McNeil knew that Pearson, though not a Catholic, disapproved of this. And whatever else you might say about the old man, he always insisted on following autopsy permissions both to the letter and the spirit. There was one phrase, sometimes used in completing the official form, which read “limited to abdominal incision.” Some pathologists he knew did a full autopsy with this single incision. As he had heard one man put it, “With an abdominal incision, if you’ve a mind to, you can reach up inside and get everything, including the tongue.” Pearson—to his credit, McNeil thought—would never permit this, and in Three Counties an “abdominal incision” release meant examination of the abdomen only.

Pearson had turned his attention back to the body.

“We’ll go on now to examine . . .” Pearson stopped and peered down. He reached for a knife and probed gingerly. Then he let out a grunt of interest.

“McNeil, Seddons, take a look at this.”

Pearson moved aside, and the pathology resident leaned over the area that Pearson had been studying. He nodded. The pleura, normally a transparent, glistening membrane covering the lungs, had a thick coating of scarring—a dense, white fibrous tissue. It was a signal of tuberculosis; whether old or recent they would know in a moment. He moved aside for Seddons.

“Palpate the lungs, Seddons.” It was Pearson. “I imagine you’ll find some evidence there.”

The surgical resident grasped the lungs, probing with his fingers. The cavities beneath the surface were detectable at once. He looked up at Pearson and nodded. McNeil had turned to the case-history papers. He used a clean knife to lift the pages so he would not stain them.

“Was there a chest X-ray on admission?” Pearson asked.

The resident shook his head. “The patient was in shock. There’s a note here it wasn’t done.”

“We’ll take a vertical slice to see what’s visible.” Pearson was talking to the nurses again as he moved back to the table. He removed the lungs and cut smoothly down the center of one. It was there unmistakably—fibrocaseous tuberculosis, well advanced. The lung had a honeycombed appearance, like ping-pong balls fastened together, then cut through the center—a festering, evil growth that only the heart had beaten to the kill.

“Can you see it?”

Seddons answered Pearson’s question. “Yes. Looks like it was a tossup whether this or the heart would get him first.”

“It’s always a tossup what we die of.” Pearson looked across at the nurses. “This man had advanced tuberculosis. As Dr. Seddons observed, it would have killed him very soon. Presumably neither he nor his physician were aware of its presence.”

Now Pearson peeled off his gloves and began to remove his gown. The performance is over, Seddons thought. The bit players and stagehands will do the cleaning up. McNeil and the resident would put the essential organs into a pail and label it with the case number. The remainder would be put back into the body, with linen waste added if necessary to fill the cavities out. Then they would stitch up roughly, using a big baseball stitch—over and under—because the area they had been working on would be covered decorously with clothing in the coffin; and when they had finished the body would go in refrigeration to await the undertaker.

Pearson had put on the white lab coat with which he entered the autopsy room and was lighting a new cigar. It was a characteristic that he left behind him through the hospital a trail of half-smoked cigar butts, usually for someone else to deposit in an ash tray. He addressed himself to the nurses.

“There will be times in your careers,” he said, “when you will have patients die. It will be necessary then to obtain permission for an autopsy from the next of kin. Sometimes this will fall to the physician, sometimes to you. When that happens you will occasionally meet resistance. It is hard for any person to sanction—even after death—the mutilation of someone they have loved. This is understandable.”

Pearson paused. For a moment Seddons found himself having second thoughts about the old man. Was there some warmth, some humanity, in him after all?

“When you need to muster arguments,” Pearson said, “to convince some individual of the need for autopsy, I hope you will remember what you have seen today and use it as an example.”

He had his cigar going now and waved it at the table. “This man has been tuberculous for many months. It is possible he may have infected others around him—his family, people he worked with, even some in this hospital. If there had been no autopsy, some of these people might have developed tuberculosis and it could have remained undetected, as it did here, until too late.”

Two of the student nurses moved back instinctively from the table.

Pearson shook his head. “Within reason there is no danger of infection here. Tuberculosis is a respiratory disease. But because of what we have learned today, those who have been close to this man will be kept under observation and given periodic checks for several years to come.”

To his own surprise Seddons found himself stirred by Pearson’s words. He makes it sound good, he thought; what’s more, he believes in what he is saying. He discovered that at this moment he was liking the old man.

As if he had read Seddons’ mind, Pearson looked over to the surgical resident. With a mocking smile: “Pathology has its victories too, Dr. Seddons.”

He nodded at the nurses. Then he was gone, leaving a cloud of cigar smoke behind.

Four

The monthly surgical-mortality conference was scheduled for 2:30 p.m. At three minutes to the half-hour Dr. Lucy Grainger, a little harried as if time were working against her, hurried into the administration reception office. “Am I late?” she asked the secretary at the information desk.

“I don’t think they’ve started, Dr. Grainger. They just went in the board room.” The girl had indicated the double oak-paneled doorway down the hall, and now, as she approached, Lucy could hear a hum of conversation from inside.

As she entered the big room with its pile carpet, long walnut table, and carved chairs, she found herself close to Kent O’Donnell and another younger man she did not recognize. Around them was a babel of talk and the air was thick with tobacco smoke. The monthly mortality conferences were usually looked on as command performances, and already most of the hospital’s forty-odd staff surgeons had arrived, as well as house staff—interns and residents.

“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.”