ah.thefinaldiagnosis-第15章
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O'Donnell determined not to be provoked。 He said quietly； 〃Bill Rufus was one。 But there have been others。 You know that； Joe。〃
For a moment Pearson made no answer； and O'Donnell reflected that in a way he felt sorry for the old man。 The years were slipping by。 Pearson was sixty…six now； at best he had another five or six years of active work ahead of him。 Some people reconciled themselves to change like that； to younger men moving into prominence and taking over leadership。 Pearson had not； though； and he made his resentment plain。 O'Donnell wondered what was back of his attitude。 Did he feel himself slipping； unable to keep up with new developments in medicine？ If so； he would not be the first。 And yet Joe Pearson； for all his disagreeable ways； had a lot to mend him。 That was one of the reasons why O'Donnell trod circumspectly now。
〃Yes； I know。〃 Pearson's reply held a tone of resignation。 He had accepted the fact though。 That was typical of him； O'Donnell thought。 Right from the beginning at Three Counties he had liked Pearson's directness and at times had made use of it in raising surgical standards。
O'Donnell remembered that one of the problems he had faced in his early months at the hospital had been the elimination of needless surgery。 Under this heading had e an unnatural number of hysterectomies； and in too many cases healthy； normal uteri were being removed by a few staff surgeons。 These were men who found surgery a convenient and profitable remedy for any female pain； even those which might have responded to internal medication。 In such instances euphemisms in diagnosis like 〃chronic myometritis〃 or 〃fibrosis of uterus〃 were resorted to as a smoke screen to cover up the pathology report on the removed tissue。 O'Donnell remembered telling Pearson： 〃When we're reporting on tissue we'll call a spade a spade and a healthy uterus a healthy uterus。〃 Pearson had grinned and co…operated fully。 As a result most of the unnecessary surgery had stopped。 Surgeons found it embarrassing to have tissue they had removed from patients listed for all their colleagues to see as normal and uninfected。
〃Look； Kent。〃 Pearson was more conciliatory now。 〃Just lately I've been up to my ears。 You've no idea how much work there is。〃
〃I do have an idea； Joe。〃 This was the opening O'Donnell had hoped for。 〃Some of us think you've too much to do。 It isn't fair to you。〃 He was tempted to add 〃at your age〃 but thought better of it。 Instead he added； 〃How about getting some help？〃
The reaction was immediate； Pearson almost shouting。 〃You're telling me to get more help！ Why； man alive； I've been asking for months for more lab technicians！ We need three at least； so what am I told I can have？ One！ And stenographers！ I've got reports that have been piling up for weeks； and who's going to type them？〃 Not waiting for an answer； he went storming on。 〃Me？ If the administration would get off its fanny we might get a few things done…including faster surgicals。 By God！ When you tell me I should get more help； that's really something to hear。〃
O'Donnell had listened quietly。 Now he said； 〃Finished； Joe？〃
〃Yeah。〃 Pearson seemed chastened； half ashamed at his outburst。
〃It wasn't technicians or office staff I was thinking about；〃 O'Donnell told him。 〃When I meant help I meant another pathologist。 Someone to help you run the department。 Maybe modernize it here and there。〃
〃Now look here！〃 at the word 〃modernize〃 Pearson had bridled； but O'Donnell brushed the objection aside。 〃I listened to you； Joe。 Now you hear me out。 Please。〃 He paused。 〃I was thinking of maybe some bright young fellow who could relieve you of some duties。〃
〃I don't need another pathologist。〃 It was a flat statement； vehement and unpromising。 〃Why； Joe？〃
〃Because there's not enough work for two qualified men。 I can handle all the pathology myself…without any help。 Besides； I've already got a resident in the department。〃
O'Donnell was quietly persistent。 〃A resident is with us for training； Joe； and usually for just a short time。 Sure； a resident can carry some of the work。 But you can't give him responsibility and we can't use him for administration。 That's where you need some help right now。〃
〃Let me be the judge of that。 Give me a few days and we'll be caught up in surgicals。〃
It was obvious that Joe Pearson had no intention of giving way。 O'Donnell had expected resistance to bringing in a new pathologist； but he wondered about the other man's forcefulness。 Was it because he was unwilling to divide his personal empire； or was he simply protecting his job…fearful that a new and younger man might undermine him？ Actually the idea of removing Pearson had not occurred to O'Donnell。 In the field of pathological anatomy alone Joe Pearson's long experience would be hard to replace。 O'Donnell's objective was to strengthen the department and thereby the hospital organization。 Perhaps he should make this clear。
〃Joe； there's no question of any major change。 No one has suggested it。 You'd still be in charge 。 。 。〃
〃In that case let me run Pathology my own way。〃
O'Donnell found his patience ebbing。 He decided that perhaps he had pressed the point enough for now。 He would let it go for a day or two； then try again。 He wanted to avoid a showdown if he could。 He said quietly； 〃I'd think it over if I were you。〃
〃There's nothing to think over。〃 Pearson was at the door。 He nodded curtly and went out。
So there it is； O'Donnell thought。 We've laid the lines of battle。 He stood there； considering thoughtfully what the next move should be。
Five
The cafeteria of Three Counties Hospital was a traditional meeting place for most of the hospital grapevine； its stems and branches extending tenuously to every section and department within Three Counties' walls。 Few events occurred in the hospital…promotions； scandals； firings； and hirings…which were not known and discussed in the cafeteria long before official word was ever published。
Medical staff frequently used the cafeteria for 〃curbstone consultations〃 with colleagues whom they seldom saw except at a meal or coffee break。 Indeed； a good deal of serious medical business was transacted over its tables； and weighty specialist opinions； which at other times would be followed by a substantial bill； were often tossed out freely； sometimes to the great advantage of a patient who； recovering later from some ailment which at first had proven troublesome； would never suspect the somewhat casual channels through which his eventual course of treatment had e。
There were exceptions。 A few staff physicians now and then resented this informal use of their arduously acquired talénts and resisted attempts by colleagues to draw them out in the discussion of specific cases。 In such instances the usual rejoinder was； 〃I think we'd better set up a consultation in my office。 I'll have the meter running then。〃
Gil Bartlett was one who disapproved of such approaches and at times could be a good deal blunter in refusing off…the…cuff opinions。 One story told about his personal tactics of resistance had its origin not in the cafeteria but at a cocktail party in a private home。 His hostess； a grand dame of Burlington society； had buttonholed Bartlett and bombarded him with questions about her illnesses； real and imagined。 Bartlett had listened for a while； then announced in a loud voice which brought a hush to the crowded room； 〃Madam； I believe from what you say you have a menstrual problem。 If you'll strip right now I'll examine you here。〃
Mostly though； much as they might resist informal consultations outside the hospital； the medical staff accepted the cafeteria exchanges on the basis that they had as much to gain as lose； and a good many physicians around the hospital used the mildewed quip on leaving their contact points； 〃If you want me I'll be in my second office。〃 Normally no further explanation was required or given。
Generally the cafeteria was a democratic area where hospital rank； if not forgotten； was at least temporarily ignored。 An exception； possibly； was the practice of setting aside a group of tables for the medical staff。 Mrs。 Straughan； the chief dietitian； hovered over this area periodicall
