The Patient Was…

The patient was a twenty-something-year-old Air Force wife, married to a young airman stationed at the military base where I was serving as Chief of what was designated as the Air Force Clinic. The clinic was actually just the family medicine clinic that served all the people on the base who were not on so-called “flying status,” and those in the community who were entitled to medical care from the clinic, such as retired veterans and their families. (People on flying status were cared for by specially trained physicians known as flight surgeons.)

The young woman patient had come in for a relatively minor complaint but, as I did with all new patients, I took a detailed medical history. I was always especially alert in dealing with young women patients to problems that might be complications of early and yet unrecognized pregnancies. With thousands of young men and women on the base, the majority married, copulation seemed to be a varsity sport, and pregnancies were quite common. In fact, we had three board-certified obstetricians on the medical staff, and they were kept damned busy.

At one time our hospital commander, in his infinite wisdom (or lack thereof), allowed all three board-certified obstetricians to go on leave at the same time. My personal encounter, as a result of that error in judgment, is detailed in an earlier entry in this blog.

As I was recording the patient’s medical history, which seemed in general to be quite unremarkable, I asked routinely about any history of surgery that she might have undergone. I was expecting maybe to hear about a tonsillectomy, removal of the tonsils from the back of the throat, or perhaps an appendectomy, removal of an infected appendix.

She calmly replied, “Only a hysterectomy.”

“Wait,” I said. “What?”

She said, “I had a hysterectomy. That was my only operation.”

I remember holding my hands up, palms toward her, as if to say, ‘Stop, whoa.”

I am a little bit embarrassed now to admit that I assumed that this “small-town girl”  —  she had earlier told me that she was from a town in rural Louisiana  —  simply did not know what a hysterectomy was, that she didn’t understand the actual meaning of the term.

“Do you,” I asked, “know what a hysterectomy is?” (I cringe now as I reflect how supercilious I might have sounded.)

“Yes,” she replied, calmly, and without emotion. “It means I had my womb removed.”

Any concern about a current pregnancy was, of course, removed. But now, I had to think of really serious issues. Had she had cancer? Had she been seriously injured? Had she had some catastrophic event, perhaps uncontrolled hemorrhage, associated with a previous pregnancy? My mind was reeling with serious considerations.

I felt I needed to approach the issue of her history and diagnosis very carefully. This could, I feared, become a very traumatic discussion, with severe emotional impact.

“Can you tell me why you had your womb removed?” I asked as gently as I could.

“I had painful periods,” she answered.

My hands involuntarily went up again. Wait!

“Are you telling me that the only reason you had a hysterectomy, removal of your womb, was because your periods were painful?”

“Yes,” was the simple answer.

“And how old were you when you had the operation?”

“Seventeen,” she said.

“Did you have other problems,” I asked, “things like very heavy bleeding with your periods, chronic pain in your pelvic area between your periods, some other abnormality of your womb?”

“No, I don’t think so,” she said. “Nobody ever said anything about it.”

“Did you understand that you could never be pregnant after your womb was removed?” I asked. “Did you know that you could never bear children?”

“I knew that, but the doctor never discussed it with me. He just said I needed the operation.”

“Did you try other things first? Did you have any other treatment before surgery?”

“No,” she answered. “The doctor said I needed surgery and how could I refuse? He was the doctor.”

“What about your parents?” I said. “What did they think?”

“Oh, I couldn’t talk about periods with my parents,” she said.

“They had to approve the surgery,” I said. “You were a minor.”

“Well,” she replied, “they couldn’t go against the doctor. I mean, he was the doctor!”

“Did you or your parents at least consult another doctor, a specialist in gynecology?” I asked, almost in desperation, trying to find some additional reason or factor to explain or justify what seemed to me to be an egregious act against a young and vulnerable woman.

“There was no other doctor,” she explained. “He was a GP and the only doctor in our town.”

I sat there silently at that point, trying to calm my outrage at what I perceived as a terrible “assault” on this patient.

Seeing my discomfort, and clearly trying to mollify me, she said, “Don’t be upset, doctor. It wasn’t just me. He did it to a lot of the girls.”

That has stuck with me through the years.

He did it to a lot of girls.