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Eleanor - Part 4

Eleanor's Surgery

by D

I looked out the apartment window. "It looks like the perfect storm," I remarked.

"The perfect blizzard," Eleanor replied. "I think a foot's fallen already. They said on the news they've taken the plows off the roads -- they can't keep up with it. We could be snowed in for a couple of days. It's okay with me. I'm ready for a snow day."

I scooped some rice and beans from a pot. "At least we're adequately stocked with rice and chickpeas."

I set a plate before her and sat across. She poked at hers and unenthusiastically picked up a forkful.

"No appetite?" I asked.

She set down the fork. "No. My stomach's been off today. There's a flu going around the lab."

I finished my dinner and carried the plates into the kitchen. "What do you wanna do?" I asked her. "We're not going anywhere."

"I've got some papers to grade."

"If we're going to be snowed in, they can wait."

"It'll take my mind off my stomach."

"Do you need an enema?" I asked her.

She shook her head. "I don't think it'll help," she replied pressing her hand below her ribcage. "It's up here -- not down there."

She sat at the table with a stack of papers. I stood and looked out the window. "It is still coming down," I said. I turned and looked at her. "Ellie, are you all right? I don't think I've ever seen you that color."

She sprinted into the bathroom. I followed and found her kneeling before the toilet. She crossed her arms over the bowl and rested her forehead against them. I sat beside her and caressed her back.

"I really don't need any help," she said. "Please don't watch."

I stood and turned my back. In the same instant I heard her vomiting into the toilet; then she flushed it.

I knelt by her again. "Feel better?"

"No. Get me a glass of water... please?"

I filled a tumbler and handed it to her. She chugged it down. "Another." She drank that one.

"What's with the water?" I asked.

"If you're going to vomit, it's easier with something in your stomach to throw up," she replied. "Dry heaves are the pits."

She leaned over the toilet and vomited again. I refilled the tumbler and handed it to her.

"It's been years since I vomited," she said. "I was a freshman last time. That was nine years ago."

"I think I was seventeen the last time," I replied. "It's funny remembering something like that."

She leaned over the toilet and heaved. I refilled the tumbler and offered it to her. She waved it away.

"I think I'm done, now."

I gave her my hand and helped her to her feet. "Feel better?" She nodded. "You look better. Your color is better."

I walked with her to the sofa. She sat beside me and cuddled against me. "I know a lot about vomiting," she said. "I used to be bulimic."

"You?"

"Uhuh."

"I had no idea."

"There's much you don't know about me," she replied. "And, much I'd rather you never learn." She showed me her right hand and pointed to some scars on her second knuckle. "These are characteristic of a bulimic. They're caused by the front teeth. I was purging so much I got desensitized. I couldn't make myself vomit by just putting my hand down my throat. I remember swallowing an extension cord to gag myself."

"Plug end or receptacle?"

She giggled. "No, silly. I folded it in half and got the loop half way down before I started puking. Finally I ended up using syrup of ipecac to make myself throw up."

"You're not doing that now, are you? I mean -- I'd know it if you were... Wouldn't I?"

"Don't worry," she replied. "I had an epiphany during the second semester of my freshman year. Something happened to scare me straight. I'll tell you about it sometime ... maybe. It's behind me. It gave me a strong stomach, though. I haven't vomited since -- 'til tonight. I'll tell you, though... There have been moments when a good binge followed by a good purge would feel pretty good. Thinking about it makes a part of me want to do it -- pizza, ice cream, cookies ... nacho chips, all washed down with chocolate milk -- stuff myself until my stomach is bloated like a football. Then, throw it all up again."

"That would feel good to you?"

"To the bulimic part of me it would." She looked at my expression. "Don't worry. There's a saner part of me that won't let it happen. I am cured of it, believe me. Though -- once bulimic, always bulimic. It must be like alcoholism that way."

"Then, throwing up tonight must've felt pretty good to you."

"I suppose in a small way it did. I hope these revelations don't change your opinion of me."

"I'm afraid they do," I replied. She looked into my eyes. "That you could overcome something like that makes me admire you even more."

She smiled and snuggled against me. "Maybe it's why I enjoy the enemas so much," she added. "It's sort of the same sensation -- of filling and purging. It satisfies that need in me. Besides -- enemas are a lot better for you."

"Or, a lot less worse," I replied, "depending on who you believe."

"I like to think they're good for me. I know I've been feeling better since we've been doing them."

"Except for tonight."

"Yeah, but this doesn't count." I held her against me and stroked her shoulder.

She yawned. "Maybe we should go to bed," I said.

"Mmm..." She held my hand as we headed into the bedroom.

Eleanor had expropriated some of my tee shirts to use as nightgowns. As she slipped into one I dumped out a wastebasket and set it on the floor on her side of the bed. "Just in case," I said.

"You do take good care of me," she replied. "I'd kiss you... Except you probably wouldn't appreciate being kissed by someone who's been throwing up. I wouldn't want you to catch whatever it is I have."

She slid into bed beside me. I kissed the top of her head, put my arm around her and switched off the light.

There I lay, listening to the wind howl. Eleanor's legs twitched against mine as she drifted toward sleep. I closed my eyes, relaxed and began to doze.

Eleanor climbing back into bed roused me. "Something wrong?" I asked. "Throw up again?"

"No," she replied. "I'm running from the other end, now." She cuddled to me.

"Ellie, you feel warm. Do you have a fever?"

"I have a bit of a chill..." I held her tight to warm her.

Morning came. Eleanor lay with her back to me. I rose, looked out the window and swore there were four feet of snow on the ground. And, it was still coming down.

I bent over Eleanor. "Ellie," I said. "How are you feeling?"

She moaned. "It hurts." She clutched her abdomen. "You got up -- now I'm cold... Oh, God I have a chill..." She pulled herself into a ball under the covers and shivered. I could hear her teeth chattering.

I touched her. She was on fire. I fetched the fever thermometer from the bathroom, shook it down and slipped it under her tongue. "A hundred two," I said.

"I'm scared. What if it's my appendix?"

"Appendix..." I sat at my laptop and Googled up pages on appendicitis. I printed a sheet of symptoms. "You have most of these," I said. "Fever, nausea, generalized abdominal pain..." I pressed her right side.

"Ow!"

"Tenderness." I lifted my hand.

"Ouch!"

"Rebound pain. We had better get you to the hospital."

"How? There's four feet of snow out there."

"And, five below windchill..." I picked up the phone, dialed 911 and explained the situation.

"I'm sorry," the dispatcher replied. "We can't get through until the roads are cleared."

"Can't you send a chopper?" I asked. "Snowmobile? Dog sled?" I hung up the phone.

"They can't get through. You'll just have to tough it out."

I paced the apartment and decided to give my sister a call. She had married a surgeon. I wanted to know how bad the situation looked.

She picked up the phone. "Hi, Janis," I said, "it's me. Is James around?"

"He's at his office."

"Do you think he'd be willing to give me a consultation? Over the phone?"

"About what?"

"We think Ellie has appendicitis. We can't get her to the hospital because of the storm."

"I'll give you his direct line."

I pressed the switch hook and dialed the number. James answered. "Hi -- it's your brother-in- law," I said. "I need your help." I filled him in on the circumstances. "Well," I asked, "does it sound like appendicitis?"

"Among other things," he replied. "Probably the most likely. We'd do other tests."

"What tests?"

"X-ray, blood and urine analysis... Pelvic exam, CT scan ... barium enema. I don't like to do diagnoses over the phone."

"What's your gut say, James?"

"Appendicitis. But it could be something else. Appendix can be tricky, especially in a woman. There are other pelvic conditions with similar presentations ... ovarian adhesion, for example."

"Assuming it's her appendix, what's the prognosis if untreated?"

"Hard to say. There have been cases that resolve themselves -- the body throws off the infection and it heals. Those are rare, though. Worst-case scenario is perforation, peritonitis and septic shock."

"Then what happens?" I asked.

"In that case, it's usually fatal. You should get her to the E.R."

"James, we're having the blizzard of the century here. There's better than three feet on the ground already. We're not equipped to deal with it here. We may be snowbound for three or four days."

"Three or four days?"

"They're saying on the news that folks are gonna die because of this storm. I don't want Ellie to be one of them. What if I took it out?"

"What?"

"I've been on some websites with photos of an appendectomy. It doesn't look too hard to do."

"You're nuts."

"You could talk me through it. I'd set up the webcam so you could see. You'll be directing me. You do the surgery. I'll just be your hands. You know I'm good with my hands."

"They'd have my license."

"I'll take full responsibility. No one needs know of your involvement. What are her chances if it ruptures now and she isn't seen for three or four days?" Silence. "James, what are her chances?"

"I don't know -- maybe fifty-fifty. It depends. It might not rupture."

"And, if I can take it out?"

"Don't ask me that. You could kill her doing this."

"What are her chances?" I pressed him. "Better than fifty-fifty?"

"...probably..."

"Eighty-twenty?"

"...maybe, maybe better ... assuming she survives the surgery."

"I'll take 'em, then. I gotta do something for her, James. I couldn't live with myself otherwise."

"Could you live with yourself if she dies at your hands while you're doing this?"

I closed my eyes and thought. "Yes," I said. "I'd know I did everything I could for her."

"Suppose you open her up and discover it isn't her appendix and she dies anyway. Can you live with that outcome, knowing if you had done nothing she would've lived?"

"Yes, because that outcome is unlikely. It's a chance I'm willing to take. She doesn't have risk factors for the other conditions. She's current with her gyno exams, she has good pelvic health and she isn't promiscuous. The symptoms are textbook appendix."

"I'm forced to admit I agree with you," James replied. "I had to play Devil's advocate. How long has she presented symptoms?"

"She started vomiting last night. This morning she woke up in pain and with a fever of a hundred two."

"So, what's it been? About twelve hours since she first vomited?"

"More like sixteen."

"Hmmmph. Now would be the time to take it."

"James -- I respect the training you have, but it's so you can handle any situation. This is a specific situation and it doesn't look too difficult. Are you going to help me or not?" More silence. "I'm not trying to practice medicine. I'm trying to help the woman I love."

"Then you shouldn't be the one doing it. Aren't there medical residents living in your complex? Maybe you could talk one of them into doing it."

"None I know of. They're all on the other side of town. James, will you help me?" More silence yet. "James, will you help me or not?"

"I can't. I can't agree to this. The first rule for a physician is, do no harm."

"This is a case where doing nothing causes more harm than doing something. What would you do if it were Janis who was sick and it was you couldn't get her to the hospital? What, James?" There was a long pause. "What would you do?"

He sighed. "I'd take it out... You'll need to anesthetize her. I imagine you've thought that far ahead already -- or else we wouldn't be having this discussion. Do you have some ether, or God forbid, chloroform?"

"I have a can of diethyl ether."

"What are you doing with that?"

"I'm a chemist, James. I have access to chemicals. You're a doctor. Don't you have access to things like scalpels and syringes?"

"Yes, but I don't bring them home with me."

"I thought having some ether might come in handy. Looks like I was right."

"We'll shelve the discussion on what you planned on doing with diethyl ether. Open drop ether is pretty safe as anesthetics go. It's a pain in the ass, but it's pretty safe. In fact, I've done appendectomies under open drop."

"When have you done that?" I asked.

"I belong to Doctors Without Borders. I spent six months on a mission to Nepal, helping in village clinics. The only anesthesia available was open-drop ether."

"So, it is possible to do this under even ruder conditions."

"Anything's possible."

"What else would I need?"

"You'll need a scalpel ... hemostats -- a few of them ... retractors ... gauze ... sutures ... scissors ... disinfectant... And, you'll need some help. You'll need four hands and someone to mind the ether. I have a surgery scheduled. I'll email you some websites dealing with appendectomy -- and, some on open drop ether. I'll also send you a PDF of a risk assessment we use at the hospital. If she answers yes to any of the questions, the deal's off. Understood?"

"Fair enough. I'll see what I can scrounge up here. I'll call you later."

"Call me at home. I'm headed there after my surgery."

Eleanor was lying in a fetal position, moaning. I checked her temperature. She was up to a hundred three. "I'll get you some Tylenol," I said, "it might help you feel better and it should get your fever down."

She swallowed the tablets and I sat on the bed. "Ellie -- you never met my brother-in-law."

"I haven't met any of your family."

"I know. We'll have to fix that. I've told them about you. My sister married a surgeon. I've been on the phone with him discussing your condition."

"What does he think?"

"James thinks ... it's likely your appendix. We should get you to the hospital..."

"But the storm..."

"Exactly. He's afraid that ... it'll burst and cause peritonitis. If that happens, and if this storm doesn't let up and it really is three or four days before we can get you there..." I found a lump forming in my throat. "He thinks your chances are fifty-fifty."

"Fifty-fifty?"

"Fifty-fifty tops. James is willing to talk me through taking out your appendix. It isn't optimum -- it's far from optimum -- but it may be the only way to increase your odds."

"You?"

"He'll be supervising the surgery. I'll set up the webcam so he can see... He'll be using my hands. You know I'm good with my hands. Don't you trust me?"

"I trust your intentions."

I closed my eyes and felt a tear run down my face. "I can't bear the thought of losing you, Ellie. Not if there's anything I can do to help. I spent my whole life looking for you. Now that I have you, I'm not letting go. Not without a fight. Ellie -- James has agreed to this. He wouldn't if he didn't think it was the best way."

"How will you ... put me under?"

"I have some ether."

"Ether? Would I have to breathe it?"

"That's how it usually works. Think about it. I'm not even sure it's possible. You think about it while I start taking inventory of our assets. Then, I'm going to study the procedure. James sent me some private URLs to medical school websites with photos."

"When would you do it?"

"Later this afternoon."

"Okay, I'll think about it."

I set about collecting items. I found a fresh snap-blade box cutter. It was as sharp as a scalpel, I figured. I also located a hemostat I used as a clamp for soldering... needle-nosed pliers... needle and thread... cuticle scissors... molded dust masks... the can of ether... rubbing alcohol.

The lighting was better in the living room. I had a folding cot that I used from time-to-time as a guest bed. This I set up in the living room, covered it with plastic trash bags and then with towels.

I called James. "Is it still snowing?" he asked.

"Yes, but the problem's the wind. It's white-out with sub-zero windchill. The plows are still off the street."

"How's the patient?"

"About the same. She's in a lot of discomfort."

"Is the pain still localized?"

"Yes... I think it is."

"When it ruptures the patient feels better... for a while; then, the infection sets in. If the pain is still localized, it probably hasn't ruptured."

"Let's hope that's the case."

"Has she agreed to this?"

"She will." I manipulated the keyboard to my laptop. "See if you can access my webcam. I'm emailing you the URL."

"Okay..."

"Here's what I collected." I pointed the webcam onto the implements.

"Are those bent spoons?" James asked.

I held one up. "Retractors."

"Boil everything for at least fifteen minutes."

I dropped the instruments into a saucepan and put it on the stove. Then I went to the apartment next door and rapped on the door.

Rachel and Trish lived there. They were lecturers at the Humanities college. I suspected they were lesbians -- not that it mattered. They were nice girls and they had become good friends with Eleanor since she had moved in with me. I explained that I needed their help.

Rachel brought a bottle of iodine, a stack of sterile gauze squares and some Purel. Together we helped Eleanor from the bedroom. She sat on the cot and I covered her legs with a blanket.

"Let me do this, Ellie," I said. "I'll go crazy if I don't do something to help you."

"It hurts so much," she said. "I don't want to die. I'm afraid."

"Will you let me do this?"

A tear ran down her cheek. She nodded.

"Lie on your back." She lay on the cot and I covered her.

"I'm putting you on the speaker, James," I said into the handset and pressed a button. "We're going to go scrub."

My helpers and I took turns scrubbing our hands and then used the Purel.

"All right -- here we go.," James said. "Let's see if we can get her induced. What do you have for a mask?"

I held a molded dust mask to the webcam. "This."

"It should work. You can all wear them as surgical masks. Go slow. Ether induction can take a long time. It's not like in the movies -- you don't get a whiff of the stuff and pass out. It's more like getting very drunk."

"Rachel," I said, "You do the honors. I'll sit and hold her hand."

"What do I do?"

"Pour a little onto the mask," James explained.

"Do you have a washcloth or something to put over her eyes? The ether vapors can be irritating."

"I'll get one," I said. I returned from the bathroom, folded the cloth and lay it across her face.

"Best to introduce it slowly. Pour a little onto the mask," James explained. "Make a spot about the size of a quarter."

I held Eleanor's hand. "Okay, Ellie. Relax and breath slowly and deeply."

She drew in a deep breath, then coughed and gasped. She pushed the mask away.

"Relax and try it again."

Eleanor drew in another breath. She reached and pulled the mask from Rachel's hands. "I can't do it. It feels like I'm suffocating."

"This is a common reaction with open drop," James said.

"You have to, Ellie," I said. "Try again."

Rachel refreshed the ether on the mask and held it over Eleanor's face. She sat up and pushed the mask away. "I can't," she sobbed. "I'm so afraid." She began weeping.

I picked up the mask and put it to my own face. "Whoa! Man!" I gasped and coughed from the intensity of the fumes.

"It's natural," James said, "to do anything in her power to escape the fumes. Let her calm down. Then we can try again. It's too bad we don't have something to pre-sedate her. I remember seeing patients react her way in Nepal -- and we pre-medicated them. Once it took four orderlies to hold a young man onto the table while a fifth held the mask. I'll never forget the look of terror in his eyes."

I sat beside her and held her. "I'm so sorry," she blubbered. "I've always had a fear of anesthesia - - of breathing it. I didn't think it would be so bad. I didn't expect to react that way. I just can't do it."

"It's all right," I said. "I tried on the mask. If I were lying there and someone held that to my face and I knew there wasn't any way out -- I'd freak out, too."

"If you could just give me a shot or something. I'm not afraid of needles. I just don't want to breathe it."

I stood and took the phone off speaker for a private conference with James. "I don't want her to struggle," I said. "How about administering it rectally?"

"Rectal induction? With ether?"

"Yeah... It used to be routine with obstetric patients -- to take the edge off a delivery."

"Never heard of it. I've heard of it with methohexitol but not with ether. Where did you hear of it?"

"My grandmother was an R.N. When I was a kid I would read her nursing manuals."

James laughed. "Your grandmother? It does sound like something out of the dark ages."

"They'd mix some ether with oil and inject it into the mom's rectum. Maybe it'd be easier on Ellie."

"Hmmm... Let me look in the literature..." I heard his keyboard clicking. "Yes -- I see oblique references to the practice but no dosing guidelines. You wouldn't happen to have your grandma's nursing manuals would you?"

"I'd give real money to have those books right now."

"You don't recall the dose, do you?"

I thought hard. "It was pretty small -- about an ounce of ether in three ounces of olive oil."

"Olive oil?"

"That's what I recall."

I heard more tapping on his keyboard. "Yes, that's what the literature says, too -- one to three ratio of ether and olive oil. I wouldn't attempt deep anesthesia this way, but perhaps we can sedate her enough so she won't resist the mask... How much does she weigh?"

"A hundred eight."

"Do you have a way to administer it?"

"I think she has a couple Fleet squeeze-bottle enemas," I said. "I could dump out one of those."

"I don't want to try to get her too deep -- I don't know enough about dosing for the rectal route. The nice thing about inhalation is we can withdraw it at a moment's notice if she goes too deep. Let's shoot for light sedation and hope it's enough so she'll tolerate the mask. Give her half that much."

"Half an ounce ... something like fifteen millilitres of ether in fifty of oil?"

"Yes, that sounds good. We can always give her more if it's not enough. But, if we give her too much, we've put it where it's hard to retrieve."

I located one of the Fleet enemas and dumped it out. Then I measured fifty mils of olive oil, added fifteen from the can of ether, screwed on the cap and shook it.

I carried it to the cot. Eleanor was sitting, trembling. "I can't," she said.

"Do you want to call it off and take your chances?"

"I don't know. I hurt -- I feel awful. I'm scared. I don't want to die. I'm afraid of the ether. I don't know what to do." I showed her the squeeze-bottle. She held it. "What's this?"

"It's an ether enema -- some ether in olive oil. It's a way to get you started without using the mask."

"I won't have to breathe it?"

"Not until you're asleep. This will help you go to sleep and then we'll have you breathe some to make your sleep deeper -- deep enough so you won't feel a thing." I put my arm around her and she leaned against me. "Can we try it like this?"

She turned her face toward me and I gazed into her hazel Amerasian eyes. "Okay." I started to get up. "Wait... I have to tell you something. I love you. The past year and a half have been the happiest of my life. I wanted to tell you that ... in case..."

"Don't talk like that, Ellie. You'll be fine." I kissed her lips. "I love you, too."

She handed me the bottle. "Now what?"

"Sims. If you can manage it."

She lay on the cot on her left side an attempted to draw up her right leg. "It hurts."

"It's good enough." I pulled the cover from the rectal tip, spread her buttocks and worked the tip into her anus. Then I slid the nozzle deep into her rectum, up to the hilt. "Roll over a little more. Ready?" She nodded. I squeezed the bottle and pulled it, empty from her. "Lie like that for a while." I pulled down the tee shirt and covered her with the blanket. "You okay?" I caressed her back.

"Uhuh..."

"Did it hurt at all?"

"No... It feels warm maybe... "

"Just lie there and hold it. Can you do that?"

"Uhuh..."

"Do you need me to help you?"

"No ... it's not cramping... I can taste it."

"Already?"

"Uhuh... I'm still scared."

"We're all scared, Ellie. You have the easy job."

"I feel so odd..."

"Let's roll you onto your back." I helped her roll over. She grabbed the sides of the cot. "What's the matter?"

"Felt like I was gonna fall off. Room's moving."

"You're fine. How do you feel?"

"Floating..."

"Close your eyes and try to sleep." I held her hand and caressed her forearm. She lay staring at the ceiling.

"She's fighting it," Rachel said.

"Close your eyes. Try to sleep."

"I don't want to. I'm afraid I'll never wake up."

She lay on her back staring at the ceiling. I watched her chest rise and fall with her breathing. Her eyelids began to droop.

She closed her eyes. "That's a good girl. Now, sleep." I looked toward the webcam. "Well?"

"Good bedside manners," James replied. "Let her absorb some more. I'm going to remember this one for the next time I'm in Nepal."

I looked at my watch. It had been about twenty minutes since she received the enema. "I think she's asleep..." I stroked her arm. "Ellie, are you asleep?"

She stirred. "Mmm?"

"Sorry -- I shouldn't have disturbed you. Go back to sleep." She closed her eyes again. "Shall we give her more?"

"Try inhalation," James replied. "Go slow."

I put the cloth over Eleanor's eyes. Rachel poured some ether onto the mask and held it over her nose and mouth.

"Mmmph," she grunted and turned her head. Rachel moved the mask to keep it over her face. I watched her ribcage move.

"Okay," James said, "put more on the mask. Get it saturated."

Rachel dribbled fluid from the can onto the mask. "Whew," she said and fanned fumes from her face. Eleanor moaned and started squirming.

"Hold her arms and legs," James instructed.

I grabbed her arms above her elbows. "Trish -- get her legs."

Eleanor arched her back and thrashed her head from side to side.

"Ellie ... Ellie, stop it. Please cooperate. We're trying to help you!"

"She's not aware," James replied through the speaker. "She's already unconscious. This is all reflex. Keep giving her ether and let's hope she passes through this stage quickly."

Rachel dripped more ether from the can onto the mask. Eleanor's body relaxed and her head fell to one side.

"That was easy," James said.

"Easy?" I replied. "You call that easy?"

"You should see some of the ones I've seen."

"I had no idea ether was so ... brutal."

"This is surgery, 1920s-style," James replied. "It's why the preferred setting is in a modern hospital with modern agents and equipment. She's lucky. She's tolerating it well. She's almost there."

"I'll go scrub again," I said.

I returned from washing. "Is she under?"

"How long has it been?" James replied.

"About ten minutes."

"Keep the mask saturated for ten minutes more. She'll be there when her breathing is deep and regular."

I watched her breathing. "I think she's there," I said.

"Uncover her eyes and lift an eyelid -- gently." Rachel removed the cloth and stroked her eye open. "Did it close by itself?"

"No, it didn't," I replied. I looked down into her glassy, unseeing eye. "Oh, my God," I said. "Oh, Ellie -- what have we done to you?"

"She's in a state of surgical anesthesia." Rachel stroked her eye closed and replaced the cloth. "What did it take?" James asked. "Forty-five minutes?"

"About," I replied.

"In this country -- where time is money -- that's unacceptably long. In the third world, it's another story. I think ether is underappreciated here in the west... Check her muscle tone."

I picked up her hand and dropped it. Her arm was limp. "Good enough?"

"Good enough. Rachel -- maintain her there... After each minute give her thirty seconds of fresh air."

"Understood," Rachel replied.

"Check her pulse and watch her breathing. If it goes shallow or her color changes, give her air. If it looks like she's coming out of it, give her more ether. Get ready to do mouth-to-mouth if she goes into arrest."

"Got it." Rachel felt Eleanor's temple for a pulse.

"I don't think it's likely, but be ready... Okay, now to the business at hand. we need a sterile field."

I lifted her shirt and folded down the blanket so it just covered her mons. Then, I scrubbed her abdomen with rubbing alcohol and iodine and picked up the knife. "Where do I cut?"

"Do you know how to find the McBurney's point?"

"One third of a line from her pelvis to her navel."

"You did your homework."

I pressed my thumb and forefinger to her belly. "Here?"

"Move your thumb a bit lower and to the left. Right there. Don't be tentative. Cut deep and sure. Otherwise you'll need to make another and then the wound isn't as clean."

My heart was pounding.

"Also -- have your retractor ready."

"Trish," I said. "Get ready."

"What?"

"The spoons. You'll need to hold her open with them.."

I placed the blade against her skin, pressed down and made the incision. Her skin parted cleanly with a few red droplets beginning to ooze.

"Mmmmph," Eleanor moaned. Rachel held the mask over her face.

"She's not quite deep enough," James said. "Up the ether a little. Don't worry -- she won't remember that."

Rachel poured more onto the mask and held it over her nose.

"Trish," I said, "retract here... Trish..."

Trish was looking woozy. She put her fingers to her mouth.

"Trish -- get hold of yourself. Rachel, come here. Trish -- mind Ellies' breathing."

"The fumes are making me loopy," Rachel said trading places with Trish. She handed Trish the can of ether. Remember -- sixty on and thirty off." Rachel wiped her hands with some Purel. "I have a strong stomach," she said as she slipped the bent spoons into the incision and pulled it open.

"Now, cut through the muscle," James said. "Go layer-by-layer and retract."

I cut and Rachel pulled the tissues aside.

"You're down to the peritoneum," James said. "Cut through it. Try to avoid any major blood vessels. Use gauze to control the bleeding."

I opened gauze squares and used them to pack the wound. I looked into the opening and saw Eleanor's cecum, with a dark red object hanging from it..

I regarded it with a reverence bordering on awe. A chill went down my spine. As much fun as Eleanor and I had playing with her colon; now, it was a transcendental experience to behold it for real.

"I see it," I said.

"What's it look like? I can't see through the webcam."

"I'll move the camera."

"No -- don't touch it. It isn't sterile. Describe it to me."

"It's big and red -- looks nasty."

"Is it intact?"

"Seems to be."

"See if you can bring the end of her cecum out of the incision," James said. "Be careful. Snip away any mesentery. Stay away from the appendix. It has its own mesentery." I eased the end of her bowel out of the opening. "Rachel -- see if you can hold it up so it doesn't slide back in."

Rachel adjusted her fingers to prop up Eleanor's cecum. I draped the appendix across the back of her hand. It was as big around as my finger and a deep purplish red. "Ewww..."

I looked into her blue eyes. "Are you all right?"

"Yeah... Are you?"

"I'm just finding my zone, now."

"Is the appendix adhered to her intestine?"

"No," I replied.

"Good. That makes it easier. There are some blood vessels serving the appendix," James continued. "You'll need to clamp and suture them off."

"I remember looking at the photographs," I replied. "You use two clamps and cut between them. It keeps any contents from leaking out."

"Precisely."

I examined her intestine and swollen appendix. "I don't have any way to suture this," I said.

"Just tie it off," James replied. "Trim away some of the mesentery so you can isolate the appendix and its artery. Then, tie each of them off separately. Take care not to nick it."

I trimmed the tissue with a cuticle scissors, then looped some thread around the base of her appendix and tied it. "Like this?"

"That looks good. Now, do the same with the artery."

I tied the artery. With the hemostat I clamped her appendix above the tie. "How does this look?"

"Looks good," James replied. "Be careful not to disturb the ligature."

With the knife I cut through between the knot and the clamp.

"Excellent," James coached. "Now support it with some gauze and cut the artery."

I held up the hemostat with her inflamed appendix dangling from it.

"Good job," James said. "Bring it to the camera. I want to look at it... Yes, that's a ripe one all right. Hang on to it. Pathology will want a look at it."

I set it on a towel. "Now what?" I asked.

"Do you have a syringe and some sterile saline? You should irrigate the stump in case there's anything stuck there."

I thought. "I have a wash bottle," I replied. "There's some water in the tea kettle. It ought to be pretty sterile -- it was boiled this morning."

"Beggars can't be choosers," James replied. "Just make sure none of the irrigant falls into the wound."

I found the wash bottle, filled it and squeezed water through its spout. Then I cleaned the spot where her appendix had been attached, collecting the runoff on a gauze square. "Okay," I said and dabbed the stump with some gauze.

"Do you smell bowel at all?" James asked.

I pulled the mask from my nose, leaned close to the incision and sniffed. "No, I don't."

"Looking good... Tuck it back in and close her up."

"I don't know how to suture her," I said. "What if I just used a butterfly bandage to close the incision?"

"You'll need to keep her still -- until she can be seen in an O.R. And -- nothing but clear fluids 'til then."

I tore strips of adhesive tape, twisted them in the middle and pulled closed the cut. Then, I put a gauze dressing on it and covered her with the blanket.

"As long as it took her to go under it'll take her to come out of it. Keep a close eye on her. In case she vomits, be ready to turn her over. Give her Tylenol for pain -- follow the dosing on the box. Get her to the E. R. at the first opportunity."

"I don't know how to thank you, James."

"I'll figure out a bill. Call me and let me know how she's doing."

He hung up the phone. I pressed the release key, stood and put my hand to my eyes.

Trish opened a window and set the ether-saturated mask on the ledge to air out. "Let's see if we can disperse some of these fumes," she said, fanning them away from Eleanor's face. "They've given me an awful headache."

I sat beside her, held her hand and patted the back of it. "Ellie," I said. "Come on, Ellie -- wake up."

She lay still for about half an hour. Then she began to stir.

"Ellie... Ellie are you okay?"

"Mmmmph," she said. "I feel terrible."

I showed her the appendix. "Look," I said. "This is what was making you sick."

She started to lift up on her elbows. "Let me see it."

"No -- you lie flat. You have to stay put right here until we can get you to the E.R." I held the towel so she could examine her appendix.

"You took that out of me?"

"That's right."

"What are you gonna do with it?"

"I'll put it in a deli carton and keep it in the freezer. When we finally get you to the hospital, I want them to see how bad it was."

Trish and Rachel bent over her. "It was really something to watch, Ellie," Rachel said. "I'm sorry you missed it."

"Yes," Trish added. "You slept right through it."

"I'm sorry, too..." Eleanor closed her eyes and turned her face. "Turn the light off. It hurts my eyes..."

"That's the girl," I said. "Sleep it off."

* * * *

I sat with her all night. Morning's light woke me and I went to the window. It was still snowing, and the wind had picked up again.

I sat and held Eleanor's hand. She stirred and looked into my eyes. "How do you feel?"

"It hurts. I feel better, though."

I checked her temperature. "Your fever is down."

"I'm thirsty."

I brought her some ice water and she sipped through a straw.

"I had the strangest dream," she said.

"Under the ether?"

"Uhuh. I dreamt I was a balloon being blown up. I got bigger and bigger and bigger. Then I popped."

"Then what happened?"

"I woke up." She gave me a half-smile.

"Ellie -- seeing you go under ether was the hardest thing I've ever done."

"It wasn't so bad I guess..."

"What is the last thing you remember?"

"The enema made me so groggy. I didn't want to fall asleep, but I couldn't keep my eyes open. The last thing I remember is hearing you say, 'That's a good girl. Now sleep.' Then I had my balloon dream and I woke up."

"You don't remember breathing the ether?"

"No." She started to lift up on her elbows. "I want to get up. I'm so tired of lying on my back."

"You have to lie here. You see -- you're not really put back together inside. I didn't have any way to suture you. If you move, you're going to herniate yourself."

"What about when I need to pee?" she asked.

"I don't have a bedpan or a female urinal. You'll have to pee on a towel. Then I'll put a new one down."

By that evening the snow had stopped but the wind still howled. I could hear snow blowers in the distance, but the streets were still clogged. "It looks," I said, "like it'll be late tomorrow at the earliest before they'll have the roads open. They can't use a plow -- they'll need to use an auger or a front-loader. That'll take longer. Once the road's open I'll call for an ambulance to take you to the hospital." I walked over to her. "How are you feeling?"

"I need to pee," she said.

"Other than that?"

"I need to pee real bad."

I uncovered her, rolled her legs apart and stuffed a towel between them. "Go ahead."

"I'm embarrassed..."

"It's not like I haven't seen that part of you before. And, it's not like you're the only one who's ever had to pee."

"I know, I know..." She closed her eyes, reached down and spread her labia. A trickle formed between them. It turned into a fountain. I adjusted the towel to catch it all.

"Mmm... Feels good to have an empty bladder."

"You were saving up."

"How would you like to have to pee this way? I'm done."

I dropped the towels into a bucket and tucked fresh ones under her; then I covered her again with the blanket. "Now that your bladder is empty, how do you feel?"

"It still hurts. Otherwise, much better. I am so hungry. My stomach's growling."

"That's a good sign. I think we have some apple juice. Are you recovered from the ether?"

"I can still taste it."

"Rachel came by while you were asleep. She sat with you so I could get some rest. She's a good friend. Trish is, too."

"I know they are."

* * * *

I looked out the window and saw a National Guard truck with a rotary plow working its way down the street. "They're plowing," I said. "The snowbanks are seven feet high. I have never seen anything like this."

I reached for the phone but it rang before I could pick it up. It was the emergency dispatcher. "We have word the roads are clear to you," she said. "Do you still need an ambulance?"

"Yes, yes," I said.

"We'll send one."

The paramedics arrived and I helped lift her from the cot onto a stretcher. I retrieved the deli container from the freezer and handed it to her.

I rode with her to the E.R. and paced in a waiting room. A doctor in scrubs approached me. "Are you the amateur surgeon?" he asked.

"Yes."

"I don't know whether to congratulate you or have you arrested."

"How's she doing?"

"Remarkably well. You did a good job. There's no sign of infection. All we had to do was replace the ligature, suture her cecum and close her up properly.

"How do you suture a cecum?" He looked at me with narrowed eyes. "I'm just curious. I don't plan on doing this again. Ever."

"Picture a glove. You cut off a finger, tie the stub and push it inside, then sew across the opening."

"Is it strong?"

"I've never seen one rupture," he replied.

"How long will she be laid up?"

"Two or three days here. She can go back to her routine in a week or ten days. Her body will tell her how to pace herself. It'll be about a month before she's fully recovered." He nodded toward the recovery room. "You can go see her. She's coming out of the anesthesia."

"Did you see the appendix?" I asked.

The doctor nodded. "It was close to rupturing. You're fortunate it didn't pop while you were in there."

"It was nearly three days before we could get her here," I replied. "What if I hadn't taken it out?"

"I won't say for certain you saved her life, but you might have. She'd have been a much sicker girl, that's for sure. As a doctor I can't say you did the right thing..." He extended his hand and shook mine. "...but I think it was the right thing."

I stepped into the recovery room. Eleanor lay with an I.V. line running into a vein in the back of her left wrist. She was wearing a gown that came to her knees. I sat and held her right hand. "Hi," I said.

"Hi," she replied, weakly.

"You're not chilly? Would you like something over your legs?"

"I'm warm. It's warm in here."

"You did good," I said.

"No -- you did good. The nurse told me. The surgeon was amazed. They were all amazed."

"I just spoke to him. He didn't sound amazed. Of course, a doctor can't go around condoning what we did." I put my hand on her knee.

"I'll have another scar."

"I think appendectomy scars are sexy," I replied and caressed her shin.

"I'm sorry," she said, "I don't think I'll be up to our Saturday night ritual this week."

"You'll have to take it easy for a while. No enemas for you for a month, little girl."

"A whole month?"

"No big ones, at least."

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