Cutting for Stone - Abraham Verghese [73]
“I tell you, I have never hurt like this.” He grinned from ear to ear as if to say, A man is going along when out of the blue comes a banana peel, a cosmic joke that leaves you upended and clutching your belly. A wave of pain made him wince.
I can't possibly see you today. Beloved Sister has died and any minute I expect someone to tell me they have found Dr. Thomas Stone's body. For God's sake go to the military hospital. That was what Ghosh wanted to say, but in the face of such suffering he waited.
Ghosh took the proffered hand and while supporting it he felt for the radial artery. The pulse was bounding at one hundred and twelve per minute. Ghosh's equivalent of perfect pitch was to be able to tell the heart rate without a watch.
“When did this start?” he heard himself say, taking in the swollen abdomen that was so incongruent on this lean, muscled man. “Begin at the beginning …”
“Yesterday morning. I was trying to … move my bowels.” The patient looked embarrassed. “And suddenly I had pain here.” He pointed to his lower abdomen.
“While you were still sitting on the toilet?”
“Squatting, yes. Within seconds I could feel swelling … and tightening. It came on like a bolt of lightning.”
The assonance caught Ghosh's ear. In his mind's eye he could see Sir Zachary Cope's little book, The Diagnosis of the Acute Abdomen in Rhyme. He'd found that treasure on the dusty shelf of a secondhand bookstore in Madras. The book was a revelation. Who knew that a medical text could be full of cartoon illustrations, be so playful, and yet provide serious instruction? Cope's lines regarding sudden blockage of the normal passage through the intestine came to him:
… rapid onset of distention
Will certainly attract your keen attention.
He asked the next question, even though he knew the answer. There were times like this when the diagnosis was written on the patient's forehead. Or else they gave it away in their first sentence. Or it was announced by an odor before one even saw the patient.
“Yesterday morning,” Mebratu replied. “Just before the pain began. Since then no stool, no gas, no nothing.”
Sometimes a bowel-coil gets out of place
By twisting round upon a narrow base …
“And how many enemas did you try?”
Mebratu let out a short sharp laugh. “You knew, huh? Two. But they did nothing.”
He wasn't just constipated but obstipated—not even gas could pass. The bowel was completely obstructed.
Outside the cubicle the men seemed to be arguing.
Mebratu's tongue was dry, brown, and furred. He was dehydrated, but not anemic. Ghosh exposed the grotesquely distended abdomen. The belly didn't push out when Mebratu took a breath. In fact it moved hardly at all. This is my work, Ghosh thought to himself as he pulled out his stethoscope. This is my grave-digging equivalent. Day in and day out. Bellies, chests, flesh.
In place of the normal gurgling bowel sounds, what he heard with his stethoscope was a cascade of high-pitched notes, like water dripping onto a zinc plate. In the background he heard the steady drum of the heartbeat. Astonishing how well fluid-filled loops of bowel transmitted heart sounds. It was an observation he'd never seen in a textbook.
“You have a volvulus,” Ghosh said, pulling his stethoscope off his ears. His voice came from a distance, and it didn't sound like it belonged to him. “A loop of the large bowel, the colon, twists on itself like this—” He used the tubing of his stethoscope to demonstrate first the formation of a loop, then the twist forming at the base. “It's common here. Ethiopians have long and mobile colons. That and something about the diet predisposes to volvulus, we think.”
Mebratu tried to reconcile his symptoms with Ghosh's explanation. His mouth turned up; he was laughing.
“You knew what I had as soon as I told you, right, Doctor? Before you did all these … other things.”
“I suppose I did.”