ah.thefinaldiagnosis-第11部分

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　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　unfortably　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？〃
　The　remark　and　the　question　were　outrageous。　Even　if　Bartlett　were　to　be　reprimanded；　it　should　e　from　O'Donnell；　not　Pearson；　and　be　done　in　private。　It　was　not　as　if　Bartlett　had　a　reputation　for　carelessness。　Those　who　had　worked　with　him　knew　that　he　was　thorough　and；　if　anything；　inclined　to　be　ultra…cautious。　In　this　instance；　obviously；　he　had　been　faced　with　the　need　to　make　a　fast　decision。
　Bartlett　was　on　his　feet；　his　chair　flung　back；　his　face　flaming　red。　〃Of　course　I　examined　the　chest！〃　He　barked　out　the　words；　the　beard　moving　rapidly。　〃I　already　said　the　patient　was　in　no　condition　to　have　a　chest　film；　and　even　if　he　had〃
　〃Gentlemen！　Gentlemen！〃　It　was　O'Donnell；　but　Bartlett　refused　to　be　stopped。
　〃It's　very　easy　to　have　hindsight；　as　Dr。　Pearson　loses　no　chance　to　remind　us。〃
　From　across　the　table　Charlie　Dornberger　motioned　with　his　pipe。　〃I　don't　think　Dr。　Pearson　intended〃
　Angrily　Bartlett　cut　him　off。　〃Of　course　you　don't　think　so。　You're　a　friend　of　his。　And　he　doesn't　have　a　vendetta　with　obstetricians。〃
　〃Really！　I　will　not　permit　this。〃　O'Donnell　was　standing　himself　now；　banging　with　his　gavel。　His　shoulders　were　squared；　his　athlete's　bulk　towering　over　the　table。　Lucy　thought：　He's　all　man；　every　inch。　〃Dr。　Bartlett；　will　you　be　kind　enough　to　sit　down？〃　He　waited；　still　standing；　as　Bartlett　resumed　his　seat。
　O'Donnell's　outward　annoyance　was　matched　with　an　inward　seething。　Joe　Pearson　had　no　right　to　throw　a　meeting　into　a　shambles　like　this。　Now；　instead　of　pursuing　the　discussion　quietly　and　objectively；　O'Donnell　knew　he　had　no　choice　but　to　close　it。　It　was　costing　him　a　lot　of　effort　not　to　sound　off　at　Joe　Pearson　right　here　and　now。　But　if　he　did　he　knew　it　would　make　the　situation　worse。
　O'Donnell　had　not　shared　the　opinion　of　Bill　Rufus　that　Gil　Bartlett　was　blameless　in　the　matter　of　his　patient's　death。　O'Donnell　was　inclined　to　be　more　critical。　The　key　factor　in　the　case　was　the　absence　of　a　chest　X…ray。　If　Bartlett　had　ordered　an　upright　chest　film　at　the　time　of　admission；　he　could　have　looked　for　indications　of　gas　across　the　top　of　the　liver　and　under　the　diaphragm。　This　was　a　clear　signpost　to　any　perforated　ulcer；　therefore　the　absence　of　it　would　certainly　have　set　Bartlett　thinking。　Also；　the　X…ray　might　have　shown　some　clouding　at　the　base　of　the　lung；　which　would　have　indicated　the　pneumonia　which　Joe　Pearson　had　found　later　at　the　autopsy。　One　or　another　of　these　factors　might　easily　have　caused　Bartlett　to　change　his　diagnosis　and　improved　the　patient's　chances　of　survival。
　Of　course；　O'Donnell　reflected；　Bartlett　had　claimed　the　patient　was　too　sick　for　an　X…ray　to　be　taken。　But　if　the　man　had　been　as　sick　as　that　should　Bartlett　have　undertaken　surgery　anyway？　O'Donnell's　opinion　was　that　he　should　not。
　O'Donnell　knew　that　when　an　ulcer　perforated　surgery　should　normally　be　begun　within　twenty…four　hours。　After　that　time　the　death　rate　was　higher　with　surgery　than　without。　This　was　because　the　first　twenty…four　hours　were　the　hardest；　after　that；　if　a　patient　had　survived　that　long；　the　body's　own　defenses　would　be　at　work　sealing　up　the　perforations。　From　the　symptoms　Bartlett　had　described　it　seemed　likely　that　the　patient　was　close　to　the　twenty…four…hour　limit　or　perhaps　past　it。　In　that　case　O'Donnell　himself　would　have　worked　to　improve　the　man's　condition　without　surgery　and　with　the　intention　of　making　a　more　definitive　diagnosis　later。　On　the　other　hand；　O'Donnell　was　aware　that　in　medicine　it　was　easy　to　have　hindsight；　but　it　was　quite　another　matter　to　do　an　emergency　on…the…spot　diagnosis　with　a　patient's　life　at　stake。
　All　of　this　the　chief　of　surgery　would　have　had　brought　out；　in　the　ordinary　way；　quietly　and　objectively；　at　the　mortality　conference。　Indeed；　he　would　probably　have　led　Gil　Bartlett　to　make　some　of　the　points　himself；　Bartlett　was　honest　and　not　afraid　of　self…examination。　The　point　of　the　discussion　would　have　been　evident　to　everyone。　There　would　have　been　no　need　for　emphasis　or　recriminations。　Bartlett　would　not　have　enjoyed　the　experience；　of　course；　but　at　the　same　time　he　would　not　have　been　humiliated。　More　important　still；　O'Donnell's　purpose　would　have　been　served　and　a　practical　lesson　in　differential　diagnosis　impressed　on　all　the　surgical　staff。
　Now　none　of　this　could　happen。　If；　at　this　stage；　O'Donnell　raised　the　points　he　had　had　in　mind；　he　would　appear　to　be　supporting　Pearson　and　further　condemning　Bartlett。　For　the　sake　of　Bartlett's　own　morale　this　must　not　happen。　He　would　talk　to　Bartlett　in　private；　of　course；　but　the　chance　of　a　useful；　open　discussion　was　lost。　Confound　Joe　Pearson！
　Now　the　uproar　had　quieted。　O'Donnell's　banging　of　the　gavel…a　rare　occurrence…had　had　effect。　Bartlett　had　sat　down；　his　face　still　angry　red。　Pearson　was　turning　over　some　papers；　apparently　absorbed。
　〃Gentlemen。〃　O'Donnell　paused。　He　knew　what　had　to　be　said；　it　must　be　quick　and　to　the　point。　〃I　think　I　need　hardly　say　this　is　not　an　incident　any　of　us　would　wish　to　see　repeated。　A　mortality　conference　is　for　learning；　not　for　personalities　or　heated　argument。　Dr。　Pearson；　Dr。　Bartlett；　I　trust　I　make　myself　clear。〃　O'Donnell　glanced　at　both；　then；　without　waiting　for　acknowledgment；　announced；　〃We'll　take　the　next　case；　please。〃
　There　were　four　more　cases　down　for　discussion；　but　none　of　these　was　out　of　the　ordinary　and　the　talk　went　ahead　quietly。　It　was　just　as　well；　Lucy　reflected；　controversy　Eke　that　was　no　help　to　staff　morale。　There　were　times　when　it　required　courage　to　make　an　emergency　diagnosis；　even　so；　if　you　were　unfortunate　and　guilty　of　error；　you　expected　to　be　called　to　account。　But　personal　abuse　was　another　matter；　no　surgeon；　unless　grossly　careless　and　inpetent；　should　have　to　take　that。
　Lucy　wondered；　not　for　the　first　time；　how　much　of　Joe　Pearson's　censure　at　times　like　this　was　founded　on　personal　feelings。　Today；　with　Gil　Bartlett；　Pearson　had　been　rougher　than　she　remembered　his　ever　being　at　any　mortality　meeting。　And　yet　this　was　not　a　flagrant　case；　nor　was　Bartlett　prone　to　mistakes。　He　had　done　some　fine　work　at　Three　Counties；　notably　on　types　of　cancer　which　not　long　before　were　considered　inoperable。
　Pearson　knew　this；　too；　of　course；　so　why　his　antagonism？　Was　it　because　Gil　Bartlett　represented　something　in　medicine　which　Pearson　envied　and　had　never　attained？　She　glanced　down　the　table　at　Bartlett。　His　face　was　set；　he　was　still　smarting。　But　normally　he　was　relaxed；　amiable；　friendly…all　the　things　a　successful　man　in　his　early　forties　could　afford　to　be。　Along　with　his　wife；　Gil　Bartlett　was　a　prominent　figure　in　Burlington　society。　Lucy　had　seen　him　at　ease　at　cocktail　parties　and　in　wealthy　patients'　homes。　His　practice　was　successful。　Lucy　guessed　his　annual　ine　from　it　would　be　in　the　region　of　fifty　thousand　dollars。
　Was　this　what　griped　Joe　Pearson？…Joe　Pearson　who　could　never　pete　with　the　glamor　of　surgery；　whose　work　was　essential　but　undramatic；　who　had　chosen　a　branch　of　medicine　seldom　in　the　public　eye。　Lucy　herself　had　heard　people　ask：　What　does　a　pathologist　do？　No　one　ever　said：　What　does　a　surgeon　do？　She　knew　there　were　some　who　thought　of　pathologists　as　a　breed　of　hospital　technician；　failing　to　realize　that　a　pathologist　had　to　be　first　a　physician　with　a　medical　degree；　then　spend　years　of　extra　training　to　bee　a　highly　qualified　specialist。
　Money　sometimes　was　a　sore　point　too。　On　Three　Counties'　staff　Gil　Bartlett　ranked　as　an　attending　physician；　receiving　no　payment　from　the　hospital；　only　from　his　patients。　Lucy　herself；　and　all　the　other　attending　physicians；　were　on　staff　on　the　same　basis。　But；　in　contrast；　Joe　Pearson　was　an　employee　of　the　hospital；　receiving　a　salary　of　twenty…five　thousand　dollars　a　year；　roughly　half　of　what　a　successful　surgeon…many　years　his　junior…could　earn。　Lucy　had　once　read　a　cynical　summation　of　the　difference　between　surgeons　and　pathologists：　〃A　surgeon　gets　500　for　taking　out　a　tumor。　A　pathologist　gets　five　dollars　for　examining　it；　making　a　diagnosis；　remending　further　treatment；　and　predicting　the　patient's　future。〃
　Lucy　herself　had　fared　well　in　her　relationship　with　Joe　Pearson。　For　some　reason　she　was　not　sure　of；　he　had　seemed　to　like　her；　and　there　were　moments　she　found　herself　responding　and　liking　him　also。　Sometimes　this　could　prove　a　help　when　she　needed　to　talk　with　him　about　a　diagnosis。
　Now　the　discussion　was　ending；　O'Donnell　winding　things　up。　Lucy　brought　her　attention　back　into　focus。　She　had　let　it　wander　during　the　last　case；　that　was　not　good…she　would　have　to　watch　herself。　The　others　were　rising　from　their　seats。　Joe　Pearson　had　collected　his　papers　and　was　shambling　out。　But　on　the　way　O'Donnell　stopped　him；　she　saw　the　chief　of　surgery　steer　the　old　man　away　from　the　others。
　〃Let's　go　in　here　a　minute；　Joe。〃　O'Donnell　opened　the　door　to　a　small　office。　It　adjoined　the　board　room　and　was　sometimes　used　for　mittee　meetings。　Now　it　was　empty。　Pearson　followed　the　chief　of　surgery　in。
　O'Donnell　was　elaborately　casual。　〃Joe；　I　think　you　should　quit　riding　people　at　these　meetings。〃
　〃Why？〃　Pearson　was　direct。
　All　right；　O'Donnell　thought；　if　that's　the　way　you　want　it。　Aloud　he　said；　〃Because　it　gets　us　nowhere。〃　He　allowed　his　voice　to　take　on　an　edge。　Ordinarily　in　dealing　with　the　old　man　he　deferred　a　little　to　the　gap　of　years　between　them。　But　this　was　a　moment　to　exercise　his　own　authority。　Although；　as　chief　of　surgery；　O'Donnell　had　no　direct　control　of　Pearson's　activities；　he　did　have　certa