6PM – my overnight call shift had just begun. After a whole day of assessing laboring mothers and getting in a few deliveries, I was a bit excited to be paged to go down to the ER to see something different. “We need an obstetric consult, we have an ectopic pregnancy in B9.”
There’s an old piece of wisdom that they teach every medical student who rotates through obstetrics.
Every women of reproductive age is pregnant, and every pregnancy is an ectopic pregnancy until proven otherwise
Although that saying does not apply most of the time, the consequences of an ectopic pregnancy are so severe, you should always have a high clinical suspicion for one. I had just recently reviewed the topic in my studies, so I was naturally curious to see how it would present. Would it be a ruptured ectopic, was she hemodynamically stable, would we have to rush her to the OR? These thoughts swirled in my head as I briskly made my way to the ER. When I finally met Mrs. C, it ended up being a different lesson that I will always remember.
Mrs. C was a pleasant 32 year old lady who had come in to the ER because of vaginal bleeding that morning. She was alert and stable and seemed to be well composed. The history went by quickly, her condition seemed stable. It wasn’t until I asked her how many pregnancies she has had that the mood changed completely. G3A2P0. She and her husband had been trying for 10 years to have a child and they really thought this time it was going to happen. She had a previous ectopic pregnancy and a previous therapeutic abortion ten years ago, her mind probably scarred over that decision she made when she was younger. The HSG showed that one tube was completely blocked and the other was barely patent. My heart sank for her. All I could say was, “I’m so sorry to hear that, this must be so difficult for you.” She broke down into tears. I could barely contain the water in my eyes.
In medicine, there are tears of happiness and tears of sadness. Earlier that day, I had witnessed mothers and fathers overcome with joy as they held their first child in their arms. And in that same day, I was now listening to the sobs of a mother who was running out of hope. It wasn’t fair. There were probably 3-4 unwanted pregnancies back in the caseroom waiting to be seen and here was a woman so deserving of a child contemplating whether or not she could ever have a natural pregnancy.
The attending was called and surgery was booked for that night. The ectopic pregnancy was flushed out, the tubes left intact because the mother wanted to try once more.
I’ll probably never see Mrs. C again but I know her story will always be with me, and I know I am changed because of our encounter. What I initially thought would be an interesting case to see became a lesson in empathy. We don’t just treat diseases or cases, we take care of patients. As Hippocrates so wisely said, “Cure sometimes, treat often, comfort always.”
Disclaimer: The details of this event have been changed and modified so that they are fictional and that they protect patient confidentiality. If this story resembles any story you have heard, it is purely coincidence.
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