ah.thefinaldiagnosis-第10部分

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　might　be　problems　as　well　about　their　parallel　careers。　Nonetheless；　he　still　felt　more　fortable　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　unfortable　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　ing　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　bat　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　ing。　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　ing　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　roo