The Final Diagnosis (7 page)

“Lucy!” She smiled a greeting at two of the other surgeons, then turned back as O’Donnell called to her. He was maneuvering the other man with him.

“Lucy, I’d like you to meet Dr. Roger Hilton. He’s just joined the staff. You may recall his name came up some time ago.”

“Yes, I do remember.” She smiled at Hilton, her face crinkling.

“This is Dr. Grainger.” O’Donnell was always punctilious about helping new staff members to become known. He added, “Lucy is one of our orthopedic surgeons.”

She offered Hilton her hand and he took it. He had a firm grasp, a boyish smile. She guessed his age at twenty-seven. “If you’re not tired of hearing it,” she said, “welcome!”

“Matter of fact, I’m rather enjoying it.” He looked as if he were.

“Is this your first hospital appointment?”

Hilton nodded. “Yes. I was a surgical resident at Michael Reese.”

Lucy remembered more clearly now. This was a man whom Kent O’Donnell had been very keen to get to Burlington. And undoubtedly that meant Hilton had good qualifications.

“Come over here a minute, Lucy.” Kent O’Donnell had moved back near her and was beckoning.

Excusing herself to Hilton, she followed the chief of surgery to one of the board-room windows, away from the immediate press of people.

“That’s a little better; at least we can make ourselves heard.” O’Donnell smiled. “How have you been, Lucy? I haven’t seen you, except in line of duty, for quite a while.”

She appeared to consider. “Well, my pulse has been normal; temperature around ninety-eight point eight. Haven’t checked blood pressure recently.”

“Why not let me do it?” O’Donnell said. “Over dinner, for example.”

“Do you think it’s wise? You might drop the sphygmomanometer in the soup.”

“Let’s settle for dinner then and forget the rest.”

“I’d love to, Kent,” Lucy said. “But I’ll have to look at my book first.”

“Do that and I’ll phone you. Let’s try to make it next week.” O’Donnell touched her lightly on the shoulder as he turned away. “I’d better get this show opened.”

Watching him ease his way through other groups toward the center table, Lucy thought, not for the first time, how much she admired Kent O’Donnell, both as a colleague and a man. The invitation to dinner was not a new thing. They had had evenings together before, and for a while she had wondered if perhaps they might be drifting into some kind of tacit relationship. Both were unmarried, and Lucy, at thirty-five, was seven years younger than the chief of surgery. But there had been no hint in O’Donnell’s manner that he regarded her as anything more than a pleasant companion.

Lucy herself had a feeling that, if she allowed it, her admiration for Kent O’Donnell could grow to something more deep and personal. But she had made no attempt to force the pace, feeling it better to let things develop if they happened to, and if not—well, nothing was lost. That at least was one advantage of maturity over the first flush of youth. You learned not to hurry, and you discovered that the rainbow’s end was a good deal further than the next city block.

“Shall we get started, gentlemen?” O’Donnell had reached the head of the table and raised his voice across the heads of the others. He too had savored the brief moment with Lucy and found the thought pleasing that he would be meeting her again shortly. Actually he would have called her a good deal sooner, but there had been a reason for hesitation. The truth was that Kent O’Donnell found himself being drawn more and more toward Lucy Grainger, and he was not at all sure this was a good thing for either of them.

By now he had become fairly set in his own mode of life. Living alone and being independent grew on you after a while, and he doubted sometimes if he could adjust to anything else. He suspected, too, that something of the same thing might apply to Lucy, and there might be problems as well about their parallel careers. Nonetheless, he still felt more comfortable in her presence than that of any other woman he had known in a long time. She had a warmth of spirit—he had once described it to himself as a strong kindness—that was at once soothing and restoring. And he knew there were others, particularly Lucy’s patients, on whom she had the same effect.

It was not as if Lucy were unattractive; she had a mature beauty that was very real. As he watched her now—she had stopped to speak with one of the interns—he saw her raise a hand and push back her hair from the side of her face. She wore it short, in soft waves which framed her face, and it was almost golden. He noticed, though, a few graying strands. Well, that was something medicine seemed to do for everyone. But it reminded him that the years were moving on. Was he wrong in not pursuing this more actively? Had he waited long enough? Well, he would see how their dinner went next week.

The hubbub had not died and, this time more loudly, he repeated his injunction that they start.

Bill Rufus called out, “I don’t think Joe Pearson is here yet.” The gaudy necktie which O’Donnell had observed earlier made Rufus stand out from the others around him.

“Isn’t Joe here?” O’Donnell seemed surprised as he scanned the room.

“Has anyone seen Joe Pearson?” he asked. Some of the others shook their heads.

Momentarily O’Donnell’s face revealed annoyance, then he covered up. He moved toward the door. “Can’t have a mortality conference without a pathologist. I’ll see what’s keeping him.” But as he reached the doorway Pearson walked in.

“We were just going to look for you, Joe.” O’Donnell’s greeting was friendly, and Lucy wondered if she had been wrong about the flash of irritation a moment ago.

“Had an autopsy. Took longer than I figured. Then I stopped for a sandwich.” Pearson’s words came out muffled, principally because he was chewing between sentences. Presumably the sandwich, Lucy thought; then she saw he had the rest of it folded in a napkin among the pile of papers and files he was carrying. She smiled; only Joe Pearson could get away with eating lunch at a mortality conference.

O’Donnell was introducing Pearson to Hilton. As they shook hands Pearson dropped one of his files and a sheaf of papers spilled out on the floor. Grinning, Bill Rufus collected them and replaced the file under Pearson’s arm. Pearson nodded his thanks, then said abruptly to Hilton, “A surgeon?”

“That’s right, sir,” Hilton answered pleasantly. A well-brought-up young man, Lucy thought; he shows deference to his elders.

“So we have another recruit for the mechanics,” Pearson said. As he spoke, loudly and sharply, there was a sudden silence in the room. Ordinarily the remark would have passed as banter, but somehow from Pearson it seemed to have an edge, a touch of contempt.

Hilton was laughing. “I guess you could call it that.” But Lucy could see he had been surprised by Pearson’s tone.

“Take no notice of Joe,” O’Donnell was saying good-naturedly. “He has a ‘thing’ about surgeons. Well, shall we begin?”

They moved to the long table, some of the senior staff members going automatically to the front rectangle of chairs, the others dropping into the row behind. Lucy herself was in front. O’Donnell was at the head of the table, Pearson and his papers on the left. While the others were settling down she saw Pearson take another bite from his sandwich. He made no effort to be surreptitious about it.

Lower down the table she noticed Charlie Dornberger, one of Three Counties’ obstetricians. He was going through the careful process of filling his pipe. Whenever Lucy saw Dr. Dornberger he seemed to be either filling, cleaning, or lighting a pipe; he seldom seemed to smoke it. Next to Dornberger was Gil Bartlett and, opposite, Ding Dong Bell from Radiology and John McEwan. McEwan must be interested in a case today; the ear, nose, and throat specialist did not normally attend surgical-mortality meetings.

“Good afternoon, gentlemen.” As O’Donnell looked down the table the remaining conversations died. He glanced at his notes. “First case. Samuel Lobitz, white male, age fifty-three. Dr. Bartlett.”

Gil Bartlett, impeccably dressed as ever, opened a ring notebook. Instinctively Lucy watched the trim beard, waiting for it to move. Almost at once it began bobbing up and down. Bartlett began quietly, “The patient was referred to me on May 12.”

“A little louder, Gil.” The request came from down the table.

Bartlett raised his voice. “I’ll try. But maybe you’d better see McEwan afterward.” A laugh ran round the group in which the e.n.t. man joined.

Lucy envied those who could be at ease in this meeting. She never was, particularly when a case of her own was being discussed. It was an ordeal for anyone to describe their diagnosis and treatment of a patient who had died, then have others give their opinion, and finally the pathologist report his findings from the autopsy. And Joe Pearson never spared anyone.

There were honest mistakes that anybody in medicine could make—even, sometimes, mistakes which cost patients their lives. Few physicians could escape errors like this in the course of their careers. The important thing was to learn from them and not to make the same mistake again. That was why mortality conferences were held—so that everyone who attended could learn at the same time.

Occasionally the mistakes were not excusable, and you could always sense when something like that came up at a monthly meeting. There was an uncomfortable silence and an avoidance of eyes. There was seldom open criticism; for one thing, it was unnecessary, and for another, you never knew when you yourself might be subject to it.

Lucy recalled one incident which had concerned a distinguished surgeon at another hospital where she had been on staff. The surgeon was operating for suspected cancer in the intestinal tract. When he reached the affected area he had decided the cancer was inoperable and, instead of attempting to remove it, had looped the intestine to bypass it. Three days later the patient had died and was autopsied. The autopsy showed there had, in fact, been no cancer at all. What had really happened was that the patient’s appendix had ruptured and had formed an abscess. The surgeon had failed to recognize this and thereby condemned the man to death. Lucy remembered the horrified hush in which the pathologist’s report had been received.

In an instance like this, of course, nothing ever came out publicly. It was a moment for the ranks of medicine to close. But in a good hospital it was not the end. At Three Counties nowadays O’Donnell would always talk privately with an offender and, if it were a bad case, the individual concerned would be watched closely for a while afterward. Lucy had never had to face one of these sessions herself, but she had heard the chief of surgery could be extremely rough behind closed doors.

Gil Bartlett was continuing. “The case was referred to me by Dr. Cymbalist.” Lucy knew that Cymbalist was a general practitioner, though not on Three Counties’ staff. She herself had had cases referred from him.

“I was called at my home,” Bartlett said, “and Dr. Cymbalist told me he suspected a perforated ulcer. The symptoms he described tallied with this diagnosis. By then the patient was on the way to the hospital by ambulance. I called the surgical resident on duty and notified him the case would be coming in.”

Bartlett looked over his notes. “I saw the patient myself approximately half an hour later. He had severe upper abdominal pain and was in shock. Blood pressure was seventy over forty. He was ashen gray and in a cold sweat. I ordered a transfusion to combat shock and also morphine. Physically the abdomen was rigid, and there was rebound tenderness.”

Bill Rufus asked, “Did you have a chest film made?”

“No. It seemed to me the patient was too sick to go to X-ray. I agreed with the original diagnosis of a perforated ulcer and decided to operate immediately.”

“No doubts at all, eh, Doctor?” This time the interjection was Pearson’s. Previously the pathologist had been looking down at his papers. Now he turned directly to face Bartlett.

For a moment Bartlett hesitated and Lucy thought: Something is wrong; the diagnosis was in error and Joe Pearson is waiting to spring the trap. Then she remembered that whatever Pearson knew Bartlett knew also by this time, so it would be no surprise to him. In any case Bartlett had probably attended the autopsy. Most conscientious surgeons did when a patient died. But after the momentary pause the younger man went on urbanely.

“One always has doubts in these emergency cases, Dr. Pearson. But I decided all the symptoms justified immediate exploratory surgery.” Bartlett paused. “However, there was no perforated ulcer present, and the patient was returned to the ward. I called Dr. Toynbee for consultation, but before he could arrive the patient died.”

Gil Bartlett closed his ring binder and surveyed the table. So the diagnosis
had
been wrong, and despite Bartlett’s outwardly calm appearance Lucy knew that inside he was probably suffering the torments of self-criticism. On the basis of the symptoms, though, it could certainly be argued that he was justified in operating.

Now O’Donnell was calling on Joe Pearson. He inquired politely, “Would you give us the autopsy findings, please?” Lucy reflected that the head of surgery undoubtedly knew what was coming. Automatically the heads of departments saw autopsy reports affecting their own staff.

Pearson shuffled his papers, then selected one. His gaze shot around the table. “As Dr. Bartlett told you, there was no perforated ulcer. In fact, the abdomen was entirely normal.” He paused, as if for dramatic effect, then went on. “What was present, in the chest, was early development of pneumonia. No doubt there was severe pleuritic pain coming from that.”

So that was it. Lucy ran her mind over what had been said before. It was true—externally the two sets of symptoms would be identical.

O’Donnell was asking, “Is there any discussion?”

There was an uneasy pause. A mistake had been made, and yet it was not a wanton mistake. Most of those in the room were uncomfortably aware the same thing might have happened to themselves. It was Bill Rufus who spoke out. “With the symptoms described, I would say exploratory surgery was justified.”

Pearson was waiting for this. He started ruminatively. “Well, I don’t know.” Then almost casually, like tossing a grenade without warning: “We’re all aware that Dr. Bartlett rarely sees beyond the abdomen.” Then in the stunned silence he asked Bartlett directly, “Did you examine the chest at all?”