“Lucy!” She smiled a greeting at two of the other surgeons, then turned back as O’Donnell called to her. He was maneuvering the other man with him.
   “Lucy, I’d like you to meet Dr. Roger Hilton. He’s just joined the staff. You may recall his name came up some time ago.”
   “Yes, I do remember.” She smiled at Hilton, her face crinkling.
   “This is Dr. Grainger.” O’Donnell was always punctilious about helping new staff members to become known. He added, “Lucy is one of our orthopedic surgeons.”
   She offered Hilton her hand and he took it. He had a firm grasp, a boyish smile. She guessed his age at twenty-seven. “If you’re not tired of hearing it,” she said, “welcome!”
   “Matter of fact, I’m rather enjoying it.” He looked as if he were.
   “Is this your first hospital appointment?”
   Hilton nodded. “Yes. I was a surgical resident at Michael Reese.”
   Lucy remembered more clearly now. This was a man whom Kent O’Donnell had been very keen to get to Burlington. And undoubtedly that meant Hilton had good qualifications.
   “Come over here a minute, Lucy.” Kent O’Donnell had moved back near her and was beckoning.
   Excusing herself to Hilton, she followed the chief of surgery to one of the board-room windows, away from the immediate press of people.
   “That’s a little better; at least we can make ourselves heard.” O’Donnell smiled. “How have you been, Lucy? I haven’t seen you, except in line of duty, for quite a while.”
   She appeared to consider. “Well, my pulse has been normal; temperature around ninety-eight point eight. Haven’t checked blood pressure recently.”
   “Why not let me do it?” O’Donnell said. “Over dinner, for example.”
   “Do you think it’s wise? You might drop the sphygmomanometer in the soup.”
   “Let’s settle for dinner then and forget the rest.”
   “I’d love to, Kent,” Lucy said. “But I’ll have to look at my book first.”
   “Do that and I’ll phone you. Let’s try to make it next week.” O’Donnell touched her lightly on the shoulder as he turned away. “I’d better get this show opened.”
   Watching him ease his way through other groups toward the center table, Lucy thought, not for the first time, how much she admired Kent O’Donnell, both as a colleague and a man. The invitation to dinner was not a new thing. They had had evenings together before, and for a while she had wondered if perhaps they might be drifting into some kind of tacit relationship. Both were unmarried, and Lucy, at thirty-five, was seven years younger than the chief of surgery. But there had been no hint in O’Donnell’s manner that he regarded her as anything more than a pleasant companion.
   Lucy herself had a feeling that, if she allowed it, her admiration for Kent O’Donnell could grow to something more deep and personal. But she had made no attempt to force the pace, feeling it better to let things develop if they happened to, and if not—well, nothing was lost. That at least was one advantage of maturity over the first flush of youth. You learned not to hurry, and you discovered that the rainbow’s end was a good deal further than the next city block.
   “Shall we get started, gentlemen?” O’Donnell had reached the head of the table and raised his voice across the heads of the others. He too had savored the brief moment with Lucy and found the thought pleasing that he would be meeting her again shortly. Actually he would have called her a good deal sooner, but there had been a reason for hesitation. The truth was that Kent O’Donnell found himself being drawn more and more toward Lucy Grainger, and he was not at all sure this was a good thing for either of them.
   By now he had become fairly set in his own mode of life. Living alone and being independent grew on you after a while, and he doubted sometimes if he could adjust to anything else. He suspected, too, that something of the same thing might apply to Lucy, and there might be problems as well about their parallel careers. Nonetheless, he still felt more comfortable in her presence than that of any other woman he had known in a long time. She had a warmth of spirit—he had once described it to himself as a strong kindness—that was at once soothing and restoring. And he knew there were others, particularly Lucy’s patients, on whom she had the same effect.
   It was not as if Lucy were unattractive; she had a mature beauty that was very real. As he watched her now—she had stopped to speak with one of the interns—he saw her raise a hand and push back her hair from the side of her face. She wore it short, in soft waves which framed her face, and it was almost golden. He noticed, though, a few graying strands. Well, that was something medicine seemed to do for everyone. But it reminded him that the years were moving on. Was he wrong in not pursuing this more actively? Had he waited long enough? Well, he would see how their dinner went next week.
   The hubbub had not died and, this time more loudly, he repeated his injunction that they start.
   Bill Rufus called out, “I don’t think Joe Pearson is here yet.” The gaudy necktie which O’Donnell had observed earlier made Rufus stand out from the others around him.
   “Isn’t Joe here?” O’Donnell seemed surprised as he scanned the room.
   “Has anyone seen Joe Pearson?” he asked. Some of the others shook their heads.
   Momentarily O’Donnell’s face revealed annoyance, then he covered up. He moved toward the door. “Can’t have a mortality conference without a pathologist. I’ll see what’s keeping him.” But as he reached the doorway Pearson walked in.
   “We were just going to look for you, Joe.” O’Donnell’s greeting was friendly, and Lucy wondered if she had been wrong about the flash of irritation a moment ago.
   “Had an autopsy. Took longer than I figured. Then I stopped for a sandwich.” Pearson’s words came out muffled, principally because he was chewing between sentences. Presumably the sandwich, Lucy thought; then she saw he had the rest of it folded in a napkin among the pile of papers and files he was carrying. She smiled; only Joe Pearson could get away with eating lunch at a mortality conference.
   O’Donnell was introducing Pearson to Hilton. As they shook hands Pearson dropped one of his files and a sheaf of papers spilled out on the floor. Grinning, Bill Rufus collected them and replaced the file under Pearson’s arm. Pearson nodded his thanks, then said abruptly to Hilton, “A surgeon?”
   “That’s right, sir,” Hilton answered pleasantly. A well-brought-up young man, Lucy thought; he shows deference to his elders.
   “So we have another recruit for the mechanics,” Pearson said. As he spoke, loudly and sharply, there was a sudden silence in the room. Ordinarily the remark would have passed as banter, but somehow from Pearson it seemed to have an edge, a touch of contempt.
   Hilton was laughing. “I guess you could call it that.” But Lucy could see he had been surprised by Pearson’s tone.
   “Take no notice of Joe,” O’Donnell was saying good-naturedly. “He has a ‘thing’ about surgeons. Well, shall we begin?”
   They moved to the long table, some of the senior staff members going automatically to the front rectangle of chairs, the others dropping into the row behind. Lucy herself was in front. O’Donnell was at the head of the table, Pearson and his papers on the left. While the others were settling down she saw Pearson take another bite from his sandwich. He made no effort to be surreptitious about it.
   Lower down the table she noticed Charlie Dornberger, one of Three Counties’ obstetricians. He was going through the careful process of filling his pipe. Whenever Lucy saw Dr. Dornberger he seemed to be either filling, cleaning, or lighting a pipe; he seldom seemed to smoke it. Next to Dornberger was Gil Bartlett and, opposite, Ding Dong Bell from Radiology and John McEwan. McEwan must be interested in a case today; the ear, nose, and throat specialist did not normally attend surgical-mortality meetings.
   “Good afternoon, gentlemen.” As O’Donnell looked down the table the remaining conversations died. He glanced at his notes. “First case. Samuel Lobitz, white male, age fifty-three. Dr. Bartlett.”
   Gil Bartlett, impeccably dressed as ever, opened a ring notebook. Instinctively Lucy watched the trim beard, waiting for it to move. Almost at once it began bobbing up and down. Bartlett began quietly, “The patient was referred to me on May 12.”
   “A little louder, Gil.” The request came from down the table.
   Bartlett raised his voice. “I’ll try. But maybe you’d better see McEwan afterward.” A laugh ran round the group in which the e.n.t. man joined.
   Lucy envied those who could be at ease in this meeting. She never was, particularly when a case of her own was being discussed. It was an ordeal for anyone to describe their diagnosis and treatment of a patient who had died, then have others give their opinion, and finally the pathologist report his findings from the autopsy. And Joe Pearson never spared anyone.
   There were honest mistakes that anybody in medicine could make—even, sometimes, mistakes which cost patients their lives. Few physicians could escape errors like this in the course of their careers. The important thing was to learn from them and not to make the same mistake again. That was why mortality conferences were held—so that everyone who attended could learn at the same time.
   Occasionally the mistakes were not excusable, and you could always sense when something like that came up at a monthly meeting. There was an uncomfortable silence and an avoidance of eyes. There was seldom open criticism; for one thing, it was unnecessary, and for another, you never knew when you yourself might be subject to it.
   Lucy recalled one incident which had concerned a distinguished surgeon at another hospital where she had been on staff. The surgeon was operating for suspected cancer in the intestinal tract. When he reached the affected area he had decided the cancer was inoperable and, instead of attempting to remove it, had looped the intestine to bypass it. Three days later the patient had died and was autopsied. The autopsy showed there had, in fact, been no cancer at all. What had really happened was that the patient’s appendix had ruptured and had formed an abscess. The surgeon had failed to recognize this and thereby condemned the man to death. Lucy remembered the horrified hush in which the pathologist’s report had been received.
   In an instance like this, of course, nothing ever came out publicly. It was a moment for the ranks of medicine to close. But in a good hospital it was not the end. At Three Counties nowadays O’Donnell would always talk privately with an offender and, if it were a bad case, the individual concerned would be watched closely for a while afterward. Lucy had never had to face one of these sessions herself, but she had heard the chief of surgery could be extremely rough behind closed doors.
   Gil Bartlett was continuing. “The case was referred to me by Dr. Cymbalist.” Lucy knew that Cymbalist was a general practitioner, though not on Three Counties’ staff. She herself had had cases referred from him.
   “I was called at my home,” Bartlett said, “and Dr. Cymbalist told me he suspected a perforated ulcer. The symptoms he described tallied with this diagnosis. By then the patient was on the way to the hospital by ambulance. I called the surgical resident on duty and notified him the case would be coming in.”
   Bartlett looked over his notes. “I saw the patient myself approximately half an hour later. He had severe upper abdominal pain and was in shock. Blood pressure was seventy over forty. He was ashen gray and in a cold sweat. I ordered a transfusion to combat shock and also morphine. Physically the abdomen was rigid, and there was rebound tenderness.”
   Bill Rufus asked, “Did you have a chest film made?”
   “No. It seemed to me the patient was too sick to go to X-ray. I agreed with the original diagnosis of a perforated ulcer and decided to operate immediately.”
   “No doubts at all, eh, Doctor?” This time the interjection was Pearson’s. Previously the pathologist had been looking down at his papers. Now he turned directly to face Bartlett.
   For a moment Bartlett hesitated and Lucy thought: Something is wrong; the diagnosis was in error and Joe Pearson is waiting to spring the trap. Then she remembered that whatever Pearson knew Bartlett knew also by this time, so it would be no surprise to him. In any case Bartlett had probably attended the autopsy. Most conscientious surgeons did when a patient died. But after the momentary pause the younger man went on urbanely.
   “One always has doubts in these emergency cases, Dr. Pearson. But I decided all the symptoms justified immediate exploratory surgery.” Bartlett paused. “However, there was no perforated ulcer present, and the patient was returned to the ward. I called Dr. Toynbee for consultation, but before he could arrive the patient died.”
   Gil Bartlett closed his ring binder and surveyed the table. So the diagnosis had been wrong, and despite Bartlett’s outwardly calm appearance Lucy knew that inside he was probably suffering the torments of self-criticism. On the basis of the symptoms, though, it could certainly be argued that he was justified in operating.
   Now O’Donnell was calling on Joe Pearson. He inquired politely, “Would you give us the autopsy findings, please?” Lucy reflected that the head of surgery undoubtedly knew what was coming. Automatically the heads of departments saw autopsy reports affecting their own staff.
   Pearson shuffled his papers, then selected one. His gaze shot around the table. “As Dr. Bartlett told you, there was no perforated ulcer. In fact, the abdomen was entirely normal.” He paused, as if for dramatic effect, then went on. “What was present, in the 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 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 Joe Pearson?—Joe Pearson who could never compete with the glamor of surgery, whose work was essential but undramatic, who had chosen a branch of medicine seldom in the public eye. Lucy herself had heard people ask: What does a pathologist do? No one ever said: What does a surgeon do? She knew there were some who thought of pathologists as a breed of hospital technician, failing to realize that a pathologist had to be first a physician with a medical degree, then spend years of extra training to become a highly qualified specialist.
   Money sometimes was a sore point too. On Three Counties’ staff Gil Bartlett ranked as an attending physician, receiving no payment from the hospital, only from his patients. Lucy herself, and all the other attending physicians, were on staff on the same basis. But, in contrast, Joe Pearson was an employee of the hospital, receiving a salary of twenty-five thousand dollars a year, roughly half of what a successful surgeon—many years his junior—could earn. Lucy had once read a cynical summation of the difference between surgeons and pathologists: “A surgeon gets $500 for taking out a tumor. A pathologist gets five dollars for examining it, making a diagnosis, recommending further treatment, and predicting the patient’s future.”
   Lucy herself had fared well in her relationship with Joe Pearson. For some reason she was not sure of, he had seemed to like her, and there were moments she found herself responding and liking him also. Sometimes this could prove a help when she needed to talk with him about a diagnosis.
   Now the discussion was ending, O’Donnell winding things up. Lucy brought her attention back into focus. She had let it wander during the last case; that was not good—she would have to watch herself. The others were rising from their seats. Joe Pearson had collected his papers and was shambling out. But on the way O’Donnell stopped him; she saw the chief of surgery steer the old man away from the others.
   “Let’s go in here a minute, Joe.” O’Donnell opened the door to a small office. It adjoined the board room and was sometimes used for committee meetings. Now it was empty. Pearson followed the chief of surgery in.
   O’Donnell was elaborately casual. “Joe, I think you should quit riding people at these meetings.”
   “Why?” Pearson was direct.
   All right, O’Donnell thought, if that’s the way you want it. Aloud he said, “Because it gets us nowhere.” He allowed his voice to take on an edge. Ordinarily in dealing with the old man he deferred a little to the gap of years between them. But this was a moment to exercise his own authority. Although, as chief of surgery, O’Donnell had no direct control of Pearson’s activities, he did have certain prerogatives when the work of Pathology cut across his own division.
   “I pointed out a wrong diagnosis—that’s all.” Pearson was aggressive himself now. “Do you suggest we keep quiet about such things?”
   “You know better than to ask that.” O’Donnell slammed out the answer, this time not bothering at all to keep the ice from his voice. He saw Pearson hesitate and suspected the old man knew he had gone too far.
   Grumblingly he conceded, “I didn’t mean that; not that way.”
   Despite himself Kent O’Donnell smiled. Apologizing did not come easily to Joe Pearson. It must have cost him quite a lot to say that. Now O’Donnell went on more reasonably, “I think there are better ways to do it, Joe. If you don’t mind, at these meetings I’d like you to give us the autopsy findings, then I’ll lead the discussion afterward. I think we can do it without getting tempers frayed.”
   “I don’t see why anybody has to get in a temper.” Pearson was still grumbling, but O’Donnell sensed he was backing down.
   “All the same, Joe, I’d like to do it my way.” I don’t want to ram it down his throat, O’Donnell thought, but this is the time to make things clear.
   Pearson shrugged. “If that’s the way you want it.”
   “Thanks, Joe.” O’Donnell knew he had won; it had been easier than he had expected. Maybe this would be a good time to raise the other thing. “Joe,” he said, “while we’re here, there’s something else.”
   “I’ve got a lot to do. Couldn’t it wait?” As Pearson spoke, O’Donnell could almost read his mind. The pathologist was making it clear that though he had conceded one point he had not abandoned his independence.
   “I don’t think it can. It’s about surgical reports.”
   “What about them?” The reaction was aggressively defensive.
   O’Donnell went on smoothly. “I’ve had complaints. Some of the reports have been a long time coming through Pathology.”
   “Rufus, I suppose.” Pearson was openly bitter now. You could almost hear him saying: Another surgeon causing trouble.
   O’Donnell determined not to be provoked. He said quietly, “Bill Rufus was one. But there have been others. You know that, Joe.”
   For a moment Pearson made no answer, and O’Donnell reflected that in a way he felt sorry for the old man. The years were slipping by. Pearson was sixty-six now; at best he had another five or six years of active work ahead of him. Some people reconciled themselves to change like that, to younger men moving into prominence and taking over leadership. Pearson had not, though, and he made his resentment plain. O’Donnell wondered what was back of his attitude. Did he feel himself slipping, unable to keep up with new developments in medicine? If so, he would not be the first. And yet Joe Pearson, for all his disagreeable ways, had a lot to commend him. That was one of the reasons why O’Donnell trod circumspectly now.
   “Yes, I know.” Pearson’s reply held a tone of resignation. He had accepted the fact though. That was typical of him, O’Donnell thought. Right from the beginning at Three Counties he had liked Pearson’s directness and at times had made use of it in raising surgical standards.
   O’Donnell remembered that one of the problems he had faced in his early months at the hospital had been the elimination of needless surgery. Under this heading had come an unnatural number of hysterectomies, and in too many cases healthy, normal uteri were being removed by a few staff surgeons. These were men who found surgery a convenient and profitable remedy for any female pain, even those which might have responded to internal medication. In such instances euphemisms in diagnosis like “chronic myometritis” or “fibrosis of uterus” were resorted to as a smoke screen to cover up the pathology report on the removed tissue. O’Donnell remembered telling Pearson: “When we’re reporting on tissue we’ll call a spade a spade and a healthy uterus a healthy uterus.” Pearson had grinned and co-operated fully. As a result most of the unnecessary surgery had stopped. Surgeons found it embarrassing to have tissue they had removed from patients listed for all their colleagues to see as normal and uninfected.
   “Look, Kent.” Pearson was more conciliatory now. “Just lately I’ve been up to my ears. You’ve no idea how much work there is.”
   “I do have an idea, Joe.” This was the opening O’Donnell had hoped for. “Some of us think you’ve too much to do. It isn’t fair to you.” He was tempted to add “at your age” but thought better of it. Instead he added, “How about getting some help?”
   The reaction was immediate, Pearson almost shouting. “You’re telling me to get more help! Why, man alive, I’ve been asking for months for more lab technicians! We need three at least, so what am I told I can have? One! And stenographers! I’ve got reports that have been piling up for weeks, and who’s going to type them?” Not waiting for an answer, he went storming on. “Me? If the administration would get off its fanny we might get a few things done—including faster surgicals. By God! When you tell me I should get more help, that’s really something to hear.”
   O’Donnell had listened quietly. Now he said, “Finished, Joe?”
   “Yeah.” Pearson seemed chastened, half ashamed at his outburst.
   “It wasn’t technicians or office staff I was thinking about,” O’Donnell told him. “When I meant help I meant another pathologist. Someone to help you run the department. Maybe modernize it here and there.”
   “Now look here!” at the word “modernize” Pearson had bridled, but O’Donnell brushed the objection aside. “I listened to you, Joe. Now you hear me out. Please.” He paused. “I was thinking of maybe some bright young fellow who could relieve you of some duties.”
   “I don’t need another pathologist.” It was a flat statement, vehement and uncompromising. “Why, Joe?”
   “Because there’s not enough work for two qualified men. I can handle all the pathology myself—without any help. Besides, I’ve already got a resident in the department.”
   O’Donnell was quietly persistent. “A resident is with us for training, Joe, and usually for just a short time. Sure, a resident can carry some of the work. But you can’t give him responsibility and we can’t use him for administration. That’s where you need some help right now.”
   “Let me be the judge of that. Give me a few days and we’ll be caught up in surgicals.”
   It was obvious that Joe Pearson had no intention of giving way. O’Donnell had expected resistance to bringing in a new pathologist, but he wondered about the other man’s forcefulness. Was it because he was unwilling to divide his personal empire, or was he simply protecting his job—fearful that a new and younger man might undermine him? Actually the idea of removing Pearson had not occurred to O’Donnell. In the field of pathological anatomy alone Joe Pearson’s long experience would be hard to replace. O’Donnell’s objective was to strengthen the department and thereby the hospital organization. Perhaps he should make this clear.
   “Joe, there’s no question of any major change. No one has suggested it. You’d still be in charge . . .”
   “In that case let me run Pathology my own way.”
   O’Donnell found his patience ebbing. He decided that perhaps he had pressed the point enough for now. He would let it go for a day or two, then try again. He wanted to avoid a showdown if he could. He said quietly, “I’d think it over if I were you.”
   “There’s nothing to think over.” Pearson was at the door. He nodded curtly and went out.
   So there it is, O’Donnell thought. We’ve laid the lines of battle. He stood there, considering thoughtfully what the next move should be.


   The cafeteria of Three Counties Hospital was a traditional meeting place for most of the hospital grapevine, its stems and branches extending tenuously to every section and department within Three Counties’ walls. Few events occurred in the hospital—promotions, scandals, firings, and hirings—which were not known and discussed in the cafeteria long before official word was ever published.
   Medical staff frequently used the cafeteria for “curbstone consultations” with colleagues whom they seldom saw except at a meal or coffee break. Indeed, a good deal of serious medical business was transacted over its tables, and weighty specialist opinions, which at other times would be followed by a substantial bill, were often tossed out freely, sometimes to the great advantage of a patient who, recovering later from some ailment which at first had proven troublesome, would never suspect the somewhat casual channels through which his eventual course of treatment had come.
   There were exceptions. A few staff physicians now and then resented this informal use of their arduously acquired talйnts and resisted attempts by colleagues to draw them out in the discussion of specific cases. In such instances the usual rejoinder was, “I think we’d better set up a consultation in my office. I’ll have the meter running then.”
   Gil Bartlett was one who disapproved of such approaches and at times could be a good deal blunter in refusing off-the-cuff opinions. One story told about his personal tactics of resistance had its origin not in the cafeteria but at a cocktail party in a private home. His hostess, a grand dame of Burlington society, had buttonholed Bartlett and bombarded him with questions about her illnesses, real and imagined. Bartlett had listened for a while, then announced in a loud voice which brought a hush to the crowded room, “Madam, I believe from what you say you have a menstrual problem. If you’ll strip right now I’ll examine you here.”
   Mostly though, much as they might resist informal consultations outside the hospital, the medical staff accepted the cafeteria exchanges on the basis that they had as much to gain as lose; and a good many physicians around the hospital used the mildewed quip on leaving their contact points, “If you want me I’ll be in my second office.” Normally no further explanation was required or given.
   Generally the cafeteria was a democratic area where hospital rank, if not forgotten, was at least temporarily ignored. An exception, possibly, was the practice of setting aside a group of tables for the medical staff. Mrs. Straughan, the chief dietitian, hovered over this area periodically, knowing that even minor shortcomings in hygiene or service could bring testy complaints at some future meeting of the hospital’s medical board.
   With few exceptions the senior attending physicians used the reserved tables. House staff, however, were less consistent, residents and interns sometimes asserting their independence by joining the nurses or other groups. There was nothing unusual, therefore, in Mike Seddons dropping into a chair opposite Vivian Loburton who, released from an assignment earlier than some of her fellow student nurses, was eating lunch alone.
   Since they had met ten days ago in the autopsy room, Vivian had encountered Mike Seddons several times in the hospital and on each occasion—seeing his thatch of red hair and wall-to-wall grin—she had increasingly come to like the look of him. Intuitively she had expected that soon he might make a direct approach to her, and now here it was.
   “Hi!” Seddons said.
   “Hullo.” The greeting came out awkwardly, Vivian having just bitten, with healthy appetite, into a chicken leg. She pointed to her mouth and mumbled, “Excuse me.”
   “That’s perfectly all right,” Seddons said. “Take your time. I’m here to proposition you.”
   She finished the mouthful of chicken, then said, “I thought that was supposed to come later.”
   Mike Seddons grinned. “Haven’t you heard?—this is the jet age. No time for formal frills. Here’s my proposition: theater the day after tomorrow, preceded by dinner at the Cuban Grill.”
   Vivian asked curiously, “Can you afford it?” Among house staff and student nurses poverty was a time-honored, rueful joke.
   Seddons lowered his voice to a stage whisper. “Don’t tell a soul, but I’m on to a side line. Those patients we get in autopsy. A lot of ’em have gold fillings in their teeth. It’s a very simple matter . . .”
   “Oh, shut up; you’ll ruin my lunch.” She bit the chicken leg again, and Seddons reached over for two of her trench fries.
   He savored them. “Um, not bad. I must eat more often. Now here’s the story.” He produced two tickets from his pocket and a printed voucher. “Take a look at this—compliments of a grateful patient.” The tickets were for the road show of a Broadway musical. The voucher covered dinner for two at the Cuban Grill.
   “What did you do?” Vivian was frankly curious. “Heart surgery?”
   “No. Last week I filled in for half an hour for Frank Worth in emergency. A guy had a bad gash on his hand and I stitched it. Next thing I knew, these were in the mail.” He chuckled. “Worth is furious, of course. Says he’ll never leave his post again. Well, will you come?”
   “I’d love to,” Vivian said, and meant it.
   “Great! I’ll pick you up at the nurses’ residence at seven o’clock. Okay?” As he spoke Mike Seddons found himself regarding this girl with even greater interest. He was suddenly aware that she had a good deal more than a pretty face and a good figure. When she looked at him and smiled it conveyed the feeling of something warm and fragrant. He thought: I wish we were meeting today instead of the day after tomorrow; it’s a long time to wait. Then a faint warning voice inside him cautioned: Beware entanglements! Remember the Seddons policy: love ’em and leave ’em—happy with their memories; parting is such sweet sorrow but, oh, so very practical for staying unattached.
   “Okay,” Vivian said. “I might be a little late but not much.”
   A week and a half had passed since Harry Tomaselli had told O’Donnell that construction of the hospital’s extension was planned to begin in the spring. Now, in the administrator’s office, he, Kent O’Donnell, and Orden Brown, the board chairman, were meeting to discuss immediate things to be done.
   Months before, with an architect at their elbows, the three had worked over the detailed plans for each section which would have its home in the new wing. The wishes of heads of medical departments had had to be balanced against the money likely to be available. Orden Brown had been the arbiter with O’Donnell as medical liaison. As always, the chairman had been crisp and incisive, but with a humor that seasoned his basic toughness. Sometimes they had gone along entirely with what was asked; at other times, when they suspected empire building for its own sake, the inquiries had been more searching.
   One section head, the chief pharmacist, had pressed hard to have a private toilet included in his own office design. When the architect had pointed out that more general facilities were available a mere forty feet down the corridor, the pharmacist had gone so far as to observe that forty feet was a long way when he was suffering one of his periodic attacks of diarrhea. Orden Brown had dryly referred him to the department of internal medicine.
   A few worth-while projects had had to be vetoed solely on the grounds of cost. Ding Dong Bell, the senior radiologist, had made out a convincing case for creation of a cine-radiography unit—its purpose to improve diagnosis and treatment of heart disease. But on learning that the equipment alone would cost fifty thousand dollars the plan had regretfully been ruled out.
   But now, with the main planning completed, the focus of attention was on the practical matter of getting the money. Strictly speaking, this was the responsibility of the board of directors; but the medical staff was expected to help.
   Orden Brown said, “We’re suggesting some quotas for the doctors—six thousand dollars for senior attending physicians, four thousand for associates, two thousand for assistants.”
   O’Donnell whistled softly. He told the chairman, “I’m afraid there’ll be some complaining.”
   Brown smiled. “We must do our best to endure it.”
   Harry Tomaselli put in, “The money can be spread over four years, Kent. As long as we have written pledges we can use them to borrow from the bank.”
   “There’s another thing,” Brown said. “When word gets around town that this is what the doctors themselves are giving, it will help our general fund raising a good deal.”
   “And you’ll see that word does get around?”
   Brown smiled. “Naturally.”
   O’Donnell reflected that it would be his job to break the news at a medical staff meeting. He could visualize the pained expressions he would face. Most medical men he knew, like the majority of people nowadays, lived right up to their incomes. Of course, there would be no compulsion about the quotas, but it would be hard for an individual to take a stand against them, especially since the medical staff had a lot to gain from the hospital’s growth. A good many certainly would give the full amount asked and, human nature being what it was, they would bring pressure on others to suffer equally. A hospital was a breeding ground for politics, and there were many ways in which a nonconformist could have life made difficult for him.
   Harry Tomaselli, intuitive as usual, said, “Don’t worry, Kent. I’ll brief you thoroughly before the staff meeting. We’ll have all the selling points lined up. In fact, when you’re through some people may even want to exceed quota.”
   “Don’t count on it.” O’Donnell smiled. “You’re about to touch a number of doctors on their tenderest nerve—the pocketbook.”
   Tomaselli grinned back. He knew that when the chief of surgery made his appeal to the staff it would be as incisive and thorough as everything else O’Donnell did. He reflected, not for the first time, how good it was to work with someone of O’Donnell’s character. In Tomaselli’s last hospital, where he had been assistant administrator, the president of the medical board had been a man who courted popularity and trimmed his sails to every wind of opinion. As a result there had been no real leadership and hospital standards had suffered accordingly.
   Harry Tomaselli admired forthrightness and swift decisions, mostly because those were methods he used himself as administrator of Three Counties. With swift decisions you sometimes made mistakes, but on the whole you got a lot more done, and your average of hits unproved as time went on. Quickness—of speech and thought, as well as action—was something Harry Tomaselli had learned in courtrooms long before he ever thought of finding his destiny behind a hospital desk.
   He had entered law school from college and bad begun to lay the foundations of a good practice when war intervened. Anticipating the draft, he had enlisted in the U.S. Navy where he had received a commission and a job in medical administration. Later, as the navy hospitals filled with wounded, Lieutenant Tomaselli had proven himself an able administrator with an instinct for sensing the invisible border line between the practice of medicine and the business of hospital management.
   After the war, faced with the choice of returning to law or remaining in hospital work, he had chosen the latter and enrolled in the School of Hospital Administration at Columbia University. He had graduated from Columbia at a time when there was growing recognition of hospital administration as a specialized field of endeavor in which a medical degree was neither necessary nor particularly useful. This had opened up a brisk demand for good administrators, and after two years as an assistant he had accepted Orden Brown’s offer of the top post at Three Counties.