Eleven

The prop-jet Viscount turned evenly into wind and began to lose height. Landing gear and flaps down, it was lined up with number one runway of Burlington’s municipal airport, dead ahead. Watching the airplane’s approach from the public mezzanine, just below the control tower, Dr. Kent O’Donnell reflected idly that aviation and medicine had a good deal in common. Both were products of science; both were changing the world’s life and destroying old concepts; both were moving toward unknown horizons and a future only dimly seen. There was another parallel too. Aviation nowadays was having trouble keeping pace with its own discoveries; an aircraft designer he knew had told him recently, “If an airplane’s flying it’s already out of date.”

The practice of medicine, O’Donnell thought, shading his eyes from the bright afternoon sun of mid-August, was very much the same. Hospitals, clinics, physicians themselves, were never able to be entirely up to date. No matter how they tried, experimentation, development, new techniques were always ahead—sometimes by years. A man might die today when the drug that could save him was already invented and even, perhaps, in limited use. But it took time for new developments to become known and to gain acceptance. The same was true of surgery. One surgeon, or a group of surgeons, might develop a new life-saving technique. But before it could be used generally others must master it and pass their skill along. Sometimes it was a long process. Heart surgery, for example, was fairly general now and within reach of most who needed it badly. But for a long time only a handful of surgeons were qualified or willing to attempt it.

There was always the question, too, with new things: is this good; is it a wise development? Not all change meant progress. Plenty of times in medicine there were false scents, theories running contrary to fact, individuals with enthusiasms and obsessions who would go off half cocked, misleading others when they did. Sometimes it was hard to steer a mid-course between open-mindedness and reasonable caution. At Three Counties, with its quota of diehards and progressives—and with good men in both camps—it was a continuing problem for someone like O’Donnell to know, at any given moment, exactly where and with whom his allegiance lay.

His thoughts were broken by the Viscount taxiing in, the shrill whine of its motors drowning out the voices of others around him. O’Donnell waited until the motors stopped and passengers began to disembark. Then, seeing Dr. Coleman among them, he went down the stairs to greet the hospital’s new assistant director of pathology in the arrival lobby.

David Coleman was surprised to see the chief of surgery—tall, bronzed, standing out from the crowd—waiting for him with outstretched hand. O’Donnell said, “It’s good to see you. Joe Pearson couldn’t make it, but we thought that someone should be around to say ‘welcome.’ ” What O’Donnell failed to add was that Joe Pearson had flatly refused to go and, Harry Tomaselli being out of town, O’Donnell had taken the time to drive out himself.

As they moved through the hot, crowded lobby O’Donnell saw Coleman glance around him. He got the impression that the younger man was making a quick assessment of his surroundings. Perhaps it was a habit—if so, a good one. Certainly David Coleman would stand up to scrutiny himself. Though he had had a three-hour air journey, his gabardine suit was uncreased, his well-trimmed hair carefully parted and brushed, his shave recent. He wore no hat, which made him look younger than his thirty-one years. Though slighter than O’Donnell in build, his features were clear-cut and well defined; he had a longish face and an incisive jaw. The brief case under his arm added a professional touch; picture of a young scientist, O’Donnell thought. He steered Coleman toward the baggage counter. A trailerload of bags was being unloaded, and they joined the scrimmage with other passengers who had disembarked.

O’Donnell said, “This is the part of air travel I dislike.”

Coleman nodded and smiled faintly. It was almost as if he had said, Let’s not waste our talents on small talk, shall we?

This is a cool customer, O’Donnell thought. He noticed, as he had at their previous meeting, the steel-gray eyes and wondered what it took to penetrate behind them. Now Coleman was standing, unmoving among the crowd, glancing around. Almost as if by command, ignoring others, a redcap gravitated toward him.

Ten minutes later, as O’Donnell threaded his Buick through the airport traffic and headed toward town, he said, “We’ve put you up in the Roosevelt Hotel. It’s as comfortable as any and quiet. I believe our administrator wrote you about the apartment situation.”

“Yes, he did,” Coleman said. “I’d like to do something about that quite quickly.”

“You won’t have any problem,” O’Donnell said, then added, “Perhaps you’d like to take a day or two to fix up an apartment before you report at the hospital.”

“I don’t think so, thank you. I plan to start work tomorrow morning.”

Coleman was polite but definite. O’Donnell thought: This is a man who makes up his mind, then states his opinion plainly. He sounded, too, as if he were not dissuaded easily. O’Donnell found himself speculating on how Joe Pearson and David Coleman were going to get along. Superficially it looked as if they might clash. But you could never tell. Sometimes in a hospital the most unlikely people hit it off like lifetime friends.

Looking around him as they drove through the approaches to the city, David Coleman found himself close to a sense of excitement at the prospect ahead. This was unusual because mostly he took whatever came with a matter-of-fact acceptance. But it was, after all, his first staff appointment to a hospital. He told himself: a touch of down-to-earth humanity is nothing to be ashamed of, my friend, then smiled inwardly at the silent self-criticism. Old habits of thought, he reflected, were hard to break.

He wondered about O’Donnell, sitting beside him. Everything he had heard about the chief of surgery at Three Counties had been good. How was it, he wondered, that a man with O’Donnell’s background and qualifications would choose a place like Burlington? Did he, too, have a mixed-up motivation, or was there some other reason? Maybe he just liked it here. There were some people, Coleman supposed, whose preferences were straightforward and uncomplicated.

O’Donnell pulled out to pass a tractor-trailer. Then he said, “I’d like to tell you a couple of things, if I may.”

Coleman said politely, “Please do.”

“We’ve had a number of changes at Three Counties these past few years.” O’Donnell was going slowly, choosing his words. “Harry Tomaselli told me you’d heard of some of them—as well as our plans.”

Coleman smiled. “Yes, I had.”

O’Donnell sounded his horn and a car ahead of them moved over. He said, “The fact of your being here represents a major change, and I imagine that, once installed, there will be other changes you’ll want to make yourself.”

Coleman thought of the hospital’s pathology department as he had seen it during his brief visit. “Yes,” he responded, “I’m sure there will.”

O’Donnell was silent. Then, more slowly, he said, “Whenever we could, we’ve tried to make our changes peaceably. Sometimes that hasn’t been possible; I’m not one who believes in sacrificing a principle just to keep the peace.” He looked sideways at Coleman. “Let’s be clear about that.”

Coleman nodded but made no answer. O’Donnell went on, “All the same, wherever you can, I’d suggest you move discreetly.” He smiled. “Do what you can by persuasion, and save the big guns for things that really matter.”

Noncommittally Coleman said, “I see.” He was not sure just what he was being told; he would need to know O’Donnell better before deciding that. Had he been wrong in his impression of O’Donnell? Was the chief of surgery, after all, just a pussyfooter? Was Coleman being told here and now, as a newcomer, not to rock the boat? If that were so, they would quickly find they had obtained the wrong man. David Coleman made a mental note not to take a long lease on any apartment he might find in Burlington.

O’Donnell was wondering now if he had been wise in saying what he had. They had been fortunate to get this man Coleman, and he had no wish to put him off, not right at the beginning. But all the time at the back of O’Donnell’s mind had been the problem of Joe Pearson and Pearson’s admitted influence with Eustace Swayne. As far as he could O’Donnell wanted to be loyal to Orden Brown; in the past the board chairman had done a good deal to support the chief of surgery. O’Donnell knew that Brown wanted Swayne’s quarter million dollars and, indeed, the hospital needed it badly. And if that meant placating Joe Pearson a little, O’Donnell was prepared to go along—within reason.

But where did hospital politics end and O’Donnell’s responsibility as a medical practitioner begin? It was a question that troubled him; someday he might have to decide just where the line of demarcation lay. Was he himself playing politics now? O’Donnell supposed he was. If he were not, he would not have just said what he had to Dr. Coleman. Power corrupts, he thought; you can’t escape it, no matter who you are. He considered expanding the subject a little more with Coleman, perhaps taking the younger man into his confidence, then decided against it. Coleman was, after all, a newcomer; and O’Donnell was acutely aware that he had not penetrated yet behind those cool gray eyes.

Now they were coming into the city center, the streets of Burlington hot and dusty, sidewalks shimmering and the black-top roadways sticky in the heat. He turned the Buick into the forecourt of the Roosevelt Hotel. A porter opened the car doors and began to remove Coleman’s bags from the rear seat.

O’Donnell said, “Would you like me to come in? Make sure everything’s in order?”

From outside the car Coleman answered, “There’s really no need.” Once more the quiet but definite statement.

O’Donnell leaned across the seat. “All right. We’ll expect you tomorrow then. Good luck.”

“Thank you.”

The porter slammed the doors, and O’Donnell eased the car into the city traffic. He glanced at his watch. It was 2 p.m. He decided he would go to his own office first, the hospital later.

Seated on the leather-covered bench outside the outpatients’ laboratory of Three Counties, Elizabeth Alexander wondered why it was that the corridor walls had been painted two shades of brown instead of something lighter and brighter. It was a dark part of the hospital anyway; a little yellow, or even a light green, would have made the place so much more cheerful.

From as far back as her memory went Elizabeth had liked bright colors. She remembered, as a little girl, the first pair of draperies she had made for her own room at home; they had been powder-blue chintz with shapes of stars and moons woven into them. She suspected now that they had been very badly made, but at the time they had seemed quite wonderful. To hang them she had gone downstairs into her father’s store and indulgently he had sought out the things she needed—a rod cut to the right length, metal brackets, screws, a screw driver. She remembered his groping to find what he wanted among the other hardware—always piled high and untidily so that more often than not he had to search for whatever a customer asked for.

That was back in New Richmond, Indiana—two years before her father had died in the accident. Or was it three? It was hard to be sure; time went by so quickly. She knew it was six months before her father’s death that she had first met John. In a way that had had to do with color too. He was on vacation from high school and had come into the store to buy some red paint. By then Elizabeth was helping in the store, and she had talked him out of it and sold him green instead. Or was it the other way around? That too was misty now.

She knew, though, she had fallen in love with John right at the first moment. Probably it was just to keep him in the store that she had suggested the switch in colors. And looking back, it seemed from then on there had never been any doubt about their feelings for each other. They had stayed sweethearts through the transition from high school to college and had been married six years after their first meeting. Strangely, though neither had any money and John was still at college on a scholarship, no one had urged them to wait. Everyone they knew seemed to accept their marriage as natural and inevitable.

To some people their first year together might have seemed difficult. To John and Elizabeth it had been a gloriously happy time. The previous year Elizabeth had gone to night secretarial’ school. And in Indianapolis, where John was at college, she had worked as a stenographer and supported them both.

That was the year they had discussed seriously the question of John’s future—whether he should aim high and try for medical school or settle for the shorter course of a medical technologist. Elizabeth had favored medical school. Though it would mean several more years before John began earning, she had been willing to continue working. But John was less sure. For as long as he could remember he had wanted to enter medicine, and his college grades were good, but he was impatient to contribute something to their marriage. Then they had discovered that Elizabeth was pregnant and, for John, it was the deciding factor. Over his wife’s protests he had enrolled in medical-technology school and they had moved to Chicago.

There they had had their baby and had called her Pamela. Four weeks later the child had died of bronchitis, and for a while all of Elizabeth’s world seemed to have fallen in about her. For all her stability and common sense, she had gone to pieces and had ceased to care. John had done all he could, had never been kinder or more considerate, but it had not helped.

She had felt she had to get away and had gone home to her mother in New Richmond. But after a week she had longed for John and had gone back to Chicago. From that point on her return to normalcy had been gradual but sure. Six weeks before John’s graduation she had learned she was pregnant again; it was the final thing she had needed for readjustment. Now she felt healthy, her old cheerfulness back, and there was a growing excitement at the thought of the unborn child within her.

In Burlington they had found a small but pleasant apartment. The rent was economical. Out of their careful savings they had made a down payment on furniture and could meet the monthly installments out of John’s hospital pay. As of this moment everything was fine. Except, Elizabeth thought, that horrible brown on the corridor walls.

The door of the outpatients’ lab opened and a woman who had been waiting ahead of Elizabeth came out. A white-coated girl technician was behind her. The technician consulted a clip board. “Mrs. Alexander?”

“That’s right.” Elizabeth stood up.

“Will you come in, please?”

She followed the girl through the doorway.

“Sit down, Mrs. Alexander. This won’t take long.”

“Thank you.”

At her desk the technician consulted the requisition slip which Dr. Dornberger had written. “Rh typing and sensitivity. All right, just put your hand here, please, and clench your fist.” She took Elizabeth’s wrist and sponged it with antiseptic, then deftly slipped on a rubber tourniquet. From a tray she selected a hypodermic and broke open a package with a sterile needle which she fitted to the syringe. Quickly selecting a vein on Elizabeth’s arm, the girl inserted the needle with a single sharp movement and eased back the plunger. She drew blood until it was level with the 7 cc. mark on the syringe, then whipped the needle out, putting a tuft of cotton batting on the puncture it had made. The whole procedure had taken less than fifteen seconds.

“I think you’ve done that before,” Elizabeth said.

The girl smiled. “A few hundred times.”

Elizabeth watched while the technician labeled a test tube and transferred the blood sample to it. When she had finished she put the test tube in a rack. Then she announced, “That’s all, Mrs. Alexander.”

Elizabeth pointed to the tube. “What happens to it now?”

“It goes to the serology lab. One of the technicians there will do the test.”

Elizabeth speculated on whether it might be John.

Mike Seddons, sitting alone in the house-staff lounge, was deeply troubled. If someone had told him a month ago that he could be this concerned about a girl that to all intents and purposes he scarcely knew, he would have adjudged the other person crazy. Yet for forty-eight hours, ever since he had read the chart in the nursing station near Vivian’s hospital room, his worry and distress had steadily grown. Last night he had scarcely slept; for hours he had lain awake, his mind turning over the full significance of the words written on the chart in Dr. Lucy Grainger’s handwriting, “Vivian Loburton—suspected osteogenic sarcoma—prepare for biopsy.”

On the first occasion he had seen Vivian—the day of the autopsy—she was merely another pretty student nurse. Even at their second meeting—before the incident in the park—he had thought of her principally as an interesting, exciting lay. Mike Seddons never fooled himself either about words or his own intentions.

Nor did he now.

For the first time in his life he was deeply and genuinely in love. And tortured with a haunting, dreadful fear.

The night he had told Vivian that he wanted to marry her he had had no time to think the implications through. Up to that point Mike Seddons had always told himself there would be no question of marriage until he was established in practice, his wild oats sown, his future financially secure. But once the words to Vivian were out he had known them to be true. A hundred times since he had repeated them silently, without a single thought of wanting to turn back.

Then this.

Unlike Vivian, who still thought of her problem as a small bump below the knee—a nuisance, but something which treatment of one kind or another would clear up—Mike Seddons knew the implications of the phrase “suspected osteogenic sarcoma.” He knew that if the diagnosis were confirmed it would mean that Vivian had a virulent, malignant tumor which could spread, and perhaps already had, elsewhere in her body. In that event, without swift surgery, her chances of survival beyond a year or so were almost nil. And surgery meant amputation of the limb—with all speed once the diagnosis was confirmed—in the hope of containing the spreading, poisonous cells before they moved too far beyond the original site. And even then, statistically, only 20 per cent of osteogenic patients were free from further trouble after amputation. The rest went steadily downhill, sometimes living only a few more months.

But it didn’t have to be osteogenic sarcoma. It could be a harmless bone tumor. The chances either way were fifty-fifty—odds even, the same chance you got with the spin of a single coin. Mike Seddons felt himself sweating at the thought of, how much—both for himself and Vivian—was riding on the biopsy result. He had considered going to Lucy Grainger and talking the whole thing over; then he had decided no. He could probably find out more by staying on the fringes. If he declared a personal interest some sources of information might be closed off to him. To spare his feelings others might be guarded in what they said. He did not want that. One way or the other he had to know!

Talking with Vivian and, at the same time, trying to keep his thoughts to himself had not been easy. Last night, sitting alone with her in the hospital room—the other woman patient had been discharged, and for the time being the second bed was empty—she had teased him about seeming downcast.

Cheerfully chewing grapes, which he had brought her earlier, she had said, “I know what’s wrong. You’re scared of being pinned down—not being able to hop from bed to bed.”

“I never did hop from bed to bed,” he had said, trying to match her mood. “It isn’t that easy; you have to work at it.”

“You didn’t do much work on me.”

“You were different. It just sort of happened.”

She had stopped at that. “Yes, I know.” Then, gaily again, she had said, “Well, anyway, it’s no good thinking you’re going to get out of this, Dr. Michael Seddons, M.D. I have no intention of letting you loose again—ever.”

He had kissed her at that, holding her tightly, feeling more emotion than he had believed he had. She moved her face and nuzzled his ear. Her hair against his cheek was soft and fragrant. Softly she said, “And another thing, Doctor—stay away from those student nurses; they have no morals.”

“Really!” Again he responded with a brightness he did not feel. He held her away from him. “Why didn’t someone tell me this before?”

She was wearing a thin blue negligee, open at the front. Beneath it was a nylon nightgown of the same transparent blue. All at once he realized, breathlessly, how young and beautiful she was.

Vivian had looked at the door. It was closed. She said, “They’re busy at the nursing station tonight. I know because they told me. It’ll probably be an hour, at least, before anyone comes around.”

For a moment he had been shocked. Then he had laughed and fallen in love all over again with her honesty and simple frankness. He said, “You mean here? Now?”

“Why not?”

“If anyone came I’d be thrown out of the hospital.”

Softly she said, “You weren’t so worried about that the other night.” Her finger tips moved lightly down his face. Impulsively he had bent and kissed her neck. As his lips moved lower he heard her breathing quicken and felt her fingers tighten on his shoulder.

For a moment he had been tempted, then sanity won out. He put his arms around her. Tenderly he murmured, “When all this is over, Vivian darling, then we’ll be really alone. What’s more, we’ll have all the time we want.”

That was yesterday. This afternoon, on the operating floor, Lucy Grainger would be performing the biopsy. Mike Seddons looked at his watch. It was 2:30 p.m. According to the O.R. schedule, they should be starting now. If Pathology worked fast the answer might be known by tomorrow. With a fervor at once incongruous and real he found himself praying: Oh, God! Please, God—let it be benign!

The anesthetist nodded. “We’re ready when you are, Lucy.”

Dr. Lucy Grainger came around to the head of the operating-room table. She was already gloved and gowned. Smiling down at Vivian, she said reassuringly, “This won’t take long, and you won’t feel a thing.”

Vivian tried to smile back confidently. She knew, though, she didn’t quite succeed. Maybe it was because she was a little drowsy—she was aware that she had been given some kind of sedation as well as the spinal anesthetic which had taken away all feeling from the lower portion of her body.

Lucy nodded to her assisting intern. He lifted Vivian’s left leg, and Lucy began to remove the towels which were taped around it. Earlier this morning, before Vivian had been brought to the operating floor, the leg had been shaved, bathed thoroughly, and painted with merthiolate. Now Lucy repeated the antiseptic procedure and draped fresh sterile towels above and below the knee.

On the other side of the operating table the scrub nurse was holding a folded green sheet. With Lucy taking one side, they draped it over the table so that a hole in the sheet was immediately above the exposed knee. The anesthetist reached over, fastening the top of the sheet to a metal bar above Vivian’s head, so that her view of the rest of the operating room was cut off. As he looked down at her he said, “Just stay relaxed, Miss Loburton. This is really like having a tooth out—only a lot more comfortable.”

“Knife, please.” Lucy held out her hand and the scrub nurse put a scalpel into it. Using the belly portion of the blade, she made a quick, firm incision, just below the knee and about four centimeters long. Immediately blood welled up.

“Mosquito clamps.” The scrub nurse was ready, and Lucy clamped off two small spurters. “Will you tie off, please?” She moved back to allow the intern to put ligatures around both clamps.

“We’ll make our incision through the periosteum.” The intern nodded as Lucy applied the knife she had used previously to the thick fibrous tissue above the bone, cutting cleanly down.

“Ready for the saw.” The scrub nurse passed Lucy a Stryker oscillating saw. Behind her a circulating nurse held the trailing electric cable clear of the operating table.

Talking again for the intern’s benefit, Lucy said, “We shall take a wedge-shaped sample of bone. About half to three-quarters of an inch should be enough.” She glanced up at the X-ray films, in place on a lighted screen at the end of the room. “We must be sure, of course, that we are into the tumor and don’t take a piece of normal bone that has been forced outward.”

Lucy switched on the saw and applied it twice. There was a soft crunching sound each time it bit into bone. Then she switched off and passed the saw back. “There, I think that will do. Tweezers!”

Gingerly she extracted the bone sample, dropping it into a small jar of Zenker’s solution which the circulating nurse was holding out. Now the specimen—identified and accompanied by a surgical work requisition—would go to Pathology.

The anesthetist asked Vivian, “Still feel all right?”

She nodded.

He told her, “They won’t be long now. The bone sample is out. All they have to do is zip up your knee.”

At the table Lucy was already sewing the periosteum, using a running suture. She was thinking: If only this were all, how simple everything would be. But this was merely exploratory. The next move would depend on Joe Pearson’s verdict about the bone sample she was sending to him.

The thought of Joe Pearson reminded Lucy of what she had learned earlier from Kent O’Donnell: that this was the day on which the hospital’s new assistant pathologist was due to arrive in Burlington. She hoped that things would go smoothly with the new man—for O’Donnell’s sake as much as any other reason.

Lucy respected the chief of surgery’s efforts to achieve improvement within the hospital without major upheavals, though she knew from observation that O’Donnell would never shun an issue if it really became necessary to meet it head on. There she went again, she reflected: thinking about Kent O’Donnell. It was strange how, just recently, her thoughts had kept returning to him. Perhaps it was the proximity in which they worked; there were few days when the two of them failed to meet sometime during their stint in surgery. Now Lucy found herself wondering how soon it would be before he invited her to dinner once more. Or perhaps she could arrange a small dinner party at her own apartment. There were a few people she had been planning to invite for some time, and Kent O’Donnell could be among them.

Lucy let the intern move in to sew the subcutaneous tissue. She told him, “Use interrupted sutures; three should be sufficient.” She watched closely. He was being slow but careful. She knew some of the surgeons at Three Counties gave interns very little to do when they were assisting. But Lucy remembered how many times she herself had stood by an operating table, hoping for at least a little practice in tying knots.