The Final Diagnosis

"Is there any news?"



From the wheel chair Vivian looked up as Dr. Lucy Grainger came into the hospital room. It was four days since the biopsy, three since Pearson had sent the slides to New York and Boston.



Lucy shook her head. "I'll tell you, Vivian - just as soon as I know."



"When . . . when will you know . . . for sure?"



"Probably today." Lucy answered matter-of-factly. She did not want to reveal that she, too, was troubled by the waiting. She had spoken to Joe Pearson again last night; at that time he had said that if the second opinions were not forthcoming by midday today he would phone the two consultants to hurry them along. Waiting was hard on everyone - including Vivian's parents, who had arrived in Burlington from Oregon the previous day.



Lucy removed the dressing from Vivian's knee; the biopsy scar appeared to be healing well. Replacing the dressing, she said, "It's hard to do, I know, but try to think of other things as much as you can."



The girl smiled faintly. "It isn't easy."



Lucy was at the door now. She said, "Perhaps a visitor will help. You have an early one." She opened the door and beckoned. Mike Seddons came in as Lucy left.



Seddons was wearing his hospital whites. He said, "I stole ten minutes. You can have them all."



He crossed to the chair and kissed her. For a moment she closed her eyes and held on to him tightly. He ran his hands through her hair. His voice in her ear was gentle. "It's been hard, hasn't it? - just waiting."



"Oh, Mike, if only I knew what was going to happen! I don't think I'd mind so much. It's . . . wondering . . . not knowing."



He drew slightly away, looking into her face. "Vivian darling, I wish there were something, just something I could do."



"You've done a lot already." Vivian was smiling now. "Just being you - and being here. I don't know what it would have been like without . . ." She stopped as he reached out and put a finger across her lips.



"Don't say it! I had to be here. It was preordained - all worked out by cosmic coincidence." He gave her his bright, broad grin. Only he knew there was a sense of hollowness behind it. Mike Seddons, like Lucy, was aware of the implications of the delayed report from Pathology.



He had succeeded in making Vivian laugh though. "Rubbish!" she said. "If I hadn't gone to that old autopsy, and if some other student nurse had got to you first . . ."



"Uh, uh!" He shook his head. "It might look that way, but you can't escape predestination. Ever since our great-great ancestors were swinging from trees, scratching their underarms, our genes have been moving together across the dusty sands of Time, Life, and Fortune." He was talking now for the sake of it, using the first words which came into his head, but it was having the effect he wanted.



Vivian said, "Oh, Mike, you talk such wonderful nonsense. And I do love you very much."



"I can understand that." He kissed her again, lightly. "I think your mother likes me too."



She put a hand to her mouth. "You see what you do to me! I should have asked first. Was everything all right - after you all left here last night?"



"Sure it was. I went back with them to the hotel. We sat around and talked for a bit. Your mother didn't say much, but I could see your father summing me up, thinking to himself: What kind of a man is this who presumes to marry my beautiful daughter?"



Vivian said, "I'll tell him today."



"What will you say?"



"Oh, I don't know." She reached out and held Seddons by the ears, turning his head from side to side, inspecting it. "I might say, 'He has the nicest red hair which is always untidy, but you can put your fingers through it and it's very soft.' " She matched the action to her words.



"Well, that should be a big help. No marriage is complete without it. What else?"



"I'll say, 'Of course, he isn't much to look at. But he has a heart of gold and he's going to be a brilliant surgeon.' "



Seddons frowned. "Couldn't you make it 'exceptionally brilliant'?"



"I might, if . . ."



"If what?"



"If you kiss me again - now."



On the second floor of the hospital Lucy Grainger knocked lightly on the chief of surgery's office door and went inside.



Looking up from a sheaf of reports, Kent O'Donnell said, "Hullo, Lucy - rest your weary bones."



"Now you mention it, they are a little weary." She dropped into the big leather chair which faced O'Donnell's desk.



"I had Mr. Loburton in to see me first thing this morning." O'Donnell came around the desk and perched informally on the corner nearest Lucy. "Cigarette?" He held out an embossed gold case.



"Thank you." She took a cigarette. "Yes - Vivian's father." Lucy accepted the light which O'Donnell offered and inhaled deeply; the smoke was cool, relaxing. She said, "Both parents got here yesterday. Naturally they're very concerned, and they know nothing about me, of course. I suggested Mr. Loburton have a talk with you."



"He did." O'Donnell spoke quietly. "I told him that in my opinion his daughter couldn't possibly be in better hands, that there was no one on the hospital's staff in whom I would have greater confidence. I may tell you he seemed quite reassured."



"Thank you." Lucy found herself intensely gratified by O'Donnell's words.



The chief of surgery smiled. "Don't thank me; it's an honest appraisal." He paused. "What about the girl, Lucy? What's the story so far?"



In a few words she summed up the case history, her tentative diagnosis, and the biopsy.



O'Donnell nodded. He asked, "Is there any problem with Pathology? Has Joe Pearson come through promptly?"



Lucy told him of the delay and the reasons for it. He thought briefly, then said, "Well, I guess that's reasonable. I don't believe we can complain about that. But keep after Joe; I don't think you should let it go beyond today."



"I won't." Lucy glanced at her watch. "I plan to see Joe again after lunch. He expected to know something definite by then."



O'Donnell made a wry face. "As definite as anything like that can ever be." He mused. "Poor kid. How old did you say she is?"



"Nineteen." Lucy was watching Kent O'Donnell's face. To her eyes it seemed to mirror thought, character, and understanding. She reflected: He has greatness and he wears it easily because it belongs to him. It made what he had said a few moments ago about her own ability seem warmer and more significant. Then suddenly, explosively, as if in a burst of revelation, Lucy knew what she had denied herself knowing these past months: that she loved this man - profoundly and ardently. She became aware, with startling clarity, that she had shielded herself from the knowledge, perhaps from an instinctive fear of being hurt. But now, whatever happened, she could shield herself no longer. For a moment the thought made her weak; she wondered if she had betrayed it on her face.



O'Donnell said apologetically, "I'll have to leave you, Lucy. It's another full day." He smiled. "Aren't they all?"



Her heartbeat faster, her emotions surging, she had risen and gone to the door. As he opened it O'Donnell put an arm around her shoulders. It was a casual, friendly gesture that any other of her colleagues might have made. But at this moment the effect seemed electric; it left her breathless and confused.



O'Donnell said, "Let me know, Lucy, if there's any problem. And if you don't mind, I might drop in today and see your patient."



Collecting her thoughts, she told him, "I'm sure she'd like it, and so would I." Then, as the door closed behind her, Lucy shut her eyes for a moment to control her racing mind.



The ordeal of waiting for the diagnosis concerning Vivian had had a profound effect on Mike Seddons. By nature a genial and outgoing personality, in normal times he was noted for being one of the livelier spirits on Three Counties' house staff, and it was not unusual to find him the focus of a noisy, boisterous group in the residents' quarters. For the past several days, however, most of the time he had avoided the company of others, his spirits dampened by the knowledge of what an adverse verdict from Pathology could mean to Vivian and himself.



His feelings about Vivian had not wavered; if anything, they had become more intense. He hoped he had conveyed this in the time he had spent last evening with Vivian's parents after their initial meeting at the hospital. At first, as was to be expected, all of them - Mr. and Mrs. Loburton, Vivian, and himself - had been constrained, their talk awkward and at times formal. Even afterward it had seemed that the Loburtons' meeting with a prospective son-in-law, which in other circumstances might have been an important occasion, had taken second place to their concern with the immediate problem of Vivian's health. In a sense Mike Seddons felt he had become accepted because there was no time for anything else.



Back at the Loburtons' hotel, though, they had talked briefly about himself and Vivian. Henry Loburton, his big frame spilling from an overstuffed chair in the sitting room of their hotel suite, had asked Mike Seddons about his future, more, Seddons suspected, from courtesy than from any real concern. He had responded by telling them briefly of his own intention to practice surgery in Philadelphia when his residency at Three Counties ended. The Loburtons had nodded politely and had left the matter there.



Certainly, it seemed, there would be no opposition to a marriage. "Vivian has always seemed to know what she wanted," Henry Loburton had observed at one point. "It was the same way when she wanted to be a nurse. We were doubtful about it, but she had already made up her mind. There wasn't much else to say after that."



Mike Seddons had expressed the hope that they would not consider Vivian too young to marry. It was then that Angela Loburton had smiled. "I imagine it would be rather difficult to object on that account," she had said. "You see, I was married at seventeen. I ran away from home to do it." She smiled at her husband. "We didn't have any money, but we managed to get by."



Seddons had said with a grin, "Well, that much we'll have in common - anyway, until my practice gets going."



That had been last night. This morning, after the visit with Vivian, he had felt for some reason a sense of lightness and relief. Perhaps he had been depressed unnaturally long and brighter spirits were seeking an outlet. But, whatever the cause, he felt himself seized by a cheerful conviction that everything would turn out well. The feeling was with him now - in the autopsy room where he was assisting Roger McNeil with the autopsy of an elderly woman patient who had died last night in the hospital. It had prompted him to begin telling humorous stories to McNeil; Mike Seddons had a fund of them - another reason for his reputation as a joker.



Pausing in the middle of the latest, he asked McNeil, "Have you any cigarettes?"



The pathology resident motioned with his head. He was sectioning the heart he had just removed from the body.



Seddons crossed the room, found the cigarettes in McNeil's suit coat, and lighted one. Returning, he continued, "So she said to the undertaker, 'Thank you for doing that, even though it must have been a lot of trouble.' And the undertaker said, 'Oh, it wasn't any trouble really. All I did was change their heads.' "



Grim as the jest was in these surroundings, McNeil laughed aloud. He was still laughing as the autopsy-room door opened and David Coleman stepped inside.



"Dr. Seddons, will you put out that cigarette, please?" Coleman's voice cut quietly across the room.



Mike Seddons looked around. He said amiably, "Oh, good morning, Dr. Coleman. Didn't see you there for a minute."



"The cigarette, Dr. Seddons!" There was ice in Coleman's tone, his eyes steely.



Not quite understanding, Seddons said, "Oh . . . oh yes." none, moved his hand toward the autopsy table with the body upon it.



"Not there!" Coleman rapped out the words, stopping the surgical resident short. After a moment Seddons moved across the room, found an ash tray, and deposited the cigarette.



"Dr. McNeil."



"Yes, Dr. Coleman," Roger McNeil answered quietly.



"Will you . . . drape the face, please?"



Uncomfortably, knowing what was going through Coleman's mind, McNeil reached out for a towel. It was one they had used earlier; it had several big bloodstains. Still with the same soft intensity, Coleman said, "A clean towel, please. And do the same for the genitals."



McNeil nodded to Seddons, who brought over two clean towels. McNeil placed one carefully across the face of the dead woman; the other he used to cover the external genitalia.



Now the two residents stood facing Coleman. Both showed traces of embarrassment. Both sensed what was coming next.



"Gentlemen, I think there is something I should remind you of." David Coleman still spoke quietly - at no time since entering the room had he raised his voice - but there was no mistaking the underlying purpose and authority. Now he said deliberately, "When we perform an autopsy we do so with permission from the family of the one who has died. Without that permission there would be no autopsy. That is quite clear to you, I presume?"



"Quite clear," Seddons said. McNeil nodded.



"Very well." Coleman glanced at the autopsy table, then at the others. "Our own objective is to advance medical learning. The family of the deceased, for its part, gives us the body in trust, expecting that it will be treated with care, respect, and dignity." As he paused there was silence in the room. McNeil and Seddons were standing very still.



"And that is the way we will treat it, gentlemen." Coleman emphasized the words again, "With care, respect, and dignity." He went on, "At all autopsies the face and genitals will be draped and there will be no smoking in the room at any time. As for your own demeanor, and particularly the use of humor" - at the word Mike Seddons flushed a deep red - "I think I can leave that to your imagination."



Momentarily Coleman looked directly at each man in turn. Then, "Thank you, gentlemen. Will you carry on, please?" He nodded and went out.



For several seconds after the door had closed neither spoke. Then, softly, Seddons observed, "We appear to have been skillfully taken apart."



Ruefully McNeil said, "With some reason, I think. Don't you?"



As soon as they could afford it, Elizabeth Alexander decided, she would buy a vacuum cleaner. The old-fashioned carpet sweeper she was using now collected the superficial dirt, but that was about all. She pushed it back and forth a few more times over the rug and inspected the result critically. Not very good, but it would have to do. She must remember to have a talk with John tonight. Vacuum cleaners were not terribly expensive, and one extra monthly payment shouldn't make all that difference. The trouble was, though, there were so many things they needed. It was a problem, deciding which should come first.



In a way, she supposed, John was right. It was all very well to talk of making sacrifices and doing without things so that John could go to medical school. But when you came right down to it, it was hard to manage on any reduced income once you became accustomed to a certain standard. Take John's salary at the hospital, for example. It certainly did not put them in the big brackets, but it had made their life together comfortable and they were able to enjoy small luxuries which a few months ago had been out of reach. Could they surrender those things now? Elizabeth supposed so, but it would be difficult all the same. Medical school would mean another four years of struggling, and even after that there would be internship and perhaps residency, if John decided to specialize. Would it be worth it? Weren't they perhaps better off taking their happiness as they found it at this moment, accepting a role - even if a modest one - in the here and now?



That made sense, didn't it? And yet, somehow, Elizabeth was still unsure. Should she still continue to urge John to aim higher, to enter medical school, at whatever cost? Dr. Coleman obviously believed he should. What was it he had said to John? - If you feel like this, and don't go to medical school while you have the chance, it may be something you'll regret the rest of your life. At the time the words had made a deep impression on Elizabeth and, she suspected, on John too. Now, remembering, they seemed more significant than ever. She frowned; perhaps they had better talk over the whole subject again tonight. If she were convinced of what John really wanted, maybe she could force him into a decision. It would not be the first time Elizabeth had had her own way about things that concerned them both.



Elizabeth put the sweeper away and began to move around the apartment, tidying and dusting. Now, dismissing more serious thoughts for the time being, she sang as she worked. It was a beautiful morning. The warm August sun, shining brightly into the small but comfortable living room, showed off to advantage the new draperies she had made and had hung last night. Elizabeth stopped at the center table to rearrange a vase of flowers. She had removed two blooms which had faded and was about to cross to the tiny kitchen when the pain struck her. It came suddenly, without warning, like a blazing, searing fire and worse, much worse, than the day before in the hospital cafeteria. Drawing in her breath, biting her lip, trying not to scream aloud, Elizabeth sank into a chair behind her. Briefly the pain went away, then it returned, even - it seemed - more intensely. It was as if it were a cycle. Then the significance dawned upon her. Involuntarily she said, "Oh no! No!"



Dimly, through the enveloping anguish, Elizabeth knew she had to act quickly. The hospital number was on a pad by the telephone. Suddenly the instrument on the other side of the room became an objective. Biding her time between each onset of pain, grasping the table for support, Elizabeth eased out of the chair and moved across. When she had dialed and a voice answered, she said, gasping, "Dr. Dornberger . . . it's urgent."



There was a pause and he came on the line. "It's . . . Mrs. Alexander," Elizabeth said. "I've started . . . to have . . . my baby."



David Coleman knocked once on the door of Dr. Pearson's office, then went in. He found the senior pathologist seated behind the desk, Carl Bannister standing alongside. The lab technician's face had a taut expression; after a first glance he studiously avoided looking Coleman's way.



"You wanted to see me, I believe." Coleman had been returning from doing a frozen section on the surgical floor when his name had been called on the public-address system.



"Yes, I did." Pearson's manner was cool and formal. "Dr. Coleman, I have received a complaint concerning you from a member of the staff. Carl Bannister here."



"Oh?" Coleman raised his eyebrows. Bannister was still looking straight ahead.



Pearson went on, "I understand you two had a little brush this morning."



"I wouldn't call it exactly that." Coleman kept his voice casual and unperturbed.



"What would you call it then?" There was no mistaking the acidity in the old man's tone.



Coleman said levelly, "Frankly, I hadn't planned to bring the matter to your attention. But, since Mr. Bannister has chosen to, I think you had better hear the whole story."



"If you're sure it's not too much trouble."



Ignoring the sarcasm, Coleman said, "Yesterday afternoon I told both serology technicians that I planned to make occasional spot checks of laboratory work. Early this morning I did make one such check." Coleman glanced at Bannister. "I intercepted a patient's specimen before delivery to the serology lab and divided the specimen into two. I then added the extra sample to the listing on the requisition sheet, showing it as an extra test. Later, when I checked, I found that Mr. Bannister had recorded two different test results when, of course, they should have been identical." He added, "If you wish, we can get the details from the lab record now."



Pearson shook his head. He had risen from his chair and was half turned away; he appeared to be thinking. Coleman wondered curiously what would happen next. He knew that he himself was on perfectly secure ground. The procedure he had followed was standard in most well-run hospital labs. It provided a protection for patients and was a safeguard against carelessness. Conscientious technicians accepted lab checks without resentment and as a part of their job. Moreover, Coleman had followed protocol in telling both Bannister and John Alexander yesterday that the checks would be made.



Abruptly Pearson wheeled on Bannister. "All right, what have you got to say?"



"I don't like being spied on." The answer was resentful and aggressive. "I've never had to work that way before and I don't figure I should start now."



"And I tell you you're a fool!" Pearson shouted the words. "You're a fool for making a damn silly mistake, and you're an even bigger fool for coming to me when you get caught out." He paused, his lips tight, his breathing heavy. Coleman sensed that part of the old man's anger stemmed from his frustration at having no choice but to support what the younger pathologist had done, much as he might dislike it. Now, standing directly in front of Bannister, he snarled, "What did you expect me to do - pat you on the back and give you a medal?"



Bannister's face muscles were working. For once he appeared to have no answer. Surveying him grimly, Pearson seemed about to go on, then abruptly he stopped. Turning partly away, he gestured with his hand. "Get out! Get out!"



Without a word, his face set, looking neither to right nor left, Bannister went out of the room and closed the door behind him.



Now Pearson turned sharply to Coleman. "What the devil do you mean by this?"



David Coleman could see the burning anger in the old man's eyes. He realized that the affair with Bannister was merely a preliminary skirmish. Determined not to lose his own temper, he answered mildly, "What do I mean by what, Dr. Pearson?"



"You know damn well what I mean! I mean by making lab checks - without my authority."



Coleman said coldly, "Do I really need your authority? For something routine like that?"



Pearson slammed his fist on the desk. "Any time I want lab checks I'll order them!"



"If it's of any interest," Coleman said, still quietly, "I happen to have had your authority. As a matter of courtesy I mentioned to you yesterday that I would like to do standard lab checks in Serology, and you agreed."



Suspiciously Pearson said, "I don't remember."



"I assure you the conversation took place. In any case, I'm not in the habit of making that kind of invention." David Coleman felt his own anger rising; it was hard to conceal his contempt for this aged incompetent. He added, "I may say you seemed rather preoccupied at the time."



He appeared to have checked Pearson, at least partially. Grumblingly the old man said, "If you say so, I'll believe you. But it'll be the last time you do something like that on your own. Understand?"



Coleman sensed that this was a critical moment, both for Pearson and himself. Icily he asked, "Do you mind telling me what kind of responsibility I'm to have in this department?"



"You'll get whatever I choose to give you."



"I'm afraid I don't find that at all satisfactory."



"You don't, eh?" Pearson was directly in front of the younger man now, his head jutted forward. "Well, there happen to be a few things I don't find satisfactory either."



"For instance?" David Coleman had no intention of being intimidated. And if the old man wanted a showdown, he himself was quite willing to have it, here and now.



"For instance, I hear you've been laying down the law in the autopsy room," Pearson said.



"You asked me to take charge of it."



"I told you to supervise autopsies, not to set up a lot of fancy rules. No smoking, I understand. Is that supposed to include me?"



"I imagine that will be up to you, Dr. Pearson."



"I'll say it'll be up to me!" The other's calmness seemed to make Pearson angrier. "Now you listen to me, and listen good. You may have some pretty fancy qualifications, mister, but you've still got a lot to learn and I'm still in charge of this department. What's more, there are good reasons I'm going to be around here for a long time yet. So now's the time to decide - if you don't like the way I run things, you know what you can do."



Before Coleman could answer there was a knock on the door. Impatiently Pearson called out, "Yes?"



A girl secretary came in, glancing curiously from one to the other. It occurred to Coleman that Pearson's voice, at least, must have been clearly audible in the corridor outside. The girl said, "Excuse me, Dr. Pearson. There are two telegrams for you. They just came." Pearson took the two buff envelopes the girl held out.



When she had gone Coleman was about to reply. But Pearson stopped him with a gesture. Beginning to thumb open the first envelope, he said, "These will be the answers about the girl - Lucy Grainger's patient." His tone was quite different from that of a few moments before. He added, "They took long enough about it."



Automatically David Coleman felt a quickening of interest. Tacitly he accepted Pearson's view that their argument could be postponed; this was more important. As Pearson had the first flap open the telephone jangled sharply. With an exclamation of annoyance he put the two envelopes down to answer it.



"Yes?"



"Dr. Pearson, this is Obstetrics," a voice said. "Dr. Dornberger is calling you. One moment, please."



There was a pause, then Dornberger came on the line. He said urgently, "Joe, what's wrong with you people in Pathology?" Without waiting for an answer, "Your technician's wife - Mrs. Alexander - is in labor and the baby will be premature. She's on the way here in an ambulance, and I haven't got a blood-sensitivity report. Now get it up here fast!"



"Right, Charlie." Pearson slammed the receiver down and reached for a pile of forms in a tray marked "Signature." As he did, the two telegraph envelopes caught his eye. Quickly he passed them to Coleman. "Take these. See what they say."



Pearson riffled through the forms. The first time, in his haste, he missed the one he wanted; the second time through he found it. He lifted the telephone again, listened, then said brusquely, "Send Bannister in." Replacing the phone, he scribbled a signature on the form he had removed.



"You want me?" Bannister's tone and expression made it plain that he was still smarting from the reprimand earlier.



"Of course I want you!" Pearson held out the form he had signed. "Get this up to Dr. Dornberger - fast. He's in Obstetrics. John Alexander's wife is in trouble. She's going to have a premie."



Bannister's expression changed. "Does the kid know? He's down in - "



Impatiently Pearson cut him off. "Get going, will you! Get going!" Hastily Bannister went out with the form.



Dimly David Coleman had been aware of what was going on around him. His mind, however, had not yet grasped the details. For the moment he was too concerned with the awesome significance of the two telegrams which he held, opened, in his hand.



Now Pearson turned to him. The old man said, "Well, does the girl lose her leg or not? Are they both definite?"



Coleman thought: This is where pathology begins and ends; these are the borderlands where we must face the truth of how little we really know; this is the limit of learning, the rim of the dark, swirling waters of the still unknown. He said quietly, "Yes, they're both definite. Dr. Chollingham in Boston says, 'Specimen definitely malignant.' Dr. Earnhart in New York says, 'The tissue is benign. No sign of malignancy.' "



There was a silence. Then Pearson said slowly, softly, "The two best men in the country, and one votes 'for,' the other 'against.' " He looked at Coleman, and when he spoke there was irony but no antagonism. "Well, my young pathologist friend, Lucy Grainger expects an answer today. She will have to be given one, and it will have to be definite." With a twisted smile, "Do you feel like playing God?"