Working in a hospital is an education in itself. Not just a medical education, although that is the primary purpose of being there, but an education in the human condition. Anything can happen in a hospital. There is nothing too strange, too bizarre or too outlandish. Human frailty and foibles as well as indomitable strength are constantly on display.
Consider the case of the devil’s baby.
The chief resident in obstetrics is responsible for the care of patients who don’t have a doctor of their own. Therefore, when the warden of the state women’s prison called the hospital with a problem, he was put through to the chief resident, and that was me. A patient in the prison was currently nine months pregnant and very upset. She was convinced that she was pregnant with the devil’s baby. They were sending her in by ambulance for evaluation.
“Evaluation?” I was dumbfounded. “What do you want me to evaluate?”
“Just make sure the baby is normal,” he replied. “Show her that she’s not carrying the devil’s baby.”
I couldn’t believe it. “I don’t have to examine her to know she’s not carrying the devil’s baby.”
“Well, she’s already on her way,” he responded. “Just do … something.”
Unfortunately, it was a very busy day. There weren’t any exam rooms available to see her. She was placed in the doctor’s lounge and was forced to wait hours while I dealt with other medical problems before I could get to her, since “carrying the devil’s baby” did not seem to be a medical emergency.
The patient was not perturbed at the wait. In fact, she was enjoying it. She was shackled to the stretcher, but in all other respects, the surroundings were far superior to the woman’s prison. The nurses had gotten her a meal. (“Yes,” I had exasperatedly replied when asked if she was allowed to eat. “We don’t really believe that she is carrying the devil’s baby.”) She was watching television and enjoying a glorious view of the city from her tenth floor quarters.
I swept in with a medical student in tow. “What seems to be the problem?”
She remembered why she was there and her brow furrowed. “I’ve got the devil’s baby inside of me, and I’m afraid.”
The delusions of mental illness are not likely to be changed by reality, but I was obligated to try. I affected a cheerful demeanor. “Oh, I’m sure that your baby is a normal baby and not the devil’s baby at all. How about if I get the ultrasound machine and show you the baby?”
“I don’t know,” she replied. “I’m afraid.”
“No reason to be afraid,” I responded briskly. “You’ll see that everything is okay.”
I got the ultrasound machine and proceeded with a careful examination and explanation of what we were seeing. I traced the baby’s body parts on the screen, all the while feeling extremely foolish.
I traced the baby’s head. “See, no horns.”
I showed her the baby’s body. “No sign of a tail,” I announced cheerfully. “Perfectly normal in every way!”
“I don’t know,” the patient seemed extremely doubtful.
“Now that I’ve shown you that the baby is healthy and normal, I’m going to invite a very nice man to talk to you about your worries. He has lots of experience with people who are afraid of being pregnant with the devil’s baby,” and I headed off to call the psychiatry resident on call.
The psychiatry resident visited with her and decided to hold off on any psychiatric medication until after the baby’s birth, since the patient currently did not seem distressed. We gave her another meal, let her watch her favorite shows on television, and call the ambulance to take her back.
I phoned the warden’s office to inform them. I emphasized to them that she was perfectly fine (except for her delusions) and that the baby appeared to be normal and growing well. “She’s not carrying the devil’s baby,” I admonished, “and if she complains about it again, you should not send her back.”
I thought the matter was settled.
Several weeks later, the secretary on the labor floor paged me to the phone. The prison was on the line again. It was the warden.
“Remember the lady you saw a few weeks ago? Um, well, we have another little problem.”
“Another problem?” I was not in the mood for riddles. “Now what’s wrong?”
“Well, this morning she complained of pain in her stomach, but we didn’t believe her. Oh, no, we weren’t going to fall for her tricks. Last time we sent her to the hospital because she said she was carrying the devil’s baby and she wasn’t!
I could immediately see where this was going.
He continued. “She kept calling us, but we just ignored her. She tricked us before, so we didn’t believe her.”
He finished in a rush, “So she lay down on the floor of her cell and had the baby all by herself. We just found her and called for an ambulance.”
The warden had summoned a nurse from the prison infirmary, who had tied off and cut the umbilical cord. They bundled up the baby, who seemed healthy and content, and the mother, who was not bleeding very much, and sent them in.
She was glad to be back, and thrilled that she could stay for several days. The nurses ordered her favorite foods and arranged for a nice room. I arranged for the visit from the psychiatrist, and pondered the strange way that prison officials manage medical problems. They sent the patient in for “evaluation” when she claimed that she was carrying the devil’s baby, but ignored her cries for help when she was in labor. It’s amazing what you can learn about the human condition when you work in a hospital.
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