was a source of reference, a means of teaching, a supplement to a pathologist’s own knowledge and experience, a detective which could assimilate clues and offer solutions, a means of reassurance, and a staff to lean on in moments of doubt.
It was all of this and more. It was an indication that a pathology department was doing its work efficiently; that, as well as giving service for the present, it was storing up knowledge for the future. It was a warranty that tomorrow’s hospital patients would benefit from what was learned today. Pathology departments in new hospitals considered establishment of a cross file a priority task. In older, established centers the type of cross file varied. Some were straightforward and simple, others elaborate and complex, providing research and statistical data as well as information for day-to-day work. But, simple or elaborate, all had one thing in common: their usefulness in comparing a present case against others in the past. To David Coleman the absence of a cross file at Three Counties could be described with only one word: criminal.
Until this moment, despite his outward impression that the pathology department of Three Counties was seriously in need of changes, he had tried to withhold any personal opinion on Dr. Joseph Pearson. The old man had, after all, been operating alone for a long time, and the amount of work involved in a hospital this size could not have been easy for one pathologist to handle. That kind of pressure could account for the inadequate procedure which Coleman had already discovered in the lab, and, while the fault was not excusable, at least it was understandable.
It was possible, too, that Pearson might have been strong in other ways. In David Coleman’s opinion good administration and good medicine usually went together. But, of the two, medicine—in this case pathology—was the more important. He knew of too many whited sepulchers where gleaming chrome and efficient paper work ranked first, with medicine coming in a poor second. He had considered it possible that the situation here might be the reverse—with administration poor and pathology good. This was the reason he had curbed his natural tendency to judge the older pathologist on the basis of what had been evident so far. But now he found it impossible to pretend any longer to himself. Dr. Joseph Pearson was a procrastinator and incompetent.
Trying to keep the contempt out of his voice, Coleman asked, “What do you propose?”
“There’s one thing I can do.”
Pearson had gone back to his desk and picked up the telephone. He pressed a button labeled “Intercom.” After a pause, “Tell Bannister to come in.”
He replaced the phone, then turned to Coleman. “There are two men who are experts in this field—Chollingham in Boston and Earnhart in New York.”
Coleman nodded. “Yes, I’ve heard of their work.”
Bannister entered. “Do you want me?” He glanced at Coleman, then pointedly ignored him.
“Take these slides.” Pearson closed the folder and passed it across the desk. “Get two sets off tonight—air mail, special delivery, and put on an urgent tag. One set is to go to Dr. Chollingham at Boston, the other to Dr. Earnhart in New York. Get the usual covering notes typed; enclose a copy of the case history, and ask both of them to telegraph their findings as quickly as possible.”
“Okay.” The slide folder under his arm, Bannister went out.
At least, Coleman reflected, the old man had handled that part of it efficiently. Getting the two expert opinions in this case was a good idea, cross file or not.
Pearson said, “We ought to get an answer within two or three days. Meanwhile I’d better talk to Lucy Grainger.” He mused. “I won’t tell her much. Just that there’s a slight doubt and we’re getting”—he looked sharply at Coleman—“some outside confirmation.”
Thirteen
Vivian kept very still—bewildered, uncomprehending. This thing could not be happening to her; it must be someone else Dr. Grainger was speaking about. Her thoughts raced. That was it! Somehow the charts of two patients had become mixed. It had happened before in hospitals. Dr. Grainger was busy; she could easily be confused. Perhaps some other patient was even now being told . . .
Abruptly she stopped her thoughts, made them stand still, tried to clear her mind. There was no mistake. She knew it, clearly and definitely, from the expressions of Dr. Grainger and Mike Seddons. They were watching her now, seated on either side of the hospital bed where Vivian half lay, half sat, propped up by pillows behind her.
She turned to Lucy Grainger. “When will you know . . . for sure?”
“In two days. Dr. Pearson will tell us then. One way or the other.”
“And he doesn’t know . . .”
Lucy said, “Not at this moment, Vivian. He doesn’t know. He doesn’t know anything for sure.”
“Oh, Mike!” She reached for his hand.
He took it gently. Then she said, “I’m sorry . . . but I think . . . I’m going to cry.”
As Seddons put his arms around Vivian, Lucy rose to her feet. “I’ll come back later.” She asked Seddons, “You’ll stay for a while?”
“Yes.”
Lucy said, “Make sure that Vivian is quite clear in her mind that nothing is definite. It’s just that I want her to be prepared . . . in case.”
He nodded, the untidy red hair moving slowly. “I understand.”
As she went out into the corridor Lucy thought: Yes, I’m quite sure you do.”
Yesterday afternoon, when Joe Pearson had reported to her by telephone, Lucy had been undecided whether to tell Vivian at this stage what the possibilities were or to wait until later. If she waited, and Pathology’s report on the biopsy was “benign,” all would be well and Vivian would never know of the shadow which, for a while, had drifted darkly over her. But, on the other hand, if, two days from now, the pathology report said “malignant,” amputation would become vitally urgent. In that case, could Vivian be prepared in time, or would the psychological impact be too great? The shock, suddenly thrust upon a young girl who had not suspected that anything serious was wrong, could be tremendous. It might be days before Vivian was ready mentally to accept major surgery—days they could ill afford to lose.
There was something else Lucy had also weighed in balance. The fact that Joe Pearson was seeking outside opinion was significant in itself. If it had been a clear-cut case of benign tissue, he would have said so at once. The fact that he had not, despite his unwillingness to commit himself either way when they had talked, meant that malignancy was at least a strong possibility.
Deliberating all these things, Lucy had decided that Vivian must be told the situation now. If, later, the verdict was “benign,” it was true she would have suffered fear unneedfully. But better that than a sudden explosive impact for which she was completely unprepared.
The immediate problem had also been simplified by the appearance of Dr. Seddons. Last evening the young resident had come to Lucy and told her of his own and Vivian’s plans for marriage. He had admitted that at first his own intention had been to remain in the background, but now he had changed his mind. Lucy was glad he had. At least it meant that Vivian was no longer alone and there was someone whom she could turn to for support and comfort.
Without question, the girl would need plenty of both. Lucy had broken the news that she suspected osteogenic sarcoma—with all its tragic possibilities—as gently as she could. But no matter how one put it, there was no real way of softening the blow. Now Lucy remembered the next thing she had to do: apprise the girl’s parents of the situation as it stood. She glanced down at a slip of paper in her hand. It contained an address in Salem, Oregon, which she had copied earlier from the “next-of-kin” entry on Vivian’s admitting form. She already had the girl’s agreement that her parents could be told. Now Lucy must do the best job she could of breaking the news by long- distance telephone.
Already her mind was anticipating what might happen next. Vivian was a minor. Under state law a parent’s consent was required before any amputation could be performed. If the parents planned to fly here immediately from Oregon, the written consent could be obtained on arrival. If not, she must do her best to persuade them to telegraph the authority, giving Lucy the discretion to use it if necessary.
Lucy glanced at her watch. She had a full schedule of appointments this morning in her office downtown. Perhaps she had better make the call now, before leaving Three Counties. On the second floor she turned into the tiny hospital office she shared with Gil Bartlett. It was little more than a cubicle—so small that they rarely used it at
