I Just Know
Posted by WhiteCoat on October 9, 2008
It has to be me.
A 20 year old came in at 11:30 PM for the following complaint: “There’s something crawling inside of me.”
“Where?”
“In my stomach.”
“OK, just out of curiosity, when was your last period?”
“About 6 months ago.”
“Hate to break it to you, but you’re probably pregnant.”
“How do you know?”
“I don’t. Let’s see. Hmmm. Your uterus is sticking up to the level of your belly button. That usually means you’re about 20 weeks pregnant.”
“There’s nothing else that it could be?”
“Well, I suppose you could be constipated. Hmmm. Hear that heartbeat of about 152 when I put the Doppler on that lump in your belly? That would be the baby’s heart beat.”
“Are you sure that isn’t my heart rate?”
“No, see that pulse oximeter reading on the monitor? Your heart rate is 88. This one is 152. Big difference.”
“Are you sure it couldn’t anything else?”
“Unless we’re on another planet and this is a scene from Alien, then yes, I’m sure.”
“Does that mean that you’re not going to do a pregnancy test on me?”
“Yes, it does.”
“You’re saying you know for sure I’m pregnant without even checking a pregnancy test?”
“Yes I do. You should read my blog some time.”
“I should what?”
“Nevermind. Have a nice day.”
The thing that got me the most was that even the patient’s nurse wondered why I didn’t do an ultrasound before discharging her.
By the way, the picture is from the movie “Alien” – it’s fake. The blood is fake, too. Monsters don’t really live in people’s stomachs.
rogue medic said
Did she look like John Hurt, or try the Texas accent that he does when he’s playing an American?
Joanna said
How do you not notice missing periods for 6 months? Or the fact your stomach is swelling up?
QuietusLeo said
-”Monsters don’t really live in people’s stomachs.”-
I’m not so sure about that. The last bezoar I saw was very monsterous.
;P
QuietusLeo said
bezoar
Dustin said
It’s funny (well, I thought it was funny), I was trying to get my wife to watch the Alien movies all throughout her pregnancy. She always refused…. Then we watched the second episode of Fringe (new series on… Fox?) and agreed that we were both very glad that she had the baby before we watched it.
Liz A. said
Poor kid. The baby, not the genius “mother.”
Kathy said
omg.
and I thought teaching people how to correct their dogs properly was bad enough.
(No, you do NOT stick your finger down your puppy’s throat to teach him not to bite you. That’s just dumb and doesn’t teach him anything.)
Marilyn said
If she shows up in your ED for delivery, PLEASE take this child. If she doesn’t know she’s pregnant, she won’t miss it.
Graham said
”Monsters don’t really live in people’s stomachs.”
I guess you don’t recall when your children were 2 years old.
By then, they’re outside of people’s stomachs.
How’s residency?
devy said
Did she really not notice? Really? That’s just unfortunate.
And I love your blog
Nurse K said
I hate it when all (+) pregnancy tests with no concerning symptoms are followed up with an immediate ultrasound from the ER. Like, uh, what are we going to see? She was 3 days late on her period and came in for a pregnancy test.
*High five to Whitecoat*
HyperAl said
Ok, let’s just say she got the pregnancy test and for wahtever reason it came back negative. Don’t tell me she’s going to leave you department really believing she is not pregnant. Amazing..
tempesta said
I’ve only today stumbled onto your blog but it is RIGHT ON as far as I’m concerned. I’d like to say I’ve always had monstly liberal/left-ist views, but in reality I have also always been a realist… and much of the liberal views of things are sadly naive and bear no relation to the reality out there on the streets (and in our ERs). People who slag on your blog have clearly never been told “Fuck you!” by a combative ETOH having the DTs, hit by heroin ODs after Narcan brings them around, called to their room or bed by “Hey, bitch!” nor had to give 50 g of charcoal via NG tube and then do continuous bowel irrigation with 1-2 L of GoLytely on a twentynothing who swallowed several bags of crack so the police wouldn’t find that “evidence.” Besides, either we legislate common sense on the back end (e.g. mandatory seat belt and infant/child car seat laws), because there’s been such a decline in it the last few decades, or we legislate minimum standards for parenting on the front end, which everyone would say is an abuse of power reminiscent of the forced sterilizations of mental patients in late 19th century and pre WWII US.
Yet it truly boggles me that you have to have a license to be a hairdresser or nail technician… but anyone, no matter how stupid, can have kids. There ought to be a law, but then it would be attacked for being fascist. However, as I’ve told my libertarian bf many, many times: No, I’m actually not in favor of local, county, state or federal government legislation that comes between my thoughts and my actions. However people who DON’T THINK apparently far outweigh people who do think, in our society (and seem to be getting dumber all the time) — so we have to pass laws or construct disclaimers and warnings to save these kids from their parents’ stupidity (and litigiousness). Otherwise these so-called parents would never put their kids in car seats or seat belts, would let them “play” with plastic bags, would leave buckets of water around where toddlers can fall into them, would give them toys about the same width as their airway to play with, etc. And then, when said parents are clearly at fault, they sue the maker of the car, plastic bag, bucket, etc. on top of it!
In our ER, we used to have to send urine HCG to the lab prior to any/all radiology on women of childbearing age to *prove* that they were NOT pregnant; otherwise, radiology wouldn’t take them! (More CYA/anti-lawsuit “policies & procedures.” Now that we have POC HCG, it’s just added an extra thing that Triage or the RN has to do, as if they had time. But we don’t typically tell the pt that we’re doing a urine (or blood) HCG, unless they’ve come in specifically with an ob/gyn complaint or knowing they’re pregnant from a home pregnancy test.
Which, if they do — now that our little inner city hospital closed our Ob/Gyn/L&D department — means they’ll be transferred to another hospital for L&D or Ob/Gyn emergencies. Over 1/3 of our L&Ds were self-pay, you see… which = no-pay, of course. The high cost of Ob/Gyn malpractice for Ob/gyn MDs and RNs vs. the income from only 2/3 of a largely high-risk, poor, inner-city, frequently with no prenatal care patient population… it’s simple math to try to keep us in the black. This, in addition to a 10% “workforce reduction.” Are we in the black? Um, no. But we’re less in the red now.
Last winter we had a woman in her late 30s adamantly tell us she could NOT be pregnant because “I would know if I was, I already got four at home.” So, have you been having regular menstrual periods? “No, but mine’s always been irregular.” Have you been using birth control? “I got the Depo.” When was your last Depo? “Last year.” So then you’re not getting them every three months like you’re supposed to? “Naw.” So you haven’t been using any birth control, then, have you? “Yeah, the Depo.” Which we’ve already determined you FAILED to get every 3 months like you’re supposed to. So, then, what is this full term fetus-sized protrusion of your abdomen? “I got a hernia.” (Which was true, but her hernia was only about the size of a snow globe — the REST of the large protrusion *behind* the hernia was a full term fetus.) Needless to say, her “abdominal pain” was labor, we got FHTs, & she gave birth to a full term baby boy a few hours later (who had no prenatal care, of course, because in her mind, she wasn’t pregnant).
All this, she claimed, came as a total surprise because she didn’t even know she was in labor. How, I asked her, could you not know you were in labor? “All mine’s was induced before.” Oh, so the sensation of being kicked and elbowed from the inside since you were about 20 weeks was… what? “I thought it was just gas.” Yet she already had four kids at home… Uh-huh. DeNial ain’t just a river in Egypt.
A few months later we had a 40-something woman who gave birth into her toilet (the paramedics brought her, the baby boy, and the placenta) because she “didn’t know” she was pregnant, because she was told ten years+ earlier she “couldn’t” get pregnant. She thought the movement inside was “indigestion.”
Christ on a cross, I can tell from the mittelschmerz when I’m OVULATING, yet I’ve never given birth …but these women, at full term, just “knew” they weren’t pregnant.
True stories. I wish they weren’t. The baby who came out into the toilet was a little chilled — as you can imagine — but he was fine considering she’d had no prenatal care at ALL. Of course, now if EMS brings women and babies like that to our ER, we will “stabilize” them and then transfer them to another hospital because we have no ob/gyn/L&D department anymore.
I read an article last year, I believe in the Guardian or perhaps BBC news web site, that the British (socialized) national health care system began, or was to begin, refusing to pay for the care of patients were were non-compliant with meds &/or treatment &/or lifestyle changes. We SO need to adopt something like that here. You were on Depo? Possibly the least forethought-requiring form of birth control after tubal ligation or IUD? And you just blew off the last one and haven’t gotten a Depo shot in 10 months? That pregnancy test? It’s gonna cost you $10-20… because you also have to pay for the TIME of the ER staff who perform the HCG. Somehow, they have no money for a pregnancy test from the nearest drug store, but they’ve got the bling cell phone, the boots with the fur… (and can’t afford to get a thermometer for the kids they have at home, let alone the Children’s Tylenol or Children’s Motrin to keep their fevers down so they don’t have febrile seizures and wind up in our ER).
But I digress.
Roamingcattle Blog » Blog Archive » M2 days 29, 30, 31, 32, 33 said
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C. said
There’s something crawling around in my head!
Strong One said
Aahhh.. the wonders of medicine.
SeaSpray said
Oh WOW! I am sooooooooooooooooo RELIEVED to hear monsters don’t live in people’s stomachs!
Good for you! Of course she probably lamented to anyone listening that YOU wouldn’t give her a pregnancy test.
Regarding Tempesta’s comment about the woman with 4 children and not knowing she was about to deliver her fifth, who also didn’t receive the benefits of prenatal care… I am speechless. (WC..you know that’s not the norm for me) I have so many adjectives crawling around in my brain (not all bad) but they came on so quickly they flooded and got stuck at my brain gate and I just can’t articulate a decent sentence about this behavior/lifestyle until my thought processes calm down. YIKES!!!!!! O.K…one got out.
miztres said
Maybe she’s a timelord and she ate too many jellybabies …maybe.
Once I looked up online what the hell timelords and jelly babies are, I laughed out loud at this one.
this and that » Blog Archive » lol said
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