Authors: Robert D. Lesslie
The triage nurse placed the chart of a new patient in the “To Be Seen” basket. I turned around and watched as she led a teenage girl and her mother down the hall. She directed the two into our Gyn room and then closed the door behind them.
“Hmm, wonder what that is?” I mused.
“Tonight, could be anything,” Marcella opined.
I picked up the new chart and began to read.
Samantha Towers.
15-year-old female.
Chief complaint: abdominal pain and nausea.
I looked down to her vital signs. Blood pressure and pulse were recorded as normal. No fever. All that was good.
“Well, I guess I’ll go find out.”
After tapping lightly on the exam room door, I pushed it opened and stepped in.
“Samantha Towers? Hello, I’m Dr. Lesslie,” I said, looking at the young girl who was now sitting on the exam table. Her knees were drawn up to her chin, and she had covered herself with a hospital sheet. Her toes were peeking out and I noticed her nails had recently been painted bright red. Closing the door behind me, I addressed the older woman who was sitting on a stool in the corner. “And you’re…?” I paused, leaving room for a response.
“I’m Samantha’s mother, Sarah Stroud,” she stated.
Two different last names. I glanced at the medical chart and quickly noted that the “single” box in the marital status section had been checked.
Ms. Stroud was very perceptive. She had noticed my furtive glance at the clipboard. “I got divorced when Sam—Samantha—was ten. She wanted to keep her last name.” She shrugged. “All the same to me.”
“Okay, good,” I remarked, pulling over the other stool in the room and sitting down. I put the chart in my lap and both hands on my knees. Leaning forward a little, I asked, “Samantha? Would you rather be called Sam, or Samantha?”
“Sam would be fine,” she whispered.
“Speak up, Sam,” her mother directed. “He’s got to be able to hear you.”
“Sam is fine,” she repeated, louder this time, followed by a sideways glance at her mother.
“Okay, Sam. What’s the problem tonight? What brings you to the ER?”
She looked at her mother.
“Go ahead and tell him, Sam,” Mrs. Stroud said. “Tell him why we’re here.”
Sam looked back at me. “It’s my stomach,” she said. “It’s been hurtin’.”
“Alright,” I coaxed. “And when did this start?”
This was going to take a while. I almost looked down at my wristwatch, but then I remembered Mrs. Stroud. She would probably catch me. I shifted my weight on the stool.
It turned out that Sam had been experiencing some vague lower abdominal pain for about three weeks. It had gotten a little worse over the past few days, but now the main problem was nausea. Every morning she awoke with severe nausea, and by noon she had vomited half a dozen times. There had been no fever, no bleeding, and no trauma. She had no history of any significant medical problems.
Hmm. A young woman with abdominal cramping and morning sickness. This was starting to sound a little familiar.
“Sam, when was your last period?” I asked her.
She immediately looked at her mother.
Sarah Stroud quickly spoke up. “She’s never missed a period. Regular as a clock. The last one was…when? Two weeks ago?” she asked her daughter.
“Yeah, that’s right,” Sam answered, nodding vigorously. “It was two weeks ago today.”
“Okay,” I responded, placing a question mark in the box entitled “last menstrual period.” Something didn’t seem right here.
“Now, Sam. I need to ask you a few personal questions.” I glanced over at her mother who was staring at me with pursed lips, waiting.
Looking back at Samantha, “Have you ever been sexually active? Ever had sex with anyone?” I asked as delicately as I could.
“Good Lord, no!” her mother answered for her. “This child is a virgin! Why, of course not. You tell him so, Sam.”
I had kept my eyes on Sam during this exchange. She had been watching her mother and had not blinked an eye. She remained completely impassive.
She looked at me then and coolly said, “No, Doctor. I have never had sex.”
“Are you—” I tried to pursue the issue.
“There. See? She’s never had sex,” her mother interrupted. “Now, can you please tell us what you think is the matter with Sam? What is causing her pain and vomiting?”
I shifted my feet and studied the medical chart, weighing my options. It appeared obvious that any further direct questioning would not be fruitful. In fact, it would probably end with these two women walking out of the ER.
Standing up, I said, “Well, let’s just check your tummy and see where your pain is located.”
I walked over to the side of the table.
“Samantha, could you just lie back on the bed for me? Just get comfortable.”
As I said this, her mother stood up from her stool and walked over behind me. She stood at my shoulder, watching.
Samantha dutifully followed my instructions and lay down on her back. Her hands were folded behind her head and she gazed at the ceiling, seeming quite relaxed.
“Okay,” I said, lowering the sheet just enough to expose her abdomen. “Can you point to where it hurts the most?”
She was a slender girl and I immediately noticed a rounded protuberance just below her belly button. I glanced over my shoulder at Mrs. Stroud. If she had noticed anything her expression certainly didn’t betray it.
Looking back at Sam I said, “Just show me where it hurts.”
She used the index finger of her right hand to make large, circular motions over her entire lower abdomen. Not very helpful.
“Alright,” I said, placing my left hand on her mid-abdomen with my right hand on top of it. “Tell me if this hurts.”
Her abdominal exam did not reveal any significant tenderness, and she was unable to localize any point of maximum discomfort. I had been studying her face throughout, and she had remained passive and seemingly quite comfortable.
What I
had
found was a firm, nontender mass located just below
her umbilicus and extending down into her pelvis. About twenty weeks along, I guessed.
After listening to her heart and lungs and completing my exam, I pulled the sheet back up, covering her. She grabbed the edge and again pulled it up to her chin.
“Well, Sam, I need to ask you one more time. Are you sure your periods have been regular and you’ve never been sexually active?”
“I thought we covered this, Doctor,” her mother answered, obviously agitated. “If you’re going to keep badgering her about this, we will leave right this minute. You heard what she said. She’s never had sex with a man.”
Sam continued to stare at the ceiling.
“Alright.” I backed off. “Let’s, uh, let’s just check a few things. We’ll get a CBC and a urine specimen. Then I’ll be back with you.”
Mrs. Stroud had stepped over to the side of the table and was patting her daughter’s arm.
“And how long will all that take?” she asked impatiently.
“Not long,” I answered. “Twenty, thirty minutes. And then we’ll talk.”
I walked up the hallway, considering my options here. We would get a pregnancy test, and I knew it would be positive. But how was I going to break that news to Samantha and her mother? They seemed convinced she was a virgin.
Stopping at the nurses’ station, I put the chart on the counter and began writing. After jotting down a few notes, I looked over at our secretary.
“Marcella, could you get a CBC and a urinalysis in Gyn?” I asked her. “And a pregnancy test too.”
“Sure, Doctor.” She immediately reached out for the appropriate lab slips.
Jeff had been standing nearby and he walked over.
“What’s goin’ on? You seem a little bothered,” he observed.
I told him Sam’s story, and my dilemma.
“Well, you never know. Maybe they’re telling the truth. Maybe she
is
a virgin, and maybe she’s pregnant,” he said, smiling. “Happened once before.”
I looked at him over the top of my glasses. “Now wouldn’t that be something?” I remarked, not amused.
It took forty minutes, but we had our answer. Samantha’s CBC was completely normal, as was her urinalysis. And her pregnancy test
was
positive. The lab tech had walked the results around to the ER and as she handed them to me she said, “Turned positive almost before the drop of urine hit the card.”
“Hmm,” I muttered. “Thanks.”
I picked up her chart, attached the lab results, and headed down the hall to the Gyn room. This was going to be interesting.
Jeff was pushing a wheelchair up the hall. The eighteen-year-old patient in it had sprained his ankle playing basketball and was on his way back from X-ray. As our paths crossed, Jeff asked, “Got your miracle?”
I returned his Cheshire-cat smile with a disapproving frown.
Mrs. Stroud didn’t move from Samantha’s side as I closed the door of the exam room behind me. She looked at me questioningly, while Sam just stared up at the ceiling.
“Sam, Mrs. Stroud,” I began. “I think we have our answer.” I held her chart in my left hand. Then I placed my right palm on top of it, staking my claim to the forthcoming diagnosis.
“And what is that, Doctor?” Mrs. Stroud asked.
“We’ve got our lab results back and they…” I started but then stopped, deciding on a different approach. “Sam, are you sure your periods have been—”
“Dr. Lesslie, that is just about enough!” Mrs. Stroud interrupted, with a subtle but unmistakable arching back of her shoulders.
I gave up. “Okay, okay. Let’s just go over her lab studies.”
Edging closer to Mrs. Stroud and the exam table, I opened the chart and began to review the lab-report slips attached to the top sheet of paper.
“Alright, this is her CBC, and it checks for any evidence of infection or anemia. And it’s fine. And this,” pointing to another slip, “is her urinalysis. No problem here—no blood, no infection. All that is good.”
I took a deep breath before pointing to the next lab slip. “And this one, this is a pregnancy test. We checked, just to be sure. And as you can see, it is positive.”
There, I had said it.
“What?” the mother exclaimed, grabbing the chart from my hands. “That’s impossible!”
“Well, you can see for yourself,” I explained, pointing to the appropriate box on the slip and the large “+” sign. “The lab doesn’t make mistakes about this kind of thing.”
“I don’t care about the lab!” she shouted. “This has to be wrong. It must be someone else’s report.” She said this while looking down at her daughter. Sam continued to stare at the ceiling. It might just have been the exam room lighting, but she seemed a little pale now.
I stepped between Mrs. Stroud and Samantha and I patted the young girl on her belly and said, “Mrs. Stroud, I want you to feel something.”
Slipping the sheet down far enough to expose Samantha’s lower abdomen, I guided Mrs. Stroud’s reluctant hand to the now-diagnosed gravid uterus.
“Can you feel this?” I asked, helping her fingers outline the grapefruit-sized growth. “This is her uterus, her womb. I would guess she is about twenty weeks pregnant.”
Mrs. Stroud felt the firm, curved mass, and then pulled her hand away.
“Must be a mistake,” she stated, shaking her head resolutely. “Sam is a virgin, and there must be a mistake somewhere.”
Samantha continued to stare at the ceiling, and she again pulled the hospital sheet up to her chin.
“Doctor, this is impossible, and I, we—” Mrs. Stroud stammered.
She was struggling, and I interrupted, trying to help her. “Tell you what. Why don’t the two of you talk for a few minutes. I’ve got a couple of things to do and then I’ll be back. Okay?”
There was no immediate response, and I exited the room in silence.
At the nurses’ station, Jeff stood waiting.
“What’s the verdict?” he asked, with a smile.
“Well, Jeff,” I answered. “I’d say the odds are getting slimmer. But there’s still an outside chance we could have our Christmas miracle.”
“Yeah, sure. I’d say those odds are between slim and none,” he teased.
Twenty minutes later I handed the chart of an elderly gentleman in room 3 to our secretary. “We need some blood work and a chest X-ray,” I told her. Fever, cough, shortness of breath—it would probably be pneumonia.
Just then, the triage nurse put another chart on the countertop, making a total now of at least eight new patients who needed to be seen.
That was enough. It was time to go and talk with Mrs. Stroud and her daughter. Doggone it, I needed to find out if I had my miracle or not.
As I closed the Gyn room door behind me, it was as if I had stepped into another universe. The atmosphere had radically changed, and instead of being met by a belligerent mother and an indifferent daughter, I saw the two standing before me side-by-side. They were smiling and had their arms around each other. Samantha was now dressed, and Mrs. Stroud had her pocketbook slung over her shoulder.