Mid January, 1997
This month the department of Obstetrics and Gynecology owns me lock, stock & barrel. Or as I tell my friends while grinning like an idiot, "I'm delving into some hitherto unknown crevices... "
I'm post-call today, a bit fried-out, but not nearly as badly as if I were post on a weekday. After all, I got to go home to sleep around nine this morning, whereas any other time I wudda been there until around six or so.
One of the duties of the 'tern who's taking call for Ob is to field phone calls from patients. They can range the gamut from, "I'm 39 weeks pregnant and I've been having contractions every three minutes and my water just broke. What should I do?" to "I'm six weeks pregnant, and I have this sore throat and a cough. Should I come into labor & delivery?"
For what it's worth, the answers are, "Come in right away," and "No," respectively.
The call I got the other afternoon however, was so incredibly surreal that I have trouble believing that it wasn't a prank, even though I'm quite certain that it wasn't.
I answered the outside page in typical fashion for my call-days on this service with, "Hello, this is Dr. Eubanks . . ." --Ordinarily, folks would hear something more along the lines of, "Hey, it's Marcus; I was paged," but if I do that with these calls, the question I get in response is invariably, "Er . . . are you a doctor?" I've been trying to nip that in the bud, 'cause these calls can eat up an awful lot of your night regardless, and I don't want to compound it by wasting time on confusion from the very start.
With this particular call there is dead silence for a moment, which isn't terribly unusual, then, "Er - is this a doctor?"
So much for avoiding initial confusion. "Yes. Yes I am. Hi there. What can I do for you?"
"Well, when my son was eighteen, he was arrested by the police, and they beat him up. I've been living in this area for quite a while, and you know, they had no right to do anything like that."
Startled, I let her go on for a couple-hundred seconds until she takes a break for air. Seeing my opportunity, I leap into the fray astutely. "Ah, excuse me ma'am, are you aware that you're talking to an Obstetrics and Gynecology doctor?"
Momentarily befuddled by my penetrating history-gathering, she replies, "yes."
Not to be outwitted, I shoot back, "okay - are you pregnant?"
"I see." With full realization that I'm about to open the floodgates again, I counter with, "Well, how can I help you tonight?"
"The chief of police of Sewickly has planted several microchips in my privates, and I don't think they're allowed to do that."
"Yeah. The whole police department there, they're monitoring me all the time, and they want to control my privates. They also want to cut off my clitoris. Can you recommend a good lawyer?"
She goes on at length, in the same vein. After about three minutes of this all of the nurses in Labor & Delivery are staring at me, probably because of the truly remarkable faces I'm making at the phone. The caller is absolutely emphatic about her need for a good attorney.
"O gosh, ma'am, I'm just a doctor. I don't know anything about the law. I'll tell you though, if you think there are people who are out to get you, you should come to our emergency room right away, and we'll make sure that no-one hurts you. Will you do that?"
"No, I don't think so. Goodbye."
If I'd really been thinking fast, I would have told her to call one of the local ambulance-chasers who advertises late-nite on cheap local tv stations. Well okay; maybe not, but at least it would have been funnier to meš
The other night on-call, I got paged to one of the Fateful Set of numbers. We've got a few of 'em here, but probably the worst are 3252 and 8454. Yes indeedy, these are the numbers to the two main nursing stations in the emergency department. As soon as I saw the digits, my heart sank. Aw, shit, I thought. Consult time. Damn, damn, damn.
Returned the page and ended up talking with one of my counterparts. Todd wanted me to come down and evaluate a young woman who was twelve weeks pregnant and experiencing some vaginal bleeding. "I sent off the quant HCG," he said, "and I've done both external and vaginal ultrasounds. I'm not really seeing much, bro."
"Jah love, man. We're on our way."
With her status as a gravid female with crampy abdominal pain and bleeding, she'd bought herself the Rule-out Ectopic workup. We're sorta silly in this respect - our minds always leap to the thing that could kill the patient. Once we've satisfied ourselves that they don't have something that's gonna buy them a nice burial plot and headstone we can sit back and try to figger out who we're gonna send 'em to as an outpatient for the definitive workup. In this case, however, I was the consultant for the "prove to me they ain't gonna die in the next several hours" part, or rather, I was advance guard for the real consultants.
I went down to see her, taking the medical student along with me. Grabbed the chart and cursed, right off the bat. "Oh, this is just fucking lovely. She's fourteen. Marvelous." The stud raised his eyebrows in surprise and glanced quickly around the desk at the nursing station, which was quite crowded. He still wasn't quite used to my nasty habit of casually over-using rather, ah - colorful language.
I cursed again, more quietly this time. Todd had of course told me all of the particulars when I talked to him on the phone, but somehow it hadn't quite hit me. Fourteen. Magic.
The first thing she said after I'd introduced myself and the stud as representatives of obstetrics and gynecology was, "This isn't going to take long, is it?"
I folded my chin down into my hand and looked at the floor for a moment. "Do you understand why we're down here talking to you Theresa?"
"'Cause I'm bleeding, right?"
"Well - no, not exactly. You're bleeding and you're in pain . . . " I stopped for a moment. "You are in pain, aren't you?"
"Okay. You're bleeding, you're in pain and you're pregnant. We're worried that the pregnancy might be in one of your tubes. The reason this could be bad is that your tubes aren't meant to hold a pregnancy, and when the fetus gets too big the tube can burst and you can bleed inside so bad that you die from it."
"So when did you first notice the pain?"
"When I got out of bed today."
"So sometime this morning?"
"No, I don't get up until two or three."
"Ah. You work nights?"
"No, I just like to hang out and party with my friends, you know?"
"Ah." I thought about this for a moment and decided to leave it alone. "When did the bleeding start?"
"When I woke up."
I looked down at my watch. It was about forty minutes after midnight.
"So you waited until about ten-thirty to come to the E/R, huh?"
Once again, I decided to leave it alone. Honest to god though, there was a little editorial soundtrack running through the back of my mind. Stand-up comedian on stage in a plaid jacket delivering deadpan patter in a silly voice going, Nice girl, but about as sharp as a sack of wet mice. I shook my head to rid myself of the image. "Okay. We're going to have to do another pelvic exam and ultrasound." At this she looked massively unhappy, but I couldn't tell if it was because of the news that she would have to endure the speculum again or because I'd just reached behind me to turn off the tv that was blaring in my ears.
Cynical? Me? Nah . . .
The long and short of it was that we had to take her upstairs to the room which held the special high-resolution obstetric and gyne ultrasound machine, and we had to drag one of the maternal-fetal medicine attendings in from home to run it for us.
We were in fact able to rule out the possibility of ectopic pregnancy for her, but at the same time we learned why she was bleeding - the pregnancy which she was carrying in her uterus had ceased to be viable, and by the size of what was there, this had probably happened about four weeks ago. The bleeding and discomfort she was experiencing was her body's apparently ineffective attempt at clearing her uterus.
We explained all of this to her carefully, though her affect remained rather blas the entire time. The fifteen year-old boyfriend, her partner in this endeavor had opted not to join her with us upstairs for the formal ultrasound, choosing instead to hang out in the emergency department driveway so he could smoke. Her parents were nowhere to be found.
Because she was now roughly a month out from the terminal event, we told her that we wanted to return to us on Monday so we could perform a D&C, lest she continue to retain the products of conception and eventually succumb to infection. Back in the E/R, the boyfriend's aunt (who might have been all of seventeen) suggested that she might be able to come in with Theresa on the appointed day and sign our consent forms.
"Are you her guardian?" I asked.
"Oh. Well, where are her folks?"
"She doesn't like them, so she doesn't live with either of them."
"I see. Well - you know, you really can't give consent on her behalf if you aren't her guardian. I'll need one of her parents to come in with her."
"But she doesn't like them," she insisted.
"It doesn't really matter much. This whole situation is kinda unusual." I said, in an utterly bald-faced lie. "If someone can't tell us how to get in touch with her folks tonight, I'm going to have to get County Youth Services involved in this, and I won't be able to let her leave until they get things straightened out." This last was completely true.
"Well we could just leave," the boyfriend's aunt announced angrily, with Theresa nodding vigorously behind her.
"You certainly could. Theresa, on the other hand, would be remaining with us, in our protective custody. She suffers from a potentially life-threatening medical condition, and until I'm comfortable that it will be addressed in a timely fashion I am obligated, by law, to keep her here. It's your call."
In the end I got the father's phone number, and called it sometime in the wee hours of the morning. The background was complete cacophony, with children yelling and music playing at incredible volume. I explained the whole situation to him, telling him that he'd have to come in to sign her consent, or at least to talk to us about what was going on.
Much to my surprise, he was pleasant and reasonable. It was his last remark that floored me though. "Ya know doc, I can't help thinking that this might not have been the best thing for her. I mean, at her age and all."
I rode the elevator back to the twelfth floor wondering if there might not be hope for her after all.
Copyright 1997 Marcus Eubanks, All Rights Reserved.
Copyright © 1997 MedWorld Project. All Rights Reserved.