ah.thefinaldiagnosis-第4部分

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　〃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　e　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　e　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'　plaint。
　〃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　plaint　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　e　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？〃
　Rufus　nodded。　〃I'll　be　there。〃
　〃See　you　then；　Bill。　Thanks　for　letting　me　know　about　this。　Something　will　be　done；　I　promise　you。〃
　Something；　O'Donnell　reflected　as　he　moved　down　the　corridor。　But　what　exactly？　He　was　still　thinking　about　it　as　he　turned　into　the　Administration　suite　and　opened　the　door　to　Harry　Tomaselli's　office。
　O'Donnell　did　not　see　Tomaselli　at　first；　then　the　administrator　called　to　him。　〃Over　here；　Kent。〃　On　the　far　side　of　the　birch…paneled　room；　away　from　the　desk　at　which　he　spent　most　of　his　working　hours；　Tomaselli　was　leaning　over　a　table。　Unrolled　before　him　were　whiteprints　and　sketches。　O'Donnell　crossed　the　thick　pile　carpet　and　looked　down　at　them　too。
　〃Daydreaming；　Harry？〃　He　touched　one　of　the　sketches。　〃You　know；　I'm　sure　we　could　put　you　a　fancy　penthouse　there…on　top　of　the　East　Wing。〃
　Tomaselli　smiled。　〃I'm　agreeable；　providing　you'll　convince　the　board　it's　necessary。〃　He　took　off　his　rimless　glasses　and　began　to　polish　them。　〃Well；　there　it　is…the　New　Jerusalem。〃
　O'Donnell　studied　the　architect's　profile　of　Three　Counties　Hospital　as　it　would　appear　with　the　magnificent　new　extension；　now　in　the　advanced　stages　of　planning。　The　new　buildings　were　to　prise　an　entire　wing　and　a　new　nurses'　home。　〃Any　more　news？〃　He　turned　to　Tomaselli。
　The　administrator　had　replaced　his　glasses。　〃I　talked　with　Orden　again　this　morning。〃　Orden　Brown；　president　of　the　second　largest　steel　mill　in　Burlington；　was　chairman　of　the　hospital's　board　of　directors。
　〃So？〃
　〃He's　sure　we　can　count　on　half　a　million　dollars　in　the　building　fund　by　January。　That　means　we'll　be　able　to　break　ground　in　March。〃
　〃And　the　other　half　million？　Last　week　Orden　told　me　he　thought　it　would　take　until　December。〃　Even　at　that；　O'Donnell　reflected；　he　had　considered　the　chairman　to　be　erring　toward　optimism。
　〃I　know；〃　Tomaselli　said。　〃But　he　asked　me　to　tell　you　that　he's　changed　his　mind。　He　had　another　session　with　the　mayor　yesterday。　They're　convinced　they　can　get　the　second　half　million　by　next　summer　and　wind　up　the　campaign　by　fall。〃
　〃That　is　good　news。〃　O'Donnell　decided　to　shelve　his　earlier　doubts。　If　Orden　Brown　had　gone　out　on　a　limb　like　that；　he　would　e　through　all　right。
　〃Oh；　and　by　the　way；〃　Tomaselli　said　with　elaborate　casualness；　〃Orden　and　the　mayor　have　an　appointment　with　the　governor　next　Wednesday。　Looks　like　we　may　get　that　increased　state　grant　after　all。〃
　〃Anything　else？〃　O'Donnell　snapped　at　the　administrator　in　mock　sharpness。
　〃I　thought　you'd　be　pleased；〃　Tomaselli　said。
　More　than　pleased；　O'Donnell　reflected。　In　a　way　you　might　call　all　of　this　the　first　step　toward　fulfillment　of　a　vision。　It　was　a　vision　which　had　had　its　beginnings　at　the　time　of　his　own　arrival　at　Three　Counties　three　and　a　half　years　ago。　Funny　how　you　could　get　used　to　a　place；　O'Donnell　thought。　If　someone　had　told　him　at　Harvard　Medical　School；　or　later　when　he　was　chief　surgical　resident　at　Columbia　Presbyterian；　that　he　would　wind　up　in　a　backwater　hospital　like　Three　Counties；　he　would　have　scoffed。　Even　when　he　had　gone　to　Bart's　in　London　to　round　out　his　surgical　experience；　he　had　fully　intended　to　e　back　and　join　the　staff　of　one　of　the　big…name　hospitals　like　Johns　Hopkins　or　Massachusetts　General。　With　the　background　he　had　he　could　pretty　well　have　taken　his　choice。　But　before　there　was　time　to　decide　Orden　Brown　had　e　to　meet　him　in　New　York　and　persuaded　him　to　visit　Burlington　and　Three　Counties。
　What　he　had　seen　there　had　appalled　him。　The　hospital　was　run　down　physically；　its　organization　slack；　its　medical　standards…with　a　few　exceptions…low。　The　chiefs　of　surgery　and　medicine　had　held　their　posts　for　years；　O'Donnell　had　sensed　that　their　objective　in　life　was　to　preserve　an　amiable　status　quo。　The　administrator…key　man　in　the　relationship　between　the　hospital's　lay　board　of　directors　and　its　medical　staff…was　a　doddering　inpetent。　The　hospital's　intern　and　resident　tr