The Final Diagnosis

O’Donnell heard the words, “Can’t get any satisfaction,” then Tomaselli was talking again.

“No, Mr. Bryan, I don’t remember the particular case. But I will make some inquiries. I promise you that.” He listened, then answered, “Yes, sir, I do know what a hospital bill means to a family. But the hospital doesn’t make any profit, you know.”

O’Donnell could still hear the voice on the telephone, but it sounded calmer, responding to Tomaselli’s conciliatory approach. Now the administrator said, “Well, sir, it’s the physician who decides how long a patient remains in hospital. I think you should have another talk with your wife’s physician, and what I’ll do meanwhile is have our treasurer go over your bill, item by item.” He listened briefly, then, “Thank you, Mr. Bryan. Good-by.”

He hung up the phone, tore off the page of notes, and put it in a tray marked “Dictation.”

“What was the trouble?” O’Donnell asked the question casually. In a busy hospital complaints about service and charges were not unique.

“He claims his wife was kept in too long. Now he has to go into debt to pay the bill.”

O’Donnell said sharply, “How does he know she was in too long?”

“He says he’s checked around—whatever that means.” Tomaselli said thoughtfully, “It may have been necessary, of course, but she was here nearly three weeks.”

“So?”

“Normally I wouldn’t think much about it. But we’ve had an unusual number of these complaints. They’re not always as strong as this—but on the same lines.”

Something flashed through O’Donnell’s mind: the word Pathology. Aloud he said: “Who was the attending physician?”

Tomaselli glanced at his notes. “Reubens.”

“Let’s see if we can get him and clear this up now.”

Tomaselli touched an intercom set. “Kathy,” he said, “see if you can locate Dr. Reubens.”

They waited in silence. From the corridor outside they could hear a soft voice on the hospital public-address system. “Dr. Reubens. Dr. Reubens.” After a moment the phone buzzed. Tomaselli lifted the receiver and listened. Then he passed it to O’Donnell.

“Reub? It’s Kent O’Donnell.”

“What can I do for you?” O’Donnell could hear the thin, precise voice of Reubens, one of the senior surgeons, at the other end of the line.

“Do you have a patient”—he looked at Tomaselli’s notes which the administrator had pushed toward him—“a Mrs. Bryan?”

“That’s right. What’s the matter? Has her husband been complaining?”

“You know about it then?”

“Of course I know about it.” Reubens sounded annoyed. “Personally I think he has good reason to complain.”

“What’s the story, Reub?”

“The story is that I admitted Mrs. Bryan for possible carcinoma of the breast. I removed a tumor. It turned out to be benign.”

“Then why keep her here for three weeks?” As he asked, O’Donnell remembered that you always had to go through this question-and-answer performance with Reubens. The other man seldom volunteered information.

Now he answered, “You’d better ask Joe Pearson that!”

“Be simpler if you told me, Reub.” O’Donnell was quietly insistent. “After all, she’s your patient.”

There was a silence. Then the thin, clipped voice said, “All right. I told you the tumor was benign. But it was two and a half weeks before I found out. That’s how long it took Pearson to get it under his microscope.”

“Did you remind him about it?”

“If I called him once I called him half a dozen times. He’d probably have been longer if I hadn’t kept after it.”

“And that’s why you kept Mrs. Bryan in—for three weeks?”

“Naturally.” The voice on the phone took on a note of sarcasm. “Or are you suggesting I should have discharged her?”

There was reason for Reubens to be sour on the subject, O’Donnell thought. Unquestionably he had been put in a difficult position. If he had discharged the patient, he might have had to call her back for more surgery, as had happened to Bill Rufus. On the other hand, every additional day in hospital meant an extra financial burden for the family. He answered noncommittally, “I’m not suggesting anything, Reub. Just making some inquiries.”

The thing had obviously been on Reubens’ mind. “Then you’d better talk to some of the other men,” he said. “I’m not the only one this has happened to. You know about Bill Rufus?”

“Yes, I know. Frankly, I thought things had been improving a little.”

“If they have, it’s not so’s you’d notice it. What do you propose to do about Bryan’s bill?”

“I doubt if we can do anything. After all, his wife was here for three weeks. Hospital money is tight, you know.” O’Donnell wondered what Reubens’ reaction would be when he heard he was being asked to give six thousand dollars himself to the hospital building fund.

“It’s too bad. Husband’s a decent little guy—a carpenter or something like that, works for himself. He didn’t have any insurance. This’ll set ’em back for a long time.” O’Donnell made no answer. His mind was already running ahead, thinking of what came next. Again the thin voice on the phone: “Well, is that all?”

“Yes, Reub; that’s all. Thanks.” He handed the telephone back to Harry Tomaselli.

“Harry, I want a meeting this afternoon.” O’Donnell had made up his mind what had to be done. “Let’s try to get half a dozen of the senior people on staff. We’ll meet here, if that’s convenient, and I’d like you to be here too.”

Tomaselli nodded. “Can do.”

O’Donnell was checking over names in his mind. “We’ll want Harvey Chandler, of course, as chief of medicine. Better have Bill Rufus, and Reubens should be included, I think.” He paused. “Oh yes, and Charlie Dornberger. He might be useful. How many is that?”

The administrator checked the names he had written. “Six with you and me. How about Lucy Grainger?”

Briefly O’Donnell hesitated. Then he said, “All right. Let’s make it seven then.”

“Agenda?” Tomaselli had his pencil poised.

O’Donnell shook his head. “We won’t need one. There’s just one subject—changes in Pathology.”

When the administrator had mentioned Lucy Grainger’s name, O’Donnell had hesitated for one reason only: it had reminded him of a meeting between himself and Lucy the night before.

They had met for dinner—the outcome of O’Donnell’s invitation to Lucy the day of the mortality conference—and in the Palm Court of the Roosevelt Hotel they had had cocktails, then a leisurely meal. It had been a pleasant, relaxed occasion, and they had talked lightly of themselves, of people they had known, and their own experiences in and out of medicine.

Afterward O’Donnell had driven Lucy home. She had recently moved into Benvenuto Grange, a large, fashionable apartment block on the north side of town. She had said, “You’ll come in for a nightcap, of course?”

He had left his car for the uniformed doorman to park and followed her. They rode the gleaming, silent elevator to the fifth floor, then turned down a birch-paneled corridor, their footsteps silenced in deep broadloom. He had raised his eyebrows and Lucy smiled. “It is a little awesome, isn’t it? I’m still impressed myself.”

She had used her key to open a door and inside touched a switch. Tasteful, subdued lighting sprang up around an elegant interior lounge. He could see the partly opened door of a bedroom directly ahead. “I’ll mix us a drink,” she said.

Her back was to him. Ice clinked in glasses. O’Donnell said, “Lucy, you’ve never married?”

“No.” She had answered without turning.

He said softly, “I’ve sometimes wondered why.”

“It’s very simple really. It’s quite some time since I was asked.” Lucy turned, carrying the drinks she had mixed. She gave O’Donnell his, then moved to a chair. She said thoughtfully, “Now I think of it, there was only one occasion—at least, only one that mattered. I was a good deal younger then.”

O’Donnell sipped his drink. “And your answer was ‘no’?”

“I wanted a career in medicine. At the time it seemed terribly important. That and marriage didn’t seem to go together.”

He asked casually, “Any regrets?”

Lucy considered. “Not really, I suppose. I’ve achieved what I wanted, and it’s been rewarding in many ways. Oh, sometimes one wonders how things would have turned out with a different decision, but after all, that’s human, isn’t it?”

“I suppose so.” O’Donnell was conscious of being strangely moved. There was a sense of depth and tenderness about Lucy, a feeling of peacefulness and coming home. She should have children, he thought. He had asked, “Do you still feel the same way about marriage and medicine—for you, that is?”

“I’m no longer dogmatic about anything.” She smiled. “That, at least, I’ve learned.”

O’Donnell wondered what, from his own point of view, marriage to Lucy would be like. Would there be love and mellowness? Or had each of their careers gone parallel too far and too long for change and adjustment now. If married, how might they spend their hours of leisure? Would the talk be intimate and domestic? Or would it be of hospital affairs, with charts on the table at dinner and diagnostic problems for dessert? Would he perhaps, instead of gaining sanctuary, find merely another offshoot of medicine and his daily work. Aloud he said, “I’ve always thought, you know, that we have a good deal in common.”

“Yes, Kent,” Lucy answered, “so have I.”

O’Donnell had finished his drink, then risen to leave. He realized they had both said a good deal more than had passed in words. Now he wanted time to think and to reason things through. Too much was involved for hasty decisions.

“There’s really no need to go, Kent. Stay if you wish.” Lucy had said it simply, and he knew if he stayed it would be up to him what happened next.

Part of his mind had told him to remain, but caution and habit won out. He took her hands. “Good night, Lucy. Let’s think about all this.”

When the elevator doors had closed she was still standing at the open apartment door.

Six

“I asked you here,” O’Donnell told the group around the board-room table, “because I’d like your support in something I want to do.” The others were listening attentively. Of those they had asked, all had come except Reubens, who had a herniorrhaphy scheduled. O’Donnell went on, “I think we all know there’s a problem in Pathology. I believe, too, you’ll agree it’s a personal problem as well as medical.”