I Done Good
I did a good thing yesterday.
It was one of those busy, crazy days when you think you're never going to get caught up; where there are always two people waiting to be seen (I run my office like a Russian railroad; it kills me to keep people waiting) and the pile of charts on my desk for callbacks just keeps growing (because I don't have time to go back and whittle away at it as I go.)
A lady had left a message on the machine: she thought she had a UTI, and she had just found out she was pregnant (and so was worried about what she could take.) My standard answer to a message about a UTI is that it needs an office visit. I like to have a urine culture cooking even after starting empiric therapy. I've picked up some weird bugs and some STDs, and sometimes it isn't really a UTI at all. So I try very hard not to treat these by phone. It's a quickie visit: pee, dip, pound on your back so I can document no CVA tenderness, prescription and off you go.
So this one wasn't supposed to take much time.
We went into an exam room and -- as I always do -- I took a history. My opening question to someone whose chief complaint is "I have a urinary tract infection" is "Tell me what's going on without using the words 'urinary tract infection'." Her complaints were mainly urgency and some frequency. It didn't really sound like much in the way of dysuria.
Then I added, "And I understand you're pregnant."
A strange expression came over her face as she told me about the two pregnancy tests she'd taken over the weekend. Her last period was October 1st. She took a second test because she couldn't believe the first one. She didn't look happy. I asked if it was a planned pregnancy.
It wasn't. Not exactly. Not *right* now. They had been planning to start trying in another couple of months. Her husband was thrilled; she was "still getting used to it." She still didn't look happy. She said she was in shock. She wasn't sure she was ready for it. But she also felt terribly guilty for not being completely happy. She couldn't think about anything else, but didn't want to talk about it at work. She was having a tough time, but, as she said, she was definitely "getting there."
I thought about it as I listened to her. I thought about the fact that things happen for a reason. I shared Flea's story about the "good" fortune of his colleague's wife's misdiagnosis in infancy. And then I added this:
"I don't know how or when or if you'll ever find out why this happened, but I really believe this is a soul that just couldn't wait another couple of months to come and be with you." We both teared up, so we helped ourselves to tissues.
"Does it help to think about it like that?" I asked.
"Yes it does," she replied.
I told her I wasn't at all certain she really had a UTI, as urinary frequency is a common symptom in early pregnancy and the urine dipstick was completely negative for white cells, nitrites and red cells. I sent the culture and told her I thought it would be best to hold off on antibiotics for the time being; she was ok with that. I offered her a hug, which she accepted.
Even though I was still running way behind, I felt good.