me how and when this all started.”
Haltingly, Wallberg offered, “I didn’t feel too well the last few days. My stomach started hurting and I became nauseated. I vomited once last night and felt a little better. I went to sleep and got up early. I had to be at the office for a crucial meeting, so I couldn’t let whatever this was stop me. All day my stomach was hurting and I got home earlier then usual and the shit hit the fan about ten minutes before I called you. The pain became unbearable and cramping had sort of spread all over. My stomach started blowing up. I couldn’t walk and could only get a little relief lying on my back or side with my knees drawn up. I vomited two more times.”
“Point with one finger to the part of the abdomen where your pain started.”
Wallberg placed his index finger about one inch below his navel. “Is that where it still hurts now?” Harris asked.
“No it hurts all over.” The ambulance went over a bump and Wallberg groaned loudly. Raising his head slightly, Wallberg said, “Will you tell that sonofabitch to drive more carefully. Godammit. I’m in pain here.” Harris smiled sardonically. This was the Victor Wallberg he knew, forever berating those on a lower social level. The young paramedic beside Wallberg was doing his best to make Wallberg comfortable and to monitor his vital signs at the same time. Wallberg ignored his ministrations.
“Any prior surgery of any kind?”
“No. Goddamit. Are all these questions necessary?”
“Only if you want me to save your life,” Harris said with a distinct edge to his voice that caused the paramedic to look up.
“Any problem with your health before this?”
“No.”
“Did you ever have an ulcer?”
“No. We should be at the hospital by now, damn it.” Wallberg’s pain could not completely override his combative nature.
“Are you taking any medicine now?”
“No. None.”
“When 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
