When Kowalski finally came out, he still had his cap on and looked exhausted in the way only surgery can exhaust a good doctor—physically drained, mentally keyed up, the body tired while the mind is still composing the case in operative language. “He’s stable,” he said first, which was the mercy we both needed before anything else. “The appendix had ruptured, as we suspected. There was significant contamination in the peritoneal cavity. We performed the appendectomy, irrigated extensively, and placed drains. He’s going to need IV antibiotics for several days and close monitoring, but he should make a full recovery.”
Ethan’s mother covered her mouth and started to cry in earnest. I felt my knees nearly give way with relief.
Then Kowalski’s expression shifted. “Dr. Mills, I want to be very clear. Based on the degree of inflammation and the appearance of the perforation, I believe the rupture occurred within the last two to three hours. If he had been properly assessed when he first presented to the emergency department, surgery likely could have been done before perforation. The delay directly caused the rupture and the complications.”
I met his gaze. “Will you document that?”