So as a rural physician, you practice medicine in all sorts of places. This is a prime example of "one of those days."
One day, I decided to meet my wife and kids for lunch at a local fast food resturaunt. There wasn't any lunch provided at the office that day due to impending medicare cuts. So I hop in my truck and drive over to meet them at the local noon hot spot, where 1000 calories costs the same as a movie rental. I sit down and enjoy my lunch in the peace of my kids smearing ketchup on their faces, running around the tables, fighting over toys, and generally raising a ruckus (ah, the peace of a quiet lunch after a busy morning). As I am there enjoying my 734th calorie, I notice a young couple sitting a few tables over who have requested my services in the office on multiple occasions. Okay, so they are patients of mine. As I am leaving with a 14 month old wiggling rendition of a hot dog with ketchup and mustard in my arms, trying to keep my clothes clean to go back to see patients, my patients speak up, hollering my name from across the eatery. As I recognize them, the proceed to tell me of her medical dilemma. She tells me that she thinks she is pregnant, as she hasn't had her period in a while, she's gaining weight (remember we're eating at a gain-fat-a-minute establishment), and she's been tired. As the eyes turn and the ghost of silence sweeps over the booths, I suggest that she make an appointment. I continue to move towards the door as she relates to me that all of her pregnancy tests have been negative, but that happened with her last pregnancy. I again suggest the obvious, that perhaps she should make an appointment to discuss this. Her husband proceeds to tell me that she must be pregnant, as he can feel the baby moving inside and she's eating 200 dollars worth of groceries a week. Suffice it to say, the conversation ended there with a smile, as I said, "Well, you had definitely better make an appointment!"
The Ice Cream
Oh my friend, tis not the end of the story. As we load all the children in mom's moose of a vehicle, I notice a distressed and distracted look on her face. I ask the perpetual question you should not ask when you are short on time and you can see in your mind the patients lining up to check in at the front desk, your rooms loaded with octogenarians with their lists of issues to discuss that day(dry skin, fatigue, constipation, poor sleep, fatigue, food intolerances, medications, the 4 dollar list at Wal-mart, and grandson Johnny's first deer photos), the desk full of phone message sticky notes, the overgrown grass that needs mowing that night if I get home in time since I'll be an hour behind: "Honey, what's bothering you." Lips start to quiver, frown begins to appear, eyes tear up. She requests to be polite and not tell me till later, but she knows I wouldn't be able to concentrate at work and with more prodding, she tells me - "I'm pregnant."
Now this after deciding to have no further younglings, taking all necessary precautions with medication and lack of exposure to swimmers. I hold her close in the parking lot, kids baking inside the car, hollering and fighting, people/patients/co-workers/mayor driving by to go through the drive thru (some wave), as she sobs and I tell her it will be okay. My thoughts of not getting the grass cut tonight are swept away with a fast-frame slide show of pregnant wife sick as a dog, chasing kids all over belly-first, enduring birth and telling me to shut up again, changing diapers, late nights rocking a screaming muffin ball, the mind-bending sleeplessness, how we will never have vacation alone again (who will watch 4 kids under 7 for 3 or more days?), never having a boat to go fishing, being outnumbered when teenagers, the whining, crying, pooping, diapers, bottles, college funds, cars, etc (now you see why my wife calls me a pessimist (truly I am a REALIST)). We hug a while, I wipe her tears, tell her again it will be okay, and we depart with a kiss and a few deep sighs. Ah, a nice, quiet, peaceful, relaxing, mind-restoring lunch.
The Whipped Cream and Cherry on Top
But, there is more!! The next day, one of my nurses informed me that I have a twin! A twin here in our small town of 14,000, and my parents still had not told me about him all these years? As I inquire about this twin, she relates to me that as she was driving through the drive thru of this establishment, she saw my twin hugging a good-looking blonde. The implication was obvious to me, the question asked indirectly - are you having an affair? I put 16 and 32 together (why 2 and 2, who made that up?) and clarify that no, that was not my twin, that was my wife and I, sharing a "moment" in the parking lot after a nice, peaceful, joyful, relaxing, calming lunch.
So the subsequent day my eating and conversation companions from the restaurant arrive in the office, to figure out this dilemma. I knew the history, the exam was unremarkable, so we proceed with the pee-in-a-cup test and use our super special urine pregnancy test that is the same as the over-the-counter EPT tests, just bought in bulk and kept in a box on a shelf for a year. Yep, negative. I return to the patient to ask some pointed questions. "Are you not on any birth control?" The answer was astounding, dumbfounding, awe-inspiring for our educational system, and humorous all at once: "Not since I had my tubes tied. I've been fixed." Oh, the pride just swelled up in me, what a wonderful job I have done educating my patients about pregnancy and pregnancy prevention, especially to those who already have children (yes, she has 2 rugrats). What a great historian I am, obtaining all the pertinent information before ordering tests. The visit ended by my answering 2 questions:
Patient: "So am I pregnant?"
Doctor: "No, your test was negative. You don't have to worry about getting pregnant after having your tubes tied. It's permanent and 99.98% effective at preventing pregnancy."
Patient's husband: "Then why is she gaining weight and what was that moving in her belly?"
Doctor: "Have you ever felt 1000 calories or more and 200 dollars of groceries a week travel through the bowels? Where do you think those calories go?"
The light came on, smiles all around, and a laugh. They haven't come in for a missed period since.
Ah, burgers over lunch with the family. What surprises it brings. We haven't had lunch there together on a work day since.