Dead Certain

English?”
    “Instead of female trouble, she had gallstones,” replied my roommate. “That’s what was causing the pain in her belly. I’m surprised Farah Davis didn’t suspect gallstones right off the bat. Farah is usually an excellent diagnostician, and Mrs. Estrada fit the perfect four-F profile.“
    “Meaning she was exempt from the draft?”
    “No. Meaning she was fair in terms of her coloring, fat, forty, and fecund, i.e., she’s had children. For some reason most gallstone patients fit that profile. So anyway, she was on the schedule for a laparoscopic cholecystectomy this morning—that’s a relatively new procedure for removing the gallbladder. You make a small incision and go in with a scope, kind of like playing a video game, but the small incision means that patients have less pain and heal faster.”
    “So why didn’t McDermott do the procedure?”
    “In the middle of the night last night Mrs. Estrada started complaining of pain in her abdomen and began running a fever. The resident ordered a lab workup, and the results came back with an elevated white-blood-cell count, so, not knowing his ass from a hole in the ground, he called me. I just assumed that she was experiencing a flare-up of her cholecystitis and told him to bump her off the OR schedule until the inflammation calmed down.“
    “Is that normal?”
    “Absolutely. I figured we’d watch her for a day or two and see if she got any better. If she didn’t, we’d have to send her home and wait for the acute attack to pass before rescheduling her surgery.”
    “So did things get better for her?”
    “No, they just got worse. Instead of subsiding, the pain started to localize, which means that it not only became sharper but it seemed to move. But what really caught my attention was that it didn’t move to the right upper quadrant, which is where the gallbladder is, but to the right lower quadrant of the abdomen.”
    “Meaning?”
    “Meaning that the whole thing was turning into a mess. The abdomen doesn’t always give you pain directly above the diseased organ. Not only that, but by that time I’d been awake and on my feet for thirty-six hours straight. I wasn’t sure I could find a gallbladder if someone dropped one in my lap with a label on it. Besides, Mrs. Estrada was not my problem. She was assigned to the surgical service, not trauma. The only reason I got called to see her in the first place was because the resident was scared shitless of McDermott and wanted someone to back him up in case he needed to cover his sorry ass.”
    “So what did you do?”
    “Not much. I wrote orders for something for her pain and went and hid in the on-call room to see if I could catch some sleep before morning rounds.”
    “And?”
    “And the minute my head hit the pillow the fucking resident was shaking me again. Mrs. Estrada was being a pain in the ass. Not only was she refusing to take her medication, but she was screaming blue murder that this wasn’t her gallbladder, this pain was different. The resident begged, the nurses begged, please, go and see this woman and make her shut up.
    “So I dragged my ass out of bed and went to see Mrs. Estrada, and damn if my examination doesn’t show exquisite tenderness in the lower right quadrant.”
    “Meaning?”
    “Appendicitis.”
    “You’re kidding.”
    “Nope. Just because you’re paranoid doesn’t mean you don’t have enemies.”
    “So what did you do?”
    “I started her on antibiotics, gave her some pain medication, which she took like a lamb, and left a message with McDermott’s service that his six A.M. cholecystectomy was now an appendectomy. Then I went back to bed.
    “The next thing I know, the resident is waking me up again. Apparently Mrs. Estrada’s appendix was heating up, and he wanted to know what he should do. I got out of bed, letting him know in no uncertain terms what I thought about his prospects for making it as a surgeon if he didn’t hurry up and start growing a spine. Then I told him to alert the OR coordinator, page anesthesiology, and go scrub. In the meantime I paged McDermott and went to see Mrs. Estrada to see how she was doing for myself and get her signature on the surgical consent forms.”
    “How did she seem?”
    “In a fair bit of pain and a little freaked out. She kept on repeating that she couldn’t believe this was happening to her.”
    “Why would she say that?”
    “Probably because she was in the hospital for one operation