Night Shift: Congratulations?

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Some nights it seems like everyone has belly pain. And with so many people requiring CT to rule out the bad stuff, combined with CT being slow, I’m always glad when I get one of those “uncomplicated” belly pains. So it appeared as I headed to the room with my arms full of charts and my trusty scribe in tow. I looked at the chief complaint, “Does not feel well, nausea.”

“When was your last period,” the nurse was asking as I entered the room. She took the question out of my mouth.


“February?” the patient replied rather sheepishly. The nurse just looked at me with the same look.

“That’s two months ago,” the nurse replied with restrained incredulity.

“Have you done a pregnancy test?” I jumped in. “You could be pregnant, you know.”  But, maybe not… I’m pretty old school so I reflexively looked at her ring-less hand. “Maybe the better question is, ‘Have you been having unprotected sex?’”


“I have three children, ages 18, 15, and 11. My husband and I use birth control religiously,” she replied with a certain authority.

I’ve always loved that term, “use birth control religiously.”  I never knew what that meant. I know sex can sometimes be a religious experience. But birth control?  Does that mean that you use birth control about as often as you attend church?  Show up late, leave early. Sing and dance through the first part, but fall asleep during the most important parts. Whatever it means, it’s no wonder the population is booming.

“In fact,” she went on, “I have the medicine for my depo shot right here in my purse.”  She combed through her purse to show me as if it was going to work through the thick leather bag.

“Ok, we’ll check it out though,” I said before launching into my standard work up for nausea and belly pain. She seemed to be satisfied that the question had been laid to rest. But I wasn’t. I remembered the case of my sister-in-law. After years of struggling to get pregnant she finally succeeded, only to have every complication in the book. She was satisfied to have an only child. But then after 12 years she got pregnant again.


After yet another horrific experience she gladly signed the consent for tubal cautery and excision. But then two years later, she too presented to the ER with “nausea and fatigue.” When she received the news of her pregnancy she was flabbergasted. Her husband though was beaming with pride. I remember her saying incredulously “They told me that the distance the sperm had to jump to reach the egg was the equivalent to a sperm Grand Canyon.”  My brother-in-law went around telling people that he was related to Evel Knievel.

Being pretty sure the test would come up positive, I started to ruminate on how she was going to take the news. Some people are desperate to get pregnant, I told myself. I remember talking to an OB/Gyn at a cocktail party who related the story of one of his patients who had failed IVF repeated who accosted him in a grocery store.

After looking around to see that the aisle was empty of other shoppers she grabbed him by his polo and pulled his face to hers and whispered through clenched teeth, “You are going to get me pregnant, right?”  He said his mouth went dry and he could only nod yes obediently. Everyone at the party howled at such hyperbole. But I suspected there was more truth to the story than he let on given the tremor of his hand as he recalled the situation. He recounted his relief at her eventual success. He had been convinced he was going to have to change his name and go into some kind of witness protection program in another state if he failed again.

But I also knew that there were a lot of unwanted pregnancies. I was one of them. After having three children, my mother was happy to be done. So when I came along, of course she had every complication, even requiring an emergency C-section. And if she had to have another baby she wanted a little girl to name after her mother. So after being presented with her new baby boy in the recovery room, she very famously declared “Take him back.”  I think she got over her feelings… I think.

But clearly some women don’t. Some pregnancies precipitate a crisis. When I congratulated one woman with the news that she did not have appendicitis, but rather was simply pregnant, she looked stricken. “I can’t be. I can’t be,” she cried out. Before I could even ask a follow-up she whispered, “my husband had a vasectomy years ago and I’ve been seeing another man.”

Beyond my own feelings of love for babies yet to be born and my religious teaching on the sanctity of life, I’m still quite aware of the personal dangers that all women, of every age, risk any time they choose to bring a life into the world. It is not a task to be taken up lightly. I am never far away from the memory of a beautiful young woman, big and ripe with child, who died from a saddle embolus in my ER. And when my daughter invited me into the delivery room of her first pregnancy I was a nervous wreck. Seeing her wracked with pain was one thing.

Watching petechia pop out on her face and eyes while her baby’s heart rate drop as she pushed with every contraction almost scared me to death. No, I’m fully aware that there reasons that some women choose not to take a pregnancy to term. So when I got saw the “Pos” on the HCG lab result screen I wondered how my patient was going to take the news.

“Have you told the lady in room 12 about her lab results,” I asked the nurse as I was walking to the room.

“Oh no,” she said. “I’ll give you that honor.”  Her look of uncertainty reflected my feelings as well.

“Well, I have good news and …,” I started to say upon entering the room. But no, ‘this isn’t bad news,’ I reprimanded myself mentally. “It doesn’t look like you have an appendicitis.” Of course, I never actually thought it was this diagnosis. “But you are pregnant.”  And now I know where that expression comes from. The pause.

“Really?” she said taking several slow deep breaths.

“Really,” I said. “Congratulations,” I said warmly. She said nothing as she took more long breaths and swallowed subconsciously. Then a distant warm smile spread over her face as she shook her head gently and seemed to look into the distance.

“Really?” she repeated. But this time the smile was bigger and aimed at me. I just shook my head and rubbed my chin. “I have my depo shot right here in my purse,” she said digging through her bag.

“Sorry, but it doesn’t work in your purse,” I quipped now starting to have fun with this.  She began pinching her arm. “Is this for real?  My husband slipped one more in,” she said missing the double entendre.

“Having four children is not so bad,” I said. “I’m a fourth child. Don’t they say that the best is always last? How many boys and girls do you have?”

“I have two boys and my last is a girl,” she said still taking the situation in.

“Well there you have it, I said. “My mother had two boys, a girl, and then me. Maybe you should name your little boy Mark.”

Then she broke into a broad laugh. I didn’t know if it was the ridiculous suggestion or looking into the future. But after a few more moments we got down to the details of her return to the Ob circuit. And soon I was off to see more of my sick patients.

Stopping by the nurses’ station on her way out the door she was laughing and receiving congratulations from all the nurses. She finally reached over the counter where I was writing my notes to extend her hand. “Thank you,” she said warmly. I was about to say “You’re welcome,” but I realized that all the involved parties to this situation I did the least.

“Mark,” I finally said with a wink tapping my name tag.


FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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