Seeing the Forest Through the Vagina

I don't consider myself to be a particularly wise man; in fact, even the most cursory of conversations with my wife will convince you that the converse is quite true.

I have however, gleaned a few important gems during the 19.7 or so odd million minutes I have been spewing out CO2 on this lovely little rock. For instance:

• Toast will always land on the buttered side when dropped onto the floor.

• Plumbers and proctologists should NEVER bite their fingernails.

• You are most certainly more drunk than you think you are- and on a related note, signing voices rarely improve under the influence of ethanol.

• It is universally accepted that the Emergency Department(ED) is the red-headed, bastard step-child of the hospital.

It is well established that the ED is the bane of many a medical specialties collective existence. After all, they are called to the ED to evaluate patients for for either admission (the horror!) or consultations as to recommendations for further care. This of course means more work, and that is seldom appreciated. This is but one of many the reasons that EDs have the much maligned reputation they do.

A brief disclaimer:
Since I have spent a goodly portion of my professional career working in and around emergency departments, I admittedly have a soft spot for those who suffer the slings and arrows of outrageous fortune while mired knee-deep in a wonderful concoction of bodily fluids and human pathos in the trenches of America's hospitals. I assure you there are no finer a group of people you want to be around when the shit decides to hit the proverbial fan. These are my brethren! ;-)


Last night, I was once again, On-Call with the fine folks in The Vaginas and Pending Humans Department(VPHD). As usual, as if scripted, there was to be a battle with the ED. I would love to regale you with another yarn of how the ED in all of its glorious righteousness was simply "misunderstood", but alas kind reader, this was not the case.

It seems a young lady presented to the ED with complaints of sudden onset chest pain and associated shortness of breath. She also happened to be in the first trimester of a pregnancy. Perhaps this is what confounded the situation. The ED physician on duty "admitted" her to the VPHD with the presumptive diagnosis of r/o pulmonary embolism. Seems reasonable, right? Well, in this particular case the only treatment or diagnostics performed were a chest x-ray, the insertion of an IV and CBC and basic chemistry panel. Nary an ABG, EKG, cardiac enzymes, d-dimer, venous doppler, VQ scan, spiral CT or anti-coagulant was ordered.

I had 2 questions:
1. Is the OBGYN team the most appropriate choice for the management of a potentially life-threatening medical emergency?
2. While I understand a possible sense of reluctance to perform tests and or treatment that may be harmful to the fetus, isn't maternal death harmful to a first trimester fetus? I'm just sayin'.

The vagina, and in particular-the gravid vagina, continues to mystify and perplex!