Free The Final Diagnosis by Arthur Hailey Page A

chest, was early development of pneumonia. No doubt there was severe pleuritic pain coming from that.”
    So that was it. Lucy ran her mind over what had been said before. It was true—externally the two sets of symptoms would be identical.
    O’Donnell was asking, “Is there any discussion?”
    There was an uneasy pause. A mistake had been made, and yet it was not a wanton mistake. Most of those in the room were uncomfortably aware the same thing might have happened to themselves. It was Bill Rufus who spoke out. “With the symptoms described, I would say exploratory surgery was justified.”
    Pearson was waiting for this. He started ruminatively. “Well, I don’t know.” Then almost casually, like tossing a grenade without warning: “We’re all aware that Dr. Bartlett rarely sees beyond the abdomen.” Then in the stunned silence he asked Bartlett directly, “Did you examine the chest at all?”
    The remark and the question were outrageous. Even if Bartlett were to be reprimanded, it should come from O’Donnell, not Pearson, and be done in private. It was not as if Bartlett had a reputation for carelessness. Those who had worked with him knew that he was thorough and, if anything, inclined to be ultra-cautious. In this instance, obviously, he had been faced with the need to make a fast decision.
    Bartlett was on his feet, his chair flung back, his face flaming red. “Of course I examined the chest!” He barked out the words, the beard moving rapidly. “I already said the patient was in no condition to have a chest film, and even if he had——”
    “Gentlemen! Gentlemen!” It was O’Donnell, but Bartlett refused to be stopped.
    “It’s very easy to have hindsight, as Dr. Pearson loses no chance to remind us.”
    From across the table Charlie Dornberger motioned with his pipe. “I don’t think Dr. Pearson intended——”
    Angrily Bartlett cut him off. “Of course you don’t think so. You’re a friend of his. And he doesn’t have a vendetta with obstetricians.”
    “Really! I will not permit this.” O’Donnell was standing himself now, banging with his gavel. His shoulders were squared, his athlete’s bulk towering over the table. Lucy thought: He’s all man, every inch. “Dr. Bartlett, will you be kind enough to sit down?” He waited, still standing, as Bartlett resumed his seat.
    O’Donnell’s outward annoyance was matched with an inward seething. Joe Pearson had no right to throw a meeting into a shambles like this. Now, instead of pursuing the discussion quietly and objectively, O’Donnell knew he had no choice but to close it. It was costing him a lot of effort not to sound off at Joe Pearson right here and now. But if he did he knew it would make the situation worse.
    O’Donnell had not shared the opinion of Bill Rufus that Gil Bartlett was blameless in the matter of his patient’s death. O’Donnell was inclined to be more critical. The key factor in the case was the absence of a chest X-ray. If Bartlett had ordered an upright chest film at the time of admission, he could have looked for indications of gas across the top of the liver and under the diaphragm. This was a clear signpost to any perforated ulcer; therefore the absence of it would certainly have set Bartlett thinking. Also, the X-ray might have shown some clouding at the base of the lung, which would have indicated the pneumonia which Joe Pearson had found later at the autopsy. One or another of these factors might easily have caused Bartlett to change his diagnosis and improved the patient’s chances of survival.
    Of course, O’Donnell reflected, Bartlett had claimed the patient was too sick for an X-ray to be taken. But if the man had been as sick as that should Bartlett have undertaken surgery anyway? O’Donnell’s opinion was that he should not.
    O’Donnell knew that when an ulcer perforated surgery should normally be begun within twenty-four hours. After that time the death rate was higher with surgery than