What did you find? I asked Jeff as he walked into the doctors’ lounge.
Not much. Just looked like guts to me, Jeff replied. I thought cancer or a ruptured appendix might explain the pain, he added, but as far as I could tell there was nothing in that boy’s belly but normal bowel. Maybe you’ll find something in the bone marrow--all I know for sure is that he is sicker than a dog that’s been wormed.
Our patient, J. J. Walker, had recently been hospitalized because of excruciating abdominal pain. Jeff had just completed a laparotomy--a surgical exploration of the abdomen. He had made an incision from Mr. Walker’s navel to his pubis, then looked at the organs closely, feeling for any abnormalities in the bowels, liver, stomach, and spleen. But he had come up empty-handed. There was nothing apparent to the naked eye or the soft touch of the gloved hand to explain why Mr. Walker was in such pain. As a pathologist, I would have the job of hunting for clues in the bone marrow.
Jeff and I work at a hospital in Columbus, Ohio, but Mr. Walker’s story had begun over 200 miles away in a small town tucked away in the hollows of the foothills of the Appalachian Mountains. He had woken up three days earlier, on November 11, with a pain deep in his belly. It was a Sunday morning. For the next four hours he had remained at the commode, vomiting. Finally he asked his wife to take him to a nearby hospital in Shepherd, Ohio.
Providence Hospital is a small, old facility that serves one of the state’s most impoverished counties. The land there is tough and poor, and the people reflect their geography. They are craggy, stoic, and nearly unbreakable. I’m asked to visit the hospital from time to time, and the biggest tumors I’ve seen--some the size of a rat--come out of those hollows. When a man from a hollow yelps, I know he’s not crying wolf.
