The Final Diagnosis

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.

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.”