The Final Diagnosis

The administrator had replaced his glasses. “I talked with Orden again this morning.” Orden Brown, president of the second largest steel mill in Burlington, was chairman of the hospital’s board of directors.

“So?”

“He’s sure we can count on half a million dollars in the building fund by January. That means we’ll be able to break ground in March.”

“And the other half million? Last week Orden told me he thought it would take until December.” Even at that, O’Donnell reflected, he had considered the chairman to be erring toward optimism.

“I know,” Tomaselli said. “But he asked me to tell you that he’s changed his mind. He had another session with the mayor yesterday. They’re convinced they can get the second half million by next summer and wind up the campaign by fall.”

“That is good news.” O’Donnell decided to shelve his earlier doubts. If Orden Brown had gone out on a limb like that, he would come through all right.

“Oh, and by the way,” Tomaselli said with elaborate casualness, “Orden and the mayor have an appointment with the governor next Wednesday. Looks like we may get that increased state grant after all.”

“Anything else?” O’Donnell snapped at the administrator in mock sharpness.

“I thought you’d be pleased,” Tomaselli said.

More than pleased, O’Donnell reflected. In a way you might call all of this the first step toward fulfillment of a vision. It was a vision which had had its beginnings at the time of his own arrival at Three Counties three and a half years ago. Funny how you could get used to a place, O’Donnell thought. If someone had told him at Harvard Medical School, or later when he was chief surgical resident at Columbia Presbyterian, that he would wind up in a backwater hospital like Three Counties, he would have scoffed. Even when he had gone to Bart’s in London to round out his surgical experience, he had fully intended to come back and join the staff of one of the big-name hospitals like Johns Hopkins or Massachusetts General. With the background he had he could pretty well have taken his choice. But before there was time to decide Orden Brown had come to meet him in New York and persuaded him to visit Burlington and Three Counties.

What he had seen there had appalled him. The hospital was run down physically, its organization slack, its medical standards—with a few exceptions—low. The chiefs of surgery and medicine had held their posts for years; O’Donnell had sensed that their objective in life was to preserve an amiable status quo. The administrator—key man in the relationship between the hospital’s lay board of directors and its medical staff—was a doddering incompetent. The hospital’s intern and resident training program had fallen into disrepute. There was no budget for research. Conditions under which nurses lived and worked were almost medieval. Orden Brown had shown him everything, concealed nothing. Then they had gone together to the chairman’s home. O’Donnell had agreed to remain for dinner but afterward planned to catch a night flight back to New York. Disgusted, he never wanted to see Burlington or Three Counties Hospital again.

Over dinner in the quiet, tapestried dining room of Orden Brown’s home on a hillside high above Burlington he had been told the story. It was not an unfamiliar one. Three Counties Hospital, once progressive, modern, and rated high in the state, had fallen prey to complacency and lassitude. The chairman of the board had been an aging industrialist who most of the time had delegated responsibility to someone else, appearing at the hospital only for the occasional social function. The lack of leadership had permeated downward. Heads of divisions had mostly held their posts for many years and were averse to change. Younger men beneath them had at first fretted, then, becoming frustrated, had moved elsewhere. Finally the hospital’s reputation became such that young, highly qualified graduates no longer sought to join the staff. Because of this others with lesser qualifications had been allowed in. This was the situation at the time O’Donnell had come on the scene.

The only change had come with the appointment of Orden Brown himself. Three months earlier the aged chairman had died. A group of influential citizens had persuaded Brown to succeed him. The choice had not been unanimous; a section of the old guard on the hospital board had wanted the chair for a nominee of their own—a long-time board member named Eustace Swayne. But Brown had been chosen by a majority, and now he was trying to persuade other board members to adopt some of his own ideas for modernization of Three Counties.

It was proving an uphill fight. There was an alliance between a conservative element on the board, for whom Eustace Swayne was spokesman, and a group among the senior medical staff. Together they resisted change. Brown was having to tread warily and to be diplomatic.

One of the things he wanted was authority to increase the size of the hospital board and bring in new, more active members. He had planned to recruit some of the younger executives and professional men from Burlington’s business community. But so far the board had not been unanimous and temporarily the plan was shelved.

If Orden Brown had wanted, he had explained frankly to O’Donnell, he could have forced a showdown and had his own way. He could, if he wished, have used his influence to ease some of the elderly, inactive members out of office. But this would have been shortsighted, because most were wealthy men and women and the hospital needed the legacies which normally came to it when its patrons died. If defeated now, some of the people concerned might well change their wills, cutting the hospital off. Eustace Swayne, who controlled a department-store empire, had already hinted that this might happen. Hence the need by Orden Brown for diplomacy and caution.

Some progress had been made, though, and one step which the chairman had undertaken with approval from a majority of the board members was to negotiate for a new chief of surgery. That was why he had approached O’Donnell.

Over dinner O’Donnell had shaken his head. “I’m afraid it’s not for me.”

“Perhaps not,” Brown had said. “But I’d like you to hear me out.”

He was persuasive, this man of industry who, though a scion of a wealthy family, had worked his way from puddler, through the mills, to the administrative office and eventually the president’s chair. He had a feeling, too, for people; the years in which he had rubbed shoulders daily with laborers in the mill had given him that. This may have been a reason he had accepted the burden of lifting Three Counties out of the mire into which it had fallen. But for whatever reason, even in the short time they had been together O’Donnell had sensed the older man’s dedication.

“If you came here,” Brown had said to him near the end, “I couldn’t promise you a thing. I’d like to say you’d have a free hand, but I think the chances are you’d have to fight for everything you wanted. You’d meet opposition, entrenchment, politics, resentment. There would be areas in which I couldn’t help you and in which you would have to stand alone.” Brown had paused, then added quietly, “I suppose the only good thing you could say about this situation—from the point of view of someone like yourself—is that it would be a challenge, in some ways the biggest challenge a man could take on.”

That was the last word Orden Brown had said that night about the hospital. Afterward they had talked of other things: Europe, the coming elections, the emergence of Middle East nationalism—Brown was a much-traveled and well-informed man. Later his host had driven O’Donnell to the airport and they had shaken hands at the ramp. “I’ve enjoyed our meeting,” Orden Brown had said, and O’Donnell had returned the compliment, fully meaning it. Then he had boarded the airplane, intending to write off Burlington and to think of his journey there as a learning experience.

On the flight back he had tried to read a magazine—there was an article about championship tennis which interested him. But his mind wouldn’t register the words. He kept thinking about Three Counties Hospital, what he had seen there and what was needing to be done. Then suddenly for the first time in many years he began to examine his own approach to medicine. What does it all mean? he had asked himself. What do I want for myself? What kind of achievement am I seeking? What have I got to give? At the end what will I leave behind? He had not married; probably he never would now. There had been love affairs—in bed and out—but nothing of permanence. Where is it leading, he wondered, this trail from Harvard, Presbyterian, Bart’s . . . to where? Then suddenly he had known the answer, known that it was Burlington and Three Counties, that the decision was firm, irrevocable, the direction set. At La Guardia, on landing, he had sent a wire to Orden Brown. It read simply, “I accept.”

Now, looking down at the plans of what the administrator had called flippantly “the New Jerusalem,” O’Donnell thought back to the three and a half years which lay behind. Orden Brown had been right when he had said they would not be easy. All the obstacles which the board chairman had predicted had proven to be there. Gradually, though, the most formidable had been overcome.

After O’Donnell’s arrival the former chief of surgery had slipped quietly out. O’Donnell had rallied some of the surgeons already on staff who were sympathetic to raising the hospital’s standards. Between them they had tightened surgical rules and had formed a strong operating-room committee to enforce them. A tissue committee, almost defunct, was reactivated—its job, to ensure that mistakes in surgery, particularly the unnecessary removal of healthy organs, were not repeated.

The less competent surgeons were gently but firmly urged to limit themselves to work within their capabilities. A few of the botchers, the assembly-line appendix removers, the incompetents, were given the choice of resigning quietly or being ousted officially. Though to some it meant partial loss of their livelihood, most chose to leave quietly. Among the latter was one surgeon who had actually removed a kidney without ascertaining that the patient had already lost one in previous surgery. The dreadful mistake had been revealed at autopsy.

Removal of that surgeon from the hospital’s roster had been easy. Some of the others, though, had proved more difficult. There had been rows before the County Medical Committee, and two surgeons, formerly on Three Counties’ staff, now had law suits pending against the hospital. This, O’Donnell knew, was going to mean some bitter controversy in court, and he dreaded the publicity which was certain to surround it.

But despite these problems O’Donnell and those behind him had had their way and the gaps in staff were painstakingly filled with new, well-qualified men, some of them graduates from his own alma mater whom O’Donnell had cajoled and persuaded to set up practice in Burlington.

Meanwhile the Division of Medicine had a new head—Dr. Chandler, who had been on staff under the old regime but had been frequently outspoken against it. Chandler was a specialist in internal medicine, and while he and O’Donnell sometimes disagreed on hospital policy, and O’Donnell found the other man at times pompous, at least Chandler was uncompromising when it came to upholding medical standards.