This story was too long to post all at once, so I’ve decided to post it as a miniseries, a la Sherlock and Downton Abbey. It is based on one of the most emotionally taxing patient encounters I have had so far in my medical career. I hope y’all enjoy it.
Ah, I love when my clinic days don’t start until 9. I can actually get caught up on my work and maybe have 15 or 20 minutes to read a bit, too. This is great. Let me check my schedule for the morning…hmm… pelvic pain—don’t know that patient—oh great, she’s new.…then a new OB continuity patient… crap, she needs an interpreter. That visit will take forever…ok then a stuffy nosed kid. Not like I haven’t seen a thousand of those this week… and then a neck pain. This schedule just keeps getting better and better. This guy will probably turn out to be a pain in my neck and ask for Lortab. Great…
Ahh, all caught up. Maybe I can still knock out a few pages of reading before my 9:00 patient gets here. First patients are always late getting put in a room. I got this.
Pelvic pain’s still not here. Maybe I can actually finish this reading. 2 minutes until she gets declared a no-show!
Wait, why is Pelvic pain’s name not X’ed out? That’s a no-show! 22 minutes people! 22 minutes!
Doctor, I’ve got Ms. K in a room now. And Mrs. R and her translator will be ready in about 5 minutes.
Well, there went all hope of me staying on schedule today. Ugh, pelvic pain, here we go.
Hi Ms. K, I’m Dr. Wayfaring. Nice to meet you. So tell me what’s been going on with you.
[With lips trembling, she starts quietly.] “Well… um…I went to the ER a few months ago because there’s something falling out of me. They told me it was a…prolapse? They said I needed a regular doctor to follow it but I don’t have insurance so it took me a long time to find an office that would take me. I try to hold in my bowel movements because it falls out and it hurts. And it falls out if I cough too. Do you think it’s bad that it bleeds all the time? I don’t even know if I’m having periods anymore because I bleed every day. And…this is really embarrassing…it smells really bad. I wash and I wash, but the smell won’t go away.”
[After further questioning, ruling out infection, incontinence, and fistula] Ok, well if it is a uterine prolapse, the treatment sort of depends on how far it has prolapsed. So if you don’t mind, let me examine you and see exactly what we’re dealing with.
Alright Ms. K, relax your legs for me. I’m just going to look first. Can you bear down for me like you’re going to have a bowel movement? Holy heck…what is that thing?! That is not her cervix. And wow, she was not kidding about the smell. Ms. K, have all your pap smears in the past been normal?
“Yes. My last one was about a year ago. They said it was normal.”
Ok, I’m going to insert the speculum now. Nurse B, can I get a large swab? She’s bleeding quite a bit. Dab. Dab. Dab. Oh man, that does not look good. Is this what I think it is?
To find out what I saw, check back tomorrow for Episode 2.