My Mountaintop Blog

I don’t make a habit of getting into a patient’s personal life. I am supposed to be the consummate impartial observer. Sometimes, though, it just doesn’t work out that way.

We were dispatched lights and sirens for an abdominal pain. The update from dispatch indicated a 26 year old female that was conscious, alert, and breathing normally, with an acute onset of abdominal pain below the navel. As we drove to the call, my partner and I did what we always do and tried to guess what the diagnosis would be. My partner was going with appendicitis. I went out on a limb and said ectopic pregnancy. The patient was in the right age group to be pregnant, I argued, and anyway I was feeling adventurous.

We pulled up to an apartment building and strode up one flight of stairs. The fire department was there and the update we received from them was pretty much the same thing dispatch said. I went to the patient, who was sitting on a sofa and holding her abdomen. She wasn’t pale or diaphoretic. Her vital signs were normal. She did appear to be in a lot of pain, though. I went through the routine assessment of asking whether she could be pregnant (not a chance, she was on the pill), what she had eaten recently (pizza, breadsticks, and soda), if she had experienced any trauma (nope), and if her bowel habits had been normal (yes, for God’s sake!). I palpated her abdomen and didn’t get a grimace or guarding.

She was becoming increasingly agitated and finally blurted out, “Can we just go?!”

“Um, sure,” I said. “Can you walk or do we need to carry you out?”

“I’ll walk,” she answered, and stood up.

Her boyfriend had been hovering around, pacing back and forth, and didn’t say much. The patient didn’t say much to the boyfriend. We walked the patient to the ambulance, got her situated on the cot, and then I started in on my secondary assessment. As I was asking her more questions, I started an IV and gave her just enough Morphine to take the edge off. Then we started for the hospital.

I suppose I should have left well enough alone, but I was genuinely perplexed by this abdominal pain, so I kept assessing. I asked her a million more questions, but then I made the mistake of asking her to describe what the pain felt like.

“Like a cramp,” she said.

“A cramp?” I asked. “You mean, like if you went swimming and didn’t wait thirty minutes after eating…that sort of cramp?”

“Just a cramp,” she said.

“Okay, um, well, does the pain radiate anyplace else?”

“It starts in my sphincter and goes into my stomach. It is more like a spasm, I guess.”

I am sure the expression on my face must have looked like someone that had just heard a priest pass gas. It wasn’t something I was expecting to hear. My partner could overhear the conversation and I could hear her laughing. I was stumped, and not sure where to go next with this assessment.

“Okay, so it feels like your sphincter is spasming?” I finally asked.

The patient rolled her eyes. “Yes.”

“Okay, well, any ideas what might be causing this?” She didn’t answer and I could tell she was getting even more unsettled. “Okay, um, what were you doing right before the, um, spasm started?”

The patient folded her arms in a huff. “We were having sex.”

This wasn’t the first patient I had picked up that was having ‘complications,’ shall we say, from having sex. It was still embarrassing, though, for me and the patient.

“Um, I am not trying to pry, but was this sex…”

“We had anal sex, okay? Gawd! We had anal sex! I didn’t want to but he kept pushing me and pushing me!” she said, and then turned her face away so I couldn’t see her.

The laughing coming from my partner was making it even more difficult to concentrate. I called report to the hospital and the charge nurse was laughing uncontrollably before we hung up.

I am not a prude, at least in my eyes, but I do have my limits. It was an involuntary response. Really, I couldn’t help myself.

“Your anus should be used for an exit, not an entrance,” I said.

The patient snapped her head around to face me. “Ya think! Gawd!”

When I wrote the narrative for my chart, I had visions of her insurance company’s claims person breaking into hysteria and calling everyone in the office over to read it. The poor girl.