Friday, January 24, 2014

A Preconceived Notion

Last week, I cared for a flight attendant suffering stomach flu. These are miserable episodes of vomiting, cramps, and diarrhea that rarely last long. She was better the following day, but on that day I returned to the hotel to see another flight attendant from the same airline with the same symptoms.

The visit ended an hour past lunchtime. I was hungry and decided to treat myself at restaurant near my home. I had parked when my phone rang. To my surprise, a third flight attendant at the same hotel had identical symptoms. I drove back, sucking on hard candy I keep for such occasions.

I repeated my stomach flu routine: examining her, delivering the usual advice, and handing over medication. She declined the medication, explaining that she might be pregnant.

Doctors are human. Having made a diagnosis, my inclination was to stick to it, but I asked a few questions. Her period was overdue. She admitted that her nausea, although worse today, had been present several weeks. Her cramps, also worse today, had been present a week.

OK… Maybe not a typical case of stomach flu plus an early pregnancy. She agreed to consult her doctor as soon as she returned home. I prepared to leave and then changed my mind. One of many rules medical students learn is that when a young woman of childbearing age has abdominal pain, one always considers an ectopic pregnancy. That’s a pregnancy in the fallopian tube which, unlike the womb, had no room for the growing fetus.

I told the flight attendant that she needed a test for an ectopic pregnancy which is an emergency. She did not object. I phoned the agency that handles airline crew, and its medical department promised to follow up.

I left unhappy with myself for being slow to discard a preconceived notion. It turned out she had a normal pregnancy but a chorionic hemorrhage, bleeding into the womb. This is not urgent but still….

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