Now the old man turned to Lucy. Almost sardonically, he said, “So Radiology bows out.”
She answered levelly, “I suppose you could say that.”
“And it leaves it up to me—to Pathology?”
“Yes, Joe,” she said quietly, waiting.
There was a ten-second silence before Pearson spoke again. Then he said clearly and confidently, “My diagnosis is that your patient has a malignant tumor—osteogenic sarcoma.”
Lucy met his eyes. She asked, “That’s quite definite?”
“Quite definite.” In the pathologist’s voice there was no hint of doubt or hesitation. He went on, “In any case, I’ve been sure from the beginning. I thought this”—he indicated the X-ray films—“would give some extra confirmation.”
“All right.” Lucy nodded her acceptance. Her mind was working now on immediate things to do.
Pearson asked matter-of-factly, “When shall you amputate?”
“Tomorrow morning, I expect.” Lucy gathered up the X-rays and went to the door. Her glance taking in Coleman, she said, “I suppose I’d better go and break the news.” She made a small grimace. “This is one of the hard ones.”
When the door had closed behind her, Pearson turned to Coleman. He said with surprising courtesy, “Someone had to decide. I didn’t ask your opinion then because I couldn’t take the chance of letting it be known that there was doubt. If Lucy Grainger knew, she would have no choice but to tell the girl and her parents. And once they heard, they would want to delay. People always do; you can’t blame them.” He paused, then added, “I don’t have to tell you what delay can do with osteogenic sarcoma.”
Coleman nodded. He had no quarrel with Pearson’s having made the decision. As the old man had said, someone had to do it. All the same, he wondered if the amputation to be performed tomorrow was necessary or not. Eventually, of course, they would know for sure. When the severed limb came down to the lab, dissection would show if the diagnosis of malignancy was right or wrong. Unfortunately, though, an error discovered then would be too late to do the patient any good. Surgery had learned many ways to amputate limbs effectively, but it had no procedures for putting them back.
The afternoon flight from Burlington landed at La Guardia Airport a little after four o’clock, and from the airport Kent O’Donnell took a taxi to Manhattan. On the way into town he leaned back, relaxing for the first time in several days. He always tried to relax in New York taxis, mainly because any attempt to watch the traffic, or his own progress through it, usually left him in a state of nervous tension. He had long ago decided that the correct attitude to adopt was one of fatalism; you resigned yourself to disaster, then, if it failed to happen, you congratulated yourself on abundant good luck.
Another reason for relaxing was that for the past week he had worked at full pressure, both in the hospital and outside. He had extended his office appointments and scheduled extra surgery to make possible the four-day absence from Three Counties he had now embarked on. As well, two days ago, he had presided at a special meeting of the hospital’s medical staff at which—aided by data prepared by Harry Tomaselli—he had revealed the suggested scale of donations to the hospital building fund for attending physicians and others. As he had expected, there had been plenty of grumbling, but he had no doubt that the pledges, and eventually the money, would be forthcoming.
Despite his mental withdrawal, O’Donnell was conscious of the activity of New York outside and of the familiar angled sky line of mid-town Manhattan, now growing closer. They were passing over Queensborough Bridge, the warm afternoon sun slanting lancelike through drab green girders, and down below he could see Welfare Island, its city hospitals squatting somberly and institutional midway in the gray East River. He reflected that on each occasion he saw New York its ugliness seemed greater, its disorder and grime more strikingly apparent. And yet, even to the non-New Yorker, after a while these things became comfortable and familiar, seeming to hold a welcome for the traveler, as though an old, worn garment were good enough between friends. He smiled, then chided himself for unmedical thinking—the kind that held back air-pollution control and slum removal. Sentimentality, he reflected, was an aid and comfort to the opponents of progress.
They moved off the bridge and along Sixtieth Street to Madison, then jogged a block, turning west on Fifty-ninth. At Seventh Avenue and Central Park they went left in the traffic and stopped four blocks down at the Park Sheraton Hotel.
He checked into the hotel and later, in his room, showered and changed. From his bag he took the program of the surgeons’ congress—ostensible reason for his presence in New York. He noted that there were three papers he wanted to hear—two on open heart surgery and a third on replacement of diseased arteries by grafts. But the first was not until eleven next morning, which gave him plenty of time tomorrow. He glanced at his watch. It was a little before seven—more than an hour before he was due to meet Denise. He took an elevator downstairs and strolled through the foyer to the Pyramid Lounge.
It was the cocktail hour and the place was beginning to fill with pre-dinner-and-theater groups, mostly, he guessed, like himself, from out of town. A headwaiter showed him to a table, and as they moved across he saw an attractive woman, sitting alone, glance at him interestedly. It was not a new experience, and in the past similar incidents had occasionally led to interesting results. But tonight he thought: Sorry, I have other plans. A waiter took his order for scotch and soda, and when the drink came he sipped it slowly, his mind coasting leisurely over random thoughts.
Moments like this, he reflected, were all too rare in Burlington. That was why it was good to get away for a while; it sharpened your sense of perspective, made you realize that some of the things you deemed important on your own home ground were a good deal less so when looked at from a distance. Just lately he had suspected that his own closeness to hospital business had thrown some of his thinking out of balance. He looked around him. Since he had come in the lounge had filled; waiters were hurrying to bring the drinks which three bartenders were dispensing; one or two of the earlier groups were moving out. How many of these people, he wondered—the man and the girl at the next table, the waiter by the door, the foursome just leaving—had ever heard of Three Counties Hospital and, if they had, would care what went on there? And yet, to himself just lately, the hospital’s affairs seemed almost to have become the breath of life. Was this a healthy symptom? Was it a good thing professionally? O’Donnell had always mistrusted dedicated people; they tended to become obsessed, their judgment undermined by enthusiasm for a cause. Was he in danger now of becoming one such himself?
The question of Joe Pearson, for example. Had O’Donnell’s own closeness to the scene misled him there? It had been necessary for the hospital to hire a second pathologist; he was convinced of that. But had he himself tended to criticize the old man unduly, to magnify organizational weaknesses—and every hospital department had a few—out of true proportion? For a time O’Donnell had even considered asking Pearson to retire; was that in itself a symptom of unbalanced judgment, a hasty condemnation of an older man by one his junior in years? Of course, that was before Eustace Swayne had made it clear that his quarter-million-dollar donation was contingent on Joe Pearson’s remaining at the helm of Pathology; Swayne, incidentally, had still not confirmed the gift. But O’Donnell felt his judgment was superior to considerations like that, however important they might seem. In all probability Joe Pearson had a lot to give Three Counties still; his accumulated experience should surely count for something. It was true, he decided; your thinking did improve when you were away—even if you had to find a cocktail bar to do some reasoning quietly.
A waiter had stopped at the table. “A refill, sir?”
O’Donnell shook his head. “No, thanks.”
The man produced a check. O’Donnell added a tip and signed it.
It was seven-thirty when he left the hotel. There was still plenty of time to spare, and he walked cross-town on Fifty-fifth as far as Fifth Avenue. Then, hailing a cab, he continued uptown to the address Denise had given him. The driver stopped near Eighty-sixth, outside a gray stone apartment building. O’Donnell paid off the cab and went in.
He was greeted respectfully by a uniformed hall porter. The man asked his name, then consulted a list. He said, “Mrs. Quantz left a message to say would you please go up, sir?” He motioned to the elevator, an identically uniformed operator beside it. “It’s the penthouse floor, sir—the twentieth. I’ll tell Mrs. Quantz you’re on the way.”
At the twentieth floor the elevator doors opened silently onto a spacious carpeted hallway. Occupying most of one wall was a large Gobelin tapestry depicting a hunting scene. Opposite were double carved oak doors which now opened, and a manservant appeared. He said, “Good evening, sir. Mrs. Quantz asked me to show you into the lounge. She’ll be with you in a moment.”
He followed the man down a second hallway and into a living room almost as large as his own entire apartment at Burlington. It was decorated in shades of beige, brown, and coral, a sweep of sectional settees offset by walnut end tables, their rich darkness in simple, striking contrast to the deep broadloom of pale beige. The living room opened onto a flagstoned terrace, and he could see the last rays of evening sunshine beyond.
“May I get you something to drink, sir?” the manservant said.
“No, thanks,” he answered. “I’ll wait for Mrs. Quantz.”
“You won’t have to,” a voice said, and it was Denise. She came toward him, her hands held out. “Kent dear, I’m so glad to see you.”
For a moment he looked at her. Then he said slowly, “I am too,” and added truthfully, “Until this moment I hadn’t realized how much.”
Denise smiled and leaned forward to kiss his cheek lightly. O’Donnell had a sudden impulse to take her into his arms, but restrained it.
She was even more beautiful than he remembered, with a smiling radiance that left him breathless. She had on a short, full-skirted evening gown of jet-black lace over a strapless sheath of black silk, the lace about her shoulders accenting the filmy vision of white flesh beneath. At her waist was a single red rose.
She released one of his hands and with the other led him to the terrace. The manservant had preceded them, carrying a silver tray with glasses and a cocktail shaker. Now he withdrew discreetly.
“The martinis are already mixed.” Denise looked at O’Donnell inquiringly. “Or if you like I can get you something else.”
“Martini is fine.”
Denise poured two drinks and handed him one. She was smiling, her eyes warm. Her lips said softly, “Welcome to New York from a committee of one.”
He sipped the martini; it was cool and dry. He said lightly, “Please thank the committee.”
For a brief moment her eyes caught his. Then, taking his arm, she moved across the terrace toward the low, pillared balustrade which marked its end.
O’Donnell asked, “How is your father, Denise?”
“He’s well, thank you. Entrenched like a true die-hard, of course, but in good health. Sometimes I think he’ll outlive us all.” She added, “I’m very fond of him.”
They had stopped and stood looking down. It was dusk now, the warm, mellow dusk of late summer, and the lights of New York were flickering on. From the streets below the throb of evening traffic was steady and insistent, punctuated by the peaklike whine of diesel buses and the full points of impatient horns. Across the way, its outline blurring into shadow, was Central Park, only scattered street lamps marking the roadways through. Beyond, the west-side streets dimmed darkly into the Hudson River; and on the river the pinpoint lamps of shipping were a link between the blackness and the distant glimmering New Jersey shore. Uptown, O’Donnell could see the George Washington Bridge, its highstrung floodlights a chain of white, bright beads, and, below, the headlights of cars, multi-laned, streaming across the bridge, away from the city. O’Donnell thought: People going home.
A warm, soft breeze stirred around them, and he was conscious of Denise’s closeness. Her voice said softly, “It’s beautiful, isn’t it? Even though you know that under the lights there are things that are wrong and hateful, it’s still beautiful. I love it all, especially at this time of evening.”
He said, “Have you ever considered going back—to Burlington, I mean?”
“To live?”
“Yes.”
“You can never go back,” Denise said quietly. “It’s one of the few things I’ve learned. Oh, I don’t mean just Burlington, but everything else—time, people, places. You can revisit, or renew acquaintance, but it’s never really the same; you’re detached; you’re passing through; you don’t belong because you’ve moved on.” She paused. “I belong here now. I don’t believe I could ever leave New York. Do I sound terribly unrealistic?”
“No,” he said. “You sound terribly wise.”
He felt her hand on his arm. “Let’s have one more cocktail,” she said, “then you may take me to dinner.”
Afterward they had gone to the Maisonette, a discreet and pleasantly appointed night club on Fifth Avenue. They had dined and danced, and now they had come back to their table. “How long have you in New York?” Denise asked.
“I go back in three more days,” he answered.
She inclined her head. “Why so soon?”
“I’m a workingman.” He smiled. “My patients expect me to be around and there’s a lot of hospital business too.”
Denise said, “I rather think I shall miss you.”
He thought for a moment, then turned to face her. Without preliminary he said, “You know that I’ve never been married.”
“Yes.” She nodded gravely.
“I’m forty-two,” he said. “In that time, living alone, one forms habits and patterns of life that might be hard to change or for someone else to accept.” He paused. “What I’m trying to say, I suppose, is that I might be difficult to live with.”
Denise reached out and covered his hand with her own. “Kent, darling, may I be clear about something?” She had the slightest of smiles. “Is this by any chance a proposal of marriage?”
O’Donnell was grinning broadly; he felt absurdly, exuberantly, boyish. “Now that you mention it,” he said, “I rather think it is.”
There was a moment’s silence before Denise answered, and when she spoke he sensed that she was maneuvering for time. “I’m very flattered, but aren’t you being a little rash? After all, we scarcely know one another.”
“I love you, Denise,” he said simply.
He felt her regarding him searchingly. “I could love you too,” she said. Then she added, speaking slowly and choosing her words, “At this moment everything in me tells me to say yes and to grab you, dearest, with two eager hands. But there’s a whisper of caution. When you’ve made one mistake you feel the need to be careful about committing yourself again.”
“Yes,” he said, “I can understand that.”
“I’ve never fallen in,” she said, “with the popular idea that one can shed partners quickly and afterward get over it, rather like taking an indigestion tablet. That’s one of the reasons, I suppose, why I’ve never got a divorce.”
“The divorce wouldn’t be difficult?”
“Not really. I imagine I could go to Nevada to arrange it, or some such place. But there’s the other thing—you’re in Burlington; I’m in New York.”
He said carefully, “You really meant what you said, Denise—about not living in Burlington?”
She thought before answering. “Yes. I’m afraid I do. I couldn’t live there—ever. There’s no use pretending, Kent; I know myself too well.”
A waiter appeared with coffee and replenished then: cups. O’Donnell said, “I feel a sudden compulsion for the two of us to be alone.”
Denise said softly, “Why don’t we go?”
He called for the check and paid it, helping Denise on with her wrap. Outside a doorman summoned a cab and O’Donnell gave the address of the Fifth Avenue apartment. When they had settled back, Denise said, “This is a very selfish question, but have you ever considered moving your practice to New York?”
“Yes,” he answered, “I’m thinking about it now.”
He was still thinking when they entered the apartment block and rode up in the elevator. Ever since Denise’s question he had been asking himself: Why shouldn’t I go to New York? There are fine hospitals; this is a medical city. It would not be difficult to get on staff somewhere. Setting up practice would be comparatively easy; his own record, as well as the friends he had in New York, would bring him referrals. He reasoned: What really keeps me tied to Burlington? Does my life belong there—now and for always? Isn’t it time, perhaps, for a change, a new environment? I’m not married to Three Counties Hospital, nor am I indispensable. There are things I’d miss, it’s true; the sense of building and creation, and the people I’ve worked with. But I’ve accomplished a great deal; no one can ever deny that. And New York means Denise. Wouldn’t it be worth it—all?
At the twentieth floor Denise used her own key to let them in; there was no sign of the manservant O’Donnell had seen earlier.
As if by consent they moved to the terrace. Denise asked, “Kent, would you like a drink?”
“Perhaps later,” he said, and reached out toward her. She came to him easily and their lips met. It was a lingering kiss. His arms tightened around her and he felt her body respond to his own. Then gently she disengaged herself.
Half turned away, she said, “There are so many things to think of.” Her voice was troubled.
“Are there?” The tone of voice was disbelieving.
“There’s a great deal you don’t know about me,” Denise said. “For one thing, I’m terribly possessive. Did you know that?”
He answered, “It doesn’t sound very terrible.”
“If we were married,” she said, “I’d have to have all of you, not just a part. I couldn’t help myself. And I couldn’t share you—not even with a hospital.”
He laughed. “I imagine we could work out a compromise. Other people do.”
She turned back toward him. “When you say it like that I almost believe you.” Denise paused. “Will you come back to New York again—soon?”
“Yes.”
“How soon?”
He answered, “Whenever you call me.”
As if by instinct, she moved toward him and they kissed again, this time with growing passion. Then there was a sound behind them and a shaft of light from a door opening to the living room. Denise pushed herself gently away and a moment later a small figure in pajamas came onto the terrace. A voice said, “I thought I heard someone talking.”
“I imagined you were sleeping,” Denise said. “This is Dr. O’Donnell.” Then to O’Donnell, “This is my daughter Philippa.” She added affectionately, “One half of my impossible twins.”
The girl looked at O’Donnell with frank curiosity. “Hullo,” she said, “I’ve heard about you.”
O’Donnell remembered Denise telling him that both her children were seventeen. The girl seemed small for her age, her body only just beginning to fill out. But she moved with a grace and posture uncannily similar to her mother.
“Hullo, Philippa,” he said. “I’m sorry if we disturbed you.”
“I couldn’t sleep, so I was reading.” The girl glanced down at a book in her hand. “It’s Herrick. Did you ever read it?”
“I don’t think so,” O’Donnell said. “As a matter of fact, there wasn’t much time for poetry in medical school and I’ve never really got around to it since.”
Philippa picked up the book and opened it. “There’s something here for you, Mother.” She read attractively with a feeling for words and balance and with a touch of lightness.
“That age is best, which is the first,
When youth and blood are warmer;
But being spent, the worse, and worst
Time, still succeed the former.
Then be not coy, but use your time;
And while ye may, go marry:
For having lost but once your prime,
You may for ever tarry.”
“I get the point,” Denise said. She turned to O’Donnell. “I may tell you, Kent, that my children are perennially pressing me to remarry.”
“We simply think it’s the best thing for you,” Philippa interjected. She put down the book.
“They do it under the guise of practicality,” Denise went on. “Actually they’re both revoltingly sentimental.” She turned to Philippa. “How would you feel if I married Dr. O’Donnell?”
“Has he asked you?” Philippa’s interest was prompt. Without waiting for an answer she exclaimed, “You’re going to, of course.”
“It will depend, dear,” Denise said. “There is, of course, the trifling matter of a divorce to be arranged.”
“Oh, that! Daddy was always so unreasonable about you doing it. Besides, why do you have to wait?” She faced O’Donnell. “Why don’t you just live together? Then you’d have the evidence already arranged and Mother wouldn’t have to go away to one of those awful places like Reno.”
“There are moments,” Denise said, “when I have grave doubts about the value of progressive education. That, I think, will be all.” She stepped lightly to Philippa. “Good night, dear.”
“Oh, Mother!” the girl said. “Sometimes you’re so antediluvian.”
“Good night, dear.” Denise repeated it firmly.
Philippa turned to O’Donnell. “I guess I have to go.”
He said, “It’s been a pleasure, Philippa.”
The girl came to him. She said artlessly, “If you’re going to be my stepfather, I suppose it’s all right to kiss you.”
He answered, “Why don’t we chance it?—whichever way it goes.”
He leaned toward her and she kissed him on the lips, then stood back. There was a slight smile, then she said, “You’re cute.” She warned Denise, “Mother, whatever you do, don’t lose this one.”
“Philippa!” This time the note of discipline was unmistakable.
Philippa laughed and kissed her mother. Waving airily, she picked up her book of poems and went out.
O’Donnell leaned back against the terrace wall and laughed. At this moment his bachelorhood at Burlington seemed incredibly empty and dull, the prospect of life with Denise in New York more glowingly attractive by the second.
Eighteen
Nineteen
She answered levelly, “I suppose you could say that.”
“And it leaves it up to me—to Pathology?”
“Yes, Joe,” she said quietly, waiting.
There was a ten-second silence before Pearson spoke again. Then he said clearly and confidently, “My diagnosis is that your patient has a malignant tumor—osteogenic sarcoma.”
Lucy met his eyes. She asked, “That’s quite definite?”
“Quite definite.” In the pathologist’s voice there was no hint of doubt or hesitation. He went on, “In any case, I’ve been sure from the beginning. I thought this”—he indicated the X-ray films—“would give some extra confirmation.”
“All right.” Lucy nodded her acceptance. Her mind was working now on immediate things to do.
Pearson asked matter-of-factly, “When shall you amputate?”
“Tomorrow morning, I expect.” Lucy gathered up the X-rays and went to the door. Her glance taking in Coleman, she said, “I suppose I’d better go and break the news.” She made a small grimace. “This is one of the hard ones.”
When the door had closed behind her, Pearson turned to Coleman. He said with surprising courtesy, “Someone had to decide. I didn’t ask your opinion then because I couldn’t take the chance of letting it be known that there was doubt. If Lucy Grainger knew, she would have no choice but to tell the girl and her parents. And once they heard, they would want to delay. People always do; you can’t blame them.” He paused, then added, “I don’t have to tell you what delay can do with osteogenic sarcoma.”
Coleman nodded. He had no quarrel with Pearson’s having made the decision. As the old man had said, someone had to do it. All the same, he wondered if the amputation to be performed tomorrow was necessary or not. Eventually, of course, they would know for sure. When the severed limb came down to the lab, dissection would show if the diagnosis of malignancy was right or wrong. Unfortunately, though, an error discovered then would be too late to do the patient any good. Surgery had learned many ways to amputate limbs effectively, but it had no procedures for putting them back.
The afternoon flight from Burlington landed at La Guardia Airport a little after four o’clock, and from the airport Kent O’Donnell took a taxi to Manhattan. On the way into town he leaned back, relaxing for the first time in several days. He always tried to relax in New York taxis, mainly because any attempt to watch the traffic, or his own progress through it, usually left him in a state of nervous tension. He had long ago decided that the correct attitude to adopt was one of fatalism; you resigned yourself to disaster, then, if it failed to happen, you congratulated yourself on abundant good luck.
Another reason for relaxing was that for the past week he had worked at full pressure, both in the hospital and outside. He had extended his office appointments and scheduled extra surgery to make possible the four-day absence from Three Counties he had now embarked on. As well, two days ago, he had presided at a special meeting of the hospital’s medical staff at which—aided by data prepared by Harry Tomaselli—he had revealed the suggested scale of donations to the hospital building fund for attending physicians and others. As he had expected, there had been plenty of grumbling, but he had no doubt that the pledges, and eventually the money, would be forthcoming.
Despite his mental withdrawal, O’Donnell was conscious of the activity of New York outside and of the familiar angled sky line of mid-town Manhattan, now growing closer. They were passing over Queensborough Bridge, the warm afternoon sun slanting lancelike through drab green girders, and down below he could see Welfare Island, its city hospitals squatting somberly and institutional midway in the gray East River. He reflected that on each occasion he saw New York its ugliness seemed greater, its disorder and grime more strikingly apparent. And yet, even to the non-New Yorker, after a while these things became comfortable and familiar, seeming to hold a welcome for the traveler, as though an old, worn garment were good enough between friends. He smiled, then chided himself for unmedical thinking—the kind that held back air-pollution control and slum removal. Sentimentality, he reflected, was an aid and comfort to the opponents of progress.
They moved off the bridge and along Sixtieth Street to Madison, then jogged a block, turning west on Fifty-ninth. At Seventh Avenue and Central Park they went left in the traffic and stopped four blocks down at the Park Sheraton Hotel.
He checked into the hotel and later, in his room, showered and changed. From his bag he took the program of the surgeons’ congress—ostensible reason for his presence in New York. He noted that there were three papers he wanted to hear—two on open heart surgery and a third on replacement of diseased arteries by grafts. But the first was not until eleven next morning, which gave him plenty of time tomorrow. He glanced at his watch. It was a little before seven—more than an hour before he was due to meet Denise. He took an elevator downstairs and strolled through the foyer to the Pyramid Lounge.
It was the cocktail hour and the place was beginning to fill with pre-dinner-and-theater groups, mostly, he guessed, like himself, from out of town. A headwaiter showed him to a table, and as they moved across he saw an attractive woman, sitting alone, glance at him interestedly. It was not a new experience, and in the past similar incidents had occasionally led to interesting results. But tonight he thought: Sorry, I have other plans. A waiter took his order for scotch and soda, and when the drink came he sipped it slowly, his mind coasting leisurely over random thoughts.
Moments like this, he reflected, were all too rare in Burlington. That was why it was good to get away for a while; it sharpened your sense of perspective, made you realize that some of the things you deemed important on your own home ground were a good deal less so when looked at from a distance. Just lately he had suspected that his own closeness to hospital business had thrown some of his thinking out of balance. He looked around him. Since he had come in the lounge had filled; waiters were hurrying to bring the drinks which three bartenders were dispensing; one or two of the earlier groups were moving out. How many of these people, he wondered—the man and the girl at the next table, the waiter by the door, the foursome just leaving—had ever heard of Three Counties Hospital and, if they had, would care what went on there? And yet, to himself just lately, the hospital’s affairs seemed almost to have become the breath of life. Was this a healthy symptom? Was it a good thing professionally? O’Donnell had always mistrusted dedicated people; they tended to become obsessed, their judgment undermined by enthusiasm for a cause. Was he in danger now of becoming one such himself?
The question of Joe Pearson, for example. Had O’Donnell’s own closeness to the scene misled him there? It had been necessary for the hospital to hire a second pathologist; he was convinced of that. But had he himself tended to criticize the old man unduly, to magnify organizational weaknesses—and every hospital department had a few—out of true proportion? For a time O’Donnell had even considered asking Pearson to retire; was that in itself a symptom of unbalanced judgment, a hasty condemnation of an older man by one his junior in years? Of course, that was before Eustace Swayne had made it clear that his quarter-million-dollar donation was contingent on Joe Pearson’s remaining at the helm of Pathology; Swayne, incidentally, had still not confirmed the gift. But O’Donnell felt his judgment was superior to considerations like that, however important they might seem. In all probability Joe Pearson had a lot to give Three Counties still; his accumulated experience should surely count for something. It was true, he decided; your thinking did improve when you were away—even if you had to find a cocktail bar to do some reasoning quietly.
A waiter had stopped at the table. “A refill, sir?”
O’Donnell shook his head. “No, thanks.”
The man produced a check. O’Donnell added a tip and signed it.
It was seven-thirty when he left the hotel. There was still plenty of time to spare, and he walked cross-town on Fifty-fifth as far as Fifth Avenue. Then, hailing a cab, he continued uptown to the address Denise had given him. The driver stopped near Eighty-sixth, outside a gray stone apartment building. O’Donnell paid off the cab and went in.
He was greeted respectfully by a uniformed hall porter. The man asked his name, then consulted a list. He said, “Mrs. Quantz left a message to say would you please go up, sir?” He motioned to the elevator, an identically uniformed operator beside it. “It’s the penthouse floor, sir—the twentieth. I’ll tell Mrs. Quantz you’re on the way.”
At the twentieth floor the elevator doors opened silently onto a spacious carpeted hallway. Occupying most of one wall was a large Gobelin tapestry depicting a hunting scene. Opposite were double carved oak doors which now opened, and a manservant appeared. He said, “Good evening, sir. Mrs. Quantz asked me to show you into the lounge. She’ll be with you in a moment.”
He followed the man down a second hallway and into a living room almost as large as his own entire apartment at Burlington. It was decorated in shades of beige, brown, and coral, a sweep of sectional settees offset by walnut end tables, their rich darkness in simple, striking contrast to the deep broadloom of pale beige. The living room opened onto a flagstoned terrace, and he could see the last rays of evening sunshine beyond.
“May I get you something to drink, sir?” the manservant said.
“No, thanks,” he answered. “I’ll wait for Mrs. Quantz.”
“You won’t have to,” a voice said, and it was Denise. She came toward him, her hands held out. “Kent dear, I’m so glad to see you.”
For a moment he looked at her. Then he said slowly, “I am too,” and added truthfully, “Until this moment I hadn’t realized how much.”
Denise smiled and leaned forward to kiss his cheek lightly. O’Donnell had a sudden impulse to take her into his arms, but restrained it.
She was even more beautiful than he remembered, with a smiling radiance that left him breathless. She had on a short, full-skirted evening gown of jet-black lace over a strapless sheath of black silk, the lace about her shoulders accenting the filmy vision of white flesh beneath. At her waist was a single red rose.
She released one of his hands and with the other led him to the terrace. The manservant had preceded them, carrying a silver tray with glasses and a cocktail shaker. Now he withdrew discreetly.
“The martinis are already mixed.” Denise looked at O’Donnell inquiringly. “Or if you like I can get you something else.”
“Martini is fine.”
Denise poured two drinks and handed him one. She was smiling, her eyes warm. Her lips said softly, “Welcome to New York from a committee of one.”
He sipped the martini; it was cool and dry. He said lightly, “Please thank the committee.”
For a brief moment her eyes caught his. Then, taking his arm, she moved across the terrace toward the low, pillared balustrade which marked its end.
O’Donnell asked, “How is your father, Denise?”
“He’s well, thank you. Entrenched like a true die-hard, of course, but in good health. Sometimes I think he’ll outlive us all.” She added, “I’m very fond of him.”
They had stopped and stood looking down. It was dusk now, the warm, mellow dusk of late summer, and the lights of New York were flickering on. From the streets below the throb of evening traffic was steady and insistent, punctuated by the peaklike whine of diesel buses and the full points of impatient horns. Across the way, its outline blurring into shadow, was Central Park, only scattered street lamps marking the roadways through. Beyond, the west-side streets dimmed darkly into the Hudson River; and on the river the pinpoint lamps of shipping were a link between the blackness and the distant glimmering New Jersey shore. Uptown, O’Donnell could see the George Washington Bridge, its highstrung floodlights a chain of white, bright beads, and, below, the headlights of cars, multi-laned, streaming across the bridge, away from the city. O’Donnell thought: People going home.
A warm, soft breeze stirred around them, and he was conscious of Denise’s closeness. Her voice said softly, “It’s beautiful, isn’t it? Even though you know that under the lights there are things that are wrong and hateful, it’s still beautiful. I love it all, especially at this time of evening.”
He said, “Have you ever considered going back—to Burlington, I mean?”
“To live?”
“Yes.”
“You can never go back,” Denise said quietly. “It’s one of the few things I’ve learned. Oh, I don’t mean just Burlington, but everything else—time, people, places. You can revisit, or renew acquaintance, but it’s never really the same; you’re detached; you’re passing through; you don’t belong because you’ve moved on.” She paused. “I belong here now. I don’t believe I could ever leave New York. Do I sound terribly unrealistic?”
“No,” he said. “You sound terribly wise.”
He felt her hand on his arm. “Let’s have one more cocktail,” she said, “then you may take me to dinner.”
Afterward they had gone to the Maisonette, a discreet and pleasantly appointed night club on Fifth Avenue. They had dined and danced, and now they had come back to their table. “How long have you in New York?” Denise asked.
“I go back in three more days,” he answered.
She inclined her head. “Why so soon?”
“I’m a workingman.” He smiled. “My patients expect me to be around and there’s a lot of hospital business too.”
Denise said, “I rather think I shall miss you.”
He thought for a moment, then turned to face her. Without preliminary he said, “You know that I’ve never been married.”
“Yes.” She nodded gravely.
“I’m forty-two,” he said. “In that time, living alone, one forms habits and patterns of life that might be hard to change or for someone else to accept.” He paused. “What I’m trying to say, I suppose, is that I might be difficult to live with.”
Denise reached out and covered his hand with her own. “Kent, darling, may I be clear about something?” She had the slightest of smiles. “Is this by any chance a proposal of marriage?”
O’Donnell was grinning broadly; he felt absurdly, exuberantly, boyish. “Now that you mention it,” he said, “I rather think it is.”
There was a moment’s silence before Denise answered, and when she spoke he sensed that she was maneuvering for time. “I’m very flattered, but aren’t you being a little rash? After all, we scarcely know one another.”
“I love you, Denise,” he said simply.
He felt her regarding him searchingly. “I could love you too,” she said. Then she added, speaking slowly and choosing her words, “At this moment everything in me tells me to say yes and to grab you, dearest, with two eager hands. But there’s a whisper of caution. When you’ve made one mistake you feel the need to be careful about committing yourself again.”
“Yes,” he said, “I can understand that.”
“I’ve never fallen in,” she said, “with the popular idea that one can shed partners quickly and afterward get over it, rather like taking an indigestion tablet. That’s one of the reasons, I suppose, why I’ve never got a divorce.”
“The divorce wouldn’t be difficult?”
“Not really. I imagine I could go to Nevada to arrange it, or some such place. But there’s the other thing—you’re in Burlington; I’m in New York.”
He said carefully, “You really meant what you said, Denise—about not living in Burlington?”
She thought before answering. “Yes. I’m afraid I do. I couldn’t live there—ever. There’s no use pretending, Kent; I know myself too well.”
A waiter appeared with coffee and replenished then: cups. O’Donnell said, “I feel a sudden compulsion for the two of us to be alone.”
Denise said softly, “Why don’t we go?”
He called for the check and paid it, helping Denise on with her wrap. Outside a doorman summoned a cab and O’Donnell gave the address of the Fifth Avenue apartment. When they had settled back, Denise said, “This is a very selfish question, but have you ever considered moving your practice to New York?”
“Yes,” he answered, “I’m thinking about it now.”
He was still thinking when they entered the apartment block and rode up in the elevator. Ever since Denise’s question he had been asking himself: Why shouldn’t I go to New York? There are fine hospitals; this is a medical city. It would not be difficult to get on staff somewhere. Setting up practice would be comparatively easy; his own record, as well as the friends he had in New York, would bring him referrals. He reasoned: What really keeps me tied to Burlington? Does my life belong there—now and for always? Isn’t it time, perhaps, for a change, a new environment? I’m not married to Three Counties Hospital, nor am I indispensable. There are things I’d miss, it’s true; the sense of building and creation, and the people I’ve worked with. But I’ve accomplished a great deal; no one can ever deny that. And New York means Denise. Wouldn’t it be worth it—all?
At the twentieth floor Denise used her own key to let them in; there was no sign of the manservant O’Donnell had seen earlier.
As if by consent they moved to the terrace. Denise asked, “Kent, would you like a drink?”
“Perhaps later,” he said, and reached out toward her. She came to him easily and their lips met. It was a lingering kiss. His arms tightened around her and he felt her body respond to his own. Then gently she disengaged herself.
Half turned away, she said, “There are so many things to think of.” Her voice was troubled.
“Are there?” The tone of voice was disbelieving.
“There’s a great deal you don’t know about me,” Denise said. “For one thing, I’m terribly possessive. Did you know that?”
He answered, “It doesn’t sound very terrible.”
“If we were married,” she said, “I’d have to have all of you, not just a part. I couldn’t help myself. And I couldn’t share you—not even with a hospital.”
He laughed. “I imagine we could work out a compromise. Other people do.”
She turned back toward him. “When you say it like that I almost believe you.” Denise paused. “Will you come back to New York again—soon?”
“Yes.”
“How soon?”
He answered, “Whenever you call me.”
As if by instinct, she moved toward him and they kissed again, this time with growing passion. Then there was a sound behind them and a shaft of light from a door opening to the living room. Denise pushed herself gently away and a moment later a small figure in pajamas came onto the terrace. A voice said, “I thought I heard someone talking.”
“I imagined you were sleeping,” Denise said. “This is Dr. O’Donnell.” Then to O’Donnell, “This is my daughter Philippa.” She added affectionately, “One half of my impossible twins.”
The girl looked at O’Donnell with frank curiosity. “Hullo,” she said, “I’ve heard about you.”
O’Donnell remembered Denise telling him that both her children were seventeen. The girl seemed small for her age, her body only just beginning to fill out. But she moved with a grace and posture uncannily similar to her mother.
“Hullo, Philippa,” he said. “I’m sorry if we disturbed you.”
“I couldn’t sleep, so I was reading.” The girl glanced down at a book in her hand. “It’s Herrick. Did you ever read it?”
“I don’t think so,” O’Donnell said. “As a matter of fact, there wasn’t much time for poetry in medical school and I’ve never really got around to it since.”
Philippa picked up the book and opened it. “There’s something here for you, Mother.” She read attractively with a feeling for words and balance and with a touch of lightness.
“That age is best, which is the first,
When youth and blood are warmer;
But being spent, the worse, and worst
Time, still succeed the former.
Then be not coy, but use your time;
And while ye may, go marry:
For having lost but once your prime,
You may for ever tarry.”
“I get the point,” Denise said. She turned to O’Donnell. “I may tell you, Kent, that my children are perennially pressing me to remarry.”
“We simply think it’s the best thing for you,” Philippa interjected. She put down the book.
“They do it under the guise of practicality,” Denise went on. “Actually they’re both revoltingly sentimental.” She turned to Philippa. “How would you feel if I married Dr. O’Donnell?”
“Has he asked you?” Philippa’s interest was prompt. Without waiting for an answer she exclaimed, “You’re going to, of course.”
“It will depend, dear,” Denise said. “There is, of course, the trifling matter of a divorce to be arranged.”
“Oh, that! Daddy was always so unreasonable about you doing it. Besides, why do you have to wait?” She faced O’Donnell. “Why don’t you just live together? Then you’d have the evidence already arranged and Mother wouldn’t have to go away to one of those awful places like Reno.”
“There are moments,” Denise said, “when I have grave doubts about the value of progressive education. That, I think, will be all.” She stepped lightly to Philippa. “Good night, dear.”
“Oh, Mother!” the girl said. “Sometimes you’re so antediluvian.”
“Good night, dear.” Denise repeated it firmly.
Philippa turned to O’Donnell. “I guess I have to go.”
He said, “It’s been a pleasure, Philippa.”
The girl came to him. She said artlessly, “If you’re going to be my stepfather, I suppose it’s all right to kiss you.”
He answered, “Why don’t we chance it?—whichever way it goes.”
He leaned toward her and she kissed him on the lips, then stood back. There was a slight smile, then she said, “You’re cute.” She warned Denise, “Mother, whatever you do, don’t lose this one.”
“Philippa!” This time the note of discipline was unmistakable.
Philippa laughed and kissed her mother. Waving airily, she picked up her book of poems and went out.
O’Donnell leaned back against the terrace wall and laughed. At this moment his bachelorhood at Burlington seemed incredibly empty and dull, the prospect of life with Denise in New York more glowingly attractive by the second.
Eighteen
The amputation of Vivian’s left leg began at 8:30 a.m. precisely. Punctuality in the operating rooms was something that Dr. O’Donnell had insisted on when he first became chief of surgery at Three Counties, and most surgeons complied with the rule.
The procedure was not complicated, and Lucy Grainger anticipated no problems other than routine. She had already planned to amputate the limb fairly high, well above the knee and in the upper part of the femur. At one point she had considered disarticulating at the hip in the belief that this might give a better chance of getting ahead of the spreading malignancy from the knee. But the disadvantage here would be extreme difficulty later on in fitting an artificial limb to the inadequate stump. That was why she had compromised in planning to leave intact a portion of the thigh.
She had also planned where to cut her flaps so that the flesh would cover the stump adequately. In fact, she had done this last night, sketching out the necessary incisions in her mind, while allowing Vivian to believe that she was making another routine examination.
That had been after she had broken the news to Vivian, of course—a sad, strained session in which the girl at first had been dry-eyed and composed and then, breaking down, had clung to Lucy, her despairing sobs acknowledging that the last barriers of hope had gone. Lucy, although accustomed by training and habit to be clinical and unemotional at such moments, had found herself unusually moved.
The session with the parents subsequently, and later when young Dr. Seddons had come to see her, had been less personal but still troubling. Lucy supposed she would never insulate entirely her own feelings for patients the way some people did, and sometimes she had had to admit to herself that her surface detachment was only a pose, though a necessary one. There was no pose, though, about detachment here in the operating room; that was one place it became essential, and she found herself now, coolly and without personal feelings, assessing the immediate surgical requirements.
The anesthetist, at the head of the operating table, had already given his clearance to proceed. For some minutes now Lucy’s assistant—today, one of the hospital interns—had been holding up the leg which was to be removed, so as to allow the blood to drain out as far as possible. Now Lucy began to arrange a pneumatic tourniquet high on the thigh, leaving it, for the moment, loosely in position.
Without being asked the scrub nurse handed scissors across the table, and Lucy began to snip off the bandages which had covered the leg since it had been shaved, then prepped with hexachlorophene, the night before. The bandages fell away and the circulating nurse removed them from the floor.
Lucy glanced at the clock. The leg had been held up, close to vertical, for five minutes and the flesh appeared pale. The intern changed hands and she asked him, “Arms getting tired?”
He grinned behind his face mask. “I wouldn’t want to do it for an hour.”
The anesthetist had moved to the tourniquet and was looking at Lucy inquiringly. She nodded and said, “Yes, please.” The anesthetist began to pump air into the rubber tourniquet, cutting off circulation to the leg, and when he had finished the intern lowered the limb until it rested horizontally on the operating table. Together the intern and scrub nurse draped the patient with a sterile green sheet until only the operative portion of the leg remained exposed. Lucy then began the final prepping, painting the surgical area with alcoholic zephiran.
There was an audience in the O.R. today—two medical students from the university, and Lucy beckoned them closer. The scrub nurse passed a knife, and Lucy began to scrape the tip of the blade against the exposed flesh of the thigh, talking as she worked.
“You’ll notice that I’m marking the level of the flaps by scratching them on first. That’s to give us our landmarks.” Now she began to cut more deeply, exposing the fascia immediately below the skin, with its layer of yellow fatty tissue. “It’s important always to make the front flap longer than the back one, so that afterward the suture line comes a little posterially. In that way the patient won’t have a scar right at the end of the stump. If we did leave a scar in that position it could be extremely sore when any weight was put upon it.”
Now the flesh was cut deeply, the lines of both flaps defined by the blood which had begun to seep out. The effect, front and rear, was rather like two shirttails—one long, one short—which eventually would be brought together and sewn neatly at their edges.
Using a scalpel and working with short, sharp movements, Lucy began to strip back the flesh, upward, exposing the bloody red mass of underlying tissue.
“Rake, please!” The scrub nurse passed the instrument and Lucy positioned it, holding back the loose, cut flesh, clear of the next layer below. She signaled to the intern to hold the rake in place, which he did, and she applied herself to cutting deeper, through the first layer of quadriceps muscle.
“In a moment we shall expose the main arteries. Yes, here we are—first the femoral vessel.” As Lucy located it the two medical students leaned forward intently. She went on calmly, matching her action to the words. “We’ll try to free the vessels as high up as possible, then pull them down and tie off so that they retract well clear of the stump.” The needle which the scrub nurse had passed danced in and out. Lucy tied the big vessels twice to be sure they were secure and would remain so; any later hemorrhage in this area could be catastrophic for the patient. Then, holding her hand for scissors, she took them and severed the main artery leading to the lower limb. The first irrevocable step to amputation had now been taken.
The same procedure followed quickly for the other arteries and veins. Then, cutting again through muscle, Lucy reached and exposed the nerve running parallel downward. As her gloved hands ran over it exploringly, Vivian’s body stirred suddenly on the table and all eyes switched quickly to the anesthetist at its head. He nodded reassuringly. “The patient’s doing fine; no problems.” One of his hands was against Vivian’s cheek; it was pale, but her breathing was deep and regular. Her eyes were open but unseeing; with her head fully back, untilted to one side or the other, the pockets of her eyes were deep with water—her own tears, shed in unconsciousness.
“We follow the same procedure with the nerve, as with the arteries and veins—pull it down, tie it off as high as possible, then cut and allow it to retract.” Lucy was talking almost automatically, the words following her hands, the habit of teaching strong. She went on calmly, “There’s always been a lot of discussion among surgeons on the best way to treat nerve ends during amputation. The object, naturally, is to avoid pain afterward at the stump.” She deftly tied a knot and nodded to the intern, who snipped off the spare ends of suture. “Quite a few methods have been tried—injection of alcohol; burning the nerve end with an electric cautery; but the method we’re following today is still the simplest and most widely used.”
Lucy glanced up at the clock on the O.R. wall. It showed 9:15—forty-five minutes so far since they had begun. She returned her eyes by way of the anesthetist.
“Still all right?”
The anesthetist nodded. “Couldn’t be better, Lucy. She’s a real healthy girl.” Facetiously he asked, “You sure you’re taking the leg off the right patient?”
“I’m sure.”
Lucy had never enjoyed operating-room jokes about patients on the table, though she had known some surgeons who wisecracked their way from first incision to closure. She supposed it was all in your point of view. Perhaps with some people levity was a means to cover up deeper feelings, perhaps not. At any rate she preferred to change the subject. Beginning to cut the muscles at the back of the leg, she asked the anesthetist, “How’s your family?” Lucy paused to use a second rake to hold back the flesh from the new incision.
“They’re fine. We’re moving into a new house next week.”
“Oh, really. Whereabouts?” To the intern she said, “A little higher, please. Try to hold it back right out of the way.”
“Somerset Heights. It’s a new subdivision in the north end.”
The back leg muscles were almost severed. She said, “I think I’ve heard of it. I expect your wife is pleased.”
Now the bone was visible, the whole incision big, red, gaping. The anesthetist answered, “She’s in seventh heaven—buying rugs, choosing draperies, all the other things. There’s only one problem.”
Lucy’s fingers went around the leg bone, working up and freeing the surrounding muscles. Speaking for the students’ benefit, she said, “You’ll notice that I’m pushing the muscles as far out of the way as I can. Then we can sever the bone quite high so that afterward it will be entirely covered with muscle.”
The intern was having trouble holding back the overlapping muscles with his two rakes. She helped him position them and he gumbled, “Next time I do this I’ll bring my third hand.”
“Saw, please.”
Again the scrub nurse was ready, placing the handle of the bone saw in Lucy’s outstretched palm. To the anesthetist Lucy said, “What problem is that?”
Positioning the saw blade as high as she could, Lucy began to move it in short, even strokes. There was the dull, penetrating sound of bone scrunching as the saw teeth bit inward. The anesthetist said, “Paying for it all.”
Lucy laughed. “We’ll have to keep you busier—schedule more surgery.” She had sawed halfway through the bone now; it was proving tougher than some, but of course young bones were naturally hard. Suddenly the thought occurred to her: this is a moment of tragedy, and yet here we are, casually talking, even jesting, about commonplace things. In a second or two, no more, this leg would be severed and a young girl—little more than a child—would have lost, for always, a part of her life. Never again would she run freely, wholly like other people, or dance, or swim, or ride horseback, or, uninhibited, make love. Some of these things she would eventually do, and others with effort and mechanical aid; but nothing again could ever be quite the same—never so gay or free or careless as with the fullness of youth and the body whole. This was the nub of the tragedy: it had happened too soon.
Lucy paused. Her sensitive fingers told her that the saw cut was almost complete. Then, abruptly, there was a crunching sound, followed by a sharp crack; at the last moment, under the weight of the almost separated limb, the final fragment of bone had snapped. The limb was free and it fell to the table. For the first time raising her voice, Lucy said, “Catch it! Quickly!”
But the warning was too late. As the intern grabbed and missed, the leg slipped from the operating table and thudded to the floor.
“Leave it there!” Lucy spoke sharply as, forgetful of the fact that he would render himself unsterile, the intern bent to retrieve the limb. Embarrassed, he straightened up.
The circulating nurse moved in, collected the leg, and began to wrap it in gauze and paper. Later, along with more packages containing other surgical specimens, it would be collected by a messenger and taken to Pathology.
“Hold the stump clear of the table, please.” Lucy gestured to the intern, and he moved around her to comply. The scrub nurse had a rasp ready, and Lucy took it, feeling for the rough edges of bone that the break had left and applying the rasp to them. Again for the students she said, “Always remember to get the bone end clean, making sure that no little spikes stick out, because if they do, they’re likely to overgrow and become extremely painful.” Without looking up, she asked, “How are we doing for time?”
The anesthetist answered, “It’s been seventy minutes.”
Lucy returned the rasp. “All right,” she said; “now we can begin to sew up.” With the end in sight she found herself thinking gratefully of the coffee which would be waiting in the surgeons’ room down the hall.
Mike Seddons had, quite literally, sweated out the period while Vivian was undergoing surgery. With the Loburtons—Vivian’s parents had remained in Burlington and planned to stay on for the time being—he had gone to one of the small waiting rooms reserved for relatives of surgical patients. Before that, in the early morning and with the hospital only just beginning to come awake, he had met them at the main doorway and taken them to visit Vivian in her hospital room. But there had seemed little to say, and Vivian, already drowsy from sedation, appeared hardly aware that they were with her. Then, a few minutes after they had come, she was wheeled away to the surgical floor.
Now, in the uneasy backwater of the sparsely furnished room with its uncomfortable leatherette chairs and varnished tables, the three of them had run out of even the most perfunctory conversation. Henry Loburton, tall and heavily built, his thinning hair iron gray, his face creased and weathered from years spent in the open air, stood by a window, looking down at the street below. Mike Seddons could predict that in a moment or two Vivian’s father would turn from the window, go back to one of the leatherette chairs, then after a while get up and cross to the window again. It was a sequence the older man had been following for more than an hour, a slow-fire nervousness that caused Seddons to wish desperately that he would vary it a little—either move more quickly or, once in a while, change the interval of time between the two positions.
In contrast, Vivian’s mother had remained still—almost, it seemed, unmoving since they had come here. She had chosen a straight-backed chair in preference to some of the others which appeared more comfortable and held herself upright in a way that suggested a habit of conscious self-discipline. As she had for some time now, Angela Loburton was looking directly ahead, her eyes, it seemed, on infinity, her hands crossed delicately in her lap. Today her color was paler than usual, but the high cheekbones, which accented a natural dignity and poise, were as noticeable as ever. At one and the same time she seemed a woman fragile but indestructible.
Since their first meeting a few days before Mike Seddons had wondered several times about Mrs. Loburton. Her emotion, her fears about Vivian, had been much less transparent than those of her husband; and yet, as the days went by, Seddons sensed that they were as deep, perhaps deeper. He also suspected that, despite the apparent masculinity of Vivian’s father, her mother possessed by far the stronger character of the two and that she was the rock on which, over the years of their marriage, her husband had come to depend.
Seddons found himself wondering how it would be between himself and Vivian in the time ahead. Which of them would prove, in the end, more resolute and more enduring? He knew that no two people were ever quite equal, either in strength of character or in leadership, or even in the capacity to love. He knew, too, that difference in sex had little to do with it, that women were often stouter than men in mind and heart, and that apparent masculinity was sometimes a hollow pose designed to camouflage internal weakness.
Was Vivian stronger than himself, her character finer, her courage higher? The question had come to him last night and had remained with him since. He had gone to see her, knowing the decision had been made to amputate and aware that Vivian knew it too. He had found her, not in tears, but smiling. “Come in, Mike darling,” she had said, “and please don’t look so glum. Dr. Grainger’s told me, and I’ve done my crying, and it’s over now—or at least it will be in the morning.”
At the words he had felt his love for her deepen, and he had held her and kissed her passionately. Afterward she had twisted his hair affectionately and, holding his head back, had looked directly into his eyes.
“I’m going to have just one leg, Mike,” she had said, “for all the rest of my life. I won’t be the girl you met—not as you met me, and not as you know me now. If you want out, I’ll understand.”
He had answered emphatically, “Don’t talk like that!”
“Why?” she had said. “Are you afraid to talk about it?”
“No!” It was a loud, firm protest, but even as he made it he had known it to be a lie. He was afraid, just as he sensed that Vivian was not—not now, not any more.
It was a reflection of Vivian, he realized, that he could see now in her mother—or, he supposed, the other way around. The sense of strength was there, unmistakable, in both. Could he match it with his own? For the first time a feeling of uneasy doubt assailed him.
Mr. Loburton had broken his routine. He had stopped halfway between the window and the chair. “Michael,” he said, “it’s been an hour and a half. Can they be very much longer?”
Seddons found Vivian’s mother looking at him too. He shook his head. “I don’t believe so. Dr. Grainger said she’d come here . . . immediately after.” He paused, then added, “We should all know something—very soon.”
The procedure was not complicated, and Lucy Grainger anticipated no problems other than routine. She had already planned to amputate the limb fairly high, well above the knee and in the upper part of the femur. At one point she had considered disarticulating at the hip in the belief that this might give a better chance of getting ahead of the spreading malignancy from the knee. But the disadvantage here would be extreme difficulty later on in fitting an artificial limb to the inadequate stump. That was why she had compromised in planning to leave intact a portion of the thigh.
She had also planned where to cut her flaps so that the flesh would cover the stump adequately. In fact, she had done this last night, sketching out the necessary incisions in her mind, while allowing Vivian to believe that she was making another routine examination.
That had been after she had broken the news to Vivian, of course—a sad, strained session in which the girl at first had been dry-eyed and composed and then, breaking down, had clung to Lucy, her despairing sobs acknowledging that the last barriers of hope had gone. Lucy, although accustomed by training and habit to be clinical and unemotional at such moments, had found herself unusually moved.
The session with the parents subsequently, and later when young Dr. Seddons had come to see her, had been less personal but still troubling. Lucy supposed she would never insulate entirely her own feelings for patients the way some people did, and sometimes she had had to admit to herself that her surface detachment was only a pose, though a necessary one. There was no pose, though, about detachment here in the operating room; that was one place it became essential, and she found herself now, coolly and without personal feelings, assessing the immediate surgical requirements.
The anesthetist, at the head of the operating table, had already given his clearance to proceed. For some minutes now Lucy’s assistant—today, one of the hospital interns—had been holding up the leg which was to be removed, so as to allow the blood to drain out as far as possible. Now Lucy began to arrange a pneumatic tourniquet high on the thigh, leaving it, for the moment, loosely in position.
Without being asked the scrub nurse handed scissors across the table, and Lucy began to snip off the bandages which had covered the leg since it had been shaved, then prepped with hexachlorophene, the night before. The bandages fell away and the circulating nurse removed them from the floor.
Lucy glanced at the clock. The leg had been held up, close to vertical, for five minutes and the flesh appeared pale. The intern changed hands and she asked him, “Arms getting tired?”
He grinned behind his face mask. “I wouldn’t want to do it for an hour.”
The anesthetist had moved to the tourniquet and was looking at Lucy inquiringly. She nodded and said, “Yes, please.” The anesthetist began to pump air into the rubber tourniquet, cutting off circulation to the leg, and when he had finished the intern lowered the limb until it rested horizontally on the operating table. Together the intern and scrub nurse draped the patient with a sterile green sheet until only the operative portion of the leg remained exposed. Lucy then began the final prepping, painting the surgical area with alcoholic zephiran.
There was an audience in the O.R. today—two medical students from the university, and Lucy beckoned them closer. The scrub nurse passed a knife, and Lucy began to scrape the tip of the blade against the exposed flesh of the thigh, talking as she worked.
“You’ll notice that I’m marking the level of the flaps by scratching them on first. That’s to give us our landmarks.” Now she began to cut more deeply, exposing the fascia immediately below the skin, with its layer of yellow fatty tissue. “It’s important always to make the front flap longer than the back one, so that afterward the suture line comes a little posterially. In that way the patient won’t have a scar right at the end of the stump. If we did leave a scar in that position it could be extremely sore when any weight was put upon it.”
Now the flesh was cut deeply, the lines of both flaps defined by the blood which had begun to seep out. The effect, front and rear, was rather like two shirttails—one long, one short—which eventually would be brought together and sewn neatly at their edges.
Using a scalpel and working with short, sharp movements, Lucy began to strip back the flesh, upward, exposing the bloody red mass of underlying tissue.
“Rake, please!” The scrub nurse passed the instrument and Lucy positioned it, holding back the loose, cut flesh, clear of the next layer below. She signaled to the intern to hold the rake in place, which he did, and she applied herself to cutting deeper, through the first layer of quadriceps muscle.
“In a moment we shall expose the main arteries. Yes, here we are—first the femoral vessel.” As Lucy located it the two medical students leaned forward intently. She went on calmly, matching her action to the words. “We’ll try to free the vessels as high up as possible, then pull them down and tie off so that they retract well clear of the stump.” The needle which the scrub nurse had passed danced in and out. Lucy tied the big vessels twice to be sure they were secure and would remain so; any later hemorrhage in this area could be catastrophic for the patient. Then, holding her hand for scissors, she took them and severed the main artery leading to the lower limb. The first irrevocable step to amputation had now been taken.
The same procedure followed quickly for the other arteries and veins. Then, cutting again through muscle, Lucy reached and exposed the nerve running parallel downward. As her gloved hands ran over it exploringly, Vivian’s body stirred suddenly on the table and all eyes switched quickly to the anesthetist at its head. He nodded reassuringly. “The patient’s doing fine; no problems.” One of his hands was against Vivian’s cheek; it was pale, but her breathing was deep and regular. Her eyes were open but unseeing; with her head fully back, untilted to one side or the other, the pockets of her eyes were deep with water—her own tears, shed in unconsciousness.
“We follow the same procedure with the nerve, as with the arteries and veins—pull it down, tie it off as high as possible, then cut and allow it to retract.” Lucy was talking almost automatically, the words following her hands, the habit of teaching strong. She went on calmly, “There’s always been a lot of discussion among surgeons on the best way to treat nerve ends during amputation. The object, naturally, is to avoid pain afterward at the stump.” She deftly tied a knot and nodded to the intern, who snipped off the spare ends of suture. “Quite a few methods have been tried—injection of alcohol; burning the nerve end with an electric cautery; but the method we’re following today is still the simplest and most widely used.”
Lucy glanced up at the clock on the O.R. wall. It showed 9:15—forty-five minutes so far since they had begun. She returned her eyes by way of the anesthetist.
“Still all right?”
The anesthetist nodded. “Couldn’t be better, Lucy. She’s a real healthy girl.” Facetiously he asked, “You sure you’re taking the leg off the right patient?”
“I’m sure.”
Lucy had never enjoyed operating-room jokes about patients on the table, though she had known some surgeons who wisecracked their way from first incision to closure. She supposed it was all in your point of view. Perhaps with some people levity was a means to cover up deeper feelings, perhaps not. At any rate she preferred to change the subject. Beginning to cut the muscles at the back of the leg, she asked the anesthetist, “How’s your family?” Lucy paused to use a second rake to hold back the flesh from the new incision.
“They’re fine. We’re moving into a new house next week.”
“Oh, really. Whereabouts?” To the intern she said, “A little higher, please. Try to hold it back right out of the way.”
“Somerset Heights. It’s a new subdivision in the north end.”
The back leg muscles were almost severed. She said, “I think I’ve heard of it. I expect your wife is pleased.”
Now the bone was visible, the whole incision big, red, gaping. The anesthetist answered, “She’s in seventh heaven—buying rugs, choosing draperies, all the other things. There’s only one problem.”
Lucy’s fingers went around the leg bone, working up and freeing the surrounding muscles. Speaking for the students’ benefit, she said, “You’ll notice that I’m pushing the muscles as far out of the way as I can. Then we can sever the bone quite high so that afterward it will be entirely covered with muscle.”
The intern was having trouble holding back the overlapping muscles with his two rakes. She helped him position them and he gumbled, “Next time I do this I’ll bring my third hand.”
“Saw, please.”
Again the scrub nurse was ready, placing the handle of the bone saw in Lucy’s outstretched palm. To the anesthetist Lucy said, “What problem is that?”
Positioning the saw blade as high as she could, Lucy began to move it in short, even strokes. There was the dull, penetrating sound of bone scrunching as the saw teeth bit inward. The anesthetist said, “Paying for it all.”
Lucy laughed. “We’ll have to keep you busier—schedule more surgery.” She had sawed halfway through the bone now; it was proving tougher than some, but of course young bones were naturally hard. Suddenly the thought occurred to her: this is a moment of tragedy, and yet here we are, casually talking, even jesting, about commonplace things. In a second or two, no more, this leg would be severed and a young girl—little more than a child—would have lost, for always, a part of her life. Never again would she run freely, wholly like other people, or dance, or swim, or ride horseback, or, uninhibited, make love. Some of these things she would eventually do, and others with effort and mechanical aid; but nothing again could ever be quite the same—never so gay or free or careless as with the fullness of youth and the body whole. This was the nub of the tragedy: it had happened too soon.
Lucy paused. Her sensitive fingers told her that the saw cut was almost complete. Then, abruptly, there was a crunching sound, followed by a sharp crack; at the last moment, under the weight of the almost separated limb, the final fragment of bone had snapped. The limb was free and it fell to the table. For the first time raising her voice, Lucy said, “Catch it! Quickly!”
But the warning was too late. As the intern grabbed and missed, the leg slipped from the operating table and thudded to the floor.
“Leave it there!” Lucy spoke sharply as, forgetful of the fact that he would render himself unsterile, the intern bent to retrieve the limb. Embarrassed, he straightened up.
The circulating nurse moved in, collected the leg, and began to wrap it in gauze and paper. Later, along with more packages containing other surgical specimens, it would be collected by a messenger and taken to Pathology.
“Hold the stump clear of the table, please.” Lucy gestured to the intern, and he moved around her to comply. The scrub nurse had a rasp ready, and Lucy took it, feeling for the rough edges of bone that the break had left and applying the rasp to them. Again for the students she said, “Always remember to get the bone end clean, making sure that no little spikes stick out, because if they do, they’re likely to overgrow and become extremely painful.” Without looking up, she asked, “How are we doing for time?”
The anesthetist answered, “It’s been seventy minutes.”
Lucy returned the rasp. “All right,” she said; “now we can begin to sew up.” With the end in sight she found herself thinking gratefully of the coffee which would be waiting in the surgeons’ room down the hall.
Mike Seddons had, quite literally, sweated out the period while Vivian was undergoing surgery. With the Loburtons—Vivian’s parents had remained in Burlington and planned to stay on for the time being—he had gone to one of the small waiting rooms reserved for relatives of surgical patients. Before that, in the early morning and with the hospital only just beginning to come awake, he had met them at the main doorway and taken them to visit Vivian in her hospital room. But there had seemed little to say, and Vivian, already drowsy from sedation, appeared hardly aware that they were with her. Then, a few minutes after they had come, she was wheeled away to the surgical floor.
Now, in the uneasy backwater of the sparsely furnished room with its uncomfortable leatherette chairs and varnished tables, the three of them had run out of even the most perfunctory conversation. Henry Loburton, tall and heavily built, his thinning hair iron gray, his face creased and weathered from years spent in the open air, stood by a window, looking down at the street below. Mike Seddons could predict that in a moment or two Vivian’s father would turn from the window, go back to one of the leatherette chairs, then after a while get up and cross to the window again. It was a sequence the older man had been following for more than an hour, a slow-fire nervousness that caused Seddons to wish desperately that he would vary it a little—either move more quickly or, once in a while, change the interval of time between the two positions.
In contrast, Vivian’s mother had remained still—almost, it seemed, unmoving since they had come here. She had chosen a straight-backed chair in preference to some of the others which appeared more comfortable and held herself upright in a way that suggested a habit of conscious self-discipline. As she had for some time now, Angela Loburton was looking directly ahead, her eyes, it seemed, on infinity, her hands crossed delicately in her lap. Today her color was paler than usual, but the high cheekbones, which accented a natural dignity and poise, were as noticeable as ever. At one and the same time she seemed a woman fragile but indestructible.
Since their first meeting a few days before Mike Seddons had wondered several times about Mrs. Loburton. Her emotion, her fears about Vivian, had been much less transparent than those of her husband; and yet, as the days went by, Seddons sensed that they were as deep, perhaps deeper. He also suspected that, despite the apparent masculinity of Vivian’s father, her mother possessed by far the stronger character of the two and that she was the rock on which, over the years of their marriage, her husband had come to depend.
Seddons found himself wondering how it would be between himself and Vivian in the time ahead. Which of them would prove, in the end, more resolute and more enduring? He knew that no two people were ever quite equal, either in strength of character or in leadership, or even in the capacity to love. He knew, too, that difference in sex had little to do with it, that women were often stouter than men in mind and heart, and that apparent masculinity was sometimes a hollow pose designed to camouflage internal weakness.
Was Vivian stronger than himself, her character finer, her courage higher? The question had come to him last night and had remained with him since. He had gone to see her, knowing the decision had been made to amputate and aware that Vivian knew it too. He had found her, not in tears, but smiling. “Come in, Mike darling,” she had said, “and please don’t look so glum. Dr. Grainger’s told me, and I’ve done my crying, and it’s over now—or at least it will be in the morning.”
At the words he had felt his love for her deepen, and he had held her and kissed her passionately. Afterward she had twisted his hair affectionately and, holding his head back, had looked directly into his eyes.
“I’m going to have just one leg, Mike,” she had said, “for all the rest of my life. I won’t be the girl you met—not as you met me, and not as you know me now. If you want out, I’ll understand.”
He had answered emphatically, “Don’t talk like that!”
“Why?” she had said. “Are you afraid to talk about it?”
“No!” It was a loud, firm protest, but even as he made it he had known it to be a lie. He was afraid, just as he sensed that Vivian was not—not now, not any more.
It was a reflection of Vivian, he realized, that he could see now in her mother—or, he supposed, the other way around. The sense of strength was there, unmistakable, in both. Could he match it with his own? For the first time a feeling of uneasy doubt assailed him.
Mr. Loburton had broken his routine. He had stopped halfway between the window and the chair. “Michael,” he said, “it’s been an hour and a half. Can they be very much longer?”
Seddons found Vivian’s mother looking at him too. He shook his head. “I don’t believe so. Dr. Grainger said she’d come here . . . immediately after.” He paused, then added, “We should all know something—very soon.”
Nineteen
Reaching into the incubator through the two porthole-like apertures in its side, Dr. Dornberger carefully examined the Alexander baby. Three and a half days had gone by since birth, a fact which, of itself, might normally be taken as a hopeful sign. But there were other symptoms, increasingly apparent, which Dornberger knew must be looked on with disquiet.
He took his time about completing the examination, then stood back thoughtfully, weighing the available evidence in his mind, filtering it through his long years of experience and the countless other cases now behind him. At the end his reasoning confirmed what instinct had already told him; the prognosis was extremely poor. “You know,” he said, “I thought for a while he was going to make it.”
The young nurse in charge of the premature nursery—the same nurse whom John Alexander had seen a few days before—had been looking at Dornberger expectantly. She said, “His breathing was quite steady until an hour ago, then it became weak. That was when I called you.”
A student nurse around the other side of the incubator was following the conversation closely, her eyes above her gauze mask darting from Dornberger to the charge nurse and back again.
“No, he’s not breathing well,” Dornberger said slowly. He went on, thinking out loud, trying to be sure there was nothing he had missed, “There’s more jaundice than there should be, and the feet seem swollen. Tell me again—what was the blood count?”
The charge nurse consulted her clip board. “R.B.C. four point nine million. Seven nucleated red cells per hundred white.”
There was another pause, the two nurses watching while Dornberger digested the information. He was thinking: There’s altogether too much anemia, though of course it might be an exaggerated normal-type reaction. Aloud he said, “You know, if it weren’t for that sensitivity report I’d suspect this child had erythroblastosis.”
The charge nurse looked surprised. She said, “But surely, Doctor,” then checked herself.
“I know—it couldn’t happen.” He motioned to the clip board. “All the same, let me see that lab report—the original one on the mother’s blood.”
Turning over several sheets, the charge nurse found the form and extracted it. It was the report which Dr. Pearson had signed following the altercation with David Coleman. Dornberger studied it carefully, then handed it back. “Well, that’s definite enough—negative sensitivity.”
It should be definite, of course; but at the back of his mind was a nagging thought: Could the report be wrong? Impossible, he told himself; the pathology department would never make a mistake like that. All the same, he decided, he would drop in and talk with Joe Pearson after rounds.
To the charge nurse Dornberger said, “There’s nothing more we can do at the moment. Call me again, please, if there’s any change.”
“Yes, Doctor.”
When Dornberger had gone the student nurse asked, “What was it the doctor said—erythro . . . ?” She stumbled on the word.
“Erythroblastosis—it’s a blood disease in babies. It happens sometimes when the mother’s blood is Rh negative and the father’s Rh positive.” The young charge nurse with the red hair answered the question carefully but confidently, as she always did. The students liked being assigned to her; as well as having a reputation for being one of the most able nurses on staff, she was little more than twelve months away from her own student days, having graduated at the top of the senior class the year before. Knowing this, the student had no hesitation in extending her questioning.
He took his time about completing the examination, then stood back thoughtfully, weighing the available evidence in his mind, filtering it through his long years of experience and the countless other cases now behind him. At the end his reasoning confirmed what instinct had already told him; the prognosis was extremely poor. “You know,” he said, “I thought for a while he was going to make it.”
The young nurse in charge of the premature nursery—the same nurse whom John Alexander had seen a few days before—had been looking at Dornberger expectantly. She said, “His breathing was quite steady until an hour ago, then it became weak. That was when I called you.”
A student nurse around the other side of the incubator was following the conversation closely, her eyes above her gauze mask darting from Dornberger to the charge nurse and back again.
“No, he’s not breathing well,” Dornberger said slowly. He went on, thinking out loud, trying to be sure there was nothing he had missed, “There’s more jaundice than there should be, and the feet seem swollen. Tell me again—what was the blood count?”
The charge nurse consulted her clip board. “R.B.C. four point nine million. Seven nucleated red cells per hundred white.”
There was another pause, the two nurses watching while Dornberger digested the information. He was thinking: There’s altogether too much anemia, though of course it might be an exaggerated normal-type reaction. Aloud he said, “You know, if it weren’t for that sensitivity report I’d suspect this child had erythroblastosis.”
The charge nurse looked surprised. She said, “But surely, Doctor,” then checked herself.
“I know—it couldn’t happen.” He motioned to the clip board. “All the same, let me see that lab report—the original one on the mother’s blood.”
Turning over several sheets, the charge nurse found the form and extracted it. It was the report which Dr. Pearson had signed following the altercation with David Coleman. Dornberger studied it carefully, then handed it back. “Well, that’s definite enough—negative sensitivity.”
It should be definite, of course; but at the back of his mind was a nagging thought: Could the report be wrong? Impossible, he told himself; the pathology department would never make a mistake like that. All the same, he decided, he would drop in and talk with Joe Pearson after rounds.
To the charge nurse Dornberger said, “There’s nothing more we can do at the moment. Call me again, please, if there’s any change.”
“Yes, Doctor.”
When Dornberger had gone the student nurse asked, “What was it the doctor said—erythro . . . ?” She stumbled on the word.
“Erythroblastosis—it’s a blood disease in babies. It happens sometimes when the mother’s blood is Rh negative and the father’s Rh positive.” The young charge nurse with the red hair answered the question carefully but confidently, as she always did. The students liked being assigned to her; as well as having a reputation for being one of the most able nurses on staff, she was little more than twelve months away from her own student days, having graduated at the top of the senior class the year before. Knowing this, the student had no hesitation in extending her questioning.