . . what’s his name—Coleman? . . . if you want to have him come here for a talk, Joe won’t be difficult. But I’d suggest you keep Joe posted on everything you do from here on in.”

“You can be sure of that,” O’Donnell had said. Then, “Thanks, Charlie. Thank you very much.”

Afterward Dornberger had made another telephone call. It was to Mrs. John Alexander, who had phoned earlier that morning and left a message. Before calling he had looked up his record card and was reminded that this was the wife of the pathology technologist, referred to him by Joe Pearson. Talking with Mrs. Alexander, he learned that she had just arrived in town to join her husband. They made an appointment for her to come to Dornberger’s downtown office the following week.

About the same time that Mrs. Alexander was talking with Dornberger her husband was receiving his first tongue-lashing from Dr. Joseph Pearson. It happened this way.

After Pearson’s outburst that morning about the poor-quality surgical slides, Bannister had come back to the serology lab where John Alexander was working and had told him the whole story. By this time Bannister was seething, and later he had taken out some of his own bad humor on the two girl technicians and their male helper who worked in the histology lab next door. Alexander had heard what was said through the doorway which Bannister had left open behind him.

Alexander, though, knew that not all the blame for the bad slides lay with the histology technicians. Even in the short time he had been at the hospital he had sensed the real problem, and afterward he had told Bannister, “You know, Carl, I don’t believe it’s all their fault. I think they have too much to do.”

Bannister had answered sourly, “We’ve all got too much to do.” Then with clumsy sarcasm he had added, “Maybe if you know so much about it you can do your own work and part of theirs as well.”

Alexander had declined to be provoked. “I don’t think so. But I do think they’d be a lot better off with a tissue-processing machine instead of having to do everything by hand—the old-fashioned way.”

“Forget it, kid. It isn’t your problem.” Bannister had been loftily condescending. “And, besides, anything that means spending money around here is a dead duck before it starts.”

Alexander had not argued. But he resolved to raise the subject, the first chance he got, with Dr. Pearson.

He had had to go into Pearson’s office that afternoon to leave some lab reports for signature, and he had found the pathologist going through a pile of mail with obvious impatience. Glancing up at Alexander, Pearson had motioned him to put the papers on the desk and had gone on with his reading. Alexander had hesitated, and the old man had barked, “What is it? What is it?”

“Dr. Pearson, I was wondering if I could make a suggestion.”

“Now?”

A more experienced hand would have known the tone of voice meant: Leave me alone. Alexander answered, “Yes, sir.”

Resignedly Pearson said, “Well?”

A little nervously Alexander began, “It’s about speeding up the surgical reports, Doctor.” As he mentioned surgical reports, Pearson had put down his letter and looked up sharply. Alexander went on, “I was wondering if you’d ever thought of getting a tissue-processing machine.”

“What do
you
know about tissue processors?” There was an ominous note in Pearson’s voice. “And anyway, I thought we put you to work in Serology.”

Alexander reminded him, “I did a full course in histology at technologists’ school, Doctor.” There was a pause. Pearson said nothing, so Alexander went on. “I’ve used a tissue processor and it’s a good machine, sir. It would save us at least a day in preparing slides. Instead of processing tissue by hand through all the solutions, you set the machine overnight and automatically by morning——”

Abruptly Pearson cut in. “I know how it works. I’ve seen them.”

Alexander said, “I see, sir. Then don’t you think——”

“I said I’ve seen these so-called tissue processors and I’m not impressed.” Pearson’s Voice was harsh and grating. “There’s not the quality in the slides that there is with the old hand method. What’s more, the machines are expensive. You see these?” He riffled through a stack of typed yellow forms in a tray on his desk.