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GEN: Too much blood in the office today (long)From: Garry E. Siegel, M.D. (garrys@mindspring.com)Fri Aug 12 22:04:24 2005
Not a great office day Patient 1: Routine Ob, 24 week P1001 (I delivered the 2 year old), moving to another city. Easy visit, hug goodbye, etc. Downhill from there. . . 70 YO with Alzheimer's, new patient, well heeled family/daughter with her with complaint of a long-term pessary from another local gyn one block away, now with discharge and odor that others can smell. The daughter thought the other doctor was a urologist (she's not), and that I was a special geriatric gynecologist (I'm not) to whom her internist referred her. Other gyn not in the office today, so could I please look? Certainly, as no good deed goes unpunishted. . . . Donut pessary in place with creamy odorous typical discharge from a pessary that's been it a good while. Patient pleasant but repeatedly asks if the discharge is from the "ring," and that the "ring" is there for bladder prolapse to avoid surgery. Removal is desired, and she is very tough and toleratant as I extract this with much force. When I look at her bottom, there's a pool of fresh blood from her now open old episiotomy! I've never done THAT before. No one is really upset or hurting, and luckily the fine staff can run to L and D for a delivery set of instruments and suture, as I don't have the right instruments to repair this. No problem repairing under local, and I put her on Flagyl and she's on her way. A follow-up call to the daughter and all is well. Oh, by the way, I run and do an annual exam on Patient #3 who is already waiting while awaiting the stuff. Meanwhile, while I'm dealing with this. . . Patient #4 arrives, an 70-ish woman for an annual who just had a sterotactic breast biopsy elsewhere this AM. The check-in receptionist notices a huge stain of blood on her blouse (she hadn't), and she's rushed into an exam room by the staff, and they tell me as I'm sewing away. Hold pressure, and I'll get there eventually. When I get there, she has a 4 X 3 cm. mass/hematoma in her petite breast, and the incision is dry but open after I remove the occlusive dressing and steri-strips. The surgeon is called, and he directs me to re-steristrip, hold pressure, and tell her to go home and put ice on it and stay stil for a few hours. By around 11:00, back on schedule for regular patients. 1 PM see missed Ab who is added on for later. 4 PM talk to menopausal sister-in-law whose ultrasound for pain shows a 4 cm. simple cystic ovary. She is upset and fears the worst, and by 7 PM I'm drawing a Ca125 to get run over the weekend. This is done between the curettage and ectopic. It is now 11 PM and I've done an add-on curettage and an ectopic, and have a pre-eclamptic getting cytotec. I've also admitted a preterm laborer. Thanks for listening :) Garry :)
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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