The Final Diagnosis
In the pathology office the telephone bell jangled sharply and Pearson reached out for the receiver. Then, his face pale, nervousness showing, he stopped. He said to Coleman, "You take it."
As David Coleman crossed the room there was a second impatient ring. A moment later he was saying, "Dr. Coleman speaking." He listened, expressionless, then said, "Thank you," and hung up.
His eyes met Pearson's. He said quietly, "The baby just died."
The other man said nothing. His eyes dropped. Slouched in the office chair, the lined, craggy face half in shadow, his body motionless, he seemed aged and defeated.
Coleman said softly, "I think I'll go to the lab. Someone should talk with John."
There was no answer. As Coleman left the pathology office, Pearson was still sitting, silent and unmoving, his eyes unseeing, his thoughts known only to himself.
Carl Bannister had gone out of the lab when David Coleman came in. John Alexander was there alone, seated on a stool before one of the wall benches, the lab clock immediately above his head. He made no attempt to turn around as Coleman approached, his footsteps slow, the leather of his shoes creaking as he crossed the floor.
There was a silence, then, still without turning, Alexander asked softly, "It's . . . over?"
Without answering Coleman reached out his hand. He let it rest on the other's shoulder.
His voice low, Alexander said, "He died, didn't he?"
"Yes, John," Coleman said gently, "he died. I'm sorry."
He withdrew his hand as Alexander turned slowly. The younger man's face was strained, the tears streaming. He said, softly but intensely, "Why, Dr. Coleman? Why?"
Groping for words, he tried to answer. "Your baby was premature, John. His chances were not good - even if . . . the other . . . hadn't happened."
Looking him directly in the eyes, Alexander said, "But he might have lived."
This was a moment of truth in which evasion had no place. "Yes," Coleman said. "He might have lived."
John Alexander had risen to his feet. His face was close to Coleman's, his eyes imploring, questioning. "How could it happen . . . in a hospital . . . with doctors?"
"John," Coleman said, "at this moment I haven't any answer for you." He added softly, "At this moment I haven't any answer for myself."
Alexander nodded dumbly. He took out a handkerchief and wiped his eyes. Then he said quietly, "Thank you for coming to tell me. I think I'll go to Elizabeth now."
Kent O'Donnell had not spoken during his progress through the hospital with Dr. Dornberger; the intense anger and frustration, which had engulfed him like a wave as he had looked down at the dead child, kept him tight-lipped and silent. As they swept through corridors and pattered down stairways, eschewing the slow-moving elevators, bitterly once more O'Donnell reviled himself for his own inaction about Joe Pearson and the pathology department of Three Counties. God knows, he thought, there had been plenty of danger signs: Rufus and Reubens had warned him, and he had had the evidence of his own eyes to tell him Pearson was failing with his years, his responsibilities growing beyond him in the busy, expanded hospital. But no! He, Kent O'Donnell, M.D., F.R.C.S. (Eng.), F.A.C.S., chief of surgery, medical-board president - off with your hats for a fine, big man! "Send him victorious, happy and glorious, long to reign over us, God save O'Donnell!" - he had been too preoccupied to bestir himself, to use the toughness his job demanded, to face the unpleasantness which was bound to follow action. So, instead, he had looked the other way, pretended all was well, when experience and instinct had told him deep inside he was only hoping that it would be. And where had he been all this time - he, the great man of medicine? Wallowing in hospital politics; supping with Orden Brown; fawning on Eustace Swayne, hoping that by inaction, by permitting a status quo, by leaving Swayne's friend Joe Pearson severely alone, the old tycoon would graciously come through with money for the fancy new hospital buildings - O'Donnell's dream of empire, with himself as king. Well, the hospital might receive the money now, and again it might not. But whether it did or didn't, one price, at least, had already been paid. He thought: You'll find the receipt upstairs - a small dead body in an O.R. on the fourth floor. Then, as they came to Pearson's door, he felt his anger lessen and sorrow take its place. He knocked, and Dornberger followed him in.
Joe Pearson was still sitting, exactly as Coleman had left him. He looked up but made no attempt to rise.
Dornberger spoke first. He spoke quietly, without antagonism, as if wanting to set the mood of this meeting as a service to an old friend. He said, "The baby died, Joe. I suppose you heard."
Pearson said slowly, "Yes. I heard."
"I've told Dr. O'Donnell everything that happened." Dornberger's voice was unsteady. "I'm sorry, Joe. There wasn't much else I could do."
Pearson made a small, helpless gesture with his hands. There was no trace of his old aggressiveness. He said expressionlessly, "It's all right."
Matching his tone to Dornberger's, O'Donnell asked, "Is there anything you want to say, Joe?"
Twice, slowly, Pearson shook his head.
"Joe, if it were just this one thing . . ." O'Donnell found himself searching for the right words, knowing they did not exist. "We all make mistakes. Maybe I could . . ." This was not what he had intended to say. He steadied his voice and went on more firmly. "But it's a long list. Joe, if I have to bring this before the medical board, I think you know how they'll feel. You could make it less painful for yourself, and for all of us, if your resignation were in the administrator's office by ten o'clock tomorrow morning."
Pearson looked at O'Donnell. "Ten o'clock," he said. "You shall have it."
There was a pause. O'Donnell turned away, then back. "Joe," he said, "I'm sorry. But I guess you know, I don't have any choice."
"Yeah." The word was a whisper as Person nodded dully.
"Of course, you'll be eligible for pension. It's only fair after thirty-two years." O'Donnell knew, as he said them, the words had a hollow ring.
For the first time since they had come in Pearson's expression changed. He looked at O'Donnell with a slight, sardonic smile. "Thanks."
Thirty-two years! O'Donnell thought: My God! It was most of any man's working life. And to have it end like this! He wanted to say something more: to try to make it easier for them all; to find phrases in which to speak of the good things Joe Pearson had done - there must be many of them. He was still debating how when Harry Tomaselli came in.
The administrator had entered hurriedly, not waiting to knock. He looked first at Pearson, then his glance took in Dornberger and O'Donnell. "Kent," he said quickly, "I'm glad you're here."
Before O'Donnell could speak Tomaselli had swung back to Pearson. "Joe," he said, "can you come to my office immediately? There's an emergency staff meeting in an hour. I'd like to talk with you first."
O'Donnell said sharply, "An emergency meeting? What for?"
Tomaselli turned. His expression was serious, his eyes troubled. "Typhoid has been discovered in the hospital," he announced. "Dr. Chandler has reported two cases, and there are four more suspected. We've an epidemic on our hands and we have to find the source."
As Elizabeth looked up the door opened and John came in. He closed the door, then stood for a moment with his back against it.
There was nothing said, only with their eyes - grief, entreaty, and an overwhelming love.
She held out her arms and he came into them.
"Johnny! Johnny, darling." It was all she could murmur before she began to cry softly.
After a while, when he had held her tightly, he moved back, then dried her tears with the same handkerchief he had used for his own.
Later still he said, "Elizabeth, honey, if you're still willing, there's something I'd like to do."
"Whatever it is," she answered, "it's 'yes.' "
"I guess you always wanted it," he said. "Now I want it too. I'll write for the papers tomorrow. I'm going to try for medical school."
Mike Seddons got up from the chair and paced around the small hospital room. "But it's ridiculous," he said heatedly. "It's absurd; it isn't necessary, and I won't do it."
"For my sake, darling. Please!" From the bed Vivian eased herself around so that her face was toward him.
"But it isn't for your sake, Vivian. It's just some damn silly, stupid idea you might have got out of a fourth-rate sentimental novel."
"Mike darling, I love you so much when you get mad. It goes with your beautiful red hair." She smiled at him fondly as, for the first time, her mind moved away from immediate things. "Promise me something."
"What?" He was still angry, the answer curt.
"Promise me that when we're married sometimes you'll get mad - really mad - so we can have fights, then afterward enjoy the fun of making up."
He said indignantly, "That's just about as daft a suggestion as the other one. And anyway, what's the point of talking about getting married when you want me to stay away from you?"
"Only for a week, Mike dear. Just one week; that's all."
"No!"
"Listen to me, darling." She urged, "Please come and sit down. And listen to me - please!"
He hesitated, then returned reluctantly to the chair at the side of the bed. Vivian let her head fall back on the pillows, her face turned sideways toward him. She smiled and reached out her hand. He took it gently, his anger dissolving. Only a vague, disquieting sense of doubt remained.
It was the fourth day since Vivian had returned from surgery, and in the meanwhile her progress had been good. The stump of her thigh was healing well; there was still some localized pain and inevitable soreness, but the big and overwhelming agony of the first two days of recovery had eased, and yesterday Dr. Grainger, with Vivian's knowledge and agreement, had withdrawn the order for injections of demerol which had helped dim the pain over the worst period, now behind. Only one thing Vivian found distressing - a surprising thing that she had not anticipated. The foot of her amputated leg - a foot that was no longer there - itched frequently with a malicious, recurring torment; it was anguish not to be able to scratch it. At first when the feeling came she had groped with her remaining foot for the sole of the other. Then for a while, lightheadedly, she had begun to believe that there had been no amputation after all. It was only when Dr. Grainger had assured her that the sensation was entirely normal and something experienced by most people who had any limb removed that she realized her belief was illusory. Nevertheless, it was an uncanny feeling which Vivian hoped would disappear soon.
Psychologically, too, her progress appeared to be good. From the moment when, the day before surgery, Vivian had accepted the inevitable with the simple courage that had so impressed itself on Mike Seddons the mood had continued and upheld her. There were still moments of blackness and despair; they came to her when she was alone, and twice, waking at night, with the hospital around her quiet and eerie, she had lain crying silently for what had been lost. But mostly she banished the moods, using her innate strength to rise above them.
Lucy Grainger was aware of this and was grateful; it made easier her own task of supervising the healing process. Nonetheless, Lucy knew that for Vivian the real test of her emotions and spirit lay somewhere still ahead. That test would come after the initial shock had passed, when the real significance of events had had time to develop more gradually in Vivian's mind and when the implications for the future were closer and more real. Perhaps the moment might not come for six months or even a year; but sooner or later it would, and Lucy knew that at that time Vivian would pass through the deep darkness of despair to some permanent attitude of mind beyond, whatever that might be. But that was for the future; for the present the short-term prognosis seemed reasonably bright.
Lucy knew, of course - and was aware that Vivian knew it too - that the possibility remained that the osteogenic sarcoma which Dr. Pearson had diagnosed might have metastasized ahead of the amputation, spreading its creeping malignancy elsewhere in Vivian's body. In that case there would be little more that Three Counties Hospital, or medicine generally, could do for Vivian beyond temporary, palliative relief. But later would be time enough to learn if that were true. For the patient's sake it seemed best and wisest at this moment to assume that for Vivian the future stretched indefinitely ahead and to help her adapt to it actively.
Today, also, Vivian's beginning of recovery was reflected in her appearance. For the first time since her return from surgery she had put on make-up, bringing color to her face. Earlier her mother had come in to help arrange her hair, and now, wearing the same nightgown which on a previous occasion had come close to stirring Mike to indiscretion, much of her youthful loveliness was back on view.
Now, as Mike took her hand, she said, "Don't you understand, darling, I want to be sure - sure for my own sake as much as for yours."
"But sure of what?" On Mike Seddons' cheeks there were two points of high color.
She said levelly, "Sure that you really love me."
"Of course I love you." He asked vehemently, "Haven't I been telling you that for the past half-hour? Haven't I said that I want us to marry - as we arranged to before" - he hesitated - "before this happened? Even your mother and father are in favor of it. They've accepted me; why can't you?"
"Then why . . . ?"
She pleaded, "Please, Mike. Hear me out. You said you would."
Impatiently he said, "Go on."
"Whatever you may say, Mike, I'm not the same girl you met that first time we saw each other. I can't be, ever again." She went on softly, intensely, "That's why I have to be sure - sure that you love me for what I am and not for what I was. Don't you see, darling, if we're going to spend the rest of our lives together, I couldn't bear to think - not later on, not ever - that you married me . . . out of pity. No, don't stop me; just listen. I know you think it isn't true, and perhaps it isn't; and I hope it isn't - with all my heart. But, Mike, you're kind and generous, and you might even be doing this - for that reason - without admitting it to yourself."
He snapped back, "Are you suggesting I don't know my own motives?"
Vivian answered softly, "Do any of us really know?"
"I know mine." He took her hands gently, their faces close. "I know that I love you - whole or in part, yesterday, today, or tomorrow. And I know that I want to marry you - without doubts, without pity, without waiting one day longer than we have to."
"Then do this one thing for me - because you love me. Go away from me now, and even though you're in the hospital, don't come back to see me for one week - seven whole days." Vivian looked at him levelly. She went on quietly, "In that time think of everything - of me, what our life would be like together; how it would be for you - living with a cripple; the things we couldn't share and those we could; our children - how it would affect them, and through them, you; everything, Mike - everything there is. Then when you've done that, come back and tell me, and if you're still sure, I promise that I'll never question you again. It's just seven days, darling - seven days out of both our lives. It isn't very much."
"Goddam," he said, "you're obstinate."
"I know." She smiled. "You'll do it then?"
"I'll do it for four days - no more."
Vivian shook her head. "Six - no less."
"Make it five," he said, "and you've got a deal."
She hesitated and Mike said, "It's positively my best offer."
Vivian laughed; it was the first time she had. "All right. Five days from this moment."
"Like hell from this moment!" Mike said. "Maybe ten minutes from now. First I've got a little storing up to do. For a young fellow with my hot blood five days is a long time."
He moved the bedside chair closer, then reached out. It was a long kiss, alternately passionate and tender.
At the end Vivian made a grimace and broke away. She sighed and eased herself to a new position in the bed.
Mike inquired anxiously, "Is something wrong?"
Vivian shook her head. "Not really." Then she asked him, "Mike, where have they got my leg - the gone one, I mean?"
He seemed startled, then told her, "In Pathology - in a refrigerator, I expect."
Vivian drew in a long breath, then expelled it slowly. "Mike darling," she said, "please go downstairs and scratch the foot."
The hospital's board room was crowded. News of the emergency meeting had gone swiftly around the hospital, and physicians not attending Three Counties that day had been notified in their downtown offices and at home. Rumors of Joe Pearson's downfall and his impending departure had also traveled with equal speed and had been the subject of a buzz of discussion which had quieted as Pearson entered, the administrator and David Coleman with him.
Kent O'Donnell was already at the head of the long walnut table. Glancing around, he could see most of the familiar faces. Gil Bartlett, his beard wagging rapidly, was chatting with Roger Hilton, the young surgeon who had joined Three Counties' staff a month or two ago. John McEwan, the e.n.t. specialist, was in what appeared to be a heated discussion with Ding Dong Bell and fat Lewis Toynbee, the internist. Bill Rufus, a tie of brilliant green and yellow marking him out from the crowd, was about to seat himself in the second row of chairs. Immediately in front, looking over a page of handwritten notes, was Dr. Harvey Chandler, chief of medicine. There were several members of the house staff, and among them O'Donnell noticed McNeil, the pathology resident. Alongside the administrator, attending the meeting by special request, was Mrs. Straughan, the chief dietitian. Nearby was Ernie Reubens, who appeared to be quizzically appraising the dietitian's quivering, voluptuous breasts. Absent from the meeting was the familiar figure of Charlie Dornberger, who had already made known his intention to retire immediately.
Looking toward the door, O'Donnell saw Lucy Grainger come in; she caught his eye and smiled slightly. Seeing Lucy was a reminder of the personal decision about his own future which, when all this was settled and done, he had still to face. Then suddenly he realized that since this morning he had not once thought of Denise. The hospital activity had driven all awareness of her from his mind, and he knew that for the next day or two, anyway, there would be other occasions when the same thing would be true. O'Donnell wondered how Denise herself would react about taking second place to medical affairs. Would she be understanding? As understanding, say, as Lucy would be? Fleeting as the thought was, it made him uncomfortable, as if by the mental comparison he had been disloyal. For the moment he preferred to think of present things. Now, he decided, it was time the meeting began.
O'Donnell rapped for silence, then waited until the talk stilled and those who had been standing had slipped into their seats. He began quietly. "Ladies and gentlemen, I think all of us are aware that epidemics in hospitals are not unique and, in fact, are a good deal more frequent than most members of the public realize. In a way, I suppose, one might say that epidemics are a hazard of our existence. When one considers how many diseases we harbor inside these walls, it's surprising, really, there are not more." All eyes in the room were upon him. He paused for a moment, then continued. "I have no wish to minimize what has happened, but I want us to keep a sense of proportion. Dr. Chandler, perhaps you'd be kind enough to lead off."
As O'Donnell sat down the chief of medicine rose to his feet.
"To begin with, let's summarize." Harvey Chandler was holding his page of notes, and his glance moved theatrically around the room. Harvey's enjoying this, O'Donnell thought; but then he always does enjoy attention. The medical chieftain went on, "The picture so far is that we have two definite cases of typhoid and four suspected. All of the cases are hospital employees, and we may count ourselves fortunate that no patients are affected - yet. Because of the number of cases I'm sure it's evident to you, as it is to me, that we have a typhoid carrier somewhere in the hospital. Now, I may say I'm as shocked as everyone else must have been to learn that examination of food handlers here hasn't been done for . . ."
At the mention of food handlers O'Donnell had jolted to attention. Now he cut in, quietly, as politely as he could.
"Excuse me, Doctor."
"Yes?" Chandler's tone made it plain the interruption was not appreciated.
Gently O'Donnell said, "We're going to be dealing with that phase very shortly, Harvey. I wonder if, for the moment, you would outline the clinical aspects."
He could sense the other man's resentment. Harvey Chandler, who was virtually equal to O'Donnell in the hospital hierarchy, did not like this at all. Moreover, Dr. Chandler enjoyed talking at length; he had a reputation for never employing one word where it was possible to use two or three. Now he grumbled, "Well, if you wish, but . . ."
Suavely, but firmly, O'Donnell put in, "Thank you."
Chandler shot him a glance which said: We'll discuss this later in private. Then, after a barely perceptible pause, he went on, "For the benefit of those of you who are not familiar with typhoid - and I realize there will be some, because there isn't too much of it around nowadays - I'll run over the principal early-stage symptoms. Generally speaking, there's a rising fever, chills, and a slow pulse. There's also a low blood count and, naturally, the characteristic rose spots. In addition to all that a patient will probably complain of a dull headache, no appetite, and general aching. Some patients may say they're drowsy in the daytime and that they're restless at night. One thing to look out for also is bronchitis; that's quite common with typhoid, and you may encounter nosebleed too. And, of course, a tender, swollen spleen."
The chief of medicine sat down. O'Donnell asked, "Any questions?"
Lucy Grainger asked, "I take it that typhoid shots are being arranged."
"Yes," Chandler said, "for all employees and staff, also patients who are well enough to have them."
"What about kitchen arrangements?" The question was from Bill Rufus.
O'Donnell said, "If you don't mind, we'll come to that shortly. At this point is there anything more medically?" He looked around; there was a shaking of heads, "Very well, then. We'll hear from Pathology." He announced quietly, "Dr. Pearson."
Until this moment there had been background noises in the room - fidgeting, the movement of chairs, murmurs of conversation aside from the main discussion. But now there was a hush as eyes turned curiously to where, halfway down the long table, Joe Pearson sat. Since entering he had not spoken but had remained quite still, his eyes fixed directly ahead. For once he had no cigar lighted, and the effect was like the absence of a familiar trade-mark. Even now, as his name was called, he made no move.
O'Donnell waited. He was about to repeat the announcement when Pearson stirred. As his chair went back the old pathologist rose to his feet.
Slowly his eyes swept the board room. They went the length of the table, then returned to its head. Looking directly at O'Donnell, Pearson said, "This epidemic should not have happened. Nor would it, if Pathology had been alert to a breakdown in hygiene precautions. It is the responsibility of my department, and therefore my own responsibility, that this neglect occurred."
Again a silence. It was as if history had been made. In this room so many times Joe Pearson had charged others with error and misjudgment. Now he stood himself - accuser and accused.
O'Donnell wondered if he should interrupt. He decided not. Again Pearson looked around him. Then he said slowly, "Having allocated some of the blame, we must now prevent the outbreak going further." He glanced across the table at Harry Tomaselli. "The administrator, the heads of departments, and I have formulated certain procedures to be carried out at once. I will tell you what they are."
Now Pearson paused, and when he resumed there was a stronger note to his voice. It was almost, O'Donnell thought, as if in this single moment the old man were throwing off some of his years, as if providing a glimpse of what he had been like long ago as a younger practitioner - intense, earnest, and competent. The old sardonic humor, the air of borderline contempt, which all of them in this room had come to know so well, were gone. In their place were authority and know-how and the forthright frankness of one who accepts without question the fact that he is speaking with equals.
"The immediate problem," Pearson said, "is to locate the source of infection. Because of the failure to check food handlers properly over the past six months it is logical that we should suspect food as a means of contamination and should begin our search there. For this reason there must be a medical inspection of all food handlers before the next hospital meal is served." From his frayed woolen vest he extracted a watch and placed it on the table. "The time is now 2:15 p.m. That gives us two and three-quarter hours. In that time every employee who has any part in the preparation and serving of hospital food is to be given a thorough physical check. Facilities are being set up now in the outpatient clinics. I understand that all the internists and house staff were notified before this meeting." He glanced around and there was a nodding of heads. "Very well. As soon as we are finished here Dr. Coleman" - Pearson glanced down at David Coleman beside him - "will give you your assignment to a specific room."
Gesturing toward the chief dietitian, Pearson said, "Mrs. Straughan is arranging to assemble all the people concerned, and they will be reporting to Outpatients in batches of twelve. That means ninety-five people to be examined within the time we have.
"When you make these examinations, by the way, remember that the typhoid carrier - and we are assuming there is a carrier - probably has none of the symptoms Dr. Chandler described. What you should look for particularly is any lack of personal cleanliness. And anyone you have doubts about should be suspended from duty for the time being."
Pearson stopped as if thinking. So far he had consulted no notes. Now he went on again. "Of course, we are all aware that physical checkups will not give us the whole story. We may be lucky and find the individual we're looking for that way, but the chances are we won't. Most likely the major work will come in the labs as soon as the medicals are completed. All the people you examine are to be told that stool cultures are required and stool samples must be in the hospital by tomorrow morning." There was the ghost of a smile. "Constipation will not be taken as an excuse; and if anyone can come through with a sample today we will, of course, accept it gratefully.
"The labs are being set up now to cope with all the cultures we shall be doing. Of course, it will take us a few days - two or three at least - to handle all those stool samples."
A voice - O'Donnell thought it was Gil Bartlett's - said quietly, "Ninety-five people! That's a lot of shit." A ripple of laughter ran around the table.
Pearson turned. "Yes," he said, "it is a lot. But we shall do our best."
With that he sat down.
Lucy signaled with her hand, and O'Donnell nodded for her to speak. She asked, "If the source of infection is not found immediately, will we continue to use the hospital kitchens - to serve food here?"
"For the moment - yes," O'Donnell answered.
The administrator added, "My office is checking now to see if there's any outside caterer who could handle food supply if that were felt necessary. I doubt, though, if there's anyone in town who has facilities - at short notice like this - to do it."
Bill Rufus asked, "What's our policy to be on admissions?"
"I'm sorry," O'Donnell said. "I should have mentioned that. As of this moment we've stopped admissions. The admitting department has already been notified. But, of course, we're hoping pathology can track down the source of infection quickly, and then we'll review our admissions policy again. Anything else?"
There were no more questions. Looking down the table, O'Donnell asked, "Dr. Coleman, do you have anything to add?"
David Coleman shook his head. "No."
O'Donnell closed the file which had been open in front of him. "Very well, ladies and gentlemen, I suggest we get started." Then, as chairs scraped back and conversation began, he asked Pearson, "Joe, could I have a word with you?"
Together they crossed to a window, away from the others who were filing out through the door. O'Donnell said quietly, making sure his voice did not carry, "Joe, naturally you'll remain in charge of Pathology during this outbreak. But I think I must make clear to you that, concerning other things, nothing has changed."
Pearson nodded slowly. "Yes," he said, "I'd already figured that."