Face Plant

I did my residency training at a County Hospital. Part of the training involved working at the University Medical Center, which is also known as the pelvic exam capital of the world. I’m not even joking. Some days, you would do 25 pelvic exams in your 8 hour shift. People would check in with chest pain and then say, “oh by the way, I also have vaginal discharge.” My residency program is a 4 year residency and a large part of the third year curriculum was acting as the senior resident while at the University.

I remember one day I was the senior at the U and I had a 4th year medical student working with me.  Let’s call him Alex (not his real name). One of the roles of the senior was to see all of the patients that the medical students saw. On this shift, my medical student saw a patient (let’s call her Mrs. Smith) who had presented for vaginal pain and discharge. We had discussed the need to perform a pelvic exam and we had the nurse get all of the required supplies. The University was nice in that most beds had the capability to transform into a pelvic bed. The legs would pull out and the center part of the bed would be removed so that the patient could sit in the lithotomy position comfortably. Traditionally if I was working solo, I wouldn’t take the time to transform the bed. In my experience, having the patient sit in the frog leg position with their bottom on an inverted bed pan works just as well in a fraction of the time. For this patient, however, we had the bed transformed and the woman was instructed to scoot down to the foot of the bed with her feet in the stirrups.

I had instructed Alex, the medical student, on the typical procedure (how to insert the speculum, collect swabs, bimanual exam, etc). This was the first pelvic exam he had performed and he was clearly nervous. As we walked into the room, the nurse was already there with the patient in the lithotomy position with her feet in the stirrups. There was a stool in the room and I wheeled the stool in between the patient’s legs so that Alex could sit as he performed her exam. At first, things seemed to be going as planned. Alex asked the patient to relax her legs and advised that she would feel his hand as it touched her inner thigh. He advised that she would feel some pressure as he continued the exam with the speculum. So far, so good.

And then, things took a turn for the worse. Alex had forgotten to remove his stethoscope prior to getting ready for the pelvic exam and it had started to slide off his neck as he leaned forward to place the speculum. The stethoscope slid off his right shoulder and landed flat on the ground in front of his stool. As if by rudimentary reaction, Alex bent forward to pick up his stethoscope. Unfortunately, he forgot that directly in front of him was the vagina that belonged to the lovely Mrs. Smith, who had come to the emergency dept for vaginal odor and discharge. As you can see where this is going, Alex blindly bent forward to pick up his stethoscope and face planted directly into Mrs. Smith’s vagina. In complete horror and dismay, Alex jumped up, started screaming incoherently, and ran out of the room; leaving me, the nurse, and this frightened patient wondering what to do now.

Unfortunately, my gut reaction was to start laughing violently. I mean, this poor kid just accidentally smashed his face into this woman’s vagina and his response was to start screaming at the top of his lungs and then run out of the room. As hard as it is to admit, this was the funniest thing I had seen in a long time. So as I stood there laughing uncontrollably, I thought my best plan of action would be to also leave the room. So in between gasps of laughter, I excused myself and stepped outside. Which left just Mrs. Smith and the nurse. And Alex’s stethoscope, which he never successfully retrieved.

After what felt like ten solid minutes of laughing, I managed to collect myself and return to the room. I successfully completed Mrs. Smith’s exam and wrote her a prescription for Flagyl to treat her BV. I apologized for the interaction that occurred earlier and advised she return for any new or worsening symptoms. She gave me a dirty look as she retrieved her prescription and left the department. The nurse gave me a similarly cheeky look, which was then followed by the both of us breaking down in uncontrollable laughter for another ten minutes. I never saw Alex again. I can only assume that he did not pursue a career in emergency medicine. Or gynecology.

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Dr Erik Adler

Emergency Medicine Doctor. Trained in Colorado. Hobbies include snowboarding, mountain biking, camping, and hanging out with his wife, daughter, and two dogs. 

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