The Final Diagnosis

The Final Diagnosis (1959)

A novel by Arthur Hailey
One

At midmorning of a broiling summer day the life of Three Counties Hospital ebbed and flowed like tide currents around an offshore island. Outside the hospital the citizens of Burlington, Pennsylvania, perspired under a ninety-degree shade temperature with 78 per cent humidity. Down by the steel mills and the rail yards, where there was little shade and no thermometers, the reading—if anyone had bothered to take it—would have been a good deal higher. Within the hospital it was cooler than outside, but not much. Among patients and staff only the fortunate or influential escaped the worst of the heat in air-conditioned rooms.

There was no air conditioning in the admitting department on the main floor, and Madge Reynolds, reaching into her desk for her fifteenth Kleenex that morning, dabbed her face and decided it was time she slipped out to make another application of deodorant. Miss Reynolds, at thirty-eight, was chief clerk in Admitting and also an assiduous reader of feminine-hygiene advertising. As a result she had acquired a horror of being less than completely sanitary and in hot weather maintained a shuttle service between her desk and the women’s toilet down the corridor. First, though, she decided, she must locate four patients for admission that afternoon.

A few minutes earlier the day’s discharge slips had come down from the wards, showing that twenty-six patients were being sent home instead of the twenty-four Miss Reynolds had expected. That, added to two deaths which had occurred during the night, meant that four new names could be plucked from the hospital’s long waiting list for immediate admission. Somewhere, in four homes in and around Burlington, a quartet of patients who had been waiting for this call either hopefully or in fear would now pack a few essential belongings and put their trust in medicine as practiced at Three Counties. Holding now her sixteenth Kleenex, Miss Reynolds opened a file folder, picked up the telephone on her desk, and began to dial.

More fortunate than the Admitting clerks in the heat were those awaiting treatment in the outpatient clinics, now in full session over in the opposite wing of the main floor. They at least would enjoy air conditioning when their turn came to enter one of the six offices leading off the general waiting room. Within the offices six specialists were making their exclusive talents available free to those who couldn’t, or wouldn’t, afford the private-patient fees charged on the specialists’ home ground in the Medical Arts Building downtown.

Old Rudy Hermant, who worked periodically at laboring when his family bullied him into it, sat back and relaxed in cool comfort as Dr. McEwan, the ear, nose, and throat specialist, probed in search of the cause of Rudy’s growing deafness. Actually Rudy didn’t mind the deafness too much; at times, when foremen wanted him to do something else or work faster, he found it an advantage. But Rudy’s eldest son had decided the old man should get his ears looked at, and here he was.

Dr. McEwan fretted irritably as he withdrew the otoscope from old Rudy’s ear. “It might help a little if you washed some of the dirt out,” he remarked acidly.

Such ill humor was unusual in McEwan. This morning, however, his wife had carried to the breakfast table a running fight about household expenses which they had started the night before, causing him, afterward, to back his new Olds out of the garage in such a temper that he had crumpled the right rear fender.

Now Rudy looked up blandly. “What was that?” he inquired.

“I said it might help . . . oh, never mind.” McEwan was debating whether the old man’s condition might be due to senility or a small tumor. It was an intriguing case, and already his professional interest was outweighing his irritability.

“I didn’t hear you,” the old man was saying again.

McEwan raised his voice. “It was nothing! I said forget it!” At this moment he was glad of old Rudy’s deafness and slightly ashamed of his own outburst.

In the general medical clinic fat Dr. Toynbee, an internist, lighting a fresh cigarette from the stub of the last, looked over at the patient on the other side of his desk. As he considered the case he felt a slight biliousness and decided he’d have to lay off Chinese food for a week or two; anyway, with two dinner parties coming off this week, and the Gourmet’s Club next Tuesday, it shouldn’t be too hard to endure. Deciding his diagnosis, he fixed his eye on the patient and said sternly, “You’re overweight and I’m going to put you on a diet. You’d better cut out smoking too.”

A hundred yards or so from where the specialists held court Miss Mildred, senior records clerk at Three Counties, perspired profusely as she hurried along a busy main-floor corridor. But, ignoring the discomfort, she moved even faster after a quarry she had just seen disappear around the next corner.

“Dr. Pearson! Dr. Pearson!”

As she caught up with him the hospital’s elderly staff pathologist paused. He moved the big cigar he was smoking over to the corner of his mouth. Then he said irritably, “What is it? What is it?”

Little Miss Mildred, fifty-two, spinsterish, and five foot nothing in her highest heels, quailed before Dr. Pearson’s scowl. But records, forms, files were her life. She summoned up courage. “These autopsy protocols have to be signed, Dr. Pearson. The Health Board has asked for extra copies.”

“Some other time. I’m in a hurry.” Joe Pearson was at his imperious worst.

Miss Mildred stood her ground. “Please, Doctor. It’ll only take a moment. I’ve been trying to get you for three days.”

Grudgingly Pearson gave in. Taking the forms and the ballpoint pen Miss Mildred offered him, he moved over to a desk, grumbling as he scribbled signatures. “I don’t know what I’m signing. What is it?”

“It’s the Howden case, Dr. Pearson.”

Pearson was fretting still. “There are so many cases. I don’t remember.”

Patiently Miss Mildred reminded him. “It’s the workman who was killed when he fell from a high catwalk. If you remember, the employers said the fall must have been caused by a heart attack because otherwise their safety precautions would have prevented it.”

Pearson grunted. “Yeah.”

As he went on signing Miss Mildred continued her summation. When she started something she liked to finish it and leave it tidy. “The autopsy, however, showed that the man had a healthy heart and no other physical condition which might have caused him to fall.”

“I know all that.” Pearson cut her short.

“I’m sorry, Doctor. I thought . . .”

“It was an accident. They’ll have to give the widow a pension.” Pearson tossed out the observation, then adjusted his cigar and scrawled another signature, half shredding the paper. He has rather more egg than usual on his tie, Miss Mildred thought, and she wondered how many days it was since the pathologist had brushed his gray, unruly hair. Joe Pearson’s personal appearance verged somewhere between a joke and a scandal at Three Counties Hospital. Since his wife had died some ten years earlier and he had begun to live alone, his dress had got progressively worse. Now, at sixty-six, his appearance sometimes suggested a vagrant rather than the head of a major hospital department. Under the white lab coat Miss Mildred could see a knitted woolen vest with frayed buttonholes and two other holes which were probably acid burns. And gray, uncreased slacks drooped over scuffed shoes that sadly needed shining.

Joe Pearson signed the last paper and thrust the batch, almost savagely, at little Miss Mildred. “Maybe I can get on with some real work now, eh?” His cigar bobbed up and down, discharging ash partly on himself, partly on the polished linoleum floor. Pearson had been at Three Counties long enough to get away with rudeness that would never be tolerated in a younger man and also to ignore the “No Smoking” signs posted conspicuously at intervals in the hospital corridors.

“Thank you, Doctor. Thank you very much.”

He nodded curtly, then made for the main lobby, intending to take an elevator to the basement. But both elevators were on floors above. With an exclamation of annoyance he ducked down the stairway which led to his own department.

On the surgical floor three stories above the atmosphere was more relaxed. With temperature and humidity carefully controlled throughout the whole operating section, staff surgeons, interns, and nurses, stripped down to their underwear beneath green scrub suits, could work in comfort. Some of the surgeons had completed their first cases of the morning and were drifting into the staff room for coffee before going on to subsequent ones. From the operating rooms which lined the corridor, aseptically sealed off from the rest of the hospital, nurses were beginning to wheel patients still under anesthesia into one of the two recovery rooms. There the patients would remain under observation until well enough to go back to their assigned hospital beds.

Between sips of scalding coffee Lucy Grainger, an orthopedic surgeon, was defending the purchase of a Volkswagen she had made the day before.

“I’m sorry, Lucy,” Dr. Bartlett was saying. “I’m afraid I may have stepped on it in the parking lot.”

“Never mind, Gil,” she told him. “You need the exercise you get just walking around that Detroit monster of yours.”

Gil Bartlett, one of the hospital’s general surgeons, was noted for possession of a cream Cadillac which was seldom seen other than in gleaming spotlessness. It reflected, in fact, the dapperness of its owner, invariably one of the best dressed among the Three Counties attending physicians. Bartlett was also the only member of staff to sport a beard—a Van Dyke, always neatly trimmed—which bobbed up and down when he talked, a process Lucy found fascinating to watch.

Kent O’Donnell strolled over to join them. O’Donnell was chief of surgery and also president of the hospital’s medical board. Bartlett hailed him.

“Kent, I’ve been looking for you. I’m lecturing the nurses next week on adult tonsillectomies. Do you have some Kodachromes showing aspiration tracheitis and pneumonia?”

O’Donnell ran his mind over some of the color photographs in his teaching collection. He knew what Bartlett was referring to—it was one of the lesser known effects which sometimes followed removal of tonsils from an adult. Like most surgeons, O’Donnell was aware that even with extreme operative care a tiny portion of tonsil sometimes escaped the surgeon’s forceps and was drawn into the lung where it formed an abscess. Now he recalled a group of pictures he had of the trachea and lung, portraying this condition; they had been taken during an autopsy. He told Bartlett, “I think so. I’ll look them out tonight.”

Lucy Grainger said, “If you don’t have one of the trachea, give him the rectum. He’ll never know the difference.” A laugh ran round the surgeons’ room.

O’Donnell smiled too. He and Lucy were old friends; in fact, he sometimes wondered if, given more time and opportunity, they might not become something more. He liked her for many things, not least the way she could hold her own in what was sometimes thought of as a man’s world. At the same time, though, she never lost her essential femininity. The scrub suit she was wearing now made her shapeless, almost anonymous, like the rest of them. But he knew that beneath was a trim, slim figure, usually dressed conservatively but in fashion.

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.