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?”
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 comprise 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 come 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
