ah.thefinaldiagnosis-第5部分

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d　resident　training　program　had　fallen　into　disrepute。　There　was　no　budget　for　research。　Conditions　under　which　nurses　lived　and　worked　were　almost　medieval。　Orden　Brown　had　shown　him　everything；　concealed　nothing。　Then　they　had　gone　together　to　the　chairman's　home。　O'Donnell　had　agreed　to　remain　for　dinner　but　afterward　planned　to　catch　a　night　flight　back　to　New　York。　Disgusted；　he　never　wanted　to　see　Burlington　or　Three　Counties　Hospital　again。
　Over　dinner　in　the　quiet；　tapestried　dining　room　of　Orden　Brown's　home　on　a　hillside　high　above　Burlington　he　had　been　told　the　story。　It　was　not　an　unfamiliar　one。　Three　Counties　Hospital；　once　progressive；　modern；　and　rated　high　in　the　state；　had　fallen　prey　to　placency　and　lassitude。　The　chairman　of　the　board　had　been　an　aging　industrialist　who　most　of　the　time　had　delegated　responsibility　to　someone　else；　appearing　at　the　hospital　only　for　the　occasional　social　function。　The　lack　of　leadership　had　permeated　downward。　Heads　of　divisions　had　mostly　held　their　posts　for　many　years　and　were　averse　to　change。　Younger　men　beneath　them　had　at　first　fretted；　then；　being　frustrated；　had　moved　elsewhere。　Finally　the　hospital's　reputation　became　such　that　young；　highly　qualified　graduates　no　longer　sought　to　join　the　staff。　Because　of　this　others　with　lesser　qualifications　had　been　allowed　in。　This　was　the　situation　at　the　time　O'Donnell　had　e　on　the　scene。
　The　only　change　had　e　with　the　appointment　of　Orden　Brown　himself。　Three　months　earlier　the　aged　chairman　had　died。　A　group　of　influential　citizens　had　persuaded　Brown　to　succeed　him。　The　choice　had　not　been　unanimous；　a　section　of　the　old　guard　on　the　hospital　board　had　wanted　the　chair　for　a　nominee　of　their　own…a　long…time　board　member　named　Eustace　Swayne。　But　Brown　had　been　chosen　by　a　majority；　and　now　he　was　trying　to　persuade　other　board　members　to　adopt　some　of　his　own　ideas　for　modernization　of　Three　Counties。
　It　was　proving　an　uphill　fight。　There　was　an　alliance　between　a　conservative　element　on　the　board；　for　whom　Eustace　Swayne　was　spokesman；　and　a　group　among　the　senior　medical　staff。　Together　they　resisted　change。　Brown　was　having　to　tread　warily　and　to　be　diplomatic。
　One　of　the　things　he　wanted　was　authority　to　increase　the　size　of　the　hospital　board　and　bring　in　new；　more　active　members。　He　had　planned　to　recruit　some　of　the　younger　executives　and　professional　men　from　Burlington's　business　munity。　But　so　far　the　board　had　not　been　unanimous　and　temporarily　the　plan　was　shelved。
　If　Orden　Brown　had　wanted；　he　had　explained　frankly　to　O'Donnell；　he　could　have　forced　a　showdown　and　had　his　own　way。　He　could；　if　he　wished；　have　used　his　influence　to　ease　some　of　the　elderly；　inactive　members　out　of　office。　But　this　would　have　been　shortsighted；　because　most　were　wealthy　men　and　women　and　the　hospital　needed　the　legacies　which　normally　came　to　it　when　its　patrons　died。　If　defeated　now；　some　of　the　people　concerned　might　well　change　their　wills；　cutting　the　hospital　off。　Eustace　Swayne；　who　controlled　a　department…store　empire；　had　already　hinted　that　this　might　happen。　Hence　the　need　by　Orden　Brown　for　diplomacy　and　caution。
　Some　progress　had　been　made；　though；　and　one　step　which　the　chairman　had　undertaken　with　approval　from　a　majority　of　the　board　members　was　to　negotiate　for　a　new　chief　of　surgery。　That　was　why　he　had　approached　O'Donnell。
　Over　dinner　O'Donnell　had　shaken　his　head。　〃I'm　afraid　it's　not　for　me。〃
　〃Perhaps　not；〃　Brown　had　said。　〃But　I'd　like　you　to　hear　me　out。〃
　He　was　persuasive；　this　man　of　industry　who；　though　a　scion　of　a　wealthy　family；　had　worked　his　way　from　puddler；　through　the　mills；　to　the　administrative　office　and　eventually　the　president's　chair。　He　had　a　feeling；　too；　for　people；　the　years　in　which　he　had　rubbed　shoulders　daily　with　laborers　in　the　mill　had　given　him　that。　This　may　have　been　a　reason　he　had　accepted　the　burden　of　lifting　Three　Counties　out　of　the　mire　into　which　it　had　fallen。　But　for　whatever　reason；　even　in　the　short　time　they　had　been　together　O'Donnell　had　sensed　the　older　man's　dedication。
　〃If　you　came　here；〃　Brown　had　said　to　him　near　the　end；　〃I　couldn't　promise　you　a　thing。　I'd　like　to　say　you'd　have　a　free　hand；　but　I　think　the　chances　are　you'd　have　to　fight　for　everything　you　wanted。　You'd　meet　opposition；　entrenchment；　politics；　resentment。　There　would　be　areas　in　which　I　couldn't　help　you　and　in　which　you　would　have　to　stand　alone。〃　Brown　had　paused；　then　added　quietly；　〃I　suppose　the　only　good　thing　you　could　say　about　this　situation…from　the　point　of　view　of　someone　like　yourself…is　that　it　would　be　a　challenge；　in　some　ways　the　biggest　challenge　a　man　could　take　on。〃
　That　was　the　last　word　Orden　Brown　had　said　that　night　about　the　hospital。　Afterward　they　had　talked　of　other　things：　Europe；　the　ing　elections；　the　emergence　of　Middle　East　nationalism…Brown　was　a　much…traveled　and　well…informed　man。　Later　his　host　had　driven　O'Donnell　to　the　airport　and　they　had　shaken　hands　at　the　ramp。　〃I've　enjoyed　our　meeting；〃　Orden　Brown　had　said；　and　O'Donnell　had　returned　the　pliment；　fully　meaning　it。　Then　he　had　boarded　the　airplane；　intending　to　write　off　Burlington　and　to　think　of　his　journey　there　as　a　learning　experience。
　On　the　flight　back　he　had　tried　to　read　a　magazine…there　was　an　article　about　championship　tennis　which　interested　him。　But　his　mind　wouldn't　register　the　words。　He　kept　thinking　about　Three　Counties　Hospital；　what　he　had　seen　there　and　what　was　needing　to　be　done。　Then　suddenly　for　the　first　time　in　many　years　he　began　to　examine　his　own　approach　to　medicine。　What　does　it　all　mean？　he　had　asked　himself。　What　do　I　want　for　myself？　What　kind　of　achievement　am　I　seeking？　What　have　I　got　to　give？　At　the　end　what　will　I　leave　behind？　He　had　not　married；　probably　he　never　would　now。　There　had　been　love　affairs…in　bed　and　out…but　nothing　of　permanence。　Where　is　it　leading；　he　wondered；　this　trail　from　Harvard；　Presbyterian；　Bart's　。　。　。　to　where？　Then　suddenly　he　had　known　the　answer；　known　that　it　was　Burlington　and　Three　Counties；　that　the　decision　was　firm；　irrevocable；　the　direction　set。　At　La　Guardia；　on　landing；　he　had　sent　a　wire　to　Orden　Brown。　It　read　simply；　〃I　accept。〃
　Now；　looking　down　at　the　plans　of　what　the　administrator　had　called　flippantly　〃the　New　Jerusalem；〃　O'Donnell　thought　back　to　the　three　and　a　half　years　which　lay　behind。　Orden　Brown　had　been　right　when　he　had　said　they　would　not　be　easy。　All　the　obstacles　which　the　board　chairman　had　predicted　had　proven　to　be　there。　Gradually；　though；　the　most　formidable　had　been　overe。
　After　O'Donnell's　arrival　the　former　chief　of　surgery　had　slipped　quietly　out。　O'Donnell　had　rallied　some　of　the　surgeons　already　on　staff　who　were　sympathetic　to　raising　the　hospital's　standards。　Between　them　they　had　tightened　surgical　rules　and　had　formed　a　strong　operating…room　mittee　to　enforce　them。　A　tissue　mittee；　almost　defunct；　was　reactivated…its　job；　to　ensure　that　mistakes　in　surgery；　particularly　the　unnecessary　removal　of　healthy　organs；　were　not　repeated。
　The　less　petent　surgeons　were　gently　but　firmly　urged　to　limit　themselves　to　work　within　their　capabilities。　A　few　of　the　botchers；　the　assembly…line　appendix　removers；　the　inpetents；　were　given　the　choice　of　resigning　quietly　or　being　ousted　officially。　Though　to　some　it　meant　partial　loss　of　their　livelihood；　most　chose　to　leave　quietly。　Among　the　latter　was　one　surgeon　who　had　actually　removed　a　kidney　without　ascertaining　that　the　patient　had　already　lost　one　in　previous　surgery。　The　dreadful　mistake　had　been　revealed　at　autopsy。
　Removal　of　that　surgeon　from　the　hospital's　roster　had　been　easy。　Some　of　the　others；　though；　had　proved　more　difficult。　There　had　been　rows　before　the　County　Medical　mittee；　and　two　surgeons；　formerly　on　Three　Counties'　staff；　now　had　law　suits　pending　against　the　hospital。　This；　O'Donnell　knew；　was　going　to　mean　some　bitter　controversy　in　court；　and　he　dreaded　the　publicity　which　was　certain　to　surround　it。
　But　despite　these　problems　O'Donnell　and　those　behind　him　had　had　their　way　and　the　gaps　in　staff　were　painstakingly　filled　with　new；　well…qualified　men；　some　of　them　graduates　from　his　own　alma　mater　whom　O'Donnell　had　cajoled　and　persuaded　to　set　up　practice　in　Burlington。
　Meanwhile　the　Division　of　Medicine　had　a　new　head…Dr。　Chandler；　who　had　been　on　staff　under　the　old　regime　but　had　been　frequently　outspoken　against　it。　Chandler　was　a　specialist　in　internal　medicine；　and　while　he　and　O'Donnell　sometimes　disagreed　on　hospital　policy；　and　O'Donnell　found　the　other　man　at　times　pompous；　at　least　Chandler　was　unpromising　when　it　came　to　upholding　medical　standards。
　In　O'Donnell's　three　and　a　half　years　administration　methods　had　been　changed　as　well。　A　few　months　after　his　own　arrival　O'Donnell　had　told　Orden　Brown　about　a　young　assistant　administrator；　one　of　the　best　he　had　known　in　his　hospital　experience。　The　chairman　had　flown　off　and；　two　days　later；　e　back　with　a　signed　contract。　A　month　after　that　the　old　administrator；　relieved　to　get　out　from　under　a　job　which　had　grown　beyond　him；　had　been　honorably　pensioned　and　Harry　Tomaselli　installed　in　his　place。　Now