I
The First of
July
First knife.\"
It was slapped into my hand.
I pressed the io-cm scalpel lightly into the stub-
bly skin just above the pubic bone and drew it smoothly across
t~e prominent bulge in the patient s groin. The bright blood
boiled up along the line of incision. Bill DeLeo， my resident，
d~bed it awa~
I continued cutting to expose the protruding bowel. As I
suspected， we had a real problem. Instead of being pink and
glistening， the bowel was black and dead.
\"Gangrene，\" Bill said. \"We ll have to do a resection.\"
\"I m afraid so.\" The mask muffled my words， but it couldn t
hide the apprehension in my voice. It meant at least another
hour on the table， an hour that might easily kill this patient.
His name was John M.， a seventy-four-year-old black man
who had arrived in the Emergency Room several hours be-
fore， complaining of abdominal pains. He was feverish and in
great agony. His groin was swollen and tender; his abdomen
distended. I listened for bowel sounds， but all I heard was an
ominous silence.
There was little doubt about the diagnosis: he had a bowel
blockage of some kind. The problem was to determine if I
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