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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