Peter Budetti

 
 

Chapter 1.  Just a stomach ache

 

"It's answering," whispered Henry Hinkel to the curled-up form of his wife huddled under their bed covers. Hearing a reassuring click he blurted into the telephone, "Hello, hello, this is Henry Hinkel, it's my wife, Eleanore. She needs…"

 

But the automated greeting choked off his plea, ignoring him with programmed indifference:

 

"You have reached the offices of Doctors Marlburg and Jefferson. If this is an emergency, hang up immediately and dial 9-1-1. Again, if this is an emergency, hang up immediately and dial 9-1-1. If this is not an emergency, but you believe you are in need of urgent medical care, go to the emergency room at Northeast Suburban Hospital, or to any emergency room or urgent care center of your choosing. If you are not in immediate need of medical care and you are an established patient of Dr. Marlburg or Dr. Jefferson, please call back for an appointment during our office hours, Monday through Friday, 9AM until 4:30PM. If you are not an established patient of Dr. Marlburg or Dr. Jefferson, please note that the practice is accepting very few new patients, and you will need to discuss your request with the office manager during normal office hours. Once again, if this is an emergency, hang up immediately and dial 9-1-1."

 

Henry shook with irritation but suffered through the entire monologue, anticipating an invitation to leave a message after a beep at the end, but heard only a final click, then a dial tone. He threw the telephone handset at its cradle, watching with perverse satisfaction as it bounced onto the bedroom floor.

 

"Sonofabitch!" he murmured through clenched teeth. "How long have we been seeing Marlburg? What the hell is this now?"

Eleanore stirred at the anger in his voice. "Henry," she said, struggling for the strength to lift her head and speak, "what's wrong? What…what did they say? When will he see me?" The words came slowly, her voice deep and hoarse.

 

Distracted by the irritating shriek of the off-the-hook signal now blaring from the phone, Henry didn't respond. He bent down, grabbed the handset, then set the phone it in its cradle to end the screeching. He felt trapped, desperate to get help for Eleanore but uncertain how to circumvent the blind loop of their doctor's answering machine. His hands tightened into fists, digging the manicured nails at the end of his small, thick fingers into his soft palms. He could feel his teeth grinding, his normally pale cheeks glowing, his face tightening.

 

"I got the goddamn answering machine."

 

"Oh…oh, I'm so…so sorry."

 

Henry caught himself, realizing that his angry words had increased Eleanore's distress. He strained to bring his voice under control, pursing his lips as he said, "Not you, Honey, I'm not mad at you, I'm the one who should be sorry. It's the damn answering machine, just 'Dial 9-1-1, or go to the ER' The ER! We must have put two of his kids through Stanford with all the goddamn bills we've paid him over the years, and now we're supposed to go to the damn ER? We're his patients, he's my client, they're our friends, we play golf together – this is the way he treats us?"

 

Eleanore's response came slowly through shallow breaths. "Please, Henry, don't. It's…it's only a stomach ache, I'll be OK." But the agony in her voice belied her pained assurances.

…

"It isn't OK, and you're not OK." Again he cringed at the harshness in his words and struggled to sound more like the way he felt – sympathetic, supportive, loving. Softening his voice he said, "You've had stomach aches plenty before, Honey, this is different. You don't look good, you're in real pain."

 

"It might just be cramps. It…" Her attempt to speak was cut off by several short, reflexive gasps. "Ah-ah-ah," she moaned as her right hand grasped her lower belly.

 

For much of the previous twenty years Henry might have given in to the urge to tease Eleanore that her long, slow menopause had put an end to her menstrual cramps, but not now, this was no time for humor. "It's not cramps, not any cramps like you ever had, anyway. I think we should go to the ER."

 

"No…please Henry, no. I don't…want to move. I…"

 

Her words were cut short by a wave of nausea. Covering her mouth with one hand she gurgled, "towel…."

 

Henry jumped from the bench and hurried into their master bathroom, eyeing the royal blue towels and wash cloths neatly stacked on the stainless steel shelves. In his haste he grabbed a hand towel, not realizing until he had slipped it under her head that it was far too small to absorb a real blast of vomit. Her body wrenched into spasm but produced only a small puddle of drool and greenish puke that pooled harmlessly on the little cloth. He rushed back to the bathroom, threw the stained hand towel into the bathtub and snatched a handful of large bath towels and a stainless steel wastebasket. He returned to his wife's side, set the trash can on the floor next to the bed and tossed the pile of clean towels nearby.

 

"Sweetheart, you really should get to a doctor. Northeast Suburban isn't that far, we can get there in twenty minutes."

"Please, no, no, Henry. Let me be, please."

 

Henry was torn between aggravating his wife's agony by forcing her to go the hospital or agreeing to wait out her misery to an uncertain end. Having watched her bear up through three deliveries, one time in labor for over twenty-four hours, he had admired her high tolerance for pain. And he could see that moving her would not be easy. Beyond the agony she would have to endure, he knew she would insist on being presentable before going out in public. No matter the pain she would want to attend to her appearance, put on some real clothes, comb the tangles out of her hair, brush her teeth and gargle away the foul smell of vomit from her breath. All the time resisting his efforts to help.

…

She shouldn't have to go to the ER anyway, we should be able to get Tony Marlburg to see her, Goddammit, he swore to himself.

…

But what was he waiting for? For her to die? To scream out in unbearable pain? She didn't want to move, that much he could appreciate, but how much longer could he let her suffer? Henry Hinkel resolved that if she didn't get better soon he would carry her to the ER whether she consented or not.

 

The hours dragged on. At 10PM she had a bad spell, her body tensing in spasms of pain for several long minutes. He slipped his arms under her to lift her out of the bed, intending to carry her to the ER, but she gasped in pain from the first slight movement.

 

"Stop, Honey, please stop, don't…don't touch. It's…not that bad, please."

Eleanore's struggle to get even those few words out was so wrenching he relaxed his arms and withdrew them from under her tense body. Desperate to be helpful he retreated to the bathroom for another cool washcloth and stared at the pile of wet washcloths and towels in the bathtub that chronicled their evening. Her retching had slowed, then ceased after he had emptied vomit from the stainless steel wastebasket into the toilet three or four times. But he kept the wastebasket at the bedside, just in case.

 

Henry wondered what the hell ever happened to doctors who made house calls? If Marlburg had come over last evening on his way home, at least Henry and Eleanore would know what was going on. Now his physician friend just clocks in and clocks out like an assembly line worker, leaving all his compassion at the office. No house calls, no speaking with patients after working hours, just 'Dial 9-1-1 and go to the goddamn ER.' He agonized over what he would do if Eleanore would not go to the ER. Would they sit around and wonder whether she was dying or just having a rough night? Could she stand it? Could he?

 

The night crawled onward, minutes seeming to last for hours. Eleanore barely moved, making no sounds other than an occasional series of shallow, labored breaths. She had another bad spell around 2AM. Again Henry prepared to cart her off, but again she pleaded with him to let her stay where she was. At last it was 8AM, time, Henry thought, to try dialing the offices of Doctors Marlburg and Jefferson. But after listening to the first few words of the recording again, he threw the phone down and waited until 9 when the official office hours were supposed to begin. Getting busy signal after busy signal, he punched the redial button on the phone repeatedly until a voice finally answered, a voice so juvenile he briefly thought he had reached a wrong number.

 

"Medical offices of Doctors Marlburg and Jefferson. This is Jennifer. May I help you?"

 

"This is Henry Hinkel. My wife, Eleanore, needs to see Dr. Marlburg."

 

"Is she an established patient of Dr. Marlburg? He is taking very few new patients."

 

"She's been his patient for over twenty years," he responded, straining to control his impatience at having to convince some child named Jennifer of the urgency of Eleanore's plight. "She needs to see him," he repeated.

 

"He has an opening at 3:30 next Wednesday, is that convenient?"

 

"She needs to see him today, right away."

 

"I'm sorry he's all booked today. If this is an emergency, you should hang up immediately and dial 9-1-1. If this is not an emergency, but you believe you are in need of urgent medical care,…"

…

Henry Hinkel was shaking, feeling he was at his breaking point, but knew he had to get through this for his wife's sake. No sleep, a wife in agony, now a yapping puppy of a guard dog deaf to his pleas refusing them entry into the doctor's presence. Straining to speak calmly he said, "Please tell Dr. Marlburg that Eleanore Hinkel needs to see him today."

 

"He's with a patient. I am not supposed to interrupt him when he is with a patient."

 

"He won't mind. We're not just patients, we're friends, we have been friends and patients for many years." Finally, the thought came: "He'll be more upset if you don't interrupt him when he finds out it was me."

 

There was silence on the line for a few seconds. Then, "I'll check with his nurse. Please hold."

…

"Dr. Marlburg says he can squeeze Mrs. Hinkel in between patients. There might be a lull about 10AM if a couple of follow-up visits go quickly. Can you be here by then?"

 

"We'll be right over, as soon as I get her dressed." Forcing himself to sound gracious, he added, "Thank you very much, Mrs. Gardiner."

…

…A bit shorter and paunchier than Henry Hinkel but about the same age, Dr. Anthony Marlburg wore a long white coat and had his professional game face on, firmly establishing a partition between physician and patient. This was business, not a meeting between old friends, not a time to chat about golf or exchange pleasantries. Not even a handshake, just a quick nod of greeting as he walked to the small office sink and began scrubbing his hands. Turning his head in their direction as he washed up, he said, "Hi Eleanore, Henry. Sorry to keep you waiting. Busy morning."

 

Henry Hinkel was smothering his thoughts. He wanted to ask his friend what kind of doctor he had turned into, what had happened to make him like this, turning cold to patients who were friends, making them beg to see him. But he bit his tongue, swallowed hard, and only replied deferentially, saying "That's OK, Tony, thanks so much for squeezing us in. Eleanore's had kind of a rough night."

 

Eleanore had drawn her knees up on the table, but now Tony Marlburg walked to her right side and said, "Please, can you extend your legs?" She did so with an effort that brought tears to her eyes. Seeing the strain on her pale face Marlburg said, "You look like you're under the weather, Eleanore. What's up?"

 

"My stomach hurts, I can't keep anything down."

 

Henry was surprised by the strength of his wife's words – she was summoning some deep reserve to keep up whatever dignity, whatever self-control, she had left. She was speaking slowly but clearly, not loud but not faltering, as composed as if she were describing a problem with her car to a mechanic.

 

"When did this start?"

 

"Yesterday morning."

 

"It was so sudden, she was fine when I went to work," Henry Hinkel added.

 

Through her pain, Eleanore spoke apologetically, straining to correct her husband without offending him. "Not really, Honey. Sorry, I didn't tell you, but I felt queasy even then, like I had heartburn. I…I didn't want to worry you."

 

Henry bit his lip and remained silent as Marlburg returned to his questioning.

 

"Heartburn? Where was the pain?"

 

"Here," Eleanore said, making small circles with her hand about midway between the bottom of her sternum and her belly button, "it was here at first."

 

"Sharp? Dull? How would you describe that pain?"

 

"At first, dull. Like bad heartburn."

 

"Now?"

 

"Sharp, bad, worse than cramps."

 

"Same place?"

 

"No, more down here," she responded, pointing to her lower right side.

 

"You say you've been vomiting. Any diarrhea or other bowel movements?"

 

"Just vomiting, especially last night."

 

"Fever? You have a little bit of a temperature now."

 

"Not much, I took it a couple of times," Henry Hinkel interrupted, remembering how he had to put his reading glasses on and rotate their old-fashioned mercury-bulb thermometer under a bright light to see the thin silver streak and the tiny etched numbers. "Never up to 102."

 

"Have you tried to eat or drink anything?"

 

"No, nothing, I just can't."

 

"She's really just been in bed the whole time, Tony."

 

"OK, let's have a look."

…

Marlburg supported her back with his left arm and helped her recline, saying in a soothing, professional voice, "Easy does it, there, Eleanore." After easing her head down onto a paper-clad pillow, he said, "Good girl, well done." In a well-practiced gesture he used one hand to raise the gown up to just below her breasts while his other hand pulled a green paper sheet up to cover her groin, leaving only her belly exposed. Retrieving his stethoscope he listened intently to her abdomen, then percussed the area very gently. Her belly was rigid. He asked, "Please relax if you can," but the tension in her muscles did not abate. He stopped tapping and laid his hands flat on her abdomen.

 

Eleanore was struck by how soft and smooth Marlburg's hands were, as gentle as the touch of a loving parent on a sick child, despite his somewhat curt manner with his two old friends. He felt the different quadrants of her belly, his left hand resting lightly on top of his right hand. As his fingers explored the lower right area, Eleanore recoiled with a gasp.

 

"That painful, huh?" Marlburg asked mechanically in response to her evident pain. "Sorry."

 

Marlburg stepped back, walked over to the small sink, squirted a few dabs of antibacterial soap on his hands, and washed thoroughly a second time. Even through her pain the thought crossed Eleanore's mind that it was the endless hand washings that kept his hands so soft.

 

Turning so that he could address both Eleanore and Henry he said, "You have what we call an acute abdomen – there is a blockage in the intestines that requires surgery. I believe the most likely diagnosis is appendicitis, but there are many other possibilities. And, with women, we always must consider a tubal or ovarian problem."

 

"What now?" intervened Henry, his voice breaking as the seriousness of his wife's illness began to set in.

 

"I will order some lab work: a complete blood count to check for signs of infection or bleeding, and an abdominal sonogram and X-rays to see if there's anything that shows up. Mostly, we need to get her to a surgeon. This is clearly something that requires a surgeon to decide on the course of action."

 

"How do we find a surgeon?"

 

"I'll take care of that. I have good relationships with several surgeons that I refer patients to. I'll call and see if the one I have in mind is free today."

 

"Who is that?"

 

"Dr. McDonald, Dr. Matthew McDonald. I've been sending patients to him ever since I went into practice. If he's available, you'll see why – he's very good with patients, which unfortunately I can't say for all my surgery colleagues. You'll like Dr. McDonald."

 

Good with patients – we'll see what that means, Henry thought. But all he said was "Thank you so much, Tony."

 

Almost simultaneously Eleanore said, "Thank you, Dr. Marlburg, thank you."

 

"You're welcome, that's what I'm here for, after all. Now, let's get going. I'll call Dr. McDonald right away."