Somehow it's hard to imagine Charles Dickens, with all his literary depth, writing about female genitalia.
No, my friends, that's why it's up to me!
Here's how it went:
2pm:
Dr A: "Frazzled, tired Social Worker lady, the 7 yr old child brought in because of green, bloody vaginal discharge has GC (gonorrhea for those of you not up on STD speak).
She has no hymenal tissue left, her anus is grossly dilated with poor tone. She has definitely been sexually abused, probably for a long time. She needs to be reported to Children's Division and the police and placed in foster care for her protection.
BTW, her mother isn't here, she left to go get the stepfather from work and they'll be back shortly"
SW: Alrighty then!
SW to Dr A (now going off duty and more than happy to turf this nightmare to the incoming Attending):
"Let's see if the Child Protection doc is available to come down to identify any source for the bleeding and discharge, rule out acute trauma and make sure there's no foreign object stuck up there that needs to come out". (Don't laugh; the last foreign object he retrieved was a 'Barbie shoe' that set up a massive infection - and you think you misplace your belongings in the oddest places!)
3:45pm
Mother and stepfather back.
Dr B (abuse MD):
"This child's physical exam was well within normal limits.
Can someone, for the love of God, explain to me how two doctors can look at the same genital area and come to such different conclusions?
2:45pm
Still no parent: have spoken to auntie and pt about things in general but not going down the abuse road until I talk to mother first.
SW to Dr A (now going off duty and more than happy to turf this nightmare to the incoming Attending):
"Let's see if the Child Protection doc is available to come down to identify any source for the bleeding and discharge, rule out acute trauma and make sure there's no foreign object stuck up there that needs to come out". (Don't laugh; the last foreign object he retrieved was a 'Barbie shoe' that set up a massive infection - and you think you misplace your belongings in the oddest places!)
3:45pm
Mother and stepfather back.
LONG conversation with them about possible sexual perps in family, suspected sexual acts upon children, abuse history for either parent, previous concerns or disclosures of abuse, treatment for any family member of STD or knowledge of same - all denied.
5:30 pm (now 1 hr and counting past time when frazzled SW was supposed to leave in the afternoon.)
5:30 pm (now 1 hr and counting past time when frazzled SW was supposed to leave in the afternoon.)
Dr A probably sitting on her deck sipping margaritas by the enclosed pool as her slaves, servants, prepare dinner.)
Dr B (abuse MD):
"This child's physical exam was well within normal limits.
Hymen intact, no acute trauma, rectal tone normal, some redness and irritation but nothing that poor hygiene can't account for.
She probably has vaginitis, maybe a bladder infection.
She needs sitz baths and continued good supervision by her family while we wait for the cultures to come back.
Don't make any reports yet; let's wait and see what happens.
She's ready to go home!"
Can someone, for the love of God, explain to me how two doctors can look at the same genital area and come to such different conclusions?
Me?
I can see how I'd get lost; I don't spend much time down there; it's a country I only visit "on holiday" as the English would say.
But you folks, Drs. A&B, you get paid big bucks to know the terrain; you're the AAA of the cootchie world. You should recognize the landmarks, know the road system...
It shouldn't be THIS random!
One side of that coin has a kid removed from her family, placed with strangers and emotional trauma inflicted on all of them by "the system" - a system BTW that has MY name, face and reputation associated with it in this family's memory long after yours is gone since I spent four times more time with them than you did!
The other side of the toss has her leaving the ER with the same people from whom she may have gotten a sexually transmitted disease in the first place, feeling unprotected by an uncaring, unknowing system.
And THAT is why they call it "practicing medicine".
7:30pm
Now brain dead SW leaving building after documentation of said 5 hour encounter with pt and family in such a manner that we won't get our asses sued if pt gets re-victimized while waiting for cultures to come back OR family decides to file law suit for false accusations of sexual abuse.
3 hours after shift supposedly over; 3 hours of my life never to be recovered or reclaimed.
Wish I could say "It was the best of times, it was the worst of times..."
but, at the moment, I can't remember when the 'best' of times might have happened; certainly not from 2-7:30 pm!
What a craptastic case!
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