ah.thefinaldiagnosis-第18部分

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roach　failed；　he　would　have　to　resort　to　more　direct　methods。　Sometimes；　he　reflected；　it　might　be　simpler　if　medical　protocol　were　less　plicated。　In　industry；　if　a　man　was　not　doing　his　job　adequately；　you　fired　him。　If　you　wanted　him　to　take　an　assistant；　you　told　him　to　do　so　and　usually　that　was　that。　But　in　medicine　and　in　a　hospital　it　was　less　straightforward。　The　lines　of　authority　were　seldom　clear…cut；　and　a　medical…department　head；　once　appointed；　was　pretty　well　master　in　his　own　domain。　What　was　even　more　important…you　hesitated　to　do　really　drastic　things　because　you　were　dealing　with　more　than　just　a　job。　You　were　questioning　the　ability　of　a　man　who；　like　yourself；　was　dependent　on　his　professional　reputation。　It　was　a　delicate　issue　in　which　a　single　decision　could　affect　the　entire　future　and　livelihood　of　a　fellow　practitioner。　That　was　why　you　proceeded　warily；　keeping　things　like　this　under　wraps　and　carefully　guarded　from　outside　scrutiny。
　Harry　Tomaselli　said　softly；　〃I　take　it；　then；　we're　going　to　look　for　an　available　pathologist。〃
　〃I　think　we　should　begin　to　look　around。〃　O'Donnell　answered　the　administrator；　then　glanced　at　the　others。　〃I　imagine　most　of　us　have　contacts　where　we　might　pass　the　word　along。　If　you　hear　of　anyone…a　good　man　who's　just　finishing　his　residency　perhaps…I'd　like　you　to　let　me　know。〃
　〃Pathologists　can　be　pretty　choosy　nowadays；〃　Bill　Rufus　said。
　〃I　know。　This　may　not　be　easy。〃　O'Donnell　added；　〃It's　all　the　more　reason　for　handling　Joe　carefully。〃
　Harry　Tomaselli　had　reached　into　one　of　his　desk　drawers　and　removed　a　file　folder。　He　said；　〃Something　here　may　interest　you。〃
　Harvey　Chandler　asked　him；　〃What　is　it　you　have？〃
　〃I've　been　receiving　the　'open　list'　on　pathologists　lately；〃　Tomaselli　answered。　〃Frankly；　I　anticipated　something　like　this　and　asked　for　it。　This　name　came　in　a　week　or　two　ago。〃
　〃May　I　see？〃　O'Donnell　reached　for　the　paper　Tomaselli　had　produced。　He　knew　the　so…called　〃open　list〃　was　circulated　periodically　to　hospitals　on　request。　It　contained　information　on　pathologists　available　for　appointments；　and　the　men　concerned　had　given　permission　for　their　names　to　be　used。　There　was　also　a　〃closed　list；〃　but　this　was　retained　in　confidence　by　the　pathologists'　professional　society。　Mostly　the　〃closed　list〃　prised　men　dissatisfied　with　their　present　appointments　who　were　seeking　discreetly　to　make　a　change。　In　this　case　a　hospital　would　advise　the　society　of　its　need　for　a　pathologist　and　those　on　the　〃closed　list〃　had　this　information　passed　along　to　them。　If　he　chose；　an　individual　could　then　approach　a　hospital　direct。　Yet　with　all　this　machinery　in　existence；　O'Donnell　knew　that　most　pathology　appointments　were　still　made　on　the　basis　of　personal　contacts　and　remendation。
　He　glanced　over　the　sheet　the　administrator　had　given　him。　The　listing　was　for　a　Dr。　David　Coleman；　his　age　thirty…one。　O'Donnell's　eyebrows　went　up　as　he　noted　Coleman's　record　and　experience。　An　N。Y。U。　honors　graduate。　Intern　at　Bellevue。　Two　years　in　the　Army；　mostly　in　pathology。　A　five…year　pathology　residence　spread　over　three　good　hospitals。　Here　was　a　man　who　plainly　shopped　for　the　best　in　education。
　He　passed　the　paper　to　Rufus。　〃I　doubt　very　much　if　he'd　look　at　us；〃　he　told　Tomaselli。　〃Not　with　those　qualifications　and　what　we　could　pay　to　begin　with。〃　O'Donnell　knew；　from　an　earlier　talk　with　the　administrator；　that　salary　level　would　have　to　be　around　ten　thousand　dollars　a　year。
　Rufus　glanced　up。　〃I　agree。　This　man　can　take　his　pick　of　the　big　city　hospitals。〃　He　passed　the　sheet　to　Harvey　Chandler。
　〃Well；　as　a　matter　of　fact　。　。　。〃　Tomaselli　paused；　he　sounded　unusually　diffident；　as　if　weighing　his　words　carefully。
　O'Donnell　asked　curiously；　〃What　is　it；　Harry？〃
　〃Well；　the　fact　is；　Dr。　Coleman　is　interested　in　this　hospital。〃　Tomaselli　paused。　〃I　gather　he's　heard　something　of　our　recent　changes　and　plans　for　the　future。〃
　O'Donnell　broke　the　sudden　stillness。　〃How　do　you　know？〃
　〃I　know　because　we've　had　some　correspondence。〃
　Rufus　said；　〃Isn't　that　a　little　unusual；　Harry？〃
　〃Perhaps　I　was　being　premature；　but　after　this　came〃…Tomaselli　indicated　the　paper　which　had　now　passed　to　Lucy…〃I　wrote　to　Dr。　Coleman。　I　said　nothing　definite；　of　course。　It　was　just　a　tentative　approach；　sounding　him　out。〃　He　turned　to　O'Donnell。　〃It　was　after　our　conversation　a　couple　of　weeks　ago。　You　may　remember；　Kent。〃
　〃Yes；　I　do。〃　O'Donnell　was　wishing　that　Harry　had　briefed　him　about　this　beforehand。　Of　course；　as　administrator　Tomaselli　had　a　right　to　correspond　with　anyone　he　chose。　He　hadn't　mitted　the　hospital　in　any　way。　The　correspondence　was　presumably　confidential。　Possibly　it　might　prove　to　have　been　a　good　move。　He　said　to　Tomaselli；　〃You　say　he's　interested？〃
　〃Yes。　He'd　like　to　e　and　see　us。　If　this　had　not　e　up　today；　I'd　intended　to　speak　to　you　about　it。〃
　Dornberger　had　the　paper　now。　He　tapped　it　with　a　forefinger。　〃What　do　you　want　me　to　do　about　this？〃
　O'Donnell　glanced　at　the　others；　seeking　confirmation。　〃I　think　you　should　take　it　with　you；　Charlie；〃　he　said。　〃And　I　suggest　you　show　it　to　Joe　Pearson。〃
　
　Seven
　
　In　an　annex　to　the　autopsy　room　Roger　McNeil；　the　pathology　resident；　was　almost　ready　for　gross　conference。　All　that　was　necessary　to　begin　was　the　presence　of　Dr。　Joseph　Pearson。
　At　Three　Counties；　as　at　many　hospitals；　a　gross　conference　was　the　second　stage　after　autopsy。　Half　an　hour　ago　George　Rinne；　diener　of　the　morgue；　had　brought　in　the　organs　removed　at　three　autopsies　earlier　in　the　week。　Two　sets　of　organs　now　stood　neatly　arrayed　in　white　enameled　pails；　and　alongside　them；　in　glass　jars；　were　three　brains。　Centerpiece　of　the　gross…conference　room　was　a　stone　table　with　a　large　sink　let　into　it　and　with　a　water　tap　above。　At　present　the　tap　was　turned　on　and　beneath　it　was　the　third　pail　of　organs；　the　water　washing　out　the　formalin　in　which　the　organs　had　been　preserved；　as　well　as　some　of　the　more　objectionable　odor。
　McNeil　looked　around；　making　a　final　check。　Pearson　was　always　irascible　if　everything　was　not　ready　at　hand。　McNeil　reflected　that　the　room　in　which　they　did　their　work　was　appropriately　macabre…particularly　when　the　organs　were　laid　out；　as　they　would　be　in　a　few　minutes；　making　the　place　look　somewhat　like　a　butcher's　shop。　He　had　been　in　hospital　dissecting　rooms　where　everything　was　gleaming　stainless　steel；　but　that　was　the　modern　way　which　had　not　touched　Three　Counties'　pathology　department　yet。　Now　he　heard　the　familiar；　half…shuffling　footsteps；　and　Pearson　came　in；　the　inevitable　cloud　of　cigar　smoke　with　him。
　〃Can't　waste　any　time。〃　Pearson　seldom　bothered　with　preliminaries。　〃It's　a　week　and　a　half　since　I　had　that　set…to　with　O'Donnell；　and　we're　still　behind。〃　The　cigar　bobbed　up　and　down。　〃When　this　is　through　I　want　a　check　on　all　surgicals　outstanding。　What's　the　first　case？〃　While　he　had　been　talking　he　had　put　on　a　black　rubber　apron　and　rubber　gloves。　Now　he　came　to　the　center　table　and　sat　down　at　it。　McNeil　perched　himself　on　a　stool　opposite　and　looked　over　the　case　notes。
　〃Fifty…five…year…old　woman。　Physician's　cause　of　death；　carcinoma　of　the　breast。〃
　〃Let　me　see。〃　Pearson　reached　for　the　file。　Sometimes　he　would　sit　patiently　while　the　resident　described　a　case；　at　other　times　he　would　want　to　read　everything　himself。　In　this；　as　in　all　things；　he　was　unpredictable。
　〃Hm。〃　He　put　down　the　papers　and　turned　off　the　running　water。　Then　he　reached　into　the　pail　and　groped　around　until　he　found　the　heart。　He　opened　it；　using　both　hands。
　〃Did　you　cut　this？〃
　The　resident　shook　his　head。
　〃I　didn't　think　so。〃　Pearson　peered　at　the　heart　again。　〃Seddons？〃
　McNeil　nodded　a　little　reluctantly。　He　had　noticed　himself　that　the　heart　was　badly　cut。
　〃He　left　the　mark　of　Zorro。〃　Pearson　grinned。　〃Looks　like　he　was　dueling　with　it。　By　the　way；　where　is　Seddons？〃
　〃I　believe　there　was　something　in　surgery。　A　procedure　he　wanted　to　see。〃
　〃Tell　him　from　me　that　while　any　resident　is　assigned　to　Pathology　I　expect　him　at　all　gross　conferences。　All　right；　let's　get　on　with　it。〃
　McNeil　balanced　a　clip　board　on　his　knee　and　prepared　to　write。　Pearson　dictated：　〃Heart　shows　a　slight　thickening　and　rolling　of　the　mitral　valve。　See　it　there？〃　He　held　it　out。
　Leaning　across；　McNeil　answered；　〃Yes；　I　do。〃
　Pearson　continued；　〃The　chordae　tendineae　are　fused；　shortened　and　thickened。〃　He　added　casually；　〃Looks　as　if　she　had　an　old　rheumatic　fever。　It　was　not　a　cause　of　death　though。〃
　He　cut　away　a　small　portion　of　tissue　and　put　it　into　a　labeled　jar　about　the　size　of　an　ink　bottle。　This　was　for　microscopic　examination　later。　Then　with　the　ease　of　long　practice　he　tossed　the　remainder　of　the　heart　accurately　into　a　hole　lower　down　the　table。　Beneath　the　hole　was　a　metal　bin。　Later　in　the　day　this　would　be　cleared　and　cleaned；　the　contents　being　burned　to　fine　ash　in　a　special　incinerator。
　Now　Pearson　had　the　lungs。　He　opened　the　first　lung　like　the　two　big　leaves　of　a　book；　then　dictated　to　McNeil；　〃Lungs　show　multiple　metastatic　nodules。〃　Again　he　held　out　the　tissue　for　the　resident　to　see。
　He　had　turned　his　attention