“All them nice peopl’ movin’ out of th’ elevator fo’ me,” she was saying. “Why, ah nevah felt so important befo’ in all mah life.” At this point Dornberger heard the intern tell the patient to relax and the answer came back, “Relax, sonny? Ah am relaxed. Ah always relaxes when ah has a baby. That th’ only time there’s no dishes, no washin’, no cookin’. Why, ah look forward to comin’ in here. This just a holiday fo’ me.” She paused as pain gripped her. Then, partly through clenched teeth, she muttered, “Nine children ah’ve got, and this’ll be the tenth. Th’ oldest one’s as big as you, sonny. Now you be lookin’ fo’ me a year from now. Ah tell you, ah’ll be back.” Dornberger heard her chuckling as her voice faded, the delivery room nurses taking over, while the intern went back to his post in Emergency.
Now Dornberger, scrubbed, gowned, sterile, and sweating from the heat, followed his patient into the delivery room.
In the hospital kitchens, where the heat was less of a problem because people who worked there were used to it, Hilda Straughan, the chief dietitian, nibbled a piece of raisin pie and nodded approvingly at the senior pastry cook. She suspected that the calories, along with others, would be reflected on her bathroom scales a week from now but quelled her conscience by telling herself it was a dietitian’s duty to sample as much as possible of the hospital fare. Besides, it was somewhat late now for Mrs. Straughan to be fretting on the subject of calories and weight. The accumulated result of many earlier samplings caused her nowadays to turn the scales around two hundred pounds, a good deal of which was in her magnificent breasts—twin Gibraltars, famed through the hospital, and which made her progress not unlike the majesty of an aircraft carrier preceded by an escort of twin battleships.
But, as well as food, Mrs. Straughan was in love with her job. Glancing around her with satisfaction, she took in her empire—the shining steel ovens and serving tables, the gleaming utensils, the sparkling white aprons of the cooks and their assistants. Her heart warmed at the sight of all of it.
This was a busy time in the kitchens—lunch was the heaviest meal of the day because, as well as patients, there was the full hospital staff to be fed in the cafeteria. In twenty minutes or so the diet trays would be going up to the wards, and for two hours afterward the service of food would continue. Then, while the kitchen help cleared and stacked dishes, the cooks would begin preparing the evening meal.
The thought of dishes caused Mrs. Straughan to frown thoughtfully, and she propelled herself into the back section of the kitchen where the two big automatic dishwashers were installed. This was a part of her domain less gleaming and modern than the other section, and the chief dietitian reflected, not for the first time, that she would be happy when the equipment here was modernized, as the rest of the kitchens had been. It was understandable, though, that everything could not be done at once, and she had to admit she had browbeaten the administration into a lot of expensive new equipment in the two years she had held her job at Three Counties. All the same, she decided as she moved on to check the steam tables in the cafeteria, she would have another talk with the administrator about those dishwashers soon.
The chief dietitian was not the only one in the hospital whose thoughts were on food. In Radiology, on the second floor, an outpatient—Mr. James Bladwick, vice-president of sales for one of Burlington’s big-three automobile dealerships—was, in his own words, “as hungry as hell.”
There was reason for this. On his physician’s instructions Jim Bladwick had fasted since midnight, and now he was in number one X-ray room, ready for a gastric series. The X-rays would confirm or deny the suspicion that flourishing in the Bladwick interior was a duodenal ulcer. Jim Bladwick hoped the suspicion was unfounded; in fact, he hoped desperately that neither an ulcer nor anything else would conspire to slow him down now that his drive and sacrifice of the past three years, his willingness to work harder and longer than anyone else on sales staff, were at last paying off.
Sure he worried; who wouldn’t when they had a dealer sales quota to meet every month. But it just couldn’t be an ulcer; it had to be something else—something trivial that could be fixed up quickly. He had been vice-president of sales only a matter of six weeks, but despite the high-sounding title he knew better than anyone that retention of it depended on a continued ability to produce. And to produce you had to be on the ball—tough, available, fit. No medical certificate would compensate for a declining sales graph.
Jim Bladwick had put this moment off for some time. It was probably two months ago that he had become aware of distress and a general aching in the stomach region, had noticed, too, he was burping a lot, sometimes at awkward moments with customers around. For a while he had tried to pretend it was nothing out of the ordinary, but finally he had sought medical advice, and this morning’s session was the outcome. He hoped, though, it was not going to take too long; that deal of Fowler’s for six panel trucks was getting hot, and they needed the sale badly. By God, he was hungry!
For Dr. Ralph Bell, the senior radiologist—“Ding Dong” to most of the hospital staff—this was just another G.I. series, no different from any of a hundred others. But, playing a mental game he sometimes indulged in, he decided to bet “yes” on this one. This patient looked the type for an ulcer. From behind his own thick-lensed, horn-rimmed glasses Bell had been watching the other man covertly. He looked a worrier, Bell decided; he was obviously stewing right now. The radiologist placed Bladwick in position behind the fluoroscope and handed him a tumbler of barium. “When I tell you,” he said, “drink this right down.”
When he was ready he ordered, “Now!” Bladwick drained the glass.
In the fluoroscope Bell watched the path of the barium as it coursed first through the esophagus, then into the stomach, and from there into the duodenum. Sharpened by the opaque liquid, the outline of each organ was clearly visible, and at various stages Bell thumbed a button recording the results on film. Now he palpated the patient’s abdomen to move the barium around. Then he could see it—a crater in the duodenum. An ulcer, clear and unmistakable. He reflected that he had won the bet with himself. Aloud he said, “That’s all, Mr. Bladwick, thank you.”
“Well, Doc, what’s the verdict? Am I going to live?”
“You’ll live.” Most of them wanted to know what he saw in the fluoroscope. Magic mirror on the wall, who is healthiest of all? It wasn’t his job to tell though. “Your own physician will get these films tomorrow. I imagine he’ll be talking to you.” Hard luck, my friend, he thought. I hope you like lots of rest and a diet of milk and poached eggs.
Two hundred yards away from the main hospital block, in a run-down building that had once been a furniture factory and now did duty as a nurses’ home, Student Nurse Vivian Loburton was having trouble with a zipper that refused to zip.
“Damn and hellfire!” She addressed the zipper with an expression much favored by her father, who had made a comfortable fortune felling tall trees and saw no reason to have one language for the woods and another at home.
Vivian, at nineteen, sometimes provided an interesting contrast between her father’s robustness and her mother’s innate New England delicacy which close contact with Oregon lumbering had never changed. Now, in her fourth month of training as a nurse, Vivian had already found something of the traits of both parents in her own reaction to the hospital and nursing. At one and the same time she was awed and fascinated, repulsed and disgusted. She supposed that close contact with sickness and disease was always a shock for anyone new. But knowing that did not help much when your stomach was ready to do flip-flops and it took all the will you possessed not to turn and run away.
It was after moments like this that she felt the need for a change of scene, a cleansing antidote; and to some extent she had found it in an old love—music. Surprisingly, for a city of its size, Burlington had an excellent symphony, and, discovering this, Vivian had become one of its supporters. She found the switch in tempo, the balm of good music, helped to steady and reassure her. She had been sorry when concerts had ended for the summer, and there had been moments recently when she had felt the need of something to replace them.
There was no time now, though, for odd, stray thoughts; the gap between morning classes and reporting to a ward for duty had been short enough. Now this zipper! . . . She tugged again, and suddenly the teeth meshed, the zipper closed. Relieved, she ran for the door, then paused to mop her face. Jeepers, it was hot! And all that effort had made her sweat like crazy.
So it went—that morning as all mornings—through the hospital. In the clinics, the nurseries, laboratories, operating rooms; in Neurology, Psychiatry, Pediatrics, Dermatology; in Orthopedics, Ophthalmology, Gynecology, Urology; in the charity wards and the private patients’ pavilion; in the service departments—administration, accounting, purchasing, housekeeping; in the waiting rooms, corridors, halls, elevators; throughout the five floors, basement, and sub-basement of Three Counties Hospital the tides and currents of humanity and medicine ebbed and flowed.
It was eleven, o’clock on the fifteenth of July.
Two blocks from Three Counties Hospital the clock-tower bell of the Church of the Redeemer was chiming the hour as Kent O’Donnell made his way from the surgical floor down to Administration. The sound of the bell, off-key as always from a flaw in its long-ago casting, drifted in through an open stairway window. Automatically O’Donnell checked his wrist watch, then moved aside as a group of interns passed him hurriedly on the staff stairway, their feet sounding noisily on the metal treads. The interns quietened a little when they saw the medical-board president and offered a respectful “Good morning, Doctor,” as each went by. On the second floor O’Donnell halted to let a nurse with a wheel chair pass. In it was a girl of about ten with a bandage over one eye, a woman, plainly the mother, hovering protectively alongside.
The nurse, whom he smiled at but failed to recognize, appraised him covertly. In his early forties, O’Donnell still rated second glances from women. He had retained the build which had made him an outstanding quarterback in his college years—a tall, erect figure with big, broad shoulders and muscular arms. Even nowadays he had a trick of squaring his shoulders when ready to do something difficult or make a decision—as if readying instinctively to stop the charge of a red-dogging tackle. Yet despite his bulk—mostly bone and muscle with less than a pound of overweight—he still moved lightly; and regular sport—tennis in summer, skiing in winter—had kept him robust and lithe.
O’Donnell had never been handsome in the Adonic sense, but he had a rugged, creased irregularity of face (his nose still carried the scar of an old football injury) which women so often, and perversely, find attractive in men. Only his hair showed the real trace of years; not so long ago jet black, now it was graying swiftly as if the color pigments had suddenly surrendered and were marching out.
Now, from behind, O’Donnell heard his name called. He stopped and saw the caller was Bill Rufus, one of the seniors on surgical staff.
“How are you, Bill?” O’Donnell liked Rufus. He was conscientious, dependable, a good surgeon with a busy practice. His patients trusted him because of a forthright integrity which came through when he talked. He was respected by the house staff—interns and residents—who found Dr. Rufus to have a painless, pleasant way of imparting sound instruction while treating them as equals—a condition not always prevailing with other surgeons.
His only peculiarity, if you could call it that, was a habit of wearing impossibly gaudy neckties. O’Donnell shuddered inwardly as he noticed the creation his colleague was sporting today—turquoise circles and vermilion zigzags on a background of mauve and lemon yellow. Bill Rufus took a good deal of ribbing about his ties. One of the psychiatrists on staff had suggested recently that they represented “a pus crater from an inner seething below a conservative surface.” But Rufus had merely laughed good-naturedly. Today, though, he seemed troubled.
“Kent, I want to talk to you,” Rufus said.
“Shall we go to my office?” O’Donnell was curious now. Rufus was not the type to come to him unless it were something important.
“No; here’s as good as anywhere. Look, Kent, it’s about surgical reports from Pathology.”
They moved over to a window to avoid the traffic in the corridor, and O’Donnell thought: I was afraid of this. To Rufus he said, “What’s on your mind, Bill?”
“The reports are taking too long. Much too long.”
O’Donnell was well aware of the problem. Like other surgeons, Rufus would frequently operate on a patient with a tumor. When the tumor was exposed he would remove it for examination by the hospital’s pathologist, Dr. Joseph Pearson. The pathologist would then make two studies of the tissue. First, working in a small lab adjoining the operating room, and with the patient still under anesthetic, he would freeze a small portion of tissue and examine it under a microscope. From this procedure could come one of two verdicts—“malignant,” meaning the presence of cancer and indicating the need for major surgery on the patient; or “benign,” a reprieve which usually meant that nothing more need be done once the tumor was out. If a frozen section produced a “malignant” verdict, surgery would continue at once. On the other hand, the opinion “benign” from the pathologist was a signal for the surgeon to make his closure and send the patient to the recovery room.
“There’s no delay in frozen sections, is there?” O’Donnell had not heard of any, but he wanted to be sure.
“No,” Rufus said. “You’d hear plenty of howling if there were. But it’s the full tissue report that’s taking so long.”
“I see.” O’Donnell was maneuvering for time while he marshaled his thoughts. His mind ran over procedures. After a frozen section any removed tumor went to the pathology lab where a technician prepared several slides, more carefully and working under better conditions. Later the pathologist would study the slides and give his final opinion. Sometimes a tumor which had seemed benign or doubtful at frozen section would prove malignant during this subsequent, more close examination, and it was not considered abnormal for a pathologist to reverse his opinion in this way. If this happened the patient would be returned to the operating room and the necessary surgery done. But obviously it was important for the pathologist’s second report to be prompt. O’Donnell had already realized that this was the nub of Rufus’ complaint.
“If it were just once,” Rufus was saying, “I wouldn’t object. I know Pathology’s busy, and I’m not trying to get at Joe Pearson. But it isn’t just once, Kent. It’s all the time.”
“Let’s get specific, Bill,” O’Donnell said crisply. He had no doubt, though, that Rufus would have facts to back up a complaint like this.
“All right. I had a patient in here last week, Mrs. Mason—breast tumor. I removed the tumor, and at frozen section Joe Pearson said benign. Afterward, though, on surgical report he had it down as malignant.” Rufus shrugged. “I won’t quarrel with that; you can’t call them all the first time.”
“But?” Now that he knew what it was about, O’Donnell wanted to get this over with.
“Pearson took eight days to make the surgical report. By the time I got it the patient had been discharged.”
“I see.” This was bad all right, O’Donnell thought. He couldn’t duck this one.
“It isn’t easy,” Rufus was saying quietly, “to call a woman back and tell her you were wrong—that she does have cancer after all, and that you’ll have to operate again.”
No, it wasn’t easy; O’Donnell knew that too well. Once, before he had come to Three Counties, he had had to do the same thing himself. He hoped he never would again.
“Bill, will you let me handle this my way?” O’Donnell was glad it was Rufus. Some of the other surgeons might have made things more difficult.
“Sure. As long as something definite is done.” Rufus was within his rights to be emphatic. “This isn’t just an isolated case, you know. It just happens to be a bad one.”
Again O’Donnell knew this was true. The trouble was, Rufus was not aware of some of the other problems which went with it.
“I’ll talk to Joe Pearson this afternoon,” he promised. “After the surgical-mortality conference. You’ll be there?”