Hot Monotony

From algorithms and equations my decisions are made.

In response to fragmented sentences on the screen in front of me... my fingers swipe and command orders. Electrical impulses from the computer illicit electrical impulses from my brain, to my nerves, and eventually to my muscles. Sodium and Potassium frantically trade places again and again within my cells. Action potentials are fired; a series of unconscious chemical messages that dictate my body's action... fueled by ATP... the gasoline for us all.

The result: click, point, click, clack, fwiiip... slide, tap, tap, tap.... ENTER.

Often times, before I even see you.... before I meet you, shake your hand, see the fear in your eyes, feel the deceit from the lack of their contact with mine, or judge the honesty (or lack-there-of) in the animated writhing of your body in this room, I have decided.

I already know what I am to do with you today.

These formulas usually find a very repeatable, reliable and calculable result. This is why they are useful, yes, but they are not mathematic certainties. To believe this, and to practice this, will create for you a brief career in this business.

Like many other in this world, my profession is defined, and decided, within the 'gray areas.'

Black and white is easy. It's the haze of the gray that causes confusion, panic and accidents.

When the computer screen and chart read, "vaginal bleeding x10 hours, +6 weeks pregnant," it triggers the automatic response from my brain, nerves and muscles to order the appropriate labs, and imaging. "This," I think to myself, "is about a mathematical as they come." (In the emergency setting, there are only a couple of things to worry about here, and really, only ONE work-up. If there was ever a time to put in the orders before seeing the patient, (to speed up their stay in the ER) now's that time.

As I head towards room 31, and leave the computer to perform its task of electronically sending my orders throughout the hospital on wires of copper, fiber-optics and ethernet, to separate destinations... (lab, nurses, techs and radiology), I find my patient outside of said room, waiting in line for the bathroom.

She is youthful, petite, and has the look of a scared young child in line for a haunted house, one that she would not have dared to step in to, if it were not for her braver, and older sister. Though today, she is alone here in the ER, and she is buried in her far too large hooded sweatshirt as if to hide from the ghouls in this place. Oh the horror she must feel as she thinks of all the terrible possibilities. She disappears further into her sweatshirt.

We begin talk. More specifically, I ask questions and listen to her answers, marking down the responses in the correct area on my chart, making sure to look up frequently and capture her gaze. Though rather than look at me, she aims her stare at the cuffs of her sweatshirt, as she teases at a loose thread in the cotton seam. This, a nervous gesture I have seen before. Still, I attempt to be more of a person while listening to her, rather than appear as the robot that I am, programmed with algorithms that will (or have already) led me to my implemented plan.

I am an accountant of words.

She tells me of her trip yesterday to planned parenthood, of her positive pregnancy test, and her diagnoses of a 6 week pregnancy. Her last period being about 6 weeks ago, and had not bled since then, until today. Now, there is pain, too, accompanying the crimson.

I finish logging her words, like a transcriptionist.

My hinges squeak while being pushed by the various pistons positioned nearest them as I set down the clipboard, and pick up the ophthalmoscope to check pupillary reflexes, then look in her throat. There are no surprises here. Next, check lymph nodes in the neck and listen for bruits. Now the heart and lungs.... I hear clicks of S1 and S2, no murmurs, rubs, gallops. Lungs are clear to auscultation, no wheezes rhonchi or rales. Now I have her lay back to check her abdomen.....

Does not compute.

As I pull back her oversized sweatshirt, her last line of defense... her big-sister-stand-in, the fear permeates from her pregnant belly, and fills the room, banging at my metal exterior. There is nowhere for her to hide now. Her exposed belly is convex, and hard to the touch.... and resembles the harvest moon.

She is full term. She is in labor.

This forces my circuitry to immediately rewire and demand a manual override.

I snap into action.... decipher how far apart contractions are... explain to her that she is much farther along than 6 weeks, in fact, she appears to be full term, and beginning to have contractions (I still am unsure if she really didn't know, or did, but was just in denial). I quickly perform a pelvic exam, the cervical os is partially open, admitting a finger, which now feels the calvaria of another living being, yet to officially join this world, and unknown (supposedly) to its mother only moments before.

Mother and surprise child are immediately transported to another facility where OBGyn can handle the delivery.

I, on the other hand, call the producers of "I didn't know I was pregnant" and tell them that I've got another story for their show.