Ted’s hands guarded his abdomen and fended me off. A quick scan of his belly revealed no scars.

“Does it hurt all over your belly, Ted?”

“Mostly down here.” Ted’s hands waved over the his lower right quadrant. Dang!

“What makes it worse, Ted?”

“I coughed at dinner and thought I was gonna die.” He told me.  

“Ted…have you ever had your appendix taken out?” I asked him.

Ted was thoughtful for a couple of seconds. “I don’t think so,” he said.

I got that sick feeling in my gut. I needed to make a phone call to Dr. Holmes STAT. If it was appendicitis, time was of the essence. 

Hey there little fella!

A simple appendectomy usually carries pretty low risk for a patient. Pull that little inflamed appendage out with a minimally invasive procedure and it was no big deal. You were usually out of the hospital the next morning and could resume light activities. But, you leave it too long and that little sucker ruptures, you have a big mess in that belly. Infection pours out of the appendix and bowel and into the abdomen. Peritonitis and/or an abscess are possible complications from a ruptured appendix. These complications require weeks of recovery. Patients can become septic and possibly die. I had seen it myself in the ICU. The memory of a sixty year old man with peritonitis and subsequent sepsis and his prolonged, and ultimately unsuccessful, struggle to survive made my blood run cold. I needed to get Ted to the ER and fast!

“OK Ted.” I said very calmly. “I’m gonna have you rest in the infirmary for now. I am thinking that we may need to take you into town to have a physician look at you. Stay tuned while I try to work out the details, OK?” Ted and David both nodded. 

“David.” I said as I turned to address him. “I will need you to gather up some things for Ted please. A change of clothes, a pillow maybe, a book, some of his basic toiletries. That way we will be prepared if he has to stay overnight. OK?” David nodded.

The guys left quietly discussing what items that Ted wanted from his hut and I pulled the list of phone numbers off the bulletin board and located Ted’s health form. The health form had basic information on there, including a health insurance number, emergency contact numbers, a health history, immunizations and allergies. Ted’s form had minimal information noted on it. That meant the kid was a healthy specimen, thankfully.

I took the stairs two at a time up to the main office. I found Bill sitting at the computer typing. 

“Hey Bill. I think I might need to make a trip into town.” I told him a bit breathlessly.

“OK. When?” He stopped typing, sat back in his seat and pushed his glasses onto his forehead.

“Ummmm…like maybe in the next ten minutes.” I said and frowned.

“Oh geez. OK. Sounds like an emergency? What’s the situation?” Bill pushed his chair back. I had his full attention.

“I suspect Ted has appendicitis. I would like to use the phone to just bounce this off Dr. Holmes first before I start ruining everyone’s evening.”

“Phone away Anne. While you do that, I will take a look at the staffing for tonight and see who we could potentially pull for an emergency road trip.” Bill turned the phone around to face me. 

“Awesome! Thanks.” I said as I started to punch in the numbers for Dr. Holmes’ residence. The phone rang three times and Mrs. Holmes picked up. 

“Holmes residence.” She said politely.

“Hi Mrs. Holmes. This is Anne, the camp nurse at Acorn. I wondered if I could please speak to Dr. Holmes about a potentially urgent situation.”

“Oh yes Anne. Absolutely. He is actually just getting ready to go in for his night shift in the ER. Let me get him for you.” I breathed a small sigh of relief. That would make things a lot easier. I could hear Mrs. Holmes calling to her husband and after a brief wait he picked up the receiver.

“Anne! What can I do for you?”

SBAR is an important communication tool for all nurses. SBAR stands for: situation, background, assessment, recommendation. It’s a quick and dirty summary of your state of affairs. Having worked plenty of night shifts in the ICU, I learned very quickly that this was the best form of communication, especially when you were waking, for example, a curmudgeonly sleeping neurosurgeon. Trust me. I know this. From experience. 

“Hey Dr. Holmes. I have a healthy 14 year old camper with belly pain. Yesterday he came to the office with nausea, anorexia and this evening he admits to abdominal pain. He temp is 37.9, HR is 98. His belly looks OK but when I went to palpate his abdomen he was guarding it, so I was not able to do so. He says his pain is to the right lower quadrant. I wondered if I could bring him in to have you look at him?”

“What was his blood pressure?”

“I don’t know. We don’t have a sphygmomanometer in the office.” I made a mental note to ask for one. A blood pressure in this situation sure would have help been helpful.  

Source

“It’s sounds a bit suspicious for appendicitis, Anne. I am getting ready to go in for the night shift. I will alert the ER staff to bring this guy in as soon as you get here. You need to leave as soon as possible.” 

I was stunned for a couple of seconds. I had mixed emotions. He agreed with me! Yeah! But it was possibly appendicitis. Boo!

“Excellent. We are working on transportation right now.”

“Good. What do you think your ETA will be?”

“I’m hoping we can get him in a vehicle in the next ten minutes and then the 45 minute commute.” I told Dr. Holmes as I looked up at Bill who was holding Teds’s camper profile in one hand and the staffing list in the other. Bill had been listening in to the whole conversation and he nodded his understanding.

“Thanks Anne. See you soon.” Dr. Holmes said and then hung up. I replaced the receiver and looked up at Bill.

“We need transportation to the ER immediately and we should call Ted’s parents too.”

“Well…so here’s the thing. I can only spare one counselor to take Ted in, I can only give you the camp car for this evening and….Ted’s parents are camping this week and are without phone service.” Bill said sheepishly as he counted off on three fingers.

“So…it sounds like I will have to go with them, I will need to prepare for the possibility of staying overnight with Ted and….we will have to figure something out in terms of who can sign consent if Ted needs an operation…” I sighed as Bill nodded. “Well…I had better go quickly and pack some sort of bag.”

“I will gather a counselor and have them meet you at the car.”

As I turned to leave the office I heard the music start up in the dining hall.

“But all I wanna know is where the party at!” The rave was starting and the music of the Backstreet Boys was blaring. The base was so loud I could feel the vibration in the floor. Impressive!

One thing was certain. I would not be going to any rave tonight. And neither would Ted. 

Party’s cancelled!