The Delayed History

She said that she had been vomiting for the past six hours and thought it might be related to the chicken she had eaten for lunch. Over the last couple of hours she had developed right lower abdominal pain. With her last menstrual period reportedly three weeks prior and the absence of vaginal discharge, appendicitis was certainly a possibility.

Her examination wasn't really impressive, however, so perhaps it was the chicken. Her husband had eaten something different.

"Do you think I could be pregnant?" she asked innocently.

"We'll see. We need to get some urine from you, too" I said on the way out the door. My plan was to hydrate her with IV fluids, control her pain and nausea, and re-examine her after a bit. As we were quite busy, the hours passed quickly. She had not really improved; in fact now she was even more tender at McBurney's point, and she still had not provided a urine sample. By this time, her husband had gone home with their two children.

"Try to squeeze out some urine, even just a little bit, or we will need to catheterize you."

Of course, her urine pregnancy test was positive. More blood was sent for a serum pregnancy test, and I told her that we would need to do a pelvic ultrasound.

"Oh, I just had one of those last week," she said.

"You did? Well, we need to do another one anyway. You weren't pregnant then, and you might have a tubal pregnancy."

"Well, my gynecologist told me I had a 'chemically positive' pregnancy."

"Chemically positive? What do you mean?" Now I was starting to feel a little bit queasy myself.

"Well, my pregnancy test was positive, but she couldn't see a baby on the ultrasound."

"Wait just a minute. You saw your gynecologist last week, and you knew you were pregnant. You even had an ultrasound. Why didn't you tell me all this before now?"

"I'm sorry," she said. "I didn't want my husband to find out. I'm not sure I really want another baby."

Oh. My. God.