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"...Presented yesterday five p.m. to the ER vomiting fresh blood. His blood pressure was low. Responded to a few liters of fluids. GI scoped him, found a large ulcer in the duodenum. It was oozing so they injected it. An hour ago he vomited a pint of clots and his pressure went down to eighty."

I sat up on the edge of the bed and tried to rescue my glasses from the puddle of water that had spread over the table.

The case needed an emergency operation. Silverstein was our best resident. Perhaps even the best surgical resident the hospital had ever seen, or would ever see at the rate it had been going. I respected his intellect and trusted his skills and judgment; I could see and feel the patient over the phone as he explained.

"Hey." Silverstein hesitated for a second.

When I'm deep in thought I have a habit of becoming absolutely motionless. Sometimes, my wife says, I even stop breathing. "Are you with me?"

"Yes," I said, careful not to lose the image forming of this case in my head. I knew if Silverstein saw a problem, there was a problem. In contrast, when our chief resident from the Ivory Coast would tell me that someone needed their belly opened there was a good chance it was something silly like gastroenteritis. I didn't press the panic button until he said the patient is well. "OK, Mike. This guy needs to be done soon. By soon I mean now!"

"That's what I thought Dr. Zohar. I booked the OR; it is ready. Radezki is busy inserting a central line. Blood is on its way. When can we start?"

I did a quick calculation in my head. "I'll be there in forty-five minutes."

"Dr. Zohar, just one more thing you might want to know. The patient's name is Pellegrino. He owns a restaurant close to the hospital; he has good insurance."

"Mike, stop talking so much and work on the guy. We can't operate on a corpse, can we?"

"No," he said with a bit of a chuckle, "we can't."