Family Medicine: Memorable Last Day

Today was my last day of Family Medicine, and it was definitely not an ordinary day. A 15-year-old girl came to the clinic with her mother and two siblings for a well-check, and among the tests they wanted to run was a pregnancy test since her last period was back in January. She went to give a urine sample, but what she gave Shari (the lab tech) in the specimen cup was clear, colorless...and cold. That's right, there was nothing in that specimen cup but tap water. Shari came to the nurses' station to tell us and said, "Does she really think we're that stupid?" At the very least, the girl could have tried to make it realistic by heating the water; there's no way a urine sample is going to be cold. Still, she's a scared teenager with her mama in the room (the mother refused to leave her daughter alone, she wanted answers), and probably thought that was the best way to trick us. Still, Tawanna went to the room and gave the girl more water, saying the last sample was "too clear" for analysis. The girl didn't fess up, even after I went to her room to do a physical on her. It was hard to tell whether or not she was pregnant (13 weeks along based on her LMP) I did notice during the abdominal exam, though, she kept covering her lower abdomen protectively when I was pushing around. Finally at one point her sister said, "Can you hear a heartbeat? She thinks she might be pregnant."

Now we're getting somewhere, since she hadn't fessed up to the nurses. I then asked her about her sexual history (her mom doesn't speak English), and she said she'd been having unprotected sex with her boyfriend for six months. Hmm, well there you go. The girl knew she was probably pregnant; but as long as she didn't know for sure (and the urine test would have clinched the diagnosis for sure) then she could still be in denial and pretend nothing was wrong. I told Dr. RR what she told me (and Tawanna told him about the "clear" urine), and Dr. RR said, "You're nicer than me" because he would have gone in there and flat-out accused her of trying to fool us by substituting water for urine and say that she needed to get tested pronto so that she can start her prenatal vitamins and see an OB (her first trimester is just about over after all). We were all curious as to how he'd handle the situation, but he just told the girl that given her history he's 99% sure she's pregnant, and that they'd draw some blood today and he wanted to see her back tomorrow. She was surprisingly fine with it; maybe being told "You're pregnant" has forced her to take responsibility for her actions. Some of the MAs commented that she must have wanted that baby, because based on their own experience, if they wanted a child, they nixed the OCPs.

We had a few interesting cases today; a woman has come in several times in the last month with hematuria; there's only so many times it can be blamed on pyelonephritis so she's going to get a urology appointment. Another kid came in with a stomachache that all but vanished by the time he arrived at the clinic? The culprit? Spicy Hot Cheetos, which he apparently ate too much of. So in his assessment, I wrote, "Stomachache secondary to too many Hot Cheetos =)" Dr. RR laughed when he saw the smiley face. At the end of the day, Dr. RR said that I was an "excellent student" who was an asset to the clinic, and that if I ever need another rotation I can always come back. Lupe and Tawanna gave me hugs and I wish I could have said goodbye to Sue, but yes, I was sad to leave the clinic. From here on out, things are going to be harder.