Читать книгу Bad Blood - James Baehler - Страница 4

As Dr. Harris was falling asleep after his most hectic of nights, his mind went over the details of the evening that led up to the death of Victor Wallberg. Office hours that were supposed to end at 4 p.m. had ended at 7:45. He got home at eight and his wife greeted him as he entered the kitchen through the door that led to the three-car garage. She gave him a quick hug and turned to the microwave to heat the dinner she had prepared earlier for him. Laurel had long since accepted the long hours Cliff’s work demanded. In a good week he managed two or three evenings with his wife and family. She accepted the fact that he was a serious dedicated surgeon who believed in putting his patients first. Laurel sat with him while the meal was warming, bringing him up to date on the activities of their twin twelve-year-old daughters. Halfway through his meal the phone rang. Laurel picked up the phone, listened for a moment and handed it to Cliff with a grimace of distaste on her face. “I don’t believe this,” she said, handing him the phone.

“Is this Dr. Harris?” said a croaking, strained voice.

“Yes, who’s this?”

“It’s Victor Wallberg.”

Harris stared at Laurel, an expression of amazement on his face. “You’ve got a lot of nerve calling me, you bastard. I don’t get it.”

Wallberg’s voice was strained and barely audible. “I have no place to turn. I can’t move. Something bad’s happening… I’ve got a pain in my belly like…you couldn’t believe…it even hurts to talk. I’m desperate.”

Jesus, he sounds like he’s in extremis, thought Harris. “Is your wife there?”

“She’s at a friend’s house,” was the reply through gritted teeth.

“Can you call your regular doctor?”

“I don’t have one,” Wallberg said, followed by a deep moan. “I know how you feel, doc, but I think I’m dyin’ here.” Wallberg’s usual tone of arrogant command had been replaced by the fearful voice of a man in a high state of pain and anxiety.

For perhaps the first time in his life, Cliff Harris regretted the Hippocratic oath he had taken upon becoming a physician. With a sigh of frustration he said, “All right, I’ll be right over.”

It was obvious that Wallberg was in danger. There was no sense wasting time with any further phone questions. Wallberg had to be desperate to call him. However, the man now had become a patient. Once Harris told him he’d be right there, in his mind it meant he had a verbal contract to care for this patient, and that contract had to be fulfilled.

Harris turned to his wife, “I have to go next door. Wallberg sounds like he’s dying. I’m going over there and see what I can do. I’ll fill you in later.”

“But…” Laurel began to expostulate and stopped when she saw the expression on her husband’s face.

Harris donned his heavy coat and picked up his medical bag. The crisp cold of a northern Illinois winter struck his face as he quickly crossed the wide expanse of the two lawns that typically separated homes in the upscale community of Barrington Woods. As Harris approached the front door, it opened to reveal his neighbor bent over in an almost ninety-degree stoop. The effort to come to the door and open it had been exhausting and painful and Harris helped the man to a nearby couch. Wallberg could not lie flat. In order to be examined he had to lie on his back and keep his knees elevated. Seeing this, an alert rang in Harris’s mind that was reinforced when he saw that Wallberg had unstrapped his belt and unzipped his pants. Both signs suggested an abdominal emergent event, confirmed by a quick look at Wallberg’s features; his teeth were clenched and there were wrinkles on his face etched there by pain. His abdomen was markedly distended and exquisitely and diffusely tender. Harris attempted deep palpation but it was impossible. The sudden release of his palpating fingers elicited an agonized guttural groan from the throat of the patient. Clearly he had rebound tenderness, a sign of peritoneal irritation. Examination with a stethoscope revealed high-pitched bowel sounds. Harris knew he was dealing with a surgical belly. There were unmistakable signs of an intestinal obstruction, with possible perforation and peritonitis. Wallberg’s pulse rate was 116 and his respiratory rate was thirty-four. An immediate operation was called for.

“We’ve got to get you to the hospital,” Harris said with conviction.

“I knew it,” Wallberg replied in a weak voice, perspiration bathing his face.

“Are you allergic to any medicines?”

“No.”

Harris called Laurel and told her he was taking Wallberg to the hospital. He asked her to call the paramedics and tell them to hurry. If there was going to be any delay to call him back. Then he called the hospital emergency room. “I’ll be there in about fifteen minutes with a patient exhibiting all the signs of a surgical abdomen. Have you got a pen in your hand?”

“Uhh…yes,” the emergency room nurse replied.

“Write these orders down. I don’t have time for a full diagnostic work up, but we’ll at least get the routine pre-surgical blood tests and make sure the CBC, electrolytes, BUN. and creatinine are done, stat. Also a stat type and cross match for four units of whole blood. He’ll need an immediate intravenous. Start normal saline and pour it in when we arrive. Get a blood culture. He’ll need a pre-op antibiotic, so give him a bolus of two grams of Ancef after the blood culture. Have the emergency room x-ray ready for an abdominal obstructive series. After that you’ll need to insert a gastric suction tube, and a Foley catheter. Call surgery for me and tell them to be ready in one-half hour. Get anesthesia on call, stat. See you. Be ready. You got it all? Read it back quickly.” The nurse did so, accurately and completely.

There were a few minutes of anxious waiting before the ambulance arrived. Harris identified himself to the paramedic and with his help placed Wallberg in the ambulance amid much groaning and cursing on the part of the patient. Wallberg lay on his side with his knees almost touching his chest. Harris sat facing Wallberg, assessing his condition while the paramedic monitored the patient’s vital signs. As they sped to the hospital Dr. Harris said to Wallberg, “I’ve got five minutes to learn all I can about your medical history. This is very important. Can you take some questions?”

“Yes,” Wallberg answered in a hoarse and whispery voice.

“Tell 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 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 for her appearance. She was above average height, her unlined face wearing a perpetual frown. Her dark eyes showed little vitality and her dark, unkempt hair evidenced the first barely visible signs of gray. Harris had noted that as some wives aged, they put on weight or they lost their animation or they neglected their appearance. Marilyn Wallberg had managed to touch all three bases. Not for the first time Harris thanked the stars that his wife, Laurel, had retained the look and enthusiasm of youth. In fact, with maturity, he now considered her even more beautiful than when they had first met in college.

The Wallberg’s had moved to Barrington Woods when Wallberg assumed a position as CEO of Technical Dynamics Inc. three years earlier and moved next door to the Harris’s. When Harris walked into the waiting area Mrs. Wallberg was sitting quietly in the waiting room.

As Dr. Harris reported his findings at surgery her expression never changed. She listened intently with her eyes fixed on Harris’s face, her features registering no visible response. “He should do well now,” ended Dr, Harris.

“Thank you so much for your help, doctor. I know it must have been difficult for you and I appreciate it.” She gave him a grateful smile.

“No thanks are necessary, Mrs. Wallberg. Your husband required immediate medical care and I provided it.

“Well, anyway, I want you to know I’m grateful.” Harris gave her a reassuring smile.

Harris returned briefly to the ICU where he told the nurses that Mrs. Wallberg was in the Waiting Area and that when Wallberg awakened she might want to see him. Harris went back to the surgical locker where he helped himself to a glass of orange juice and was exhaustedly contemplating the day’s events when he received the cell phone call, and the chain of events unfolded that resulted in the massive bleeding, the second operation, and the death of his patient.