Dysplasia Clinic: Lots of Laughs!

This morning we had to sit through a conference with attendings, residents, and nurses as they discussed cases in which patients met with less-than-great outcomes. One case in particular stood out: a febrile woman went into labor at 27 weeks, but had to stay in triage (I think) b/c all the beds in L&D were taken. One of the nurses took off the fetal monitor, and by the time L&D had a room, the woman had to stand up and walk to a wheelchair for transport. By the time that happened, her umbilical cord had prolapsed through her vagina and the baby's heart rate was slowing down bigtime. They rushed her to do a C-section but the baby's Apgars were 0/0. It took 15 minutes to get its heart beating again and the baby is currently on life support in the NICU. Nurses and doctors were both throwing out harsh criticisms at each other, and the moderator (another doctor) said it's useless to assign blame now; rather, it's important to prevent a similar tragedy from happening again.

The Green Team had Dysplasia Clinic today, so after a drug rep hosted lunch, we trooped down to the pathology lab to look at some slides of cervical dysplasia. Dr. T, an older physician, and Dr. MB were there to supervise. Afterwards we went back to the HCW to do colposcopies on women who presented previously with abnormal pap smears. One LEEP was done but Dr. C forgot to call Anita to the room to see it. And apparently it was just as well; family members are normally not allowed at LEEPs, but for this patient, an older woman insisted on being there. Dr. MB wasn't pleased since he has a rule against family members being with patients during LEEPs, but Dr. C didn't know the rule. When he called her on it when she stepped into the office briefly, she looked around quickly and whispered, "They're lovers." Then before we could process this information she said she'd fill us in later. But after she left, Dr. MB filled us in on how his lesbian patients got pregnant (mail-order sperm, artficial insemination, getting a male friend to have sex with them, etc).

I got to watch several colposcopies (and try to find the areas of dysplasia) and winced when I saw the punch biopsies. The cervix can bleed a lot. Later Dr. B shared another hilarious story in which his patient sneezed and the speculum shot out of her vagina and skidded across the floor ("Projectile speculum. There goes your Valsalva maneuver," joked Dr. K). Dr. MB came in shortly afterwards and, upon seeing some "bloody egg-yolk substance" on the ground, made a strange face while Dr. B frantically signalled him not to say a word (I didn't witness this; but Dr. MB and Dr. B both talked about it while the rest of us roared with laughter). Then Dr. D said that her cat has pneumonia and needed erythromycin eyedrops for its eyes, and Dr. K asked if her cat had chlamydia (since babies born to chlamydia moms need erythromycin). That was pretty random.

The best part had to be at the end of the day, when Dr. C came in to fill us in on her LEEP patient and her lover. Dr. MB commented that he never picked up the fact that they were lovers, and Dr. C related the conversations they had in the room that made her realize it. The next few lines come straight from Dr. C's recollections, with some of her thoughts in italics. And this really did happen:

Dr. C: (to the lover) Are you sure you want to be in here?
Lover: Yeah, I'll be fine. I just had a stroke two days ago (she was middle aged)
Dr. C: (thinking) That's not good.
Lover: (looking at the TV screen featuring the patient's cervix) Is that where a man's penis goes?
Dr. C: The vagina?
Lover: No (points to the cervix os)
Dr. C: No, it just goes in the vagina (Unless it's a really thin penis...)
Lover: Does the penis touch it? (the cervix)
Dr. C: It could...(If it was really long)
Lover: Can women get HPV from oral sex?
Dr. C: (realizes that the women were lesbians even though the patient has had children before) [I forgot what she said]
Lover: Can a tongue reach all the way up there? (to the cervix)
Dr. C: (desperately trying to think serious thoughts to keep from busting out laughing) Um...no (not unless it's a freaky long tongue...)

Thank goodness Dr. C closed the door to the office before telling us this story, because all of us--Dr. MB, Dr. G, Dr. D, Dr. B., Dr. K, Anita, and I--were laughing sooooooooooo hard afterwards! Dr. B then said, "Back to what we were saying earlier..." and changed the subject by talking about African countries (we had a patient from Nigeria earlier, and Dr. MB started talking about different African countries and their dialects), and Dr. MB said, "Dude, we were talking about lesbians." LOLOLOLOLOL!!!

Man, after today, I love my team. It's just too bad that next month Drs. B, G, and K are moving on to other teams and clinics, and we'll get a new intern and new FP resident (or two). *sigh* Better enjoy these last few days with them while I can.