Quirky Patients Part II: “Immaculate Conception”
It was one of those busy nights at the ER, full of patients seeking OPD treatment in an emergency setting (read: patients who are either too busy to go to regular clnics during weekdays or too impatient to line-up at those clinics) when this woman, at her early 20’s, entered, sat down in front of the ER reception desk, and said she was seeking consult for an abdominal pain she thought was due to indigestion.
She is a petite, chubby young woman, fair, and seemingly shy and soft-spoken. Her companion, a female cousin, is of similar disposition. Both sat and waited patiently as my co-resident and I disposed of the other patients.
Then I interviewed her and here is how our conversation went (in Filipino, for full effect):
Me: Ano po ang ikokonsulta?
Px: Sumasakit kasi tiyan ko simula pa ng hapon. Dito sa puson. Tapos nung umihi ako may mapula.
Me: Sige, i-examine muna kita tapos ipa-examine natin urine mo.
When I made her lay on her back at the examining bed, I noticed for the first time that her abdomen was slightly globular. What I noted as a bulging abdomen when she was sitting down was actually a small globular abdomen.
Me: Buntis ka ba?
Px: Hindi po. Tumaba lang.
Me: Sigurado ka ba? Mabilog ang tiyan mo. Hindi taba ‘yan. Kailan ang huling mense mo?
Px: December last year po.
Me: Hindi ka ba kinakabahan na 9 months ka ng hindi dinadatnan?
The patient didn’t reply.
Me: Kailan ang huli mong sexual contact?
Px: December din po.
My co-resident and I computed for the age of gestation and expected date of confinement.
Co-res: Pucha, 37-38 weeks AOG na ‘to ah, if reliable ang sexual history na binigay niya. Pero hindi malaki ‘yung abdomen niya for this pregnancy.
Pregnancy test done turned out positive. I checked for fetal heart tone.
Me: May heart beat. 130bpm. Positive pregnancy na ‘to. Puede pakitanggal ‘yung pants and underwear. Kelangan ko i-examine ang puerta mo.
When the patient removed her pants and underwear, I noted that there were blood stains on it. The patient claimed the stains weren’t there before she urinated. I became rather hesitant to do an IE since there is the possibility of a placenta overlying the cervical os, or placenta previa, which could bleed further if I manipulated the cervix. An ultrasound of the abdomen was needed to rule out the possibility.
But I wasn’t given that chance anymore. Several minutes later, the patient’s sheets underneath her were stained with clear, yellowish fluid. The amniotic bag was broken already. Then I did my IE.
Cervix was 100% effaced, and fully dilated.
Patient was already screaming that her abdomen and her vagina hurts. A very different kind of pain from the one she was complaining upon coming at the ER.
I ordered that the patient be hydrated intravenously and be taken directly to the delivery room, all the requisite blood sampling to be done once in the DR already. While I followed the patient to the DR, my co-resident called upon the OB-Gyn and pedia consultants on-deck that night to inform them of the situation.
But it seemed that the baby cannot wait any longer. After an hour of crash-course on proper breathing techniques and baby pushing and not screaming and endless reprimands to keep her legs and thighs wide open, she delivered a live, healthy, term baby girl, though a bit small for her gestational age. The baby seemed asleep and did not cry immediately. Upon suctioning of the mouth and nose, she finally got disturbed and irritated enough to scream to everybody’s satisfaction.
Just imagine how bothered, bewitched, and bewildered her cousin and her other housemates were when informed that the patient they brought in complaining of indigestion delivered a live baby girl. Nobody knew she was pregnant. Even the patient herself denied ever being pregnant.
When asked who and where the father is, the patient, now a mother of a baby girl, only smiled and said he is "just around".
Hmmm.
