Love On Call

As Mari walked back to the cubicle with Antonelli dogging her heels, she scanned the chart and didn’t find anything else that teased her antennae. Antonelli was probably right. The most obvious diagnosis was usually the correct one. She smiled when she thought of the old adage, When you hear hoofbeats in the hall, don’t think of zebras. All the same, the difference between a good diagnostician and an excellent one was both curiosity and suspicion. Probably a little OCD as well. The time to be certain was before you acted, because once you began a course of treatment, uncertainty was the enemy, especially if the treatment happened to be surgical.

She pulled back the curtain and introduced herself to the pale young Asian woman who waited alone in the cubicle. She briefly ran down the history Antonelli had already taken and noted one thing he hadn’t.

“So your last period was a little late and shorter than usual?”

“Only a day and not much of that,” the patient said. “But I was right in the middle of some pretty intense rehearsals, and a lot of times when I’m really stressed that happens.”

“What do you do?” Mari asked.

“I’m a dancer. Modern, mostly.”

“Where do you perform?” Mari couldn’t imagine a local art house in this rural area, and even if there was one, she doubted it could support a dance troupe, but maybe the company was located in Albany.

Kuni Yamaguchi smiled. “We’re performing at the Saratoga Performing Arts Center this summer. I’m with the New York Dance Company, but my grandmother lives here. I stay with her whenever I can.”

“Wow, that’s incredible. I’ll have to check out the events calendar.” Mari drew the sheet down and gently palpated Kuni’s abdomen. When she reached the lower right quadrant, the young woman tensed and caught her breath. “So tell me about this pain.”

“I didn’t really pay any attention to it until last night, and then it just wouldn’t go away.”

Mari recalled Antonelli’s history and physical. Twelve-hour history of pain. “It didn’t actually start last night?”

“Well, it didn’t really start bothering me until last night. I noticed it just a time or two over the last few days. Not enough to slow me down. I didn’t miss rehearsal.”

“Aha. I know how that is.” From what Mari knew of dancers, most women in competitive fields, really, they’d have to be dead to miss a rehearsal or class or meeting. She glanced over at Antonelli, whose impatient expression had turned to a frown.

“What do you say we get an ultrasound in here,” Mari suggested casually.

“Yeah, I copy that.”

Turning back to Kuni, she said, “I want to do a quick ultrasound scan, that’s a test—”

“I know what it is, but why? The other doctor thought it was my appendix.”

“And he might very well be right. But sometimes two different things can look a lot alike at first. I just want to be sure that we’re not talking about something to do with your ovaries. We can do it while we’re waiting for the results of your pregnancy test.”

“Oh.” For an instant, Kuni looked panicked. “I can’t possibly be pregnant. I don’t have any time to be pregnant, and besides that, we’re always really careful.”

“You take the Pill?”

“I did, but it makes me bloat so I stopped. But I use a diaphragm and we use a condom.” She laughed. “Really, nothing could get through all that.”

“Uh-huh,” Mari said, seeing no point in citing the statistics.

A second later Antonelli pushed the curtain aside and trundled in with the portable ultrasound machine. He set it up beside the bed and glanced at Mari.

“Have you done one before?” Mari asked.

“A couple of times.”

“Good. Let’s see what we see.”

He squeezed the cold blue gel onto Kuni’s stomach and she stiffened at the first contact, then relaxed as Antonelli, with surprisingly sensitive hands, gently guided the probe in ever increasing circles from a spot in the right lower quadrant outward. At one point he paused, backed up, and circled again. He stopped and looked over at Mari. She had been following the images on the screen, and the mass in the right lower quadrant was pretty hard to miss.

“Let’s get GYN down here,” Mari said, looking directly into Antonelli’s eyes to make sure they were on the same wavelength. The bright snap in his dark gaze told her they were and he would make sure to request a consult stat.

Mari covered Kuni with the sheet as Antonelli stepped out to call GYN. “Did someone come with you today?”

“No, I didn’t want to worry my grandmother until I knew what was going on.”

“What about your boyfriend?”

For the first time, the young woman, who had to be in considerable pain, looked distressed. “He, uh, no. I’d rather not…”

“You might want to call him or a family member,” Mari said. “We’re going to get one of the GYN surgeons down here, but I’m pretty sure you have what we call an ectopic pregnancy. That’s a situation where a fertilized egg doesn’t make it into the uterus but lodges somewhere else—often on a fallopian tube.”