The Final Diagnosis

"I'm not even sure that defeating polio was a good or necessary thing."

The speaker was Eustace Swayne - founder of a department-store empire, millionaire philanthropist, and member of the board of directors of Three Counties Hospital. The background was the shadowed, oak-paneled library of Swayne's aging but imposing mansion, set alone in fifty acres of parkland and near the eastern fringes of Burlington.

"Come now, you can't be serious," Orden Brown said lightly. The hospital-board chairman smiled at the two women in the room - his own wife, Amelia, and Swayne's daughter, Denise Quantz.

Kent O'Donnell sipped the cognac which a soft-footed manservant had brought him and leaned back in the deep leather chair he had chosen on entering this room with the others after dinner. It occurred to him that the scene they made was almost medieval. He glanced around the softly lighted room, his eyes ranging over tiers of leather-bound books rising to the high-timbered ceiling, the dark and heavy oaken furniture, the cavernous fireplace laid with great logs - not burning now, this warm July evening, but ready to blaze to life at the touch of a servant's torch; and, across from O'Donnell, Eustace Swayne, seated kinglike in a straight-backed, stuffed wing chair, the other four - almost as courtiers - formed in a semicircle, facing the old tycoon.

"I am serious." Swayne put down his brandy glass and leaned forward to make his point. "Oh, I admit - show me a child in leg braces and I'll cringe with the rest and reach for my checkbook. But I'm talking of the grand design. The fact is - and I challenge anyone to deny it - we're busily engaged in weakening the human race."

It was a familiar argument. O'Donnell said courteously, "Would you suggest that we should stop medical research, freeze our knowledge and techniques, not try to conquer any more diseases?"

"You couldn't do it," Swayne said. "You couldn't do it any more than you could have stopped the Gadarene swine jumping off their cliff."

O'Donnell laughed. "I'm not sure I like the analogy. But if that is so, then why the argument?"

"Why?" Swayne banged a fist on the arm of his chair. "Because you can still deplore something, even though there's nothing you can do to force a change."

"I see." O'Donnell was not sure he wanted to get deeper into this discussion. Besides, it might not help relations with Swayne, either for himself or Orden Brown, which was really why they had come here. He glanced around at the others in the room. Amelia Brown, whom he had come to know well through his visits to the chairman's home, caught his eye and smiled. As a wife who kept herself posted on all her husband's activities, she was well informed about hospital politics.

Swayne's married daughter, Denise Quantz, was sitting forward, listening intently.

At dinner O'Donnell had several times found his eyes traveling, almost involuntarily, in Mrs. Quantz's direction. He had found it difficult to reconcile her as the daughter of the rugged, hard-bitten man who sat at the table's head. At seventy-eight Eustace Swayne still exhibited much of the toughness he had learned in the competitive maelstrom of large-scale retail merchandising. At times he took advantage of his age to toss out barbed remarks to his guests, though O'Donnell suspected that most times their host was merely angling for an argument. O'Donnell had found himself thinking: The old boy still likes a fight, even if it's only in words. In the same way he had an instinct now that Swayne was overstating his feelings about medicine, though perhaps in this case merely for the sake of being ornery. Watching the old man covertly, O'Donnell had suspected gout and rheumatism might be factors here.

But, in contrast, Denise Quantz was gentle and softly spoken. She had a trick of taking the edge from a remark of her father's by adding a word or two to what he had said. She was beautiful too, O'Donnell thought, with the rare mature loveliness which sometimes comes to a woman at forty. He gathered that she was visiting Eustace Swayne and came to Burlington fairly frequently. Probably this was to keep an eye on her father; he knew that Swayne's own wife had died many years before. It was evident from conversation, though, that most of the time Denise Quantz lived in New York. There were a couple of references made to children, but a husband was not mentioned. He gained the impression that she was either separated or divorced. Mentally O'Donnell found himself comparing Denise Quantz with Lucy Grainger. There was a world of difference, he thought, between the two women: Lucy with her professional career, at ease in the environment of medicine and the hospital, able to meet someone like himself on ground familiar to them both; and Denise Quantz, a woman of leisure and independence, a figure in society no doubt, and yet - he had the feeling - someone who would make a home a place of warmth and serenity. O'Donnell wondered which kind of woman was better for a man: one who was close to his working life, or someone separate and detached, with other interests beyond the daily round.

His thoughts were interrupted by Denise. Leaning toward him, she said, "Surely you're not going to give up so easily, Dr. O'Donnell. Please don't let my father get away with that."

The old man snorted. "There's nothing to get away with. It's a perfectly clear situation. For years the natural balance of nature kept populations in check. When the birth rate became too great there were famines to offset it."

Orden Brown put in, "But surely some of that was political. It wasn't always a force of nature."

"I'll grant you that in some cases." Eustace Swayne waved his hand airily. "But there was nothing political in the elimination of the weak."

"Do you mean the weak or the unfortunate?" Very well, O'Donnell thought, if you want an argument I'll give you one.

"I mean what I say - the weak." The old man's voice had a sharper tone, but O'Donnell sensed he was enjoying this. "When there was a plague or an epidemic, it was the weak who were wiped out and the strong survived. Other illnesses did the same thing; there was a level maintained - nature's level. And because of this it was the strong who perpetuated themselves. They were the ones who sired the next generation."

"Do you really think, Eustace, that mankind is so degenerate now?" Amelia Brown had asked the question, and O'Donnell saw she was smiling. She knows that Swayne's enjoying this, he thought.

"We're moving toward degeneracy," the old man answered her, "at least in the Western world. We're preserving the cripples, the weaklings, and the disease-ridden. We're accumulating burdens on society, non-producers - the unfit, unable to contribute anything to the common good. Tell me - what purpose does a sanatorium or a home for incurables serve? I tell you, medicine today is preserving people who should be allowed to die. But we're helping them to live, then letting them spawn and multiply, passing along their uselessness to their children and their children's children."

O'Donnell reminded him, "The relationship between disease and heredity is far from clear."

"Strength is of the mind as well as the body," Eustace Swayne snapped back. "Don't children inherit the mental characteristics of their parents - and their weaknesses?"

"Not all of the time." This was between the old tycoon and O'Donnell now. The others sat back, listening.

"But a lot of the time they do. Well, don't they?"

O'Donnell smiled. "There's some evidence that way, yes."

Swayne snorted. "It's one of the reasons we've so many mental hospitals. And patients in them. And people running to psychiatrists."

"It could also be that we're more aware of mental health."

Swayne mimicked him. "It could also be that we're breeding people who are weak, weak, weak!"

The old man had almost shouted the last words. Now a bout of coughing seized him. I'd better go easily, O'Donnell thought. He probably has high blood pressure.

Just as if O'Donnell had spoken, Eustace Swayne glared across at him. The old man took a sip of brandy. Then, almost malevolently, he said, "Don't try to spare me, my young medical friend. I can handle all your arguments and more."

O'Donnell decided he would go on but more moderately. He said, quietly and reasonably, "I think there's one thing you're overlooking, Mr. Swayne. You say that illness and disease are nature's levelers. But many of these things haven't come to us in the natural course of nature. They're the result of man's own environment, conditions he's created himself. Bad sanitation, lack of hygiene, slums, air pollution - those aren't natural things; they're man's creation."

"They're part of evolution and evolution is a part of nature. It all adds up to the balancing process."

Admiringly O'Donnell thought: You can't shake the old son of a gun easily. But he saw the chink in the other's argument. He said, "If you're right, then medicine is a part of the balancing process too."

Swayne snapped back, "How do you reason that?"

"Because medicine is a part of evolution." Despite his good resolution O'Donnell felt his voice grow more intense. "Because every change of environment that man has had produced its problems for medicine to face and to try to solve. We never solve them entirely. Medicine is always a little behind, and as fast as we meet one problem there's a new one appearing ahead."

"But they're problems of medicine, not nature." Swayne's eyes had a malicious gleam. "If nature were left alone it would settle its problems before they arose - by natural selection of the fittest."

"You're wrong and I'll tell you why." O'Donnell had ceased to care about the effect of his words. He felt only that this was something he had to express, to himself as well as to the others. "Medicine has only one real problem. It's always been the same; it always will. It's the problem of individual human survival." He paused. "And survival is the oldest law of nature."

"Bravo!" Impulsively Amelia Brown clapped her palms together. But O'Donnell had not quite finished.

"That's why we fought polio, Mr. Swayne, and the black plague, and smallpox, and typhus, and syphilis. It's why we're still fighting cancer and tuberculosis and all the rest. It's the reason we have those places you talked about - the sanatoria, the homes for incurables. It's why we preserve people - all the people we can, the weak as well as the strong. Because it adds up to one thing - survival. It's the standard of medicine, the only one we can possibly have."

For a moment he expected Swayne to lash back as he had before. But the old man was silent. Then he looked over at his daughter. "Pour Dr. O'Donnell some more brandy, Denise."

O'Donnell held out his glass as she approached with the decanter. There was a soft rustle to her dress, and as she leaned toward him he caught a faint, tantalizing waft of perfume. For a moment he had an absurd, boyish impulse to reach out and touch her soft dark hair. As he checked it she moved over to her father.

Replenishing the old man's glass, she asked, "If you really feel the way you say, Father, what are you doing on a hospital board?"

Eustace Swayne chuckled. "Mostly I'm there because Orden and some others are hoping I won't change my will." He looked over at Orden Brown. "They reckon there can't be long to wait in any case."

"You're doing your friends an injustice, Eustace," Brown said. His tone contained the right mixture of banter and seriousness.

"And you're a liar." The old man was enjoying himself again. He said, "You asked a question, Denise. Well, I'll answer it. I'm on the hospital board because I'm a practical man. The world's the way it is and I can't change it, even though I see what's wrong. But what someone like me can be is a balancing force. Oh, I know what some of you think - that I'm just an obstructionist."

Orden Brown interjected quickly, "Has anyone ever said that?"

"You don't have to." Swayne shot a half-amused, malicious glance at the board chairman. "But every activity needs a brake on it somewhere. That's what I've been - a brake, a steadying force. And when I'm gone perhaps you and your friends will find you need another."

"You're talking nonsense, Eustace. And you're doing your own motives an injustice." Orden Brown had evidently decided to be equally direct. He went on, "You've done as many good things in Burlington as any man I know."

The old man seemed to shrink back into his chair. He grumbled, "How do any of us really know our own motives?" Then, looking up, "I suppose you'll expect a big donation from me for this new extension."

Orden Brown said smoothly, "Frankly, we hope you'll see fit to make your usual generous contribution."

Softly, unexpectedly, Eustace Swayne said, "I suppose a quarter of a million dollars would be acceptable."

O'Donnell heard Orden Brown's quickly indrawn breath. Such a gift would be munificent - far more than they had expected, even in their most sanguine moments.

Brown said, "I can't pretend, Eustace. Frankly, I'm overwhelmed."

"No need to be." The old man paused, twirling the stem of his brandy glass. "I haven't decided yet, though I've been considering it. I'll tell you in a week or two." Abruptly he turned to O'Donnell. "Do you play chess?"

O'Donnell shook his head. "Not since I was in college."

"Dr. Pearson and I play a lot of chess." He was looking at O'Donnell directly. "You know Joe Pearson, of course."

"Yes. Very well."

"I've known Dr. Pearson for many years," Swayne said, "in Three Counties Hospital and out of it." The words were slow and deliberate. Did they have an undertone of warning? It was hard to be sure.

Swayne went on, "In my opinion Dr. Pearson is one of the best-qualified men on the hospital staff. I hope that he stays in charge of his department for many years to come. I respect his ability and his judgment - completely."

Well, there it is, O'Donnell thought - out in the open and in plain words: an ultimatum to the chairman of the hospital board and the president of the medical board. In as many words Eustace Swayne had said: If you want my quarter million dollars, hands off Joe Pearson!

Later Orden Brown, Amelia, and O'Donnell - seated together in the front seat of the Browns' Lincoln convertible - had driven back across town. They had been silent at first, then Amelia said, "Do you really think - a quarter of a million?"

Her husband answered, "He's quite capable of giving it - if he feels inclined."

O'Donnell asked, "I take it you received the message?"

"Yes." Brown said it calmly, without embellishment and without seeking to pursue the subject. O'Donnell thought: Thank you for that. He knew this had to be his problem, not the chairman's.

They dropped him at the entrance to his apartment hotel. As they said good night Amelia added, "Oh, by the way, Kent, Denise is separated but not divorced. I think there's a problem there, though we've never discussed it. She has two children in high school. And she's thirty-nine."

Orden Brown asked her, "Why are you telling him all that?"

Amelia smiled. "Because he wanted to know." She touched her husband's arm. "You could never be a woman, dear. Not even with surgery."

Watching the Lincoln move away, O'Donnell wondered how she had known. Perhaps she had overheard him and Denise Quantz saying good night. He had said politely that he hoped he would see her again. She had answered, "I live in New York with my children. Why don't you call me next time you're there?" Now O'Donnell wondered if, after all, he might take in that surgeons' congress in New York next month which a week ago he had decided not to attend.

Abruptly his mind switched to Lucy Grainger and, irrationally, he had a momentary sense of disloyalty. He had gone from the sidewalk to the building entrance when his thoughts were broken by a voice saying, "Good night, Dr. O'Donnell."

He looked around and recognized one of the surgical residents, Seddons. There was a pretty brunette with him, and her face seemed familiar. Probably one of the student nurses, he thought; she appeared about the age. He smiled at them both and said "Good night." Then, using his passkey, he went through the glass doors into the elevator.

Vivian said, "He looked worried."

Seddons answered cheerfully, "I doubt it, bright eyes. When you get to where he is, most of the worrying is behind you."

The theater was over and now they were walking back to Three Counties. It had been a good road show - a broad, noisy musical - at which they had both laughed a good deal and held hands, and a couple of times Mike had draped his arm around the back of Vivian's seat, allowing it to fall lightly, his fingers exploring her shoulders, and she had made no move to object.

Over dinner before the show they had talked of themselves. Vivian had questioned Mike about his intentions to practice surgery, and he had asked her why she had become a student nurse.

"I'm not sure I can explain, Mike," she had said, "except that nursing was something I always wanted to do as far back as I can remember." She had told him that her parents at first had opposed the idea, then, on learning how strongly she felt, had given way. "I guess it's really that I wanted to do something for myself, and nursing was what appealed to me most."

Seddons had asked her, "Do you still feel that way?"

"Yes, I do," she had said. "Oh, now and then - when you're tired sometimes, and you've seen some of the things in the hospital, and you're thinking about home - you wonder if it's worth it, if there aren't easier things to do; but I guess that happens to everybody. Most of the time, though, I'm quite sure." She had smiled, then said, "I'm a very determined person, Mike, and I've made up my mind to be a nurse."

Yes, he had thought, you are determined; I can believe that. Glancing at Vivian covertly while she talked, he could sense an inner strength - a toughness of character behind what seemed at first a facade of gentle femininity. Once more, as he had a day or two ago, Mike Seddons had felt his interest quicken, but again he warned himself: No involvements! Remember, anything you feel is basically biological!

It was close to midnight now, but Vivian had signed the late book and there was no problem about hurrying in. Some of the older nurses, who had done their training under spartan regimes, felt the students were allowed too much freedom nowadays. But in practice it was seldom abused.

Mike touched her arm. "Let's go through the park."

Vivian laughed. "That's an old line I've heard before." But she offered no resistance as he steered her to a gateway and into the park beyond. In the darkness she could make out a line of poplars on either side, and the grass was soft underfoot.

"I've a whole collection of old lines. It's one of my specialties." He reached down and took her hand. "Do you want to hear more?"

"Like what, for example?" Despite her self-assurance her voice held the slightest of tremors.

"Like this." Mike stopped and took both her shoulders, turning her to face him. Then he kissed her fully on the lips.

Vivian felt her heart beat faster, but not so much that her mind could not weigh the situation. Should she stop at once or let this go on? She was well aware that if she took no action now, later it might not be so easy.

Vivian already knew that she liked Mike Seddons and believed she could come to like him a good deal more. He was physically attractive and they were both young. She felt the stirrings of desire within her. They were kissing again and she returned the pressure of his lips. The tip of his tongue came lightly into her mouth; she met it with her own and the contact set up a delicious tingling. Mike tightened his arms around her, and through the thin summer dress she felt his thighs pressing tighter. His hands were moving, caressing her back. The right dropped lower; it passed lightly over the back of her skirt, then more heavily, each caress pulling her closer to him. Against her own body she felt a bulkiness. It stirred, intoxicatingly, heavenly. She knew clearly, as if with a second mind, that if she were going to, this was the moment to break away. Just a moment longer, she thought; just a moment longer!

Then suddenly it seemed as if this were an intermission, a release from other things around. Closing her eyes she savored the seconds of warmth and tenderness; these past months there had been so few. So many times since coming to Three Counties she had had to use control and self-discipline, her emotions pent up and tears unshed. When you were young, inexperienced, and a little frightened, sometimes it was hard to do. There had been so many things - the shocks of ward duty, pain, disease, death, the autopsy - and yet no safety valve to release the pressures building up inside. A nurse, even a student nurse, had to see so much of suffering and give so much in care and sympathy. Was it wrong, then, to grasp a moment of tenderness for herself? For an instant, with Mike holding her, she felt the same solace and relief as when, years before, she had run as a little girl into her mother's arms. Mike had released her a little now and was holding her slightly away. He said, "You're beautiful." Impulsively she buried her face in his shoulder. Then he put a hand under her chin and their lips were together again. She felt the same hand drop and, from outside her dress, move lightly over her breasts. From every part of her body the desire to love and be loved welled up, madly, uncontrollably.

His hand was at the neckline of her dress. It was made to open at the front, and a hook and eye secured the top. He was fumbling for it. She struggled. Breathlessly, "No, Mike! Please! No!" She failed even to convince herself. Her arms were around him tightly. He had the dress open a little way now and she felt his hand move, then gasped at the contact as it cupped her own young, soft flesh. He took the nipple gently between his fingers, and a shudder of ecstasy moved through her in a sensual wave. Now she knew that it was too late to stop. She wanted, craved him desperately. Her lips to his ear, she murmured, "Yes, oh yes."

"Darling, darling Vivian." He was equally excited; she could tell from his whispered, breathless voice.

Womanlike, a moment's common sense came through. "Not here, Mike. There are people."

"Let's go through the trees." He took her hand and they moved closely together. She felt a trembling excitement, a wondering curiosity to know what it would be like. She dismissed any consequence; it seemed unimportant. And Mike was a doctor; he would know how to be careful.

They had reached a small clearing surrounded by trees and shrubs. Mike kissed her again, and passionately she returned his kisses, her tongue darting and fighting his. So this is where it's to be, she thought. The real thing. Vivian was not a virgin; she had ceased to be while in high school, and there had been another incident in her first year of college, but neither experience had been satisfactory. She knew this would be. "Hurry, Mike, please hurry." She felt her own excitement transmit itself to him.

"Over here, darling," he said, and they moved toward the far side of the clearing.

Suddenly she felt a searing pain. It was so intense at first she could not be sure where it was. Then she knew it was her left knee. Involuntarily she cried out.

"What is it? Vivian, what is it?" Mike turned to her. She could see he was puzzled, not knowing what to make of it. She thought: He probably thinks it's a trick. Girls do this sort of thing to get out of these situations.

The first sharpness of pain had subsided a little. But it still returned in waves. She said, "Mike, I'm afraid it's my knee. Is there a seat somewhere?" She flinched again.

"Vivian," he said, "you don't have to put on an act. If you want to go back to the hospital, just say so and I'll take you."

"Please believe me, Mike." She took his arm. "It is my knee. It hurts me terribly. I have to sit down."

"This way." She could tell he was still skeptical, but he guided her back through the trees. There was a park bench nearby, and they made for it.

When she had rested, Vivian said, "I'm sorry, I didn't do that on purpose."

He said doubtfully, "Are you sure?"

She reached for his hand. "Mike - in there; I wanted to, as much as you. Then this." Again the pain.

He said, "I'm sorry, Vivian. I thought . . ."

She said, "I know what you thought. But it wasn't that. Honestly."

"All right. Tell me what's wrong." He was the doctor now. Back in there he had forgotten.

"It's my knee. All of a sudden - the sharpest pain."

"Let me see." He was down in front of her. "Which one?"

She lifted her skirt and indicated the left knee. He felt it carefully, his hands moving lightly. For the moment Mike Seddons dismissed the thought that this was a girl to whom, a few minutes earlier, he had been about to make love. His behavior now was professional, analytical. As he had been trained to do, his mind went methodically over the possibilities. He found Vivian's nylons impeded his sense of touch.

"Roll down your stocking, Vivian." She did so, and his probing fingers moved over the knee again. Watching him, she thought: He's good; he'll be a fine doctor; people will come to him for help and he'll be kind and do the utmost that he can. She found herself wondering what it would be like - the two of them together always. As a nurse there would be so much she could do to help him and to understand his work. She told herself: This is ridiculous; we scarcely know each other. Then, momentarily, the pain returned and she winced.

Mike asked, "Has this happened before?"

For a moment the absurdity of the situation struck her and she giggled.

"What is it, Vivian?" Mike sounded puzzled.

"I was just thinking. A minute or two ago . . . And now here you are, just like in a doctor's office."

"Listen, kid." He was serious. "Has this happened before?"

She said, "Just once. It wasn't as bad as this though."

"How long ago?"

She thought. "About a month."

"Have you seen anybody about it?" He was all professional now.

"No. Should I have?"

Noncommittally he said, "Maybe." Then he added, "You will tomorrow anyway. I think Dr. Grainger would be the best one."

"Mike, is something wrong?" Now she felt an undercurrent of alarm.

"Probably not," he reassured her. "But there's a small lump there that shouldn't be. Lucy Grainger will give us the word though. I'll talk with her in the morning. Now we have to get you home."

The earlier mood was gone. It could not be recaptured, not tonight anyway, and both of them knew it.

Mike helped her up. As his arm went around her, he had a sudden feeling of wanting to help and protect her. He asked, "Do you think you can walk?"

Vivian told him, "Yes. The pain's gone now."

"We'll just go to the gate," he said; "we can get a taxi there." Then because she looked glum he added cheerfully, "That patient was a cheap skate. He didn't send any cab fare."