his gloved digits. This done, he inserted the middle three fingers of each hand into the patient’s anus, as he had previously done in the A.O. Squeezing the Coke bottle so tightly that his teeth were clenched, he pulled. This time, with the improved traction provided by the sponge rubber, the bottle slowly emerged through the sphincter. Henry held it aloft in triumph.
The anesthetist whistled appreciatively. “Twelve full ounces, that’s a lot,” he said.
The Great Coke Bottle Extraction was a sweaty affair for a while, but it was a minor venture compared to the matter of Arthur Arisburi’s rectal miseries. Arthur was a slight young man with sandy hair that hung forward into his eyes, and when he staggered into the Admitting Office, he appeared to be about a step and a half in front of the old fellow with the scythe. He made it to the nurse’s desk, moaned, “My stomach…” and collapsed in front of her. She motioned to a guard who was standing in the corner. The guard hurried over, picked Arthur up under the arms, and dragged him into an examining room. Meanwhile, the nurse rushed into the room where I was culturing up a strep throat to tell me my talents were needed elsewhere,
prontissimo
.
An aide was undressing Arthur as I walked in. I stood and watched as they slipped a gown onto him. He lay on his side, legs drawn up to his chest, clutching his belly, and rocking gently back and forth. I put my hand on his shoulder to draw his attention, and asked him what was the matter.
His eyes were glassy as he looked up at me. “My stomach…hurts real bad,” he whispered. The very effort of saying the words seemed to cause him pain.
“When did it start?” I asked.
“Few…hours…ago,” he answered.
“Have you had any nausea? Vomiting?”
Gingerly, he shook his head yes.
I told him to turn over onto his back so I might examine his abdomen. He winced.
“I’m sorry,” I said. “But that’s the only way I can try to find out what’s wrong.”
It hurt me to watch him roll over, but finally he made it, lying on his back, breathing shallowly and rapidly, with knees pointing toward the ceiling. When I placed my hand to the right of his navel, he screamed in agony and then shivered violently.
I was puzzled. This man had all the signs of acute peritonitis, but had a normal blood pressure and temperature. That ruled against an infectious cause for his problem, and I wondered whether he was suffering from a perforated peptic ulcer, with spillage of stomach acid into the peritoneal cavity. Such a catastrophe would also have permitted the entry of free air into the peritoneal cavity through the hole in the stomach, so I had Arthur wheeled over to the X-ray department for films. When he returned, I slid the pictures up onto the view box. I had been right on the ball! Under each diaphragm was a clearly delineated pocket of air.
Clutching my roentgenologic triumph, I went into the hallway and collared Randy Braxton, the surgery resident on A.O. call that evening. “What do you think of this?” I said smugly, as I held the X-rays up to a nearby gooseneck lamp.
Randy pursed his lips as he stared at the films. “Has he got the clinical signs of a perforated viscus?” he asked.
“He sure as hell does,” I answered. “I figure it must be an ulcer. Come on in; I’ll let you look him over for yourself.”
When Randy and I walked into the room where they were keeping Arthur under observation, the nurse stage-whispered: “Dr. Karp.” As we turned in her direction, she pointed at the stretcher that Arthur had been lying on to go to and from X-ray. Right in the middle was a little puddle of blood.
Randy walked quickly over to Arthur and told him to roll off his back and onto his side again. Slowly, Arthur complied. Randy bent over and peered from below as he spread the patient’s buttocks. I watched intently from behind. The entire area around the anus was bloodstained.
“Gimme a glove and some jelly,”
The anesthetist whistled appreciatively. “Twelve full ounces, that’s a lot,” he said.
The Great Coke Bottle Extraction was a sweaty affair for a while, but it was a minor venture compared to the matter of Arthur Arisburi’s rectal miseries. Arthur was a slight young man with sandy hair that hung forward into his eyes, and when he staggered into the Admitting Office, he appeared to be about a step and a half in front of the old fellow with the scythe. He made it to the nurse’s desk, moaned, “My stomach…” and collapsed in front of her. She motioned to a guard who was standing in the corner. The guard hurried over, picked Arthur up under the arms, and dragged him into an examining room. Meanwhile, the nurse rushed into the room where I was culturing up a strep throat to tell me my talents were needed elsewhere,
prontissimo
.
An aide was undressing Arthur as I walked in. I stood and watched as they slipped a gown onto him. He lay on his side, legs drawn up to his chest, clutching his belly, and rocking gently back and forth. I put my hand on his shoulder to draw his attention, and asked him what was the matter.
His eyes were glassy as he looked up at me. “My stomach…hurts real bad,” he whispered. The very effort of saying the words seemed to cause him pain.
“When did it start?” I asked.
“Few…hours…ago,” he answered.
“Have you had any nausea? Vomiting?”
Gingerly, he shook his head yes.
I told him to turn over onto his back so I might examine his abdomen. He winced.
“I’m sorry,” I said. “But that’s the only way I can try to find out what’s wrong.”
It hurt me to watch him roll over, but finally he made it, lying on his back, breathing shallowly and rapidly, with knees pointing toward the ceiling. When I placed my hand to the right of his navel, he screamed in agony and then shivered violently.
I was puzzled. This man had all the signs of acute peritonitis, but had a normal blood pressure and temperature. That ruled against an infectious cause for his problem, and I wondered whether he was suffering from a perforated peptic ulcer, with spillage of stomach acid into the peritoneal cavity. Such a catastrophe would also have permitted the entry of free air into the peritoneal cavity through the hole in the stomach, so I had Arthur wheeled over to the X-ray department for films. When he returned, I slid the pictures up onto the view box. I had been right on the ball! Under each diaphragm was a clearly delineated pocket of air.
Clutching my roentgenologic triumph, I went into the hallway and collared Randy Braxton, the surgery resident on A.O. call that evening. “What do you think of this?” I said smugly, as I held the X-rays up to a nearby gooseneck lamp.
Randy pursed his lips as he stared at the films. “Has he got the clinical signs of a perforated viscus?” he asked.
“He sure as hell does,” I answered. “I figure it must be an ulcer. Come on in; I’ll let you look him over for yourself.”
When Randy and I walked into the room where they were keeping Arthur under observation, the nurse stage-whispered: “Dr. Karp.” As we turned in her direction, she pointed at the stretcher that Arthur had been lying on to go to and from X-ray. Right in the middle was a little puddle of blood.
Randy walked quickly over to Arthur and told him to roll off his back and onto his side again. Slowly, Arthur complied. Randy bent over and peered from below as he spread the patient’s buttocks. I watched intently from behind. The entire area around the anus was bloodstained.
“Gimme a glove and some jelly,”
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