The Final Diagnosis

O’Donnell reminded him, “The relationship between disease and heredity is far from clear.”

“Strength is of the mind as well as the body,” Eustace Swayne snapped back. “Don’t children inherit the mental characteristics of their parents—and their weaknesses?”

“Not all of the time.” This was between the old tycoon and O’Donnell now. The others sat back, listening.

“But a lot of the time they do. Well, don’t they?”

O’Donnell smiled. “There’s some evidence that way, yes.”

Swayne snorted. “It’s one of the reasons we’ve so many mental hospitals. And patients in them. And people running to psychiatrists.”

“It could also be that we’re more aware of mental health.”

Swayne mimicked him. “It could also be that we’re breeding people who are weak, weak, weak!”

The old man had almost shouted the last words. Now a bout of coughing seized him. I’d better go easily, O’Donnell thought. He probably has high blood pressure.

Just as if O’Donnell had spoken, Eustace Swayne glared across at him. The old man took a sip of brandy. Then, almost malevolently, he said, “Don’t try to spare me, my young medical friend. I can handle all your arguments and more.”

O’Donnell decided he would go on but more moderately. He said, quietly and reasonably, “I think there’s one thing you’re overlooking, Mr. Swayne. You say that illness and disease are nature’s levelers. But many of these things haven’t come to us in the natural course of nature. They’re the result of man’s own environment, conditions he’s created himself. Bad sanitation, lack of hygiene, slums, air pollution—those aren’t natural things; they’re man’s creation.”

“They’re part of evolution and evolution is a part of nature. It all adds up to the balancing process.”

Admiringly O’Donnell thought: You can’t shake the old son of a gun easily. But he saw the chink in the other’s argument. He said, “If you’re right, then medicine is a part of the balancing process too.”

Swayne snapped back, “How do you reason that?”

“Because medicine is a part of evolution.” Despite his good resolution O’Donnell felt his voice grow more intense. “Because every change of environment that man has had produced its problems for medicine to face and to try to solve. We never solve them entirely. Medicine is always a little behind, and as fast as we meet one problem there’s a new one appearing ahead.”

“But they’re problems of medicine, not nature.” Swayne’s eyes had a malicious gleam. “If nature were left alone it would settle its problems before they arose—by natural selection of the fittest.”

“You’re wrong and I’ll tell you why.” O’Donnell had ceased to care about the effect of his words. He felt only that this was something he had to express, to himself as well as to the others. “Medicine has only one real problem. It’s always been the same; it always will. It’s the problem of individual human survival.” He paused. “And survival is the oldest law of nature.”

“Bravo!” Impulsively Amelia Brown clapped her palms together. But O’Donnell had not quite finished.

“That’s why we fought polio, Mr. Swayne, and the black plague, and smallpox, and typhus, and syphilis. It’s why we’re still fighting cancer and tuberculosis and all the rest. It’s the reason we have those places you talked about—the sanatoria, the homes for incurables. It’s why we preserve people—all the people we can, the weak as well as the strong. Because it adds up to one thing—survival. It’s the standard of medicine, the only one we can possibly have.”

For a moment he expected Swayne to lash back as he had before. But the old man was silent. Then he looked over at his daughter. “Pour Dr. O’Donnell some more brandy, Denise.”

O’Donnell held out his glass as she approached with the decanter. There was a soft rustle to her dress, and as she leaned toward him he caught a faint, tantalizing waft of perfume. For a moment he had an absurd, boyish impulse to reach out and touch her soft dark hair. As he checked it she moved over to her father.

Replenishing the old man’s glass, she asked, “If you really feel the way you say, Father, what are you doing on a hospital board?”

Eustace Swayne chuckled. “Mostly I’m there because Orden and some others are hoping I won’t change my will.” He looked over at Orden Brown. “They reckon there can’t be long to wait in any case.”

“You’re doing your friends an injustice, Eustace,” Brown said. His tone contained the right mixture of banter and seriousness.

“And you’re a liar.” The old man was enjoying himself again. He said, “You asked a question, Denise. Well, I’ll answer it. I’m on the hospital board because I’m a practical man. The world’s the way it is and I can’t change it, even though I see what’s wrong. But what someone like me can be is a balancing force. Oh, I know what some of you think—that I’m just an obstructionist.”

Orden Brown interjected quickly, “Has anyone ever said that?”

“You don’t have to.” Swayne shot a half-amused, malicious glance at the board chairman. “But every activity needs a brake on it somewhere. That’s what I’ve been—a brake, a steadying force. And when I’m gone perhaps you and your friends will find you need another.”

“You’re talking nonsense, Eustace. And you’re doing your own motives an injustice.” Orden Brown had evidently decided to be equally direct. He went on, “You’ve done as many good things in Burlington as any man I know.”

The old man seemed to shrink back into his chair. He grumbled, “How do any of us really know our own motives?” Then, looking up, “I suppose you’ll expect a big donation from me for this new extension.”

Orden Brown said smoothly, “Frankly, we hope you’ll see fit to make your usual generous contribution.”

Softly, unexpectedly, Eustace Swayne said, “I suppose a quarter of a million dollars would be acceptable.”

O’Donnell heard Orden Brown’s quickly indrawn breath. Such a gift would be munificent—far more than they had expected, even in their most sanguine moments.

Brown said, “I can’t pretend, Eustace. Frankly, I’m overwhelmed.”

“No need to be.” The old man paused, twirling the stem of his brandy glass. “I haven’t decided yet, though I’ve been considering it. I’ll tell you in a week or two.” Abruptly he turned to O’Donnell. “Do you play chess?”

O’Donnell shook his head. “Not since I was in college.”

“Dr. Pearson and I play a lot of chess.” He was looking at O’Donnell directly. “You know Joe Pearson, of course.”

“Yes. Very well.”

“I’ve known Dr. Pearson for many years,” Swayne said, “in Three Counties Hospital and out of it.” The words were slow and deliberate. Did they have an undertone of warning? It was hard to be sure.

Swayne went on, “In my opinion Dr. Pearson is one of the best-qualified men on the hospital staff. I hope that he stays in charge of his department for many years to come. I respect his ability and his judgment—completely.”

Well, there it is, O’Donnell thought—out in the open and in plain words: an ultimatum to the chairman of the hospital board and the president of the medical board. In as many words Eustace Swayne had said: If you want my quarter million dollars, hands off Joe Pearson!

Later Orden Brown, Amelia, and O’Donnell—seated together in the front seat of the Browns’ Lincoln convertible—had driven back across town. They had been silent at first, then Amelia said, “Do you really think—a quarter of a million?”

Her husband answered, “He’s quite capable of giving it—if he feels inclined.”

O’Donnell asked, “I take it you received the message?”

“Yes.” Brown said it calmly, without embellishment and without seeking to pursue the subject. O’Donnell thought: Thank you for that. He knew this had to be his problem, not the chairman’s.

They dropped him at the entrance to his apartment hotel. As they said good night Amelia added, “Oh, by the way, Kent, Denise is separated but not divorced. I think there’s a problem there, though we’ve never discussed it. She has two children in high school. And she’s thirty-nine.”

Orden Brown asked her, “Why are you telling him all that?”

Amelia smiled. “Because he wanted to know.” She touched her husband’s arm. “You could never be a woman, dear. Not even with surgery.”

Watching the Lincoln move away, O’Donnell wondered how she had known. Perhaps she had overheard him and Denise Quantz saying good night. He had said politely that he hoped he would see her again. She had answered, “I live in New York with my children. Why don’t you call me next time you’re there?” Now O’Donnell wondered if, after all, he might take in that surgeons’ congress in New York next month which a week ago he had decided not to attend.

Abruptly his mind switched to Lucy Grainger and, irrationally, he had a momentary sense of disloyalty. He had gone from the sidewalk to the building entrance when his thoughts were broken by a voice saying, “Good night, Dr. O’Donnell.”

He looked around and recognized one of the surgical residents, Seddons. There was a pretty brunette with him, and her face seemed familiar. Probably one of the student nurses, he thought; she appeared about the age. He smiled at them both and said “Good night.” Then, using his passkey, he went through the glass doors into the elevator.

Vivian said, “He looked worried.”

Seddons answered cheerfully, “I doubt it, bright eyes. When you get to where he is, most of the worrying is behind you.”

The theater was over and now they were walking back to Three Counties. It had been a good road show—a broad, noisy musical—at which they had both laughed a good deal and held hands, and a couple of times Mike had draped his arm around the back of Vivian’s seat, allowing it to fall lightly, his fingers exploring her shoulders, and she had made no move to object.

Over dinner before the show they had talked of themselves. Vivian had questioned Mike about his intentions to practice surgery, and he had asked her why she had become a student nurse.

“I’m not sure I can explain, Mike,” she had said, “except that nursing was something I always wanted to do as far back as I can remember.” She had told him that her parents at first had opposed the idea, then, on learning how strongly she felt, had given way. “I guess it’s really that I wanted to do something for myself, and nursing was what appealed to me most.”

Seddons had asked her, “Do you still feel that way?”

“Yes, I do,” she had said. “Oh, now and then—when you’re tired sometimes, and you’ve seen some of the things in the hospital, and you’re thinking about home—you wonder if it’s worth it, if there aren’t easier things to do; but I guess that happens to everybody. Most of the time, though, I’m quite sure.” She had smiled, then said, “I’m a very determined person, Mike, and I’ve made up my mind to be a nurse.”