ah.thefinaldiagnosis-第1部分

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　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　pletely　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　e　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　fort　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　ing　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　disfort；　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　fort。　Some　of　the　surgeons　had　pleted　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