ah.thefinaldiagnosis-第12部分

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n's　activities；　he　did　have　certain　prerogatives　when　the　work　of　Pathology　cut　across　his　own　division。
　〃I　pointed　out　a　wrong　diagnosis…that's　all。〃　Pearson　was　aggressive　himself　now。　〃Do　you　suggest　we　keep　quiet　about　such　things？〃
　〃You　know　better　than　to　ask　that。〃　O'Donnell　slammed　out　the　answer；　this　time　not　bothering　at　all　to　keep　the　ice　from　his　voice。　He　saw　Pearson　hesitate　and　suspected　the　old　man　knew　he　had　gone　too　far。
　Grumblingly　he　conceded；　〃I　didn't　mean　that；　not　that　way。〃
　Despite　himself　Kent　O'Donnell　smiled。　Apologizing　did　not　e　easily　to　Joe　Pearson。　It　must　have　cost　him　quite　a　lot　to　say　that。　Now　O'Donnell　went　on　more　reasonably；　〃I　think　there　are　better　ways　to　do　it；　Joe。　If　you　don't　mind；　at　these　meetings　I'd　like　you　to　give　us　the　autopsy　findings；　then　I'll　lead　the　discussion　afterward。　I　think　we　can　do　it　without　getting　tempers　frayed。〃
　〃I　don't　see　why　anybody　has　to　get　in　a　temper。〃　Pearson　was　still　grumbling；　but　O'Donnell　sensed　he　was　backing　down。
　〃All　the　same；　Joe；　I'd　like　to　do　it　my　way。〃　I　don't　want　to　ram　it　down　his　throat；　O'Donnell　thought；　but　this　is　the　time　to　make　things　clear。
　Pearson　shrugged。　〃If　that's　the　way　you　want　it。〃
　〃Thanks；　Joe。〃　O'Donnell　knew　he　had　won；　it　had　been　easier　than　he　had　expected。　Maybe　this　would　be　a　good　time　to　raise　the　other　thing。　〃Joe；〃　he　said；　〃while　we're　here；　there's　something　else。〃
　〃I've　got　a　lot　to　do。　Couldn't　it　wait？〃　As　Pearson　spoke；　O'Donnell　could　almost　read　his　mind。　The　pathologist　was　making　it　clear　that　though　he　had　conceded　one　point　he　had　not　abandoned　his　independence。
　〃I　don't　think　it　can。　It's　about　surgical　reports。〃
　〃What　about　them？〃　The　reaction　was　aggressively　defensive。
　O'Donnell　went　on　smoothly。　〃I've　had　plaints。　Some　of　the　reports　have　been　a　long　time　ing　through　Pathology。〃
　〃Rufus；　I　suppose。〃　Pearson　was　openly　bitter　now。　You　could　almost　hear　him　saying：　Another　surgeon　causing　trouble。
　O'Donnell　determined　not　to　be　provoked。　He　said　quietly；　〃Bill　Rufus　was　one。　But　there　have　been　others。　You　know　that；　Joe。〃
　For　a　moment　Pearson　made　no　answer；　and　O'Donnell　reflected　that　in　a　way　he　felt　sorry　for　the　old　man。　The　years　were　slipping　by。　Pearson　was　sixty…six　now；　at　best　he　had　another　five　or　six　years　of　active　work　ahead　of　him。　Some　people　reconciled　themselves　to　change　like　that；　to　younger　men　moving　into　prominence　and　taking　over　leadership。　Pearson　had　not；　though；　and　he　made　his　resentment　plain。　O'Donnell　wondered　what　was　back　of　his　attitude。　Did　he　feel　himself　slipping；　unable　to　keep　up　with　new　developments　in　medicine？　If　so；　he　would　not　be　the　first。　And　yet　Joe　Pearson；　for　all　his　disagreeable　ways；　had　a　lot　to　mend　him。　That　was　one　of　the　reasons　why　O'Donnell　trod　circumspectly　now。
　〃Yes；　I　know。〃　Pearson's　reply　held　a　tone　of　resignation。　He　had　accepted　the　fact　though。　That　was　typical　of　him；　O'Donnell　thought。　Right　from　the　beginning　at　Three　Counties　he　had　liked　Pearson's　directness　and　at　times　had　made　use　of　it　in　raising　surgical　standards。
　O'Donnell　remembered　that　one　of　the　problems　he　had　faced　in　his　early　months　at　the　hospital　had　been　the　elimination　of　needless　surgery。　Under　this　heading　had　e　an　unnatural　number　of　hysterectomies；　and　in　too　many　cases　healthy；　normal　uteri　were　being　removed　by　a　few　staff　surgeons。　These　were　men　who　found　surgery　a　convenient　and　profitable　remedy　for　any　female　pain；　even　those　which　might　have　responded　to　internal　medication。　In　such　instances　euphemisms　in　diagnosis　like　〃chronic　myometritis〃　or　〃fibrosis　of　uterus〃　were　resorted　to　as　a　smoke　screen　to　cover　up　the　pathology　report　on　the　removed　tissue。　O'Donnell　remembered　telling　Pearson：　〃When　we're　reporting　on　tissue　we'll　call　a　spade　a　spade　and　a　healthy　uterus　a　healthy　uterus。〃　Pearson　had　grinned　and　co…operated　fully。　As　a　result　most　of　the　unnecessary　surgery　had　stopped。　Surgeons　found　it　embarrassing　to　have　tissue　they　had　removed　from　patients　listed　for　all　their　colleagues　to　see　as　normal　and　uninfected。
　〃Look；　Kent。〃　Pearson　was　more　conciliatory　now。　〃Just　lately　I've　been　up　to　my　ears。　You've　no　idea　how　much　work　there　is。〃
　〃I　do　have　an　idea；　Joe。〃　This　was　the　opening　O'Donnell　had　hoped　for。　〃Some　of　us　think　you've　too　much　to　do。　It　isn't　fair　to　you。〃　He　was　tempted　to　add　〃at　your　age〃　but　thought　better　of　it。　Instead　he　added；　〃How　about　getting　some　help？〃
　The　reaction　was　immediate；　Pearson　almost　shouting。　〃You're　telling　me　to　get　more　help！　Why；　man　alive；　I've　been　asking　for　months　for　more　lab　technicians！　We　need　three　at　least；　so　what　am　I　told　I　can　have？　One！　And　stenographers！　I've　got　reports　that　have　been　piling　up　for　weeks；　and　who's　going　to　type　them？〃　Not　waiting　for　an　answer；　he　went　storming　on。　〃Me？　If　the　administration　would　get　off　its　fanny　we　might　get　a　few　things　done…including　faster　surgicals。　By　God！　When　you　tell　me　I　should　get　more　help；　that's　really　something　to　hear。〃
　O'Donnell　had　listened　quietly。　Now　he　said；　〃Finished；　Joe？〃
　〃Yeah。〃　Pearson　seemed　chastened；　half　ashamed　at　his　outburst。
　〃It　wasn't　technicians　or　office　staff　I　was　thinking　about；〃　O'Donnell　told　him。　〃When　I　meant　help　I　meant　another　pathologist。　Someone　to　help　you　run　the　department。　Maybe　modernize　it　here　and　there。〃
　〃Now　look　here！〃　at　the　word　〃modernize〃　Pearson　had　bridled；　but　O'Donnell　brushed　the　objection　aside。　〃I　listened　to　you；　Joe。　Now　you　hear　me　out。　Please。〃　He　paused。　〃I　was　thinking　of　maybe　some　bright　young　fellow　who　could　relieve　you　of　some　duties。〃
　〃I　don't　need　another　pathologist。〃　It　was　a　flat　statement；　vehement　and　unpromising。　〃Why；　Joe？〃
　〃Because　there's　not　enough　work　for　two　qualified　men。　I　can　handle　all　the　pathology　myself…without　any　help。　Besides；　I've　already　got　a　resident　in　the　department。〃
　O'Donnell　was　quietly　persistent。　〃A　resident　is　with　us　for　training；　Joe；　and　usually　for　just　a　short　time。　Sure；　a　resident　can　carry　some　of　the　work。　But　you　can't　give　him　responsibility　and　we　can't　use　him　for　administration。　That's　where　you　need　some　help　right　now。〃
　〃Let　me　be　the　judge　of　that。　Give　me　a　few　days　and　we'll　be　caught　up　in　surgicals。〃
　It　was　obvious　that　Joe　Pearson　had　no　intention　of　giving　way。　O'Donnell　had　expected　resistance　to　bringing　in　a　new　pathologist；　but　he　wondered　about　the　other　man's　forcefulness。　Was　it　because　he　was　unwilling　to　divide　his　personal　empire；　or　was　he　simply　protecting　his　job…fearful　that　a　new　and　younger　man　might　undermine　him？　Actually　the　idea　of　removing　Pearson　had　not　occurred　to　O'Donnell。　In　the　field　of　pathological　anatomy　alone　Joe　Pearson's　long　experience　would　be　hard　to　replace。　O'Donnell's　objective　was　to　strengthen　the　department　and　thereby　the　hospital　organization。　Perhaps　he　should　make　this　clear。
　〃Joe；　there's　no　question　of　any　major　change。　No　one　has　suggested　it。　You'd　still　be　in　charge　。　。　。〃
　〃In　that　case　let　me　run　Pathology　my　own　way。〃
　O'Donnell　found　his　patience　ebbing。　He　decided　that　perhaps　he　had　pressed　the　point　enough　for　now。　He　would　let　it　go　for　a　day　or　two；　then　try　again。　He　wanted　to　avoid　a　showdown　if　he　could。　He　said　quietly；　〃I'd　think　it　over　if　I　were　you。〃
　〃There's　nothing　to　think　over。〃　Pearson　was　at　the　door。　He　nodded　curtly　and　went　out。
　So　there　it　is；　O'Donnell　thought。　We've　laid　the　lines　of　battle。　He　stood　there；　considering　thoughtfully　what　the　next　move　should　be。
　
　Five
　
　The　cafeteria　of　Three　Counties　Hospital　was　a　traditional　meeting　place　for　most　of　the　hospital　grapevine；　its　stems　and　branches　extending　tenuously　to　every　section　and　department　within　Three　Counties'　walls。　Few　events　occurred　in　the　hospital…promotions；　scandals；　firings；　and　hirings…which　were　not　known　and　discussed　in　the　cafeteria　long　before　official　word　was　ever　published。
　Medical　staff　frequently　used　the　cafeteria　for　〃curbstone　consultations〃　with　colleagues　whom　they　seldom　saw　except　at　a　meal　or　coffee　break。　Indeed；　a　good　deal　of　serious　medical　business　was　transacted　over　its　tables；　and　weighty　specialist　opinions；　which　at　other　times　would　be　followed　by　a　substantial　bill；　were　often　tossed　out　freely；　sometimes　to　the　great　advantage　of　a　patient　who；　recovering　later　from　some　ailment　which　at　first　had　proven　troublesome；　would　never　suspect　the　somewhat　casual　channels　through　which　his　eventual　course　of　treatment　had　e。
　There　were　exceptions。　A　few　staff　physicians　now　and　then　resented　this　informal　use　of　their　arduously　acquired　talénts　and　resisted　attempts　by　colleagues　to　draw　them　out　in　the　discussion　of　specific　cases。　In　such　instances　the　usual　rejoinder　was；　〃I　think　we'd　better　set　up　a　consultation　in　my　office。　I'll　have　the　meter　running　then。〃
　Gil　Bartlett　was　one　who　disapproved　of　such　approaches　and　at　times　could　be　a　good　deal　blunter　in　refusing　off…the…cuff　opinions。　One　story　told　about　his　personal　tactics　of　resistance　had　its　origin　not　in　the　cafeteria　but　at　a　cocktail　party　in　a　private　home。　His　hostess；　a　grand　dame　of　Burlington　society；　had　buttonholed　Bartlett　and　bombarded　him　with　questions　about　her　illnesses；　real　and　imagined。　Bartlett　had　listened　for　a　while；　then　announced　in　a　loud　voice　which　brought　a　hush　to　the　crowded　room；　〃Madam；　I　believe　from　what　you　say　you　have　a　menstrual　problem。　If　you'll　strip　right　now　I'll　examine　you　here。〃
　Mostly　though；　much　as　they　might　resist　informal　consultations　outside　the　hospital；　the　medical　staff　accepted　the　cafeteria　exchanges　on　the　basis　that　they　had　as　much　to　gain　as　lose；　and　a　good　many　physicians　around　the　hospital　used　the　mildewed　quip　on　leaving　their　contact　points；　〃If　you　want　me　I'll　be　in　my　second　office。〃　Normally　no　further　explanation　was　required　or　given。
　Generally　the　cafeteria　was　a　democratic　area　where　hospital　rank；　if　not　forgotten；　was　at　least　temporarily　ignored。　An　exception；　possibly；　was　the　practice　of　setting　aside　a　group　of　tables　for　the　medical　staff。　Mrs。　Straughan；　the　chief　dietitian；　hovered　over　this　area　periodically；　knowing　that　even　minor　sho