Her eyes widened just slightly, then she glanced toward Ethan with unmistakable concern. “I’ve been worried about him,” she said in a lowered voice. “His fever has gone up to 102.3. His pain keeps increasing. I’ve asked Dr. Vance twice to reassess him, but he keeps saying the patient is exhibiting drug-seeking behavior.”
For a heartbeat I had to force myself not to turn around immediately and go looking for Vance. I stepped to Ethan’s bedside. His skin had that gray, damp cast I have learned to fear. He was holding his right side protectively, every movement careful and incomplete. “Ethan,” I said, keeping my voice level, “I need you to try to straighten out for me.”
He tried. The effort triggered a sharp gasp that seemed to rip straight through him. “Can’t,” he said through clenched teeth. “Hurts too much.”
I performed the gentlest palpation I could manage, and the moment my hand touched his right lower quadrant, he flinched so violently he almost came off the table. Rebound tenderness. Guarding. The involuntary rigidity of a body trying to protect an inflamed, contaminated abdomen. Five hours of progressive pain. Fever climbing. Tachycardia. The puzzle had assembled itself. This was not merely appendicitis. This was likely a ruptured appendix, maybe recent, maybe already spilling contamination into the peritoneal cavity. My mouth went dry.
“Where is Dr. Vance?” I asked.
The nurse hesitated only long enough to decide honesty mattered more than politics. “Room Four.”
I pulled the curtain aside and walked straight there. Through the open doorway I saw a man in his mid-forties in scrubs and a white coat, leaning casually against the counter, laughing with another physician while reviewing a chart. It struck me immediately how relaxed he looked. Not busy. Not burdened. Relaxed. The other physician glanced up as I approached, saw my expression, and stepped back without a word.
“Dr. Vance.”
He turned toward me with the lazy professional smile doctors reserve for impatient family members. “Yes? Are you a relative of one of the patients?”
“I’m Dr. Garrison Mills,” I said, “chief of surgery at St. Catherine’s Hospital. I am also the father of Ethan Mills, the twenty-two-year-old male you have been refusing to treat for the past five hours despite clear symptoms of acute appendicitis.”