Free The Final Diagnosis by Arthur Hailey Page B

without. This was because the first twenty-four hours were the hardest; after that, if a patient had survived that long, the body’s own defenses would be at work sealing up the perforations. From the symptoms Bartlett had described it seemed likely that the patient was close to the twenty-four-hour limit or perhaps past it. In that case O’Donnell himself would have worked to improve the man’s condition without surgery and with the intention of making a more definitive diagnosis later. On the other hand, O’Donnell was aware that in medicine it was easy to have hindsight, but it was quite another matter to do an emergency on-the-spot diagnosis with a patient’s life at stake.
    All of this the chief of surgery would have had brought out, in the ordinary way, quietly and objectively, at the mortality conference. Indeed, he would probably have led Gil Bartlett to make some of the points himself; Bartlett was honest and not afraid of self-examination. The point of the discussion would have been evident to everyone. There would have been no need for emphasis or recriminations. Bartlett would not have enjoyed the experience, of course, but at the same time he would not have been humiliated. More important still, O’Donnell’s purpose would have been served and a practical lesson in differential diagnosis impressed on all the surgical staff.
    Now none of this could happen. If, at this stage, O’Donnell raised the points he had had in mind, he would appear to be supporting Pearson and further condemning Bartlett. For the sake of Bartlett’s own morale this must not happen. He would talk to Bartlett in private, of course, but the chance of a useful, open discussion was lost. Confound Joe Pearson!
    Now the uproar had quieted. O’Donnell’s banging of the gavel—a rare occurrence—had had effect. Bartlett had sat down, his face still angry red. Pearson was turning over some papers, apparently absorbed.
    “Gentlemen.” O’Donnell paused. He knew what had to be said; it must be quick and to the point. “I think I need hardly say this is not an incident any of us would wish to see repeated. A mortality conference is for learning, not for personalities or heated argument. Dr. Pearson, Dr. Bartlett, I trust I make myself clear.” O’Donnell glanced at both, then, without waiting for acknowledgment, announced, “We’ll take the next case, please.”
    There were four more cases down for discussion, but none of these was out of the ordinary and the talk went ahead quietly. It was just as well, Lucy reflected; controversy Eke that was no help to staff morale. There were times when it required courage to make an emergency diagnosis; even so, if you were unfortunate and guilty of error, you expected to be called to account. But personal abuse was another matter; no surgeon, unless grossly careless and incompetent, should have to take that.
    Lucy wondered, not for the first time, how much of Joe Pearson’s censure at times like this was founded on personal feelings. Today, with Gil Bartlett, Pearson had been rougher than she remembered his ever being at any mortality meeting. And yet this was not a flagrant case, nor was Bartlett prone to mistakes. He had done some fine work at Three Counties, notably on types of cancer which not long before were considered inoperable.
    Pearson knew this, too, of course, so why his antagonism? Was it because Gil Bartlett represented something in medicine which Pearson envied and had never attained? She glanced down the table at Bartlett. His face was set; he was still smarting. But normally he was relaxed, amiable, friendly—all the things a successful man in his early forties could afford to be. Along with his wife, Gil Bartlett was a prominent figure in Burlington society. Lucy had seen him at ease at cocktail parties and in wealthy patients’ homes. His practice was successful. Lucy guessed his annual income from it would be in the region of fifty thousand dollars.
    Was this what griped