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Recently in Salon Health & Body

Urge: Naked World
Jumping Jack flash
A flasher in England was arrested for jumping naked from bushes as trucks drove by.
By Jack Boulware
[04/24/00]

Urge
Make talk, not love
David Allyn talks about his history of the sexual revolution, in which he says talking about sex is sexier than sex.
By David Bowman
[04/22/00]

Urge: Naked World
Bear-naked video!
China is worried that its rare pandas aren't interested in sex, so they are showing them panda porn.
By Jack Boulware
[04/21/00]

Column
Twelve steps in the end zone
Self-help for sports junkies (or the spouses who can't stand it).
By Mary Roach
[04/21/00]

Urge: Naked World
Looking for a God time?
Hookers in Chicago are being offered money to listen to the gospel.
By Jack Boulware
[04/20/00]

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I hate to disappoint the voyeuristically inclined, but the truth is, the tough, stressful part of the job has very little to do with plunging tubes down throats of unconscious people or yelling "Clear" and slamming defibrillator paddles. The hardest thing is to uncover the spiraling cascade of events, each one worse than the last, that sends a person to the E.R.

And that's why the healthiest-seeming patients are the ones I fear the most. For so often, they have the problems I'm simply not trained to fix.

Last month a colleague of mine working at an E.R. across town sent me a 15-year-old girl with a request to do an ultrasound to determine whether she was pregnant. I looked at her chart. Gulp. She had already been given a pregnancy test and the results were positive.

So why had my colleague deemed it necessary to order a wholly unnecessary test?

This was a board-certified E.R. doctor, an otherwise perfectly competent practitioner whom I had worked with for several years. While many doctors do have substance dependency problems, this guy was not on drugs. I called the doctor and he confessed: He was scared of facing the girl's mother.

The mom had made clear to him, in no uncertain terms, that her daughter was a good girl; her daughter didn't do that. We E.R. doctors like to think we're tough, that we can handle just about any hostile or obnoxious personality type. But he had caved.

He acknowledged that, yes, there were certain conditions that might result in a virgin's having a positive pregnancy test, but these were uniformly nasty: ovarian, pituitary or some other kind of hormonally active tumors. Rather than rule any of these out, he sent her over to the mother ship -- to me -- for an ultrasound.

Upon cross-examination as to the girl's presenting symptoms, he confessed that the mom had brought her to the urgent care center because she was vomiting and tired all the time. In other words, she was acting pregnant.

Just to be perfectly clear about it, this was the stupidest referral for a medical test in the annals of medicine. If she had been bleeding or complaining of crampy abdominal pain, and was in danger of miscarrying, she would, indeed, have needed an ultrasound. The procedure could have also found out if the girl was in any danger of having a tubal, or ectopic, pregnancy. But to do it to make sure that a pregnant girl is pregnant -- well, that's lunacy.

Once they arrived, I understood. This shameless act of cowardice by a doctor who knew better was fully excused by the fact that the mother was as big as a mastodon and wore the demeanor of an irritable boar. She bullied her way past the triage nurse and planted herself in the middle of the E.R., loudly demanding the whereabouts of Dr. Orenstein. Her daughters (a younger sibling was also in tow) cowered in terror behind her.

My initial plan -- to extricate myself by telling her that her daughter was with child and to check in with the OB-GYN clinic -- was not going to do. So, in what was arguably one of the most wasteful moves in my career, I sent the daughter for the ultrasound. I figured it would give me time to formulate a Plan B, not to mention devise retribution against my colleague for sending me this mess.

By the time she arrived at our hospital, the girl was thoroughly distraught. At least the sonogram would give her time away from her mother. With her I sent our social worker, a wonderfully sensitive, empathetic human being who could cajole a confession out of John Gotti. But she was powerless to get the girl to own up.

My shift is only 12 hours long. I checked my watch. If I could somehow stall the girl in the ultrasound room for another, oh, nine hours, then I could palm her off onto someone else. As I deliberated how I would actually go about doing this, the girl was wheeled back with her sister, accompanied by the only report possible from the sonographer: normal, intrauterine pregnancy.

Plus, three words from the girl: Don't tell Mom.

Now it was my turn to do something eminently dumb. The only problem was, I didn't know which dumb option to pick: Respect the girl's wishes and leave her to figure out how to deal with her pregnancy, or sweet-talk her into letting me tell Mom and thereby preclude any chance of her ever getting an abortion -- which, according to the social worker, was what the girl wanted and what the mother would never approve.

Fortunately, the social worker provided me with a third way out. I would call in the authorities on the case. The girl had the right, as an emancipated minor, to make her own reproductive decisions. If, however, the boyfriend turned out to be older than 18, she was also a rape victim and we had the onus to report it. If not, we might not have to call in the child welfare workers.

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