The Poker Face

Never play poker with Emergency Medicine doctors. Our patients may show up in scary predicaments or with unusual piercings, but part of my job is to not participate in panic or react and make faces at gangrenous toes, etc.

The other day, I had a "surprise" while performing a pelvic exam. The story was typical: suprapubic pain in a 30's female, with her last menstrual period being in December. So we checked her urine for infection, and the tech got her all set up in the pelvic exam room.

Oh, did I mention she was from Somalia?

As I started to do the exam, I realized that she was missing all of her uh, external genitalia. Now, I had heard of this, but had never actually encountered it in person before. I think I kind of did a double-take, but didn't want to make her uncomfortable. The rest of the exam was unremarkable. In medical school, they told us to never say that everything "looks good" when doing pelvic/breast exams, so I usually say something about everything being "healthy and normal". I think this time I just settled on everything being healthy. In the end, she turned out to be pregnant, with no infection. After confirming that it wasn't an ectopic pregnancy, we sent her off on her way.

It has been interesting relocating here. Even though I am in a much smaller city, I am exposed to a much broader range of cultures and practices than I was back home. It's pretty cool.