The Grand Professor of Dermatology—tall, solemn, with closely trimmed dark hair and long white coat—strode purposefully out of the elevator and down the hall, the hierarchy dutifully in train behind him: first a Dermatology Resident, serious and close behind his superior's left elbow; then two Interns, like colts just in from the range and freshly broken, clad in hospital scrub suits and short white jackets; and last, the nervous ragtag cluster of eight or ten third-year students in short white jackets over street clothes, uncomfortable in our uncertain identity. We jockeyed for just the right place in the parade.

The ward had six beds along either side, separated by curtains and well lit by rows of windows out of reach above the beds. The Professor checked the chart in his hand and the number on the pillar by the bed, then pulled back the curtain.

"Good morning," he said crisply, as if his concerns were elsewhere. "How are you feeling this morning?" The question sounded like a routine opening gambit, like dialing the combination to a locker, rather than an actual query. I felt strangely uneasy.

The patient lying in the bed mumbled something that I could not hear from there in the back row. She appeared to be in her thirties, with light brown hair to her shoulders, and brown eyes which darted questioningly over the shuffling assortment of strangers.

"Take off your blouse, please." Our leader waited for the group to settle and for the woman to sit up and untie the strings at the back of her hospital gown and slip it down from her shoulders. She drew up the sheet to cover her as she tossed the gown aside onto the bedside table and lay back on the pillow.

"This is mycosis fungoides," said the Professor. (Strange name, I thought sarcastically, for a young woman.) "This case is not far advanced." He seized the corner of the sheet and whipped it down to the foot of the bed so that the cringing victim was totally exposed, stark naked all the way including her toes. "The skin lesions are not prominent, but you just can see these on the right side of the chest." From where I stood I couldn't see any lesions, only a wantonly violated victim.

"This tumor is already in some of her lymph glands, and will gradually invade her spleen, liver, lungs, and other internal organs. It progresses slowly; she will probably have five to seven more years."

He talked on about the microscopic characteristics of mycosis fungoides, and compared it with the appearance and behavior of other lymphomas. I heard little of what he said. Increasingly angry at his callous disregard for the patient's feelings, I waited for him to pull the sheet back up over the young woman's body. He did not. After a few minutes, without a word to the woman, the Professor turned and walked away, his entourage following like a school of fish. As I glanced back at her she reached down and grabbed the corner of the sheet and pulled it up close under her chin.

I still count it one of the failures of my life that I didn't push through the crowd, step forward and pull up that sheet.

Mae Dye was in her early sixties, but one might have guessed her older. The nondescript light gray of her hair hinted that she may once have been a redhead. Her S-shaped posture, translucent skin, and bird-like frame suggested a bamboo-and-tissue kite—delicate, fragile, yet with sturdy resilience and flexibility.

I never got much of a picture of Mae's past; she seemed to keep it hidden away somewhere in a hope chest. I learned that she had a grown son who lived far away, and that she had lived alone for many years in a neatly kept little yellow house on the back fringe of town.

Mae and I first met when she came to me with abdominal pain, sharp and crampy. It had started the day before, and she had vomited several times. Her tummy was moderately distended but soft, with very little tenderness. It didn't require a stethoscope to hear the high-pitched tinkling sounds made by loops of small intestine trying to push a fluid and gas mixture past a place where it wouldn't go. In the midline below her navel was an old scar, and she confirmed that she had had a hysterectomy many years before.

When a surgeon removes a uterus he inevitably leaves behind a number of raw, irritated areas where vessels have been tied and things have been cut away. Each of these places, as it heals, may stick to nearby loops of intestine and eventually form an adhesion—a solid attachment by scar tissue. An adhesion may not cause trouble for years, maybe never; but it also may kink or even twist and obstruct the intestine at any time.

The rest of Mae's organ systems—heart, lungs, kidneys, circulation, blood count—checked out well. But after half a day in the hospital with a tube in place through her nose into her stomach to keep it empty, her abdomen had not improved, there was a little more tenderness, and the x-ray confirmed the "ladder pattern" of distended gas-filled loops, the hallmark of small bowel obstruction.

There was no sign yet of strangulation of the bowel, nor of peritonitis, but the safe period for waiting was past. It was time to cut.

She had adhesions, all right. Several loops of bowel had to be cautiously dissected free before we could get to the actual point of the trouble, where a loop had been constricted and laid back on itself like folding the finger of a glove. Once I released this kink the problem began to resolve itself before our eyes as the collapsed loops beyond the blockage started to fill again with air and fluid.

This is always a gratifying operation. The downside, however, is that every place where an adhesion is dissected free leaves two raw surfaces where new adhesions can now form, and one's anxious hope is that an even worse problem won't eventually develop.

Mae recovered from the surgery very well, was eating normally in two days and home in less than a week. After the stitches were out I didn't see her again for several months.

Late one night she called me and said that she was having that pain again. She hadn't vomited yet, but felt that the situation was starting the same as before.

I went to her house. A brief examination confirmed her diagnosis: she was obstructed again, almost certainly by new adhesions. I shuddered at the thought of trying to whittle through the mass of scar tissue which I now envisioned. Mae shuddered at the thought of undergoing another trip to the operating room. Quite aside from the pain and misery, few people in those days had medical insurance, and she apparently lived on a very restricted income.

There is one procedure from nursing lore that has now, I believe, been largely abandoned, but which sometimes has served as a last resort in trying to unplug the intestine: the return-flow enema. If an ordinary enema has proven fruitless, one fills the enema can with warm water, inserts the black torpedo-shaped nozzle well up into the suffering victim, and elevates the can two or three feet above bed level. When the can is nearly empty or the patient protests, the operator lowers the container, allowing the fluid to run back into the can. This is repeated slowly, over and over according to the tolerance of the two participants. If some gas bubbles appear in the can, they ignite eager hope.

This activity is generally done by women, by nurses. They're paid to do this sort of thing. But the stakes here were distressingly high, and it was my job to make her well. This had to be done right, and I had to do it. I explained my intention to Mae, and in an agitation of embarrassment and anxiety and cramping she gave her assent.

I went to the hospital and returned with the borrowed equipment. Mae lay on the bed on her left side. Joined by four feet of red rubber tubing, she and I slowly and patiently traded a quart of water back and forth for perhaps ten minutes. No gas bubbles appeared, and she continued to wince frequently from both the obstructed bowel and from my determined efforts.

I must say that, in theory, I can see no reason for a return-flow enema to succeed. There is no way the water is ever going to make its way up through all that length of limp and tortuous plumbing to the point of the obstruction; and even if it did, there's nothing solid to be washed away. Maybe it's a sort of internal massage effect, just moving intestinal loops around; or maybe it triggers some sort of muscular reflex in the bowel. But past teachings, and having previously seen apparent successes, were enough to persuade me to pursue this as the procedure of first, last, and only choice short of the knife.

I desisted for a bit to give Mae a rest, and at her suggestion even fixed myself a cup of tea. Then the hose and can and I went back to work.

After a few more passes with the gleaming bucketful of liquid desperation, suddenly the gurgling sound of bubbles could be heard issuing from the can. Another in-an-out cycle and more bubbles appeared, and the can was fuller than before, the fluid now green and turbid. At her request I removed the apparatus and she went to the bathroom, and through the closed door I could hear more signs of success. Her cramping stopped, and we exchanged tentative congratulations. I instructed her to eat no solids, and to take only a couple of ounces of liquids at a time for the next twelve hours, to make sure she didn't start vomiting. Then I went home and stumbled into bed.

Between 1954 and 1958 I saw Mae occasionally for minor things, but our relationship largely congealed around the threat of the adhesions. She had two more episodes of obstruction, and by the third trip she and I had the drill well developed: She calls and reports the symptoms; I pick up the equipment, drive to the yellow cottage, and knock on the slightly sagging screen door. Her voice, faintly audible, calls from her couch, "Come on in." My hand and stethoscope quickly confirm the situation. Mae assumes the fetal position on the neatly made bed with the hand-stitched quilt turned back, knees drawn up, her pale blue nightgown clutching what shreds of modesty and decorum are left to her. I solemnly go to work with hose and bucket.

Little conversation is needed. Her humiliation, my feeling of silliness, and our mutual dread of what failure will bring remain acknowledged but unspoken bonds between us, and we treat the process as if I were there simply to help with a clogged drain in her kitchen sink.

The sacrificial choreography and the rhythmic dance of magic water seemed always to be accepted by the deities of the bowel as sufficient, and she was spared the knife once more.

I don't know the rest of the story. One day I moved away, and never saw Mae Dye again.