I’ve sewn up several vaginal lacerations women have acquired during a far too vigorous session of Feely Meely. Rings, fingernails and improvised sex toys can slice through the vaginal wall and, like scalp wounds, vaginal lacerations can make a woman bleed like a stuck pig.

The reasons I hear for the injury are rarely truthful but often entertaining. One woman, sporting an impressive rip in her vagina, claimed neither she nor her husband could retrieve her contraceptive sponge after intercourse. They called the neighbor, another man, over to help and he tore her trying to get it out. That was their story and they were sticking with it.

Lust and alcohol often lead to calamity. I got a call at 5 a.m. on a Sunday morning from the emergency room about a university co-ed who was bleeding rather steadily from her vagina. The ER physician told me she had a long tear that was bleeding steadily and he didn’t feel comfortable trying to repair it. I told him I’d have a look.

One of the nurses followed me into the examination room which smelled of fresh blood, stale cigarettes and beer breath. The young woman, an attractive blond who might have been a cheerleader, was sitting on the table sobbing, because the boyfriend had dropped her off and disappeared. I asked her what happened.

“Well, he had his fingers in me and all of a sudden I felt this sharp pain and I started bleeding.” I thought to myself Yeah and his knuckles drag on the ground when he walks.

When I put the speculum into her vagina I saw a small artery pumping blood from a 3-inch gash in the right vaginal wall. Most times I can fix these in the ER but sometimes it’s much easier to take someone to the operating room where the lights are better, the instruments are plentiful and accessible, and the patient isn’t squirming.

I did a quick history and physical examination, asking the usual questions. Have you ever had surgery? No. Are you allergic to any medicine? No. Have you had anything to eat or drink in the past few hours? No, not since about midnight. I called surgery to set up a room and talked briefly with the anethesiologist. However, when he asked about recent oral intake, she said, “Does the six-pack I drank at 4 a.m. count?” Yes, it does, because general anesthesia increases the risk of vomiting, aspiration and pneumonia, making a spinal the preferred anesthetic.

We took her to the operating room and got her onto the table. I stood in front of her holding her steady while the anesthesiologist did her spinal and she blubbered about her useless boyfriend. When she was numb, the anesthesiologist gave her intravenous medicine to make her sleepy and the sobbing ceased. It took about 30 minutes to fix the tear and I made sure there was no bleeding before we left the room. She would likely be sore for a week or so but there would be no lasting damage.

But her troubles were just beginning. I walked out to the desk and the OR secretary said, “Her father is in the waiting room and wants to talk with you.”

Father? Uh oh…

I walked out to find a man who looked a lot like Dick Cheney but far more unpleasant. “So what happened and why did my daughter need surgery?”

I fudged a little and said, “Well, sometimes women can have really heavy bleeding and we need to do a quick surgical procedure to get it under control.” I think he knew there was more to the story than I was telling him, but he just grumbled and appeared to be as satisfied as any father would be under the circumstances.

It turned out he’d driven 700 miles to take his darling daughter home for spring break. I surmised that was one very long car ride home. If I was her, I might have opted to ride in the trunk rather than submit to an inquisition or, more likely, her dad’s stony silence.

Image credit: (C) Can Stock Photo

The world lost a great woman and an even greater nurse this week, the likes of which we will probably never see again.

Dorothy Leasure Teesdale was the nursing head of Blodgett Memorial Medical Center’s Labor and Delivery unit in Grand Rapids, Michigan—one of the two hospitals in which I did my residency. She was not an administrative toad like many head nurses I meet today. Dorothy was a strong, caring woman whose priorities were patient care and her nurses, probably in that order.  She stood up for nurses and residents when they were right but called them on the carpet when they were wrong.

Dorothy didn’t take shit from anyone, including physicians.  One of the more notoriously cavalier obstetricians started a repeat Cesarean section one morning before the nursing staff was ready to attend to the baby.  This was long before operating rooms mandated safety “time-outs” before anyone laid a hand on the patient.

Dorothy confronted the physician—all six-feet four inches—after the case, noting it wasn’t the first time he’d skirted the rules.  When he tried to argue he hadn’t done anything wrong, she planted her feet and refused to back down. They yelled at each other for 45 minutes while several of us residents down the hallway watched and cheered her on.  He finally relented and apologized.  “I know you’re right and I shouldn’t have done that!”

She could be quietly effective as well.  An older, rather brusque physician was dragging his heels on surgically delivering a mother whose infant’s monitor tracing was looking ominous, she walked behind him and quietly said, “The last time you waited, the baby died.”  Mom was in surgery fifteen minutes later and the baby did well after being resuscitated.

The most important lesson Dorothy taught me was about parenting, not obstetrics.  My first child was a boy.  I’d wanted a girl because I did not relate well to men in general and the fact that he was awake every two hours for six months was wearing on me.  One morning she asked, “How is the baby?”

I said, “The little bastard never sleeps.”

She snapped at me and said, “He’s not a little bastard; he’s your SON!”

I was a little surprised but I was more ashamed of myself.  After that I looked at my son differently and it became easier to try being a nurturing father. I sometimes took him to the unit on the weekends, riding in a carrier I wore like back-pack, with him in the front drooling and making faces.  The change came in handy when his little brother arrived and they became old enough to wale on each other as toddlers (and teenagers).

I’d wanted to tell Dorothy about that when I went to see her two weeks before she passed away, but I didn’t want to cry.  So, thanks, Dorothy, for what you taught me thirty-one years ago.  We will all miss you, but I’ll always remember what you taught me.

Image: St. Catherine of Siena, patron saint of nurses (C) Can Stock Photo