The Gynecology Room

Everyone who has had the pleasure of working in emergency medicine has had their share of memorable patients. I actually have memorable patients in various categories: funny ones, stupid ones, ones I liked, and ones I hated. An old attending physician told me something that I have come to believe is true. He said, "If the patient pisses you off in the first 15 seconds of the interview, they have a personality disorder." I have found that if the patient makes you laugh in the first 15 seconds, the shift will go much faster.

The following are some patients I remember fondly from the dreaded gynecology room (colloquially called the "tuna pit" by the staff):

#1 (20-year-old Jerry Springer Show reject). I had to inform this eloquent young lady that her abdominal pain was due to her heretofore undiagnosed pregnancy to which she responded, "I can't be pregnant because my husband had a hysterectomy." Sigh...

#2 (27-year old morbidly-obese frequent flyer). After delaying the pelvic exam as long as I could (I was hoping I could push it off on my partner at shift change), I went to the gyn room with a nurse. I asked the patient, "What's the matter today Donna?" With a straight face she said, "It feels like Dr. Chong (the local Medicaid OB/GYN) put my IUD in with a pogo stick. I can feel it moving around in my pussy." Sigh...

#3 (Young married couple--not the sharpest knives in the drawer). I went to gynecology room where I found the wife reading the National Enquirer and the husband (a big burley blue collar kind of guy) reading BASSMASTERmagazine. I kindly asked, "What brings you to the ER today?" The young woman, ever so polite, said, "Doctor, I hate to bother you, but I ran out of my pills and can't get a hold of my doctor." I said, "What pills?" She produced a birth control package that was empty (we don't refill birth control pills, but I played along). The prescription was for a six month supply (21-day regimen) and was issued only 2-3 months earlier. I said, "You got a six-month supply. You know that you are supposed to stop taking the pills for a week after each pack for your period to start." She said, "Really?" I said, "Really." She pondered what I said for a minute and said, "I wondered why I ain't got my period in several months." Then, I realized that even this did not explain why she was out of her pills. I said, "How do you take your pills?" She replied, "My husband works nights so we take them before he goes to work." I paused to carefully assure I heard her right and said, "Did you say 'we'?" She replied matter-of-factly, "Yes. I take mine and he takes his." Evidently, both the husband and wife were taking oral contraceptives. I look at the man reading the BASSMASTER magazine to see if he is growing breasts. Can't tell for sure. Time to send in the nurse. Sigh...

#4 (Very prim and proper looking 50ish female with a quasi-Pentecostal look). I saw this patient walk in. She walked beside the nurse looking around the ER. She was plainly-dressed with a blue jeans skirt and a Pentecostal bun--no makeup or jewelry. Such patients were not uncommon in our ER and were usually quite pleasant. She was placed in a minor medicine room and I went to see her promptly with a young female nursing student in tow. I introduced myself and sat on the stool. She said, "Well doctor, I got a bad headache and it won't go away after two BC powders." I listened intently going through my list of differential diagnoses. I asked, "What were you doing when the headache started." Without a pause she replied, "Well doctor, my husband and I were f**king. After several minutes of it I was about to go 'boom-boom' and my head started hurting." I sat there for a few minutes literally speechless. For clarification I asked, "What do you mean by 'boom-boom'?" Again, without a pause she said, "You know I was about to come...go 'boom-boom'. Isn't that what you call it?" The young nursing student, all professional in her white dress and smock, was trying to keep from laughing so hard I literally thought she would piss her pants. I excused myself and walked to the ambulance dock where I laughed my ass off for at least 10 minutes. Sigh... (P.S. Mrs. Boom-Boom's CT was negative and her headache went away with some Imetrex).

You gotta' love medicine...