Arthur Hailey: The Final Diagnosis

At midmorning of a broiling summer day the life of Three Counties Hospital ebbed and flowed like tide currents around an offshore island. Outside the hospital the citizens of Burlington, Pennsylvania, perspired under a ninety-degree shade temperature with 78 per cent humidity. Down by the steel mills and the rail yards, where there was little shade and no thermometers, the reading—if anyone had bothered to take it—would have been a good deal higher. Within the hospital it was cooler than outside, but not much. Among patients and staff only the fortunate or influential escaped the worst of the heat in air-conditioned rooms.

There was no air conditioning in the admitting department on the main floor, and Madge Reynolds, reaching into her desk for her fifteenth Kleenex that morning, dabbed her face and decided it was time she slipped out to make another application of deodorant. Miss Reynolds, at thirty-eight, was chief clerk in Admitting and also an assiduous reader of feminine-hygiene advertising. As a result she had acquired a horror of being less than completely sanitary and in hot weather maintained a shuttle service between her desk and the women’s toilet down the corridor. First, though, she decided, she must locate four patients for admission that afternoon.

A few minutes earlier the day’s discharge slips had come down from the wards, showing that twenty-six patients were being sent home instead of the twenty-four Miss Reynolds had expected. That, added to two deaths which had occurred during the night, meant that four new names could be plucked from the hospital’s long waiting list for immediate admission. Somewhere, in four homes in and around Burlington, a quartet of patients who had been waiting for this call either hopefully or in fear would now pack a few essential belongings and put their trust in medicine as practiced at Three Counties. Holding now her sixteenth Kleenex, Miss Reynolds opened a file folder, picked up the telephone on her desk, and began to dial.

More fortunate than the Admitting clerks in the heat were those awaiting treatment in the outpatient clinics, now in full session over in the opposite wing of the main floor. They at least would enjoy air conditioning when their turn came to enter one of the six offices leading off the general waiting room. Within the offices six specialists were making their exclusive talents available free to those who couldn’t, or wouldn’t, afford the private-patient fees charged on the specialists’ home ground in the Medical Arts Building downtown.

Old Rudy Hermant, who worked periodically at laboring when his family bullied him into it, sat back and relaxed in cool comfort as Dr. McEwan, the ear, nose, and throat specialist, probed in search of the cause of Rudy’s growing deafness. Actually Rudy didn’t mind the deafness too much; at times, when foremen wanted him to do something else or work faster, he found it an advantage. But Rudy’s eldest son had decided the old man should get his ears looked at, and here he was.

Dr. McEwan fretted irritably as he withdrew the otoscope from old Rudy’s ear. “It might help a little if you washed some of the dirt out,” he remarked acidly.

Such ill humor was unusual in McEwan. This morning, however, his wife had carried to the breakfast table a running fight about household expenses which they had started the night before, causing him, afterward, to back his new Olds out of the garage in such a temper that he had crumpled the right rear fender.

Now Rudy looked up blandly. “What was that?” he inquired.

“I said it might help . . . oh, never mind.” McEwan was debating whether the old man’s condition might be due to senility or a small tumor. It was an intriguing case, and already his professional interest was outweighing his irritability.

“I didn’t hear you,” the old man was saying again.

McEwan raised his voice. “It was nothing! I said forget it!” At this moment he was glad of old Rudy’s deafness and slightly ashamed of his own outburst.

In the general medical clinic fat Dr. Toynbee, an internist, lighting a fresh cigarette from the stub of the last, looked over at the patient on the other side of his desk. As he considered the case he felt a slight biliousness and decided he’d have to lay off Chinese food for a week or two; anyway, with two dinner parties coming off this week, and the Gourmet’s Club next Tuesday, it shouldn’t be too hard to endure. Deciding his diagnosis, he fixed his eye on the patient and said sternly, “You’re overweight and I’m going to put you on a diet. You’d better cut out smoking too.”

A hundred yards or so from where the specialists held court Miss Mildred, senior records clerk at Three Counties, perspired profusely as she hurried along a busy main-floor corridor. But, ignoring the discomfort, she moved even faster after a quarry she had just seen disappear around the next corner.

“Dr. Pearson! Dr. Pearson!”

As she caught up with him the hospital’s elderly staff pathologist paused. He moved the big cigar he was smoking over to the corner of his mouth. Then he said irritably, “What is it? What is it?”

Little Miss Mildred, fifty-two, spinsterish, and five foot nothing in her highest heels, quailed before Dr. Pearson’s scowl. But records, forms, files were her life. She summoned up courage. “These autopsy protocols have to be signed, Dr. Pearson. The Health Board has asked for extra copies.”

“Some other time. I’m in a hurry.” Joe Pearson was at his imperious worst.

Miss Mildred stood her ground. “Please, Doctor. It’ll only take a moment. I’ve been trying to get you for three days.”

Grudgingly Pearson gave in. Taking the forms and the ballpoint pen Miss Mildred offered him, he moved over to a desk, grumbling as he scribbled signatures. “I don’t know what I’m signing. What is it?”

“It’s the Howden case, Dr. Pearson.”

Pearson was fretting still. “There are so many cases. I don’t remember.”

Patiently Miss Mildred reminded him. “It’s the workman who was killed when he fell from a high catwalk. If you remember, the employers said the fall must have been caused by a heart attack because otherwise their safety precautions would have prevented it.”

Pearson grunted. “Yeah.”

As he went on signing Miss Mildred continued her summation. When she started something she liked to finish it and leave it tidy. “The autopsy, however, showed that the man had a healthy heart and no other physical condition which might have caused him to fall.”

“I know all that.” Pearson cut her short.

“I’m sorry, Doctor. I thought . . .”

“It was an accident. They’ll have to give the widow a pension.” Pearson tossed out the observation, then adjusted his cigar and scrawled another signature, half shredding the paper. He has rather more egg than usual on his tie, Miss Mildred thought, and she wondered how many days it was since the pathologist had brushed his gray, unruly hair. Joe Pearson’s personal appearance verged somewhere between a joke and a scandal at Three Counties Hospital. Since his wife had died some ten years earlier and he had begun to live alone, his dress had got progressively worse. Now, at sixty-six, his appearance sometimes suggested a vagrant rather than the head of a major hospital department. Under the white lab coat Miss Mildred could see a knitted woolen vest with frayed buttonholes and two other holes which were probably acid burns. And gray, uncreased slacks drooped over scuffed shoes that sadly needed shining.

Joe Pearson signed the last paper and thrust the batch, almost savagely, at little Miss Mildred. “Maybe I can get on with some real work now, eh?” His cigar bobbed up and down, discharging ash partly on himself, partly on the polished linoleum floor. Pearson had been at Three Counties long enough to get away with rudeness that would never be tolerated in a younger man and also to ignore the “No Smoking” signs posted conspicuously at intervals in the hospital corridors.