The Final Diagnosis

His thoughts were interrupted by a nurse who had knocked, then entered discreetly.

“Dr. O’Donnell, your patient’s family are outside.”

“Tell them I’ll be right out.” He moved into the locker room and began to slip out of his scrub suit. With only one operation scheduled for the day he was through with surgery now. When he had reassured the family outside—he had just operated successfully for removal of gallstones—his next call would be in the administrator’s office.

One floor above surgical, in private patient’s room 48, George Andrew Dunton had lost the capacity to be affected by heat or coolness and was fifteen seconds away from death. As Dr. MacMahon held his patient’s wrist, waiting for the pulse to stop, Nurse Penfield turned the window fan to “high” because the presence of the family had made the room uncomfortably stuffy. This was a good family, she reflected—the wife, grown son, and younger daughter. The wife was crying softly, the daughter silent but with tears coursing down her cheeks. The son had turned away but his shoulders were shaking. When I die, Elaine Penfield thought, I hope someone has tears for me; it’s the best obituary there is.

Now Dr. MacMahon lowered the wrist and looked across at the others. No words were needed, and methodically Nurse Penfield noted the time of death as 10:52 a.m.

Along the corridor in the other wards and private patients’ rooms this was one of the quieter times of day. Morning medications had been given; rounds were over, and there was a lull until lunch time would bring the cycle of activity to a peak once more. Some of the nurses had slipped down to the cafeteria for coffee; others who remained were writing their case notes. “Complains of continued abdominal pains,” Nurse Wilding had written on a woman patient’s chart and was about to add another line when she paused.

For the second time that morning Wilding, gray-haired and at fifty-six one of the older nurses on staff, reached into her uniform and took out the letter she had read twice already since it had been delivered to her desk along with the patients’ mail. A snapshot of a young naval lieutenant, j.g., with a pretty girl on his arm, fell out as she opened it, and for a moment she gazed down at the picture before reading the letter again. “Dear Mother,” it started. “This will come as a surprise to you, but I have met a girl here in San Francisco and we were married yesterday. I know in some ways this will be a big disappointment since you always said you wanted to be at my wedding, but I’m sure you’ll understand when I tell you . . .”

Nurse Wilding let her eyes wander from the letter and thought of the boy she remembered and of whom she had seen so little. After the divorce she had taken care of Adam until college; then there had been Annapolis, a few weekends and brief holidays, after that the Navy, and now he was a man, belonging to someone else. Later on today she must send them a telegram of love and good wishes. Years ago she had always said that as soon as Adam was on his own and self-supporting she would quit nursing, but she never had, and now retirement would come soon enough without hastening it. She put the letter and photograph back in her uniform pocket and reached for the pen she had laid down. Then in careful script she added to the chart: “Slight vomiting with diarrhea. Dr. Reubens notified.”

In Obstetrics, on the fourth floor, there was never any time of day which could be predictably quiet. Babies, Dr. Charles Dornberger thought, as he scrubbed alongside two other obstetricians, had an annoying habit of coming in batches. There would be hours, even days, when things would be orderly, quiet, and babies could be delivered in tidy succession. Then suddenly all hell would break loose, with half a dozen waiting to be born at once. This was one of those moments.

His own patient, a buxom, perpetually cheerful Negress, was about to deliver her tenth child. Because she had arrived at the hospital late, and already advanced in labor, she had been brought up on a stretcher from Emergency. While he was still scrubbing Dornberger could hear part of her duologue outside with the intern who had escorted her to Obstetrics.

Apparently, as was normal for an urgent case, the intern had cleared the passenger elevator down below on the main floor.

“All them nice peopl’ movin’ out of th’ elevator fo’ me,” she was saying. “Why, ah nevah felt so important befo’ in all mah life.” At this point Dornberger heard the intern tell the patient to relax and the answer came back, “Relax, sonny? Ah am relaxed. Ah always relaxes when ah has a baby. That th’ only time there’s no dishes, no washin’, no cookin’. Why, ah look forward to comin’ in here. This just a holiday fo’ me.” She paused as pain gripped her. Then, partly through clenched teeth, she muttered, “Nine children ah’ve got, and this’ll be the tenth. Th’ oldest one’s as big as you, sonny. Now you be lookin’ fo’ me a year from now. Ah tell you, ah’ll be back.” Dornberger heard her chuckling as her voice faded, the delivery room nurses taking over, while the intern went back to his post in Emergency.

Now Dornberger, scrubbed, gowned, sterile, and sweating from the heat, followed his patient into the delivery room.

In the hospital kitchens, where the heat was less of a problem because people who worked there were used to it, Hilda Straughan, the chief dietitian, nibbled a piece of raisin pie and nodded approvingly at the senior pastry cook. She suspected that the calories, along with others, would be reflected on her bathroom scales a week from now but quelled her conscience by telling herself it was a dietitian’s duty to sample as much as possible of the hospital fare. Besides, it was somewhat late now for Mrs. Straughan to be fretting on the subject of calories and weight. The accumulated result of many earlier samplings caused her nowadays to turn the scales around two hundred pounds, a good deal of which was in her magnificent breasts—twin Gibraltars, famed through the hospital, and which made her progress not unlike the majesty of an aircraft carrier preceded by an escort of twin battleships.

But, as well as food, Mrs. Straughan was in love with her job. Glancing around her with satisfaction, she took in her empire—the shining steel ovens and serving tables, the gleaming utensils, the sparkling white aprons of the cooks and their assistants. Her heart warmed at the sight of all of it.

This was a busy time in the kitchens—lunch was the heaviest meal of the day because, as well as patients, there was the full hospital staff to be fed in the cafeteria. In twenty minutes or so the diet trays would be going up to the wards, and for two hours afterward the service of food would continue. Then, while the kitchen help cleared and stacked dishes, the cooks would begin preparing the evening meal.

The thought of dishes caused Mrs. Straughan to frown thoughtfully, and she propelled herself into the back section of the kitchen where the two big automatic dishwashers were installed. This was a part of her domain less gleaming and modern than the other section, and the chief dietitian reflected, not for the first time, that she would be happy when the equipment here was modernized, as the rest of the kitchens had been. It was understandable, though, that everything could not be done at once, and she had to admit she had browbeaten the administration into a lot of expensive new equipment in the two years she had held her job at Three Counties. All the same, she decided as she moved on to check the steam tables in the cafeteria, she would have another talk with the administrator about those dishwashers soon.

The chief dietitian was not the only one in the hospital whose thoughts were on food. In Radiology, on the second floor, an outpatient—Mr. James Bladwick, vice-president of sales for one of Burlington’s big-three automobile dealerships—was, in his own words, “as hungry as hell.”

There was reason for this. On his physician’s instructions Jim Bladwick had fasted since midnight, and now he was in number one X-ray room, ready for a gastric series. The X-rays would confirm or deny the suspicion that flourishing in the Bladwick interior was a duodenal ulcer. Jim Bladwick hoped the suspicion was unfounded; in fact, he hoped desperately that neither an ulcer nor anything else would conspire to slow him down now that his drive and sacrifice of the past three years, his willingness to work harder and longer than anyone else on sales staff, were at last paying off.

Sure he worried; who wouldn’t when they had a dealer sales quota to meet every month. But it just couldn’t be an ulcer; it had to be something else—something trivial that could be fixed up quickly. He had been vice-president of sales only a matter of six weeks, but despite the high-sounding title he knew better than anyone that retention of it depended on a continued ability to produce. And to produce you had to be on the ball—tough, available, fit. No medical certificate would compensate for a declining sales graph.

Jim Bladwick had put this moment off for some time. It was probably two months ago that he had become aware of distress and a general aching in the stomach region, had noticed, too, he was burping a lot, sometimes at awkward moments with customers around. For a while he had tried to pretend it was nothing out of the ordinary, but finally he had sought medical advice, and this morning’s session was the outcome. He hoped, though, it was not going to take too long; that deal of Fowler’s for six panel trucks was getting hot, and they needed the sale badly. By God, he was hungry!

For Dr. Ralph Bell, the senior radiologist—“Ding Dong” to most of the hospital staff—this was just another G.I. series, no different from any of a hundred others. But, playing a mental game he sometimes indulged in, he decided to bet “yes” on this one. This patient looked the type for an ulcer. From behind his own thick-lensed, horn-rimmed glasses Bell had been watching the other man covertly. He looked a worrier, Bell decided; he was obviously stewing right now. The radiologist placed Bladwick in position behind the fluoroscope and handed him a tumbler of barium. “When I tell you,” he said, “drink this right down.”

When he was ready he ordered, “Now!” Bladwick drained the glass.

In the fluoroscope Bell watched the path of the barium as it coursed first through the esophagus, then into the stomach, and from there into the duodenum. Sharpened by the opaque liquid, the outline of each organ was clearly visible, and at various stages Bell thumbed a button recording the results on film. Now he palpated the patient’s abdomen to move the barium around. Then he could see it—a crater in the duodenum. An ulcer, clear and unmistakable. He reflected that he had won the bet with himself. Aloud he said, “That’s all, Mr. Bladwick, thank you.”

“Well, Doc, what’s the verdict? Am I going to live?”

“You’ll live.” Most of them wanted to know what he saw in the fluoroscope. Magic mirror on the wall, who is healthiest of all? It wasn’t his job to tell though. “Your own physician will get these films tomorrow. I imagine he’ll be talking to you.” Hard luck, my friend, he thought. I hope you like lots of rest and a diet of milk and poached eggs.

Two hundred yards away from the main hospital block, in a run-down building that had once been a furniture factory and now did duty as a nurses’ home, Student Nurse Vivian Loburton was having trouble with a zipper that refused to zip.