The View from the Vue (19 page)

But there was no way out of it, so I took a deep breath and we wheeled her into the operating room. The anesthesiologist put her to sleep while Vince, Dr. Bean, and I scrubbed up. Then we put on our gowns. If anyone had measured the adrenalin in my blood stream, I’d have probably made the Guinness Book of Records. Vince cut an incision between the pubic bone and the navel, and then opened the peritoneum, the membrane that lines the abdominal cavity. With that, huge quantities of amniotic fluid poured out over the patient, the table, the floor, and down our legs. What had happened was that the amniotic sac, or bag of waters, had broken while she had been home sleeping. This, then, explained her intense pain: amniotic fluid can be quite irritating to intra-abdominal tissues.

Vince then proceeded to open the peritoneum the length of the incision, and there was the baby, lying all tangled up in a mess of intestines. Grabbing the feet, he pulled the child out. It began to cry immediately, even before we had clamped and cut the cord. It was a little girl, and it appeared to be perfectly normal. We gave the baby to the pediatrician, and then looked to see what was left.

My first feeling was unmitigated relief: it was obvious that no blood was flowing. We cleaned out the rest of the amniotic fluid—very gingerly—and clamped the cord right next to the placenta.

That left us with quite a sight. Usually at surgery you can see the uterus, tubes, and ovaries, all lying in their appropriate places in the pelvis. But here I could only make out the right tube and ovary and the right half of the uterus. The whole left side of the pelvis was completely buried under the placenta. Just looking at it gave me the shivers. It was sitting on the top of the left side of the uterus, covering the tube and ovary, and extending over to the left wall of the pelvis, where it was solidly implanted over the left common iliac and hypogastric arteries. These vessels supply blood to the entire pelvis and lower left side of the body. Vince pointed out that the amount of blood that the placenta must have been tapping off them had to be absolutely staggering. “That’s probably the reason the baby was able to survive all the way to term,” he said. “The blood supply from these big arteries probably could have kept three kids going.”

“What’s your next step, Professor?” Dr. Bean asked Vince. “You want to go get that placenta?” I could see him grinning behind his mask.

“I don’t even want to
look
too hard at the placenta,” Vince answered. “All I want to do is close the belly quick and get the hell out of here.”

Which is what he did. At the time, I shuddered as I thought of the postoperative complications she’d undoubtedly have, but remarkably, she didn’t turn a hair. The next day, she was up and out of bed, and a week and a half later, she went home with the baby. Shortly thereafter, my time on the obstetrics service was up, but Vince kept me posted on her progress. He checked her at monthly intervals, and found that the placenta rapidly shrank down to become a little thickened area on the left side of the uterus. Mrs. Cowens complained periodically about a feeling of heaviness or fullness in her pelvis, but no more than that. And the baby did fine.

During one of these reports, I expressed regret and embarrassment at having so completely missed the diagnosis. Vince shook his head. “No reason for you to feel like that,” he said. “Your mistake was one of inexperience, not of neglect. That’s thoroughly excusable.”

“I still wish I could have made the diagnosis,” I said.

“Why?” Vince asked. “In the end, no harm was done to anyone. Matter of fact, you might look at it this way: if you had diagnosed abdominal pregnancy at thirty-four weeks, we’d have probably operated right then. And if we had, the baby might have died of prematurity. Those extra four weeks may have saved the baby’s life.”

“Wonderful,” I said. “I did the right thing for the wrong reasons.”

Vince laughed. “Somehow, I don’t think Mrs. Cowens would argue the whys and the wherefores with you,” he said. “The results are all she cares about.” He paused for a moment. “Everything considered, this case has to be the luckiest dump in the history of The Vue.”

Of the seven body orifices that communicate with the outside world, only the mouth was designed to be used as an intake port. But man is nothing if not inventive, and he continues to try all possibilities. I’ve never heard of a dog or a cat that needed a Coke bottle extracted from its rectum; however, as described in a previous chapter, such operations have been performed in many hospital emergency rooms where humans are treated.

Since patients at Bellevue generally did run a bit to the bizarre, the foreign objects encountered in Bellevue orifices also were about as peculiar as one might imagine. Bellevue physicians were called upon to remove a fascinating assortment of material that had been lost in the different body openings. Every day we removed Q-tips from ears, wadded paper from nostrils, and a truly amazing variety of objects from rectums. Many of these were started on their travels up the wrong end of the intestinal tract as silly or drunken jokes. Others came to rest up there as the result of accidents during the sexual activities of homosexuals. Medical literature catalogs a large number of review papers which describe the odd things that the authors and/or their friends have removed from various rectums. The items range from bottles through bananas, hot dogs, knives, rubber hoses, and electric light bulbs. At least one of these bulbs was documented to still be functional upon its recovery. This was described with such pride that I wondered whether the author had offered his prize for display at the Smithsonian Institution. What a great ad that would have made for G.E. or Sylvania.

In most instances, the Bellevue Admitting Office doctors took care of these problems. However, there was one orifice which they never dared explore: the vagina.

Let a woman appear with a nasal, aural, or even a rectal bezoar, and she was promptly emptied and sent on her way. But let her even intimate that the offending substance had been secreted in her vagina, and with whitened countenance and quavering tones, the Admitting Office physician would cry, “Get her up to the gynecologist.”

I have never been able to figure it out. Otherwise competent and considerate doctors invariably seemed to feel that it was necessary to awaken a certified womb-snatcher simply to effect removal of an object from a woman’s vagina. You’d think they could at least have tried, but they never did. You may form your own conclusions regarding the matter. As an oft-awakened gynecology resident, I definitely had my own.

The majority of these referred cases were straightforward. For example, some of the patients were little girls. Large numbers of prepubertal females seem to regard the vagina as a first-class repository for appropriately shaped toys. Crayons, dolls’ arms, chalk, and cotton balls all fit very nicely into a mini-crotch. What’s more, the items are never discovered until they cause enough irritation to produce a discharge or some bleeding, at which time the mother brings the child in for evaluation. In point of fact, these foreign bodies can be anything but trifling. There was a recent report in a gynecologic journal relating the case of a grown woman with a very long history of severe, incapacitating pelvic infections who was finally demonstrated at surgery to have a bit of wire embedded beneath her vaginal wall. This wire was later identified as a part of a long-forgotten childhood toy. After its removal, the patient remained totally free of the symptoms which had troubled her for the preceding twenty-five years.

Another common problem involved removing a “missing Tampax.” I never could understand how those things managed to get crammed way up into the very top of the vagina until one night after an unplanned and unscheduled nocturnal adventure when my wife called from the bathroom to request that I perform this bit of extirpative surgery on herself. Then, at last, I understood. With rare exceptions, the patients who had lost their tampons expressed surprise at how easily they were ultimately removed. Not just uneducated patients, either. Beatniks from Greenwich Village and college girls from the nearby Washington Square campus of N.Y.U. regularly expressed their gratitude and relief that a major abdominal operation would not, after all, be necessary. They invariably thought that the tampon had passed into the uterus, either remaining there or continuing along El Camino Real to become a free-lying foreign object in the abdominal cavity. Very few of them seemed to know that the connection between the vagina and the uterus is far too small to permit passage of a menstrual tampon. This, however, I could always understand. In that situation, my patients must have felt as I invariably do when my auto mechanic tries to get me to comprehend the nature of the malfunction of my car’s engine.

But naturally, life as the gynecology consultant to the Admitting Office was not all crayons and Tampax. As anywhere else in Bellevue, unusual patients abounded.

One such woman came timidly into the consultation room about 1
P.M.
on a Sunday. Her A.O. slip identified her as Helen Jones, whose problem was “FB in Vag.” (That’s “foreign body in vagina.”) The space provided for the referring doctor’s history and physical examination were as untouched and pure as the West Virginny snow, and I quietly gnashed my teeth. Then, I asked Miss Jones what her FB was.

She was skinny and about thirty years old. Her pale face contrasted horribly with the red blotchiness around her nose and mouth. She wrung her hands and dripped a few tears onto her high-necked, sensible cotton-print dress. Then she let out a low moan and asked, “Do I have to tell you?”

I felt sorry for her. I really did. But I knew never to take a Bellevue patient’s plea so seriously that I would end up with my own soft parts exposed. It was one thing to stick my neck out for a patient when I knew it was necessary for his or her care, but it was entirely a different matter to allow myself to be taken in by one of the excellent and experienced Bellevue con ladies. So I told Miss Jones that she did indeed have to tell me what had found its way into her vagina.

She wrung her hands again. “Why do I have to tell you?” she whispered.

“Because maybe you don’t know what kinds of things I’ve removed from women here,” I answered. “I’ve taken out knives and pieces of glass. One lady even had a small mousetrap.”

“Oh, dear,” she moaned. “It’s nothing like that. It’s nothing that can hurt you. Honestly it can’t.”

“I’m sorry,” I said. “I can’t take it out unless you tell me what it is. I really can’t see why you can’t tell me.”

“I’m just too embarrassed.” She began to weep again, and the blotches began to spread.

“Look, why don’t you just tell me and we’ll be done with it? I’m eventually going to see it anyway.”

“I just can’t. But I’ve got to have it out.”

I asked the nurse to leave for a minute. Then I turned back to my nearly hysterical patient. “Okay, now there’s no one here,” I said. “Tell me what it is, and then I’ll be able to go get it out. I won’t even put it in your record. All right?”

No answer.

“Take a deep breath and let it out.”

Miss Jones inhaled and then roared, “It was a…a…”

I leaned forward.

“…lipstick,” she exhaled in a hoarse whisper.

A lipstick! I sat back. What a letdown. But how in the hell had a lipstick gotten into her vagina?

I called the nurse in, and we got Miss Jones up onto the examining table. I thought there would be no problem. I picked up a speculum and tried to insert it. It would have passed more easily through a brick wall.

I took a closer look. It became apparent that whenever my finger contacted her vulva, she would tighten her muscles and convert her carefully preserved maidenhood into a truly sturdy fortress.

A wave of sadness passed over me. Poor Miss Jones. I pictured her lying alone as usual in her bed the night before, and wondering as she often did what it felt like. She probably reached for the lipstick on an impulse; it looked small enough. Then, after a while, it must have gotten a little slippery down there. Woops—dropped it in. Oh my God. I DROPPED IT IN!

I could picture Miss Jones’s night of frantic, futile efforts at removal and the courage it must have taken for her to come in. I stopped poking around and quickly assured her that I’d leave her anatomically as she had always been. Then I gave her an intravenous dose of a tranquilizer. It didn’t help very much. Now I could slip one finger into her vagina, barely far enough to just touch the lipstick, but no more than that. And when I tried to snare it with a surgical clamp, it kept slipping away.

I was almost ready to resort to anesthesia when I suddenly had another idea. I inserted my left index finger into her rectum and used it to stabilize the elusive cosmetic. Then it was fairly easy to clamp it via the vagina and, by a combined maneuver, to work it forward and out.

Despite my request that she stay until the tranquilizer had worn off, Miss Jones was on her feet as soon as I’d finished. She hastily weaved out the door, hoisting her panties as she went. By the time I realized she had left the lipstick behind, she was well out of sight. The nurse assured me that we had no need for it either.

Another patient I’ll long remember represented a slight variation on the preceding theme. She was not an A.O. referral, but had come into the hospital to have a hysterectomy. She was a tall, thin Negro woman whose slender build accentuated the bulge in her lower abdomen that was caused by the huge fibroid tumors in her uterus. She was a delightful lady who gave funny and salty answers to most of the questions I put to her. When she laughed at her own jokes, her mouth looked like the Lost Nugget Mine. By her admission, she was the proprietress of one of the most popular—and definitely the cleanest—whorehouses in Harlem. “Y’ be s’prised, Doctuh,” she said. “We got lotsa white boys come up. We ain’t prejidiced.” She slipped me a sly smile.

“Come on now,” I said. “I bet you put the white boys in the back of the house.”

She burst into peals of laughter, and her teeth flashed brilliantly. “Gawd damn, you a funny li’l doctuh. You come by my place, I take good care o’ you.” Then she put on a mock serious expression, leaned forward, and stage-whispered, “Or you got one o’ them wifes whut doan wan’ their men messin’ wif cullid wimmin?” This accompanied by the sly smile.