Sorry, this may be my longest blog-free time. It's not for lack of stories, but for multiple other things drawing me away.
A few weeks ago, I got a call from a local psychiatric hospital saying that they had a patient on a legal hold for psychosis who was pregnant and bleeding. Being the hospital of last resort, we accept almost any transfer that nobody else wants, so I told them to bring her on up to my urgent care. She arrived about 30 minutes later, in leather and rubber restraints holding her hands to her waist. At 250 pounds, 6 feet tall,--with a beard-- this woman was quite a sight. She arrived screaming and crying because her "baby be fallin' out, doc." Her chaperone, a 5'2" 125 lb. woman, seemed initially to be in control of the situation. The patient (PT) was escorted, screamind and crying, to an exam room where she proceeded to somehow remove her restraints. My nurse had been patient up to that point, but said "oh no, I'm out of here..." and fled once PT's hands were flailing freely. I grabbed my medical student, who can't say no, and took him in with me to examine this huge crazy lady.
PT initially refused examination, but finally took off her pants to show me her maxi-pad, pointing to the spotless white surface. "My baby on there. You can't see her, but she on there...she fall out. You need a microscope...do you have a microscope??" Her eyes were wild.
I said, "Yes, we have a microscope, but why don't you put the baby on the table and I'll look for her after we know you're okay."
To my amazement, PT put the pad on the Mayo stand and finished taking off her pants. Showing her the long vaginal ultrasound probe, I said, "We need to look and make sure the baby isn't still inside." She insisted on putting the probe in her vagina herself, ramming it practically up to her diaphragm.
Wailing, she kept repeating, "We gotta push it back up. My baby fallin' out ---you gotta push it back up..."
I convinced her that we first needed to look at the baby and then she could push it back in as long as it looked okay. She agreed to this plan, so we looked at her normal 8 week pregnancy and saw the heartbeat. Thank goodness for me, because had it been anything other than a normal pregnancy, I may have found myself attempting some awful procedure. She pushed the baby back up quite forcibly with the ultrasound probe, and we rapidly left the room to do some paperwork and get her transferred back to the psych hospital.
Shortly, I heard a commotion in the hallway and looked up to see several security guards running around. As we know from prior experiences, it takes quite an event to get them moving in a timely fashion. PT had run--she escaped from our semi-secure area and was nowhere to be found. Six security guards could not locate a 250 lb, 6 ft tall bearded woman with wrist restraints and no pants!
Turns out they needed my expertise. PT had been crying about calling her friend in the pharmacy for the entire hour she was with us, but he didn' show up to save her. I sent security to the oupatient pharmacy--four floors away--and they easily recognized the fugitive amongst the customers. She came back to the fourth floor in shackles, wailing, with five security guards and, sadly, a viable intrauterine pregnancy. It's going to be a long 32 weeks until she delivers.