Mullberry Whine

poured out before bed

Scars

…adapted from Gray’s Anatomy of the Human Body, Henry Gray, 1918…

“We’ve been trying for 3 years now.  It’s so frustrating.  Sometimes I think maybe it’s just that we’re too stressed about it, you know?”

I rest my hand on the young woman’s arm a moment.

“I’m sorry – that is frustrating.  How long have you been married?”

She giggles a little.  “Three years.  We started trying on our honeymoon.  We knew what we wanted when we said ‘I do’ – and it involved the pitter patter of little feet ASAP.  But what’s possible just doesn’t seem soon enough…  Do you have children?”

“No, not yet, but someday we hope to – when life slows down a bit for Mr. Whine and I.  I think once I’ve done a good chunk of residency we’ll start thinking about it more seriously.”

“Oh, you should do it now – because you never know, you know?”

“This is true. And everyone always says there’s never really ‘a right time.’ “

We laugh.

Suddenly a powerful look falls over her pretty face, a look at once pinched and ashen.

“I’m afraid it’s me,” she says quietly.

“What do you mean, Mrs. Jones?”

“I mean, I’m afraid it’s me that’s stopping us from getting pregnant.  I was a little loose in college, you know?  I had several infections and I know that can cause scarring of the ovarian tubes…If it’s me I don’t think-“

Just then, Dr. Obgyn knocks and in short order all is ready for the hysterosalpingogram.  Dr. McFluoro makes an appearance to run the fluoroscopy equipment, bringing the machine over Mrs. Jones’ pelvis as Dr. Obgyn slowly pushes the contrast.  The outline of a normally placed and developed uterus appears on the fluoroscopy screen. I stand at the head of the bed, biting my lip, hoping to see contrast media spill from both fallopian tubes into the peritoneal cavity.

There is no spill.

A great tear runs down Mrs. Jones cheek.

Dr. Obgyn sits at her side and begins to speak in low tones.  Dr. McFluoro steps back, handing me the order for the patient in the next room. I squeeze Mrs. Jones’ limp shoulder before I follow McFluoro out to the anteroom.

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8 comments on “Scars

  1. Dr K
    July 10, 2012

    Hey Mulberry, can you explain exactly what you mean that there is no spill over? Does that mean her tubes are not connected to her uterus? ~Dr. K

    • mullberrywhine
      July 10, 2012

      Hey there Dr. K, good question. The feminine anatomy is nothing if not wily!

      Normally, the fallopian tubes project from and are continuous with the uterus on either side, the free ends lying close to the ovaries.  Those ends are enlarged distally – like little funnels – and hover over the ovaries, having little finger-like projections that sort of stroke eggs released from the ovary towards the tube lumen, where the egg can then be fertilized and make it’s way to the uterus to implant.  Although closely associated with the ovary by a number of ligaments, the tubes are normally open to the abdominal cavity.  A number of pathological conditions, including STDs in the female reproductive tract, can lead to scarring of the Fallopian tubes, which makes passage of the ovulated egg cell into those tubes – and therefore a rendezvous of egg and sperm – difficult.  We can assess patency of the tubes by instilling contrast material into the uterus.  Normally, contrast spills from the uterus through the open tubes into the abdominal cavity.  If there is no spillage of contrast, it suggests blockage of the Fallopian tubes, which is often secondary to the damage caused by inflammation. Mrs. Jones’ Fallopian tubes did not allow contrast through, suggesting there is scarring. 😦

      A sad lesson in anatomy.

  2. on thehomefrontandbeyond
    July 10, 2012

    life is the pits sometimes

  3. Trypanophobia
    July 10, 2012

    You’ve captured so much emotion in just a few lines. This is so sad.

    • mullberrywhine
      July 10, 2012

      These types of experiences are that painful sort of surreal. Poor Mrs. Jones. I hope it all works out well in the end.

  4. Peace Of Iran
    July 10, 2012

    Sometimes things are just so sad and crummy. I hope she doesn’t think it’s her fault 😦

    • mullberrywhine
      July 10, 2012

      Dr. Obgyn is a particularly good physician. I am quite sure he found the right words to give her not only understanding, but also comfort and hope.

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Creative Commons License
Nothing under the table.
***
The views expressed on "Mullberry Whine" are NOT intended to diagnose or treat disease.
***
The med-ed related stories described here are based on real events. Details have been changed in accordance with HIPAA de-identification guidelines to protect confidentiality.
***
Mullberry Whine can be enjoyed daily; there is no unsafe quantity. Real wine, though, should be enjoyed in moderation. At-Risk Drinking for males under 65 is defined as >14 alcoholic beverages per week or >4/day, with >7 drinks a week or >3/day being the cut-off for females under 65 and for anyone, male or female, who has graced this planet for 65 years for more. Drink Mullberry Whine like there are no consequences. But drink alcohol responsibly. Your friends, your family, your health-care provider, and your liver - heck, ALL of the organs in your body - will thank you.
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