Blog post about the craziest patient ever

As one of my other recent posts noted, I am in my last week of medical school. And fate had it that the single most fascinating/wild patient encounter of my 4 years of medical school occurred this week!

A 20 yo girl came in today to discuss her 1 month of “stomach pain” after drinking soda (which she drinks 5 days/wk, despite realizing the connection between these drinks and her pain). We talked about this subject, as well as her shortness of breath, induced with exercise for the past few years. As I do with all patients, I followed our conversation with a physical exam. Everything seemed normal (lungs were clear/ eyes reacted to light/ heart beat was normal), until I had her lay down for the abdominal exam. At first glance, her abdomen just seemed really large to me (out of proportion to the rest of her body). I started pressing on her protuberant abdomen and felt something similar to a mass in the lower-half of her abdomen. At this point of the visit…I panicked, left the room, and told her I’d return with the real doctor!

In my mind I thought, either she was a really strange sort of FAT or she was PREGNANT! I started replaying our conversation in my mind, I had asked her about her periods and she stated they were normal (5 days of blood) and regular (came every month), and her LMP was on the 25^th of April.

I left the room and said to my precepting doctor, “she looks and feels super pregnant”, but she has normal periods and didn’t mention anything about being pregnant. I should have asked her more questions after my exam findings, but I was too embarrassed (as I didn’t want to imply she was pregnant if she was simply overweight). While discussing the patient, we had the nurse obtain a urine analysis looking for an infection, and a urinary pregnancy test (the main reason for the urine analysis was to have something to tell the patient as we asked her for the urine sample).

The urine pregnancy test came back POSITIVE, as this point we didn’t know “if she knew, and was simply assuming we knew” or “if we had some big news for her”. I went back into the room with my supervising doctor, and started with a bunch of repeat questions. Asking specifically about her period in January, February and March confirming she had her normal cycle for the past few months. We also asked her if she had a male partner or boyfriend, her response to this question included an alleged “I have never had sex before”.

Normal periods for the past few months and a virgin--the news that she was pregnant was obviously not going to be expected. So much so, that she even denied its possibility after we showed her the pregnancy test results. We then got out the Doppler ultrasound machine and were able to auscultate the baby’s pulse (which was around 140 beats/min, compared to her pulse of 70 beats/min). We asked her to listen to the noise and she still maintained that it must be her pulse making that rapid noise. We measured her fundal height, which in centimeters roughly correlates to weeks-gestation: 26 weeks pregnant!

That’s 6.5 months pregnant, if she delivered today, the baby is old enough to survive…and yet she had no clue she was pregnant. On so many levels this case amazed me.

In talking with the doctors at the clinic, this was the first time any of them had heard of a pregnancy being diagnosed via “physical exam”. Most (all) people find out they are pregnant many, many months before a doctor would be able to touch their abdomen and palpate an occupied uterus.

Maybe she was lying about her periods and her history of no sexual activity (and she suspected the pregnancy), but if this was the case, she was an incredible liar. I honestly believed she is in complete denial and really believed that being pregnant was impossible. Whatever the case: Immaculate Conception? Honest obliviousness? Lying? It was a really good reminder to me why I must always do a physical exam on every single patient! 

she thought that the baby's heart beat was her own pulse