Letting the Cat out of the Bag

Recently, I let the cat out of the bag.  (I looked that up on Google and found several definitions / explanations, and they agree on ‘ letting out a secret’, but cannot agree on an origin; no matter.)  The result was uncomfortable, for all of us.

So, it’s about 1AM and the place is packed, as usual.  I pull the chart of a very young female, with the chief complaint “abd. pain”.  No worries, probably a UTI.  To the room.

Patient is pleasant, cooperative (a big plus).  Mom is nice, but lets the patient give the history, which is less complicated and easier for me (bonus!).  Patient able to give chief complaint in less than 2 sentences (on a roll!).  Pain is in low pelvis, intermittent, worse sitting up, better lying down, maybe better after urination.  No fever / chills, no NVD, etc.  On the the physical exam.

Patient lies supine.  As it’s an abdominal complaint, the first place my hand goes is the upper abdomen.  It’s where I start, and where patients are comfortable with me starting (don’t just go to the the pelvis student docs, it makes patients tense up very quickly).  And, this isn’t a normal abdomen.

If you’ve handled many bellies one of the things you know instinctively is that they’re normally soft, and there aren’t any really hard or lumpy spots unless something is wrong, or you’re examining a body builder (and that hasn’t happened in my practice).

When I palpated something really hard in the upper abdomen, surprise went through my arm, and my brain wasn’t far behind.  I continued the examination of the abdomen, knew what this lumpiness meant, and said completely without thinking “…when are you due”?

The instant fear in the patient’s eyes got my attention, just as the sound of mom’s gasp reached my ears.  I felt a bit more of the  abdomen to be sure, and awkwardly excused myself with ‘ let me go get the sono machine, I’ll be right back…’.  Oh, I got to make the Big Announcement.  Great….

The sono machine preceded me into the cubicle, and a show and tell of baby parts was made to a completely unappreciative (or just stunned) audience.  About 34 weeks gestation by the machine calculations.  The now older mom was teary but in control, and the now-outed very-young mom was unhappy, but more in the loss-of-denial way than any anger or defiance.

The lower abdominal pains were contractions.  Early teen pregnancy isn’t the diagnosis I’d thought I’d make.

I felt about 2 inches tall the rest of the night, because I had let the cat out of the bag into the wild rather than facilitate the release under more controlled circumstances.  The patient and mom went to the Labor Deck to meet with the nurses there, and the social workers.

I blog this as a warning to other docs: you’re going to get surprised, eventually.  Keep the cat in the bag until everyone is ready to catch, including you.


Comments

  1. Medieval_Medic says:

    Uh, wow. That’s pretty awkward. However, it sounds like you did the best that you could, given the circumstances. How old was the mom-to-be-at-any-minute?

  2. Back in the old days, when you didn’t have to be secretive about a teenager’s pregnancy, a 14-year-old girl arrives with Mom because of abdominal bloating and pain.

    I go to auscultate bowel sounds and am roundly kicked through the abdominal wall by a very developed foot.

    “Girl, you are PREGANT!” I promptly announced.

    “Grandma” says, “I knew it, it just wasn’t right. I knew it!”

    Patient says, “I am?”

    Oh dear.

    “Grandma” says that they are gonna have a lot to do to get ready for this baby! They probably have about three weeks.

    Amazing.

  3. What would you do, ask the girl in private to tell her mom or go talk with the mom in private and tell her yourself?

  4. It could be worse — you could have pressed on the Abdomen and said “What the hell is *that*?”

  5. An unusually beautiful young woman came in to the ER with her husband because they had been trying to get her pregnant, she was “a couple of weeks” overdue for her period, but now she was spotting a bit. They both seemed very concerned.

    We did a serum pregnancy test on her, and it came back positive. While I was writing a note, I saw her husband walking by the nurses’ station, and told him the good news. “Oh, congratulations!” I said with a smile.

    Meanwhile, his wife was informing my nurse that she had been unfaithful, had been impregnated by another man, and had just gotten an abortion a few days ago. She asked the nurse if we would tell her husband that she had miscarried. The beta was apparently still positive after her recent abortion.

    Less than a minute later, the husband comes in all happy and smiling, and he excitedly tells her that she was pregnant!

    Since my patient had never confided directly to me, I pretended that I knew nothing, and let them handle it themselves.

  6. I don’t know what else you could have done – one would assume that if a very-pregnant girl brings her mom to the doctor and complains of abdominal pain that the doctor will figure out she’s pregnant and want to ask her about it. It may have been awkward for them, but I think the girl brought that on herself by not telling her mother about the pregnancy about 30 weeks ago.

  7. I read one version of the origin of ‘letting the cat out of the bag’. Seems back in the dark ages in Europe archers would put a cat in a bag, tie the bag to a tree branch, and shoot at the bag, upsetting the cat terribly. The cat would claw and thrash around in the bag, making a moving target. Sooner or later the bag would tear enough for the cat to get out, thus ‘cat out of the bag’. Please do not forward this info on to the Humane Society or PETA, would hate to upset their applecart (or bag).

  8. OMG, how do you get to 34 weeks without the world knowing! Um, this is scary . . . my daughter is about to go on her first date–homecoming. I think I’ll chaperone! I don’t plan to be the mom/grandma in the exam room getting THAT news.

  9. Alison Cummins says:

    The explanation I’ve heard of cats in bags is the same as pigs in pokes. You go to the market to sell a piglet which you are conveniently carrying in a bag (poke). Your customer hefts the bag, notes that the contents are lively, pays and leaves; you leave the area quickly and pocket your cash.

    The “piglet” was of course a cat. Letting the cat out of the bag prematurely spoiled the scam. Buying a pig in a poke meant being scammed.

  10. It could be worse. For us, the young woman’s dad worked as an EMT in our ER. All hell really broke loose that night.

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