Bad Blood. James Baehler
did you eat last?”
“I couldn’t.”
Thank heaven the surgery would be performed on an empty stomach, thought Dr. Harris.
“Any problem with your heart or lungs?”
“No.”
“How much do you smoke?”
“About a pack a day.”
“Alcohol?”
“Just on social occasions.”
Yeah, sure, thought Harris. I bet he put away ten drinks at one neighborhood party I can remember.
“What’s wrong with me?” asked Wallberg in a worried voice.
“You’ve got an intestinal obstruction. At this point I only have a list of possibilities as to the cause.”
“What possibilities?”
Dr. Harris’s mind was racing. Statistically the most likely possibility was an acute appendicitis, but this case was atypical, because an intestinal obstruction doesn’t usually accompany appendicitis. The diagnostic possibilities rushed through his mind like a drum roll. He called them off for Wallberg with simple explanations: “Small bowel intestinal obstruction or a blockage of the intestine; ruptured intestine; peritonitis; inflammation of the peritoneum which is a smooth, transparent lining around the cavity of the abdomen that folds inward over the abdominal and pelvic organs; intestinal inflammation; intussusception, the slipping of one part of the intestine into the part below it; volvulus, a twisting of the bowel upon itself; diverticulitis, an infection of a diverticulum, a small outpouching of the intestinal wall…” then a long pause… “Perhaps a hidden malignancy.”
“You mean cancer?” queried Wallberg apprehensively.
“It has to be considered,” said Dr. Harris, without inflection.
“Oh, Jesus.” Wallberg moaned.
Dr. Harris continued. “What I’ve just given you is part of the informed consent process. You need to also know that there is some risk to the surgery.”
“What risk?”
Coldly, Harris answered, “Infection, bleeding, anesthetic complications, blood clots, even death.”
Wallberg raised his head and looked directly at Harris. “You don’t mind giving people bad news, eh, doc?”
The paramedic was listening in rapt attention.
Looking steadily at Wallberg, Harris spoke in a flat, even tone, “The alternatives to surgery are none in my opinion. Not to operate could mean your death in a matter of days. When we get to the ER you’ll need to sign a consent form saying that you understand the risks and that I have informed you of the risks, benefits, and alternatives. How can I get hold of your wife?”
“She’s at a friend’s house, Lily Santos, 546-7823.”
Wallberg stared at Harris, a look of bitter resignation on his face. Harris knew that a man like Wallberg could not tolerate this state of dependency, but he had no alternative. They arrived at the hospital emergency entrance. Two nurses were there with a gurney. They wheeled Wallberg into the hospital and the work up Harris had ordered was completed in eight minutes, including the four x-ray abdominal views. Holding the x-rays to the light, Harris needed only a few seconds to see the distended loops of small bowel and the air fluid levels. He confirmed his suspected diagnosis of a small bowel obstruction. A gastric tube and Foley catheter were put in place, the insertion of the catheter provoking an angry outburst from Wallberg, telling the nurse to be careful as she was messing with his most precious possession. There was no time to wait for results of the blood tests, the patient had to be moved to the operating room. While Wallberg was wheeled out, Harris made a call to Lily Santos’ house and spoke to Wallberg’s surprised wife. “This is Dr. Harris. I’m in the emergency room at Barrington Community Hospital with your husband. He called me from your home and I found him in extreme distress. The tests and x-rays confirm that he has an obstruction in his small bowel. I’m preparing him for surgery as we speak and as soon as I finish talking to you, I’m headed for the operating room.”
“Oh, my God!” she exclaimed. “I don’t believe this.”
“I know what you’re thinking. I don’t either, but he called me. I’m hopeful we caught it in time. Once we get the obstruction repaired, he should be fine. Your husband will be in the intensive care unit at least overnight and will be sedated probably until tomorrow.”
“Can I see him in the recovery room?”
“I’m afraid that at this time of night the recovery room is closed. Surgical patients are taken directly to the ICU.”
“Can I see him there?”
“That’s up to the nurses in the ICU. If you want to stay in the Waiting Area outside the ICU, I’ll stop by after surgery and let you know how things stand.”
In thirty minutes from the time of arrival in the emergency room Dr. Harris was making the initial incision into Victor Wallberg’s belly. Harris would need plenty of room, so a large vertical incision was made. He was not surprised when he identified a normal appendix. He would have to search for the affected part of the small bowel. A brief exploration revealed that about twenty-four inches of it was blue and gangrenous caused by an obstruction that had shut off the blood supply. He would have to remove the affected area and anastomose the two viable ends together. The obstruction was caused by a volvulus, the intestine had twisted upon itself affecting its blood supply. To his surprise Harris also discovered a congenital band, an accident of embryonic development that produced a band of fibrous tissue about four inches long creating a tunnel into which the intestine protruded, twisted and trapped itself thus blocking its blood supply. This was a first for him. As he deftly worked, his mind filled with thoughts long buried. Most patients could live with a congenital band and never know they had one, but complications often made its presence known. One such complication was a volvulus causing an obstruction when the intestine pushes through an opening made by the band and then gets stuck. This was the problem that Cliff Harris faced as he worked on Victor Wallberg. Harris now applied the technical competence that had caused the operating room personnel to dub him, The Wizard. The analysis of the patient’s condition was over and his mind shifted into a mechanical mode. He worked silently; the scrub nurses accustomed to his style did their best to anticipate his needs. Rarely did his eyes leave the open incision. The only verbal utterances were calm, clear calls for instruments, and simultaneously with the call, his right hand, palm up, moved toward the instrument table. The instrument was slapped into his hand, and brought to its task in Wallberg’s belly. Harris’s surgical assistant was well trained and together they collaborated like two dancers, moving in unison, scarcely missing a beat.
The gangrenous bowel segment and the congenital band were removed and the two viable ends of the small intestine joined together. Then Harris performed a full abdominal exploration. Liver, spleen, pancreas, gallbladder and ducts, stomach, remaining small intestine, colon, mesentery were all normal and pink. The anastomosis was tight with sufficient space inside to ensure against future problems. The repaired area showed no signs of blood leakage. The abdominal cavity was free of blood. Harris was satisfied. He closed Wallberg’s incision they took Walberg directly to the intensive care unit that served as a recovery room in the late evening, staffed by the ICU nurses cross-trained in recovery room procedures. Blood transfusions had not been necessary. Dr. Harris wrote his post-operative orders for the ICU nurses, and spoke briefly to them. He stepped into Victor Wallberg’s room and stood for a moment at the foot of the bed realizing that for the first time in his life he was looking at a man he had once threatened to kill. He took one last look at Wallberg, thought about the power of an ancient oath that would cause him to do what he did tonight, and left the room and walked toward the Waiting Area farther down the hall to see Wallberg’s wife.
Marilyn Wallberg had gone from a reasonably attractive forty-year-old to someone who seemed to have little concern