The Final Diagnosis

Vivian kept very still - bewildered, uncomprehending. This thing could not be happening to her; it must be someone else Dr. Grainger was speaking about. Her thoughts raced. That was it! Somehow the charts of two patients had become mixed. It had happened before in hospitals. Dr. Grainger was busy; she could easily be confused. Perhaps some other patient was even now being told . . .

Abruptly she stopped her thoughts, made them stand still, tried to clear her mind. There was no mistake. She knew it, clearly and definitely, from the expressions of Dr. Grainger and Mike Seddons. They were watching her now, seated on either side of the hospital bed where Vivian half lay, half sat, propped up by pillows behind her.

She turned to Lucy Grainger. "When will you know . . . for sure?"

"In two days. Dr. Pearson will tell us then. One way or the other."

"And he doesn't know . . ."

Lucy said, "Not at this moment, Vivian. He doesn't know. He doesn't know anything for sure."

"Oh, Mike!" She reached for his hand.

He took it gently. Then she said, "I'm sorry . . . but I think . . . I'm going to cry."

As Seddons put his arms around Vivian, Lucy rose to her feet. "I'll come back later." She asked Seddons, "You'll stay for a while?"

"Yes."

Lucy said, "Make sure that Vivian is quite clear in her mind that nothing is definite. It's just that I want her to be prepared . . . in case."

He nodded, the untidy red hair moving slowly. "I understand."

As she went out into the corridor Lucy thought: Yes, I'm quite sure you do."

Yesterday afternoon, when Joe Pearson had reported to her by telephone, Lucy had been undecided whether to tell Vivian at this stage what the possibilities were or to wait until later. If she waited, and Pathology's report on the biopsy was "benign," all would be well and Vivian would never know of the shadow which, for a while, had drifted darkly over her. But, on the other hand, if, two days from now, the pathology report said "malignant," amputation would become vitally urgent. In that case, could Vivian be prepared in time, or would the psychological impact be too great? The shock, suddenly thrust upon a young girl who had not suspected that anything serious was wrong, could be tremendous. It might be days before Vivian was ready mentally to accept major surgery - days they could ill afford to lose.

There was something else Lucy had also weighed in balance. The fact that Joe Pearson was seeking outside opinion was significant in itself. If it had been a clear-cut case of benign tissue, he would have said so at once. The fact that he had not, despite his unwillingness to commit himself either way when they had talked, meant that malignancy was at least a strong possibility.

Deliberating all these things, Lucy had decided that Vivian must be told the situation now. If, later, the verdict was "benign," it was true she would have suffered fear unneedfully. But better that than a sudden explosive impact for which she was completely unprepared.

The immediate problem had also been simplified by the appearance of Dr. Seddons. Last evening the young resident had come to Lucy and told her of his own and Vivian's plans for marriage. He had admitted that at first his own intention had been to remain in the background, but now he had changed his mind. Lucy was glad he had. At least it meant that Vivian was no longer alone and there was someone whom she could turn to for support and comfort.

Without question, the girl would need plenty of both. Lucy had broken the news that she suspected osteogenic sarcoma - with all its tragic possibilities - as gently as she could. But no matter how one put it, there was no real way of softening the blow. Now Lucy remembered the next thing she had to do: apprise the girl's parents of the situation as it stood. She glanced down at a slip of paper in her hand. It contained an address in Salem, Oregon, which she had copied earlier from the "next-of-kin" entry on Vivian's admitting form. She already had the girl's agreement that her parents could be told. Now Lucy must do the best job she could of breaking the news by long-distance telephone.

Already her mind was anticipating what might happen next. Vivian was a minor. Under state law a parent's consent was required before any amputation could be performed. If the parents planned to fly here immediately from Oregon, the written consent could be obtained on arrival. If not, she must do her best to persuade them to telegraph the authority, giving Lucy the discretion to use it if necessary.

Lucy glanced at her watch. She had a full schedule of appointments this morning in her office downtown. Perhaps she had better make the call now, before leaving Three Counties. On the second floor she turned into the tiny hospital office she shared with Gil Bartlett. It was little more than a cubicle - so small that they rarely used it at the same time. Now it was very much occupied - by Bartlett and Kent O'Donnell.

As he saw her O'Donnell said, "Sorry, Lucy. I'll get out. This place was never built for three."

"There's no need." She squeezed past the two men and sat down at the tiny desk. "I have a couple of things to do, then I'm leaving."

"You'd be wise to stay." Gil Bartlett's beard followed its usual bobbing course. His voice was bantering. "Kent and I are being extremely profound this morning. We're discussing the entire future of surgery."

"Some people will tell you it doesn't have a future." Lucy's tone matched Bartlett's. She had opened a desk drawer and was extracting some clinical notes she needed for one of her downtown appointments. "They say all surgeons are on the way to becoming extinct, that in a few years we'll be as out-of-date as the dodo and the witch doctor."

Nothing pleased Bartlett more than this kind of exchange. He said, "And who, I ask you, will do the cutting and plumbing on the bloomin' bleeding bodies?"

"There won't be any cutting." Lucy had found the notes and reached for a brief case. "Everything will be diagnostic. Medicine will employ the forces of nature against nature's own malfunctioning. Our mental health will have been proven as the root of organic disease. You'll prevent cancer by psychiatry and gout by applied psychology." She zippered the brief case, then added lightly, "As you may guess, I'm quoting."

"I can hardly wait for it to happen." Kent O'Donnell smiled. As always, nearness to Lucy gave him a feeling of pleasure. Was he being foolish, even ridiculous, in holding back from allowing their relationship to become more intimate? What was he afraid of, after all? Perhaps they should spend another evening together, then let whatever happened take its course. But here and now - with Gil Bartlett present - was obviously no time to make arrangements.

"I doubt if any of us will live that long." As Lucy spoke the phone on the desk rang softly. She picked it up and answered, then passed the instrument to Gil Bartlett. "It's for you."

"Yes?" Bartlett said.

"Dr. Bartlett?" They could hear a woman's voice at the other end of the line.

"Speaking."

"This is Miss Rawson in Emergency. I have a message from Dr. Clifford." Clifford was the hospital's senior surgical resident.

"Go ahead."

"He would like you to come down and scrub, if you can. There's been a traffic accident on the turnpike. We've several seriously injured people, including a bad chest case. That's the one Dr. Clifford would like your help with."

"Tell him I'll be right there." Bartlett replaced the phone. "Sorry, Lucy. Have to finish some other time." He moved to the doorway, then paused. "I'll tell you one thing, though - I don't think I'll worry about unemployment. As long as they go on building bigger and faster motorcars there'll always be a place for surgeons."

He went out and, with a friendly nod to Lucy, O'Donnell followed him. Alone, Lucy paused a moment, then picked up the telephone again. When the operator answered, "I want a long-distance call, please," she said, reaching for the slip of paper. "It's person-to-person - Salem, Oregon."

Threading the corridor traffic with the skill of long practice, Kent O'Donnell headed briskly for his own office in the hospital. He too had a full schedule ahead. In less than half an hour he was due on the operating floor; later there was a meeting of the medical executive committee, and after that he had several patients to see downtown, a program which would take him well into the evening.

As he walked he found himself thinking once more of Lucy Grainger. Seeing her, being as close as they were a few moments ago, had set him wondering again about Lucy and himself. But now the old familiar doubts - the feeling that perhaps their interests had too much in common for any permanent relationship - came crowding back.

He wondered why he had thought so much about Lucy lately - or any woman for that matter. Perhaps it was because the early forties were traditionally a restive time for men. Then he smiled inwardly, recollecting that there had seldom been a period when occasional love affairs - of one kind or another - had not come naturally to him. Nowadays they were merely spaced more widely apart. Also, of necessity, he was obliged to be considerably more discreet than in his younger years.

From Lucy his thoughts switched to Denise Quantz. Since the invitation to call her, which she had given him the night they had met at Eustace Swayne's house, O'Donnell had confirmed his attendance at a surgeons' congress in New York. It occurred to him that the date was next week; if he were to meet Mrs. Quantz, he had better make the arrangements soon.

As he turned into his office the clock over his desk showed twenty minutes before his first operation was scheduled. He picked up the telephone, telling himself it was always a good idea to do things when you thought of them.

He heard the operator trace the number through New York Information, then there was a ringing tone and a click. A voice said, "This's Mrs. Quantz's apartment."

"I have a long-distance call for Mrs. Denise Quantz," the Burlington operator said.

"Mrs. Quantz's not here now."

"Do you know where she can be reached?" The telephone company's ritual was in motion.

"Mrs. Quantz's in Burlington, Pennsylvania. Do you wish the number there?"

"If you please." It was the Burlington operator again.

"The number is Hunter 6-5735."

"Thank you, New York." There was a click, then the operator said, "Did you get that number, caller?"

"Yes, thank you," O'Donnell said, and hung up.

With his other hand he had already reached for the Burlington phone directory. He thumbed through it until he came to "Swayne, Eustace R." As he had expected, the number listed was the one he had just been given.

Lifting the phone, he dialed again.

A male voice said, "Mr. Eustace Swayne's residence."

"I'd like to speak with Mrs. Quantz."

"One moment, please."

There was a pause. Then, "This is Mrs. Quantz."

Until this moment O'Donnell had forgotten how much her voice had attracted him before. It had a soft huskiness, seeming to lend grace to the simplest words.

"I wonder if you remember," he said. "This is Kent O'Donnell."

"Of course! Dr. O'Donnell, how nice to hear from you!"

He had a sudden vision of her beside the telephone, the soft dark hair tumbled about her shoulders. Then he said, "I just called you in New York. They gave me the number here."

"I flew down last night," Denise Quantz said. "Father had a touch of bronchitis. I thought I'd stay with him for a day or two."

He asked courteously, "It's not too serious, I hope?"

"Not really." She laughed. "My father has the constitution of a mule - as well as the obstinacy."

He thought: I can believe that. Aloud he said, "I was going to ask you to have dinner with me in New York. I expect to be there next week."

"You can still ask me." The reply was prompt and definite. "I'll be back by then."

On impulse he said, "Possibly I could anticipate. Do you have a free evening in Burlington?"

After a moment's pause she said, "Tonight would be the only time."

O'Donnell calculated quickly. His office appointments would go on until seven. But if nothing else came up . . .

His thoughts were interrupted. "Oh, wait!" It was Denise Quantz again. "I'd forgotten. Dr. Pearson is having dinner with my father; I think I ought to stay." She added, "Unless you'd care to join us?"

Mentally he chuckled. Joe Pearson might be surprised to find him there. Instinct, though, told him it was not a good idea. He said, "Thank you, but I think perhaps we'd better postpone it."

"Oh dear." Her voice sounded disappointed; then she brightened. "I could meet you after dinner if you like. Father and Dr. Pearson are sure to get into one of their chess games, and when they do that anyone else might just as well not be there."

He found himself suddenly delighted. "That would be wonderful. What time will you be free?"

"About nine-thirty, I imagine."

"Shall I call for you?"

"It would probably save time if we met downtown. You tell me where."

He thought for a moment, then said, "The Regency Room?"

"All right; at half-past nine. Good-by now."

As O'Donnell replaced the phone he had a pleasant sense of anticipation. Then he glanced at the clock again. He would have to hurry if he were to be in the O.R. on time.

The after-dinner chess game between Eustace Swayne and Dr. Joseph Pearson had been in progress for forty minutes. The two old men faced each other across a low rosewood games table in the same paneled library where, three weeks earlier, O'Donnell and Swayne had had their verbal joust. Only two lights were burning in the room - one from a single pendant shade immediately above the table, the other a dimly glowing rococo lamp by the hallway door.

Both men's faces were in shadow, the light between them playing directly on the inlaid chessboard in the table's center. Only when one or the other leaned forward to make a move in the game were their features defined momentarily by the lamplight's outer edges.

At this moment both were still, the room's deep silence hovering like a padded mantle over the pair of Louis XV beechwood wing chairs in which they sat. Eustace Swayne had leaned back. Holding a brandy glass of ruby crystal lightly between his fingers, he surveyed the game as it had progressed so far.

The previous move had been Dr. Joseph Pearson's. A minute or two ago, gently cradling the white queen from the exquisitely carved Indian-ivory chess set, he had moved the piece a single square ahead.

Now, putting down the brandy glass, Eustace Swayne selected a pawn from his far right wing and transferred it two squares forward. Then gruffly, breaking the silence, he said, "There have been changes at the hospital, I hear."

Beyond the lamplight, Joe Pearson studied the chessboard. When he was ready he leaned forward and moved a pawn on his left wing one square forward, countering the other's advance. Only then did he grunt the one word, "Some."

Again the silence, peace, the sense of time halted. Then the old tycoon stirred in his chair. "Do you approve these changes?" He reached forward and slid his bishop diagonally two squares to the right. Half humorously he glanced across the table in the semi-darkness. His expression said: Beat that line-up if you can.

This time Joe Pearson answered before he made his move. "Not entirely." He remained in shadow, studying the other's gambit, pondering the alternatives ahead. Then, slowly, still handling the pieces tenderly, he moved his rook one square to the left, dominating an open line.

Eustace Swayne waited. A minute passed, two minutes, then three. Finally his hand reached out for his rook and made a similar move to the same open line, meeting his opponent's challenge. Then he said, "You have a means of veto for the future if you choose to exercise it."

"Oh? What kind of veto?" The question was casual but the action which accompanied it swift. Pearson picked up his queen's knight and swung it over the pieces, lodging it on a central square.

Studying the board, assessing the strength of his own position, Swayne said, "I've told Orden Brown - and your chief of surgery - I'm willing to give a quarter million dollars to the building fund." With the last word he made a corresponding move to Pearson's, sending his king's knight forward until it reached the square beside the strongly lodged knight of his opponent.

A long silence this time. At the end of it the pathologist took his bishop and, swooping down the board, removed an opposing pawn. He said quietly, "Check." Then, "That's a lot of money."

"I've attached a condition." Swayne, on the defensive now, moved his king one square to the right. "The money will only be given if you remain free to run your own department in the hospital the way you want for as long as you choose."

This time Joe Pearson made no move. He seemed to be musing, looking away into the darkness over the other man's head. Then he said simply, "I'm touched." His eyes returned to the chessboard. After a while he lifted his knight to a square so that the piece attacked Swayne's now cramped king.

Eustace Swayne had watched the action carefully. But before making his own move he reached for a brandy decanter, filled Pearson's glass and then his own. Putting the decanter down, "It's a young man's world," he said, "and I suppose it always has been. Except that sometimes old men still have power . . . and the sense to use it." Then, his eyes glinting, he reached down, picked up the pawn in front of his king, and with it captured the troublesome knight.

Thoughtfully Pearson stroked his chin with thumb and forefinger. Then he selected his queen, moved it six squares down the open file, and captured the black king's pawn. "You say . . . Orden Brown, O'Donnell . . . they know this?"

"I made it plain." The old tycoon took his king's bishop and captured his opponent's bishop on king's knight five.

Suddenly Joe Pearson chuckled. There was nothing to show whether the game or the conversation had caused his amusement. But swiftly he reached out. He moved his queen beside the black king. Then, softly, "Checkmate!"

Though defeated, caught unawares, Eustace Swayne had watched admiringly. He nodded, as if to confirm his own judgment.

"Joe," he said, "there's no doubt of it - you're as good a man as ever!"

The music stopped, and the couples on the dance floor of the small but fashionable supper club - one of the few which existed in Burlington - began drifting back to their tables.

"Tell me what you were thinking then," Denise Quantz said. She smiled at Kent O'Donnell across the small black-topped table which divided them.

"Frankly, I was thinking how pleasant it would be to do this again."

Very slightly she raised the glass she was holding. It held the last of her second old-fashioned. "To more thoughts of the same kind."

"I'll drink to that." He finished his own scotch and soda, then signaled a waiter to repeat their order. "Shall we dance?" The music had begun again.

"I'd love to." She rose, turning half toward him as he followed her to the small, dimly lighted dance floor. He held out his arms and she moved into them. They danced close together. O'Donnell had never been an expert dancer; medicine had left him too little time to become accomplished. But Denise Quantz matched every movement to his own. As the minutes went by he could feel her body - tall, willowy - moving obediently, anticipating the music and his own motion. Once her hair brushed lightly against his face; it brought with it a breath of the same perfume he had noticed at their first meeting.

The five-piece orchestra, unobtrusive, its arrangements carefully attuned to the intimate setting, was playing a popular ballad of several years before.

See the Pyramids along the Nile,

Watch the sunrise on a tropic isle,

Just remember, darling - all the while

You belong to me.

For a moment he had a sense of borrowed time, of existing in a vacuum, insulated, away from medicine, Three Counties, all the other things he lived with daily. Then the music changed to a faster tempo, and he smiled at himself for sentimentality.

As they danced he asked, "Do you come here often - to Burlington, I mean?"

"Not really," she answered. "Occasionally, to see my father, but that's all. Frankly it's a city I dislike." Then laughingly, "I hope I'm not offending your civic pride."

"No," he said. "I've no strong views one way or the other. But weren't you born here?" He added, "Denise - if I may."

"Of course. Don't let's be formal." She looked at him directly and flashed a smile. Answering his question, "Yes, I was born here," she said. "I went to school and lived at home. My mother was alive then."

"Then why New York - now?"

"I think I'm a New Yorker by instinct. Besides, my husband lived there; he still does." It was the first time she had mentioned her marriage. She did it now, easily and unself-consciously. "After we separated I found I'd never want to leave. There's no other city quite like it."

"Yes," he said, "I suppose that's true." He was thinking again how beautiful this woman was. She had a composure, a lack of artifice, that younger women could rarely attain. But nothing of her suggested a retreat from femininity; rather the reverse. To Kent O'Donnell, holding her now, her body moving evenly against his own, she seemed infinitely desirable. He suspected she could be extremely sensual.

Deliberately he switched his thoughts away. This was premature. He noticed again, as he had earlier, the gown she had on tonight. Worn off-shoulder, it was a brilliant scarlet, of rich peau de soie, curved closely around her figure and falling into fullness only below the hips. At one and the same time the effect was dramatic, discreet, expensive.

It was a reminder of another thought that had occurred to him this evening for the first time - the fact that Denise was obviously a rich woman. They had arrived at the Regency Room almost together. He had parked his own car and walked to the night club's street entrance when a gleaming Cadillac had pulled up, a uniformed chauffeur hurrying around to open the door for Denise to alight. They had greeted each other, then she had turned to the chauffeur, now standing discreetly in the background. "Thank you, Tom. I don't think you need come back. I expect Dr. O'Donnell will drive me home."

The man had answered courteously, "Thank you, madam," then to O'Donnell, "Good night, sir," and had driven off.

Of course, if he had thought about it, O'Donnell would have realized that the daughter of Eustace Swayne was obviously an heiress. Not that the realization concerned him greatly; his own income nowadays was ample for a comfortable life and more besides. Nevertheless, a really rich woman was something new in his personal experience. Again he found his mind framing the comparison between Denise and Lucy Grainger.

With a modest crescendo the orchestra ended the group of selections. O'Donnell and Denise applauded briefly, then moved from the dance floor. Taking her arm lightly, he steered her to their table. A waiter was hovering; he held out their chairs and served the drinks O'Donnell had ordered.

Sipping the fresh old-fashioned, Denise said, "We talked about me. Now tell me about you."

He poured more soda into his scotch. He liked the liquor well diluted - a practice most waiters seemed to abhor. "It's pretty routine stuff."

"I'm a pretty good listener, Kent." Denise was speaking with half her mind. The other half was thinking: This is a man - all man! Her eyes took in the big frame, broad shoulders, the strong face. She wondered if he would kiss her tonight and what it might lead to later. She decided there were interesting possibilities in Dr. Kent O'Donnell.

O'Donnell told her about Three Counties, his work there, and what he hoped to do. She asked him questions about the past, his experiences, people he had known - admiring all the while the depth of thought and feeling which came through everything he said.

They danced again; the waiter replaced their drinks; they talked; they danced; the waiter returned; the sequence was repeated. Denise told him about her marriage; it had taken place eighteen years ago, had lasted ten. Her husband was a corporation lawyer with a busy practice in New York. There were two children - twins, Alex and Philippa - who had remained in Denise's custody; in a few weeks the children would be seventeen.

"My husband is a perfectly rational being," she said. "It's simply that we were quite incompatible and wasted a lot of time coming to an obvious conclusion."

"Do you ever see him now?"

"Oh, often. At parties and around town. Occasionally we meet for lunch. In some ways Geoffrey is quite delightful. I'm sure you'd like him."

Both of them were talking more freely now. Without waiting to be told, the waiter put fresh drinks in front of them. O'Donnell asked her about divorce; was there some barrier toil?

"Not really." She answered frankly. "Geoffrey is quite willing to divorce me but insists that I supply the evidence. In the state of New York, you know, it has to be adultery. So far I haven't got around to it."

"Has your husband never wanted to remarry?"

She seemed surprised, "Geoffrey? I don't imagine so. In any case, he's married to the law."

"I see."

Denise twirled the stem of her glass. "Geoffrey always considered that bed was a good place in which to read his legal briefs." She said it softly, almost with intimacy. O'Donnell sensed a hint of why the marriage had failed. He found the thought exciting.

The waiter was at his elbow. "Excuse me, sir, the bar is closing in a few minutes. Do you wish to order now?"

Surprised, O'Donnell glanced at his watch. It was almost one o'clock in the morning. Though it seemed much less, they had been together for three and a half hours. He glanced at Denise; she shook her head.

He told the waiter, "No, thank you," and paid the check the man presented. They finished their drinks and prepared to go. The waiter offered a friendly "Good night"; the tip had been generous. O'Donnell had a sense of comfort and well-being.

In the foyer he waited for Denise while an attendant went to the parking lot for his car. When she came she took his arm. "It's such a shame to go. I almost wish we'd had that last drink after all."

He had hesitated, then said lightly, tentatively, "We could stop at my apartment if you like. I have a well-stocked bar, and it's on the way."

For an instant he feared he had been unwise. He thought he detected a sudden coolness, a hint of pained surprise. Then it was gone. She said simply, "Why don't we do that?"

Outside the Buick was waiting, the doors held open, the motor running. Going across town, he drove carefully, more slowly then usual, aware he had had a good deal to drink. It was a warm night and the car windows were down. From the other side of the front seat he caught a subtle breath of perfume once again. At his apartment he parked the car on the street and they went up in the elevator.

When he had mixed drinks he took them across and gave the old-fashioned to Denise. She was standing by an open window in the living room, looking out at the lights of Burlington below. The river which ran through the city cut a deep swath of darkness between both its banks.

Standing beside her, he said quietly, "It's been a while since I mixed an old-fashioned. I hope it isn't too sweet."

She sipped from the glass. Then softly, huskily, "Like so much else about you, Kent, it's absolutely right."

Their eyes met and he reached out for her glass. When he had put it down she came gently, effortlessly, to him. As they kissed his arms tightened around her.

Then stridently, imperiously, in the room behind them a phone bell clamored out. There was no ignoring it.

Gently Denise disengaged herself. "Darling, I think you'd better answer it." She touched his forehead gently with her lips.

As he crossed the room he saw her gather up her purse, stole, and gloves. It was obvious the evening was over. Almost angrily he picked up the phone, answered curtly, and listened. Then the anger dissolved. It was the hospital - the night-duty intern. One of O'Donnell's own patients had developed symptoms which appeared to be serious. He asked two swift questions, then, "Very well, I'll come at once. Meanwhile, alert the blood bank and prepare for a transfusion." He broke the connection, then called the night porter to get a taxi for Denise.