The phone rings in the middle of the night. It’s not my father asking me what I’m gonna do with my life – it’s labour ward. The midwife on duty sounds about as thrilled to be calling me as I am to receive her call. They’ve had a call from the local police station. They’re bringing in one of their regulars who is pregnant and there’s been an “altercation” in the cells. The first word that comes to mind is not awesome.
I’ve been working in the public system as a junior doctor for a few years now and I’m used to dealing with the margins of society but I’m not prepared for tonight’s interaction.
I slowly get out of bed and drive myself to labour ward. It’s the dead of the night, maybe 2am. I’m tired. I’m exhausted in fact. I’ve been up until late seeing several other patients previously on labour ward. I arrive to hear someone in one of the labour rooms screaming like her toe-nails are being plucked out one by one. I chat to one of the attending police officers who tells me the story of my patient. A known drug offender who is apparently pregnant who became physically aggressive in the cells and was wrestled to the ground because of her very aggressive and abusive behaviour. She now claimed to be in severe pain and bleeding. As I listened to the lilting tones of her voice emanating from birth suite 2 I am reminded of the sound of a chainsaw or perhaps the pained howls of a wolf with its leg pinned in a bear trap. I think wistfully of my bed.
With a rather large swallow I entered her room. I call it HER room as there is no doubt that both physically and acoustically her presence was all-domineering within the confines of the 4 walls. Her attending midwife had recoiled into one of the corners. She was praying, I’m sure, that her assistance would not be required. I introduced myself to the patient and explained why I was there. Surprisingly, she stopped wailing and simply stared at me – perhaps looking for a chink in my paper-thin armour. I continued talking, asking questions, putting together a story to try and figure out the seriousness of the clinical picture that sat before me.
My practice at that time was to take a loose piece of paper in with me when I took a history from a patient. I would then transcribe the notes from the paper to the hospital chart after I left the room. After several minutes watching me do this she waited until I paused between questions and stabbed at my paper with her index finger and exclaimed quite loudly, “What sort of a f.ing doctor are you that you have to write shit down on a piece of paper?”
I cannot recall what my response to this question was. Obviously if I had been quick of wit I would have replied “The only f.ing doctor who’s going to bother seeing you tonight.” But alas, I do recall that I was a little reluctant to inflame this already aggravated damsel and so I probably ignored her or laughed uncomfortably and just kept going with my questions.
My difficulties increased exponentially when it came to the point of examination. Initially, she wouldn’t let me touch her in any way, shape or form. But after some discussion with myself and the midwife she finally relented to me having a feel of her abdomen. She was about 16 weeks pregnant and the uterus could be easily felt and appeared to be normal. However, every touch of her abdomen resulted in much grimacing and contorting of her facial features. This attractive display was accompanied by groans of pain and further demonstrations of her eloquent grasp of the Queens English e.g. “Aaaarrgggghh. What the F are you trying to me?” One might have thought that the tips of my fingers were hot pokers scalding her skin with the slightest of touches.
I hadn’t been a doctor for long but I was pretty sure I knew a put-on when I saw it.
Then came the question of the bleeding.
There was no way on God’s green Earth that she going to allow me to explore her nether regions. Neither for that matter was she going to allow the midwife to have a look either. Possibly an inspection of her sanitary napkin? “No. F off.” This pleasant exchange continued for a few minutes until I gave up. She, on the other hand took this as a sign to resume with her previous melodic tones punctuated by an occasional snarling comment towards her constabulary buddies such as “Ya F.ing coppers. What have ya F.ing done to me.”
I was at a loss. My gut feeling was that she was fine but her Shakespearean performance left me unsure. I had to ring the boss to find out what to do.
Imagine if you will the trepidation that a very junior doctor feels when ringing a very senior doctor at about 3am. Take that feeling and multiply it by about 50. That’s how you feel when you’re ringing that senior doctor with a story that you’re about 95% sure is absolute crap.
Regardless of that feeling I had to ring the boss. He dutifully listened to my story and at the end of it he had one question to ask me in his soft English accent.
“Warren. Is there any objective evidence of vaginal bleeding?”
“Uhm, No.” was my reply
“Then, Warren, send her back from whence she came.”
Those were his exact words. Even now, almost 20 years on I can hear his voice giving me the green light to trust my gut feeling. It was like music to my ears.
But now, I had to go and break the news to my friend. I was secretly soiling my underwear when I re-entered her domain. “I’ve talked to the boss”, I pronounced, “You’re fine to leave”. Somewhat terrified I cringed, expecting a barrage of abuse. She simply stopped her moaning, sat up in bed, put on her thongs and strode out to the awaiting police officers and led them to the patrol car.
I was so traumatised by the turn of events on labour ward that I went and had a cup of coffee and a cigarette (yes, I did used to smoke) outside in the car park with one of the midwives. As we sat there puffing and debriefing, the police car rolled slowly past. Our pregnant friend smiled and nodded as she stared at us through the open window. “See ya later mate”, she cried out as she departed the scene. I didn’t say a word but on the inside I was praying that that would not be the case.