The Final Diagnosis (9 page)

O’Donnell had listened quietly. Now he said, “Finished, Joe?”

“Yeah.” Pearson seemed chastened, half ashamed at his outburst.

“It wasn’t technicians or office staff I was thinking about,” O’Donnell told him. “When I meant help I meant another pathologist. Someone to help you run the department. Maybe modernize it here and there.”

“Now look here!” at the word “modernize” Pearson had bridled, but O’Donnell brushed the objection aside. “I listened to
you
, Joe. Now you hear me out. Please.” He paused. “I was thinking of maybe some bright young fellow who could relieve you of some duties.”

“I don’t need another pathologist.” It was a flat statement, vehement and uncompromising. “Why, Joe?”

“Because there’s not enough work for two qualified men. I can handle all the pathology myself—without any help. Besides, I’ve already got a resident in the department.”

O’Donnell was quietly persistent. “A resident is with us for training, Joe, and usually for just a short time. Sure, a resident can carry some of the work. But you can’t give him responsibility and we can’t use him for administration. That’s where you need some help right now.”

“Let me be the judge of that. Give me a few days and we’ll be caught up in surgicals.”

It was obvious that Joe Pearson had no intention of giving way. O’Donnell had expected resistance to bringing in a new pathologist, but he wondered about the other man’s forcefulness. Was it because he was unwilling to divide his personal empire, or was he simply protecting his job—fearful that a new and younger man might undermine him? Actually the idea of removing Pearson had not occurred to O’Donnell. In the field of pathological anatomy alone Joe Pearson’s long experience would be hard to replace. O’Donnell’s objective was to strengthen the department and thereby the hospital organization. Perhaps he should make this clear.

“Joe, there’s no question of any major change. No one has suggested it. You’d still be in charge . . .”

“In that case let me run Pathology my own way.”

O’Donnell found his patience ebbing. He decided that perhaps he had pressed the point enough for now. He would let it go for a day or two, then try again. He wanted to avoid a showdown if he could. He said quietly, “I’d think it over if I were you.”

“There’s nothing to think over.” Pearson was at the door. He nodded curtly and went out.

So there it is, O’Donnell thought. We’ve laid the lines of battle. He stood there, considering thoughtfully what the next move should be.

Five

The cafeteria of Three Counties Hospital was a traditional meeting place for most of the hospital grapevine, its stems and branches extending tenuously to every section and department within Three Counties’ walls. Few events occurred in the hospital—promotions, scandals, firings, and hirings—which were not known and discussed in the cafeteria long before official word was ever published.

Medical staff frequently used the cafeteria for “curbstone consultations” with colleagues whom they seldom saw except at a meal or coffee break. Indeed, a good deal of serious medical business was transacted over its tables, and weighty specialist opinions, which at other times would be followed by a substantial bill, were often tossed out freely, sometimes to the great advantage of a patient who, recovering later from some ailment which at first had proven troublesome, would never suspect the somewhat casual channels through which his eventual course of treatment had come.

There were exceptions. A few staff physicians now and then resented this informal use of their arduously acquired talénts and resisted attempts by colleagues to draw them out in the discussion of specific cases. In such instances the usual rejoinder was, “I think we’d better set up a consultation in my office. I’ll have the meter running then.”

Gil Bartlett was one who disapproved of such approaches and at times could be a good deal blunter in refusing off-the-cuff opinions. One story told about his personal tactics of resistance had its origin not in the cafeteria but at a cocktail party in a private home. His hostess, a grand dame of Burlington society, had buttonholed Bartlett and bombarded him with questions about her illnesses, real and imagined. Bartlett had listened for a while, then announced in a loud voice which brought a hush to the crowded room, “Madam, I believe from what you say you have a menstrual problem. If you’ll strip right now I’ll examine you here.”

Mostly though, much as they might resist informal consultations outside the hospital, the medical staff accepted the cafeteria exchanges on the basis that they had as much to gain as lose; and a good many physicians around the hospital used the mildewed quip on leaving their contact points, “If you want me I’ll be in my second office.” Normally no further explanation was required or given.

Generally the cafeteria was a democratic area where hospital rank, if not forgotten, was at least temporarily ignored. An exception, possibly, was the practice of setting aside a group of tables for the medical staff. Mrs. Straughan, the chief dietitian, hovered over this area periodically, knowing that even minor shortcomings in hygiene or service could bring testy complaints at some future meeting of the hospital’s medical board.

With few exceptions the senior attending physicians used the reserved tables. House staff, however, were less consistent, residents and interns sometimes asserting their independence by joining the nurses or other groups. There was nothing unusual, therefore, in Mike Seddons dropping into a chair opposite Vivian Loburton who, released from an assignment earlier than some of her fellow student nurses, was eating lunch alone.

Since they had met ten days ago in the autopsy room, Vivian had encountered Mike Seddons several times in the hospital and on each occasion—seeing his thatch of red hair and wall-to-wall grin—she had increasingly come to like the look of him. Intuitively she had expected that soon he might make a direct approach to her, and now here it was.

“Hi!” Seddons said.

“Hullo.” The greeting came out awkwardly, Vivian having just bitten, with healthy appetite, into a chicken leg. She pointed to her mouth and mumbled, “Excuse me.”

“That’s perfectly all right,” Seddons said. “Take your time. I’m here to proposition you.”

She finished the mouthful of chicken, then said, “I thought that was supposed to come later.”

Mike Seddons grinned. “Haven’t you heard?—this is the jet age. No time for formal frills. Here’s my proposition: theater the day after tomorrow, preceded by dinner at the Cuban Grill.”

Vivian asked curiously, “Can you afford it?” Among house staff and student nurses poverty was a time-honored, rueful joke.

Seddons lowered his voice to a stage whisper. “Don’t tell a soul, but I’m on to a side line. Those patients we get in autopsy. A lot of ’em have gold fillings in their teeth. It’s a very simple matter . . .”

“Oh, shut up; you’ll ruin my lunch.” She bit the chicken leg again, and Seddons reached over for two of her trench fries.

He savored them. “Um, not bad. I must eat more often. Now here’s the story.” He produced two tickets from his pocket and a printed voucher. “Take a look at this—compliments of a grateful patient.” The tickets were for the road show of a Broadway musical. The voucher covered dinner for two at the Cuban Grill.

“What did you do?” Vivian was frankly curious. “Heart surgery?”

“No. Last week I filled in for half an hour for Frank Worth in emergency. A guy had a bad gash on his hand and I stitched it. Next thing I knew, these were in the mail.” He chuckled. “Worth is furious, of course. Says he’ll never leave his post again. Well, will you come?”

“I’d love to,” Vivian said, and meant it.

“Great! I’ll pick you up at the nurses’ residence at seven o’clock. Okay?” As he spoke Mike Seddons found himself regarding this girl with even greater interest. He was suddenly aware that she had a good deal more than a pretty face and a good figure. When she looked at him and smiled it conveyed the feeling of something warm and fragrant. He thought: I wish we were meeting today instead of the day after tomorrow; it’s a long time to wait. Then a faint warning voice inside him cautioned: Beware entanglements! Remember the Seddons policy: love ’em and leave ’em—happy with their memories; parting is such sweet sorrow but, oh, so very practical for staying unattached.

“Okay,” Vivian said. “I might be a little late but not much.”

A week and a half had passed since Harry Tomaselli had told O’Donnell that construction of the hospital’s extension was planned to begin in the spring. Now, in the administrator’s office, he, Kent O’Donnell, and Orden Brown, the board chairman, were meeting to discuss immediate things to be done.

Months before, with an architect at their elbows, the three had worked over the detailed plans for each section which would have its home in the new wing. The wishes of heads of medical departments had had to be balanced against the money likely to be available. Orden Brown had been the arbiter with O’Donnell as medical liaison. As always, the chairman had been crisp and incisive, but with a humor that seasoned his basic toughness. Sometimes they had gone along entirely with what was asked; at other times, when they suspected empire building for its own sake, the inquiries had been more searching.

One section head, the chief pharmacist, had pressed hard to have a private toilet included in his own office design. When the architect had pointed out that more general facilities were available a mere forty feet down the corridor, the pharmacist had gone so far as to observe that forty feet was a long way when he was suffering one of his periodic attacks of diarrhea. Orden Brown had dryly referred him to the department of internal medicine.

A few worth-while projects had had to be vetoed solely on the grounds of cost. Ding Dong Bell, the senior radiologist, had made out a convincing case for creation of a cine-radiography unit—its purpose to improve diagnosis and treatment of heart disease. But on learning that the equipment alone would cost fifty thousand dollars the plan had regretfully been ruled out.

But now, with the main planning completed, the focus of attention was on the practical matter of getting the money. Strictly speaking, this was the responsibility of the board of directors; but the medical staff was expected to help.

Orden Brown said, “We’re suggesting some quotas for the doctors—six thousand dollars for senior attending physicians, four thousand for associates, two thousand for assistants.”

O’Donnell whistled softly. He told the chairman, “I’m afraid there’ll be some complaining.”

Brown smiled. “We must do our best to endure it.”

Harry Tomaselli put in, “The money can be spread over four years, Kent. As long as we have written pledges we can use them to borrow from the bank.”

“There’s another thing,” Brown said. “When word gets around town that this is what the doctors themselves are giving, it will help our general fund raising a good deal.”

“And you’ll see that word does get around?”

Brown smiled. “Naturally.”

O’Donnell reflected that it would be his job to break the news at a medical staff meeting. He could visualize the pained expressions he would face. Most medical men he knew, like the majority of people nowadays, lived right up to their incomes. Of course, there would be no compulsion about the quotas, but it would be hard for an individual to take a stand against them, especially since the medical staff had a lot to gain from the hospital’s growth. A good many certainly would give the full amount asked and, human nature being what it was, they would bring pressure on others to suffer equally. A hospital was a breeding ground for politics, and there were many ways in which a nonconformist could have life made difficult for him.

Harry Tomaselli, intuitive as usual, said, “Don’t worry, Kent. I’ll brief you thoroughly before the staff meeting. We’ll have all the selling points lined up. In fact, when you’re through some people may even want to exceed quota.”

“Don’t count on it.” O’Donnell smiled. “You’re about to touch a number of doctors on their tenderest nerve—the pocketbook.”

Tomaselli grinned back. He knew that when the chief of surgery made his appeal to the staff it would be as incisive and thorough as everything else O’Donnell did. He reflected, not for the first time, how good it was to work with someone of O’Donnell’s character. In Tomaselli’s last hospital, where he had been assistant administrator, the president of the medical board had been a man who courted popularity and trimmed his sails to every wind of opinion. As a result there had been no real leadership and hospital standards had suffered accordingly.

Harry Tomaselli admired forthrightness and swift decisions, mostly because those were methods he used himself as administrator of Three Counties. With swift decisions you sometimes made mistakes, but on the whole you got a lot more done, and your average of hits unproved as time went on. Quickness—of speech and thought, as well as action—was something Harry Tomaselli had learned in courtrooms long before he ever thought of finding his destiny behind a hospital desk.

He had entered law school from college and bad begun to lay the foundations of a good practice when war intervened. Anticipating the draft, he had enlisted in the U.S. Navy where he had received a commission and a job in medical administration. Later, as the navy hospitals filled with wounded, Lieutenant Tomaselli had proven himself an able administrator with an instinct for sensing the invisible border line between the practice of medicine and the business of hospital management.

After the war, faced with the choice of returning to law or remaining in hospital work, he had chosen the latter and enrolled in the School of Hospital Administration at Columbia University. He had graduated from Columbia at a time when there was growing recognition of hospital administration as a specialized field of endeavor in which a medical degree was neither necessary nor particularly useful. This had opened up a brisk demand for good administrators, and after two years as an assistant he had accepted Orden Brown’s offer of the top post at Three Counties.