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Be careful who your friends are

Another fine day in my city. We respond to a female complaining of abdominal pain. We arrive at the Section 8 housing complex, and enter one of the second floor apartments.

As we enter, we are directed to a bedroom by a woman in her early 30’s. She tells me that her 15 year old daughter has been having cramps. Mom tells me that she originally thought they were menstrual cramps, but now her daughter looks really sick.

I enter the bedroom to see the teen curled up in a ball, holding her stomach.

I run through the standard questions.

DM: “Point to where it hurts.”

Pt (points to lower stomach, near her pubis)

DM: (rolls teen onto her back, gently pushes on her stomach in several locations) “Tell me when it hurts.”

Pt: “OW! Right there”

DM: “Does it hurt more when I push, or when I let go?”

Pt: “When you push.”

DM: “I need you to walk to the stretcher.”

Mom: “I can carry her.”

DM: “No, I need her to walk.”

The daughter walks with small, gentle, shuffling steps. She gingerly walks the distance, and gently sits down, all the while holding her stomach.

Once in the truck, and away from Mom, I ask a new line of questions. I note that she has a temp of 100.2.

DM: “Your mom isn’t here now, so I need you to HONESTLY answer some questions for me. Can you do that?”

Pt: “OK.”

DM: “Is there any chance you might be pregnant?”

Pt: “What do you mean?”

DM: “Are you sexually active?”

Pt: (stalls) “Well… The other night, my BFF and I snuck out to a party at this guys house, and they let us have some beer. I guess I drank too much and passed out. My BFF told me the guys there took turns having sex with me. I don’t want my mom to know”

DM: (tries to maintain poker face, glances at partner- significant looks exchanged) “When was this?”

Pt: “About a week ago.”

DM: “When was your last period?”

Pt: “Two days before the party.”

DM: “Do you have a bad smelling discharge coming from your vagina?”

Pt: “It started 2 days ago.”

DM: “You know that your mom is going to find out, don’t you? I think she would rather hear it from you than a stranger.”

We took her to the ER. Just as I suspected, PID, brought on by this. I hope she isn’t sterile.