...for the abdominal pain...

What's that old saying? Fool me once shame on you, fool me twice...can't get fooled again?
See, I say it and I'm an idiot. The President of the United States says it and...well...I'm still an idiot.
Ever been on a call when you told your driver, "Turn off the lights and sirens and pull over, this is not an emergency"?

THE EMERGENCY

A caller states she is experiencing severe lower abdominal pain.

THE ACTION

We arrive as a dual paramedic unit to find a mid 20s patient doubled over, guarding the lower abdomen on the left side. As we always say, "...a sexually active female experiencing lower quadrant abdominal pain is experiencing an ectopic pregnancy until a physician proves otherwise."

Not a bad base for a treatment plan, but let's make sure to follow up on everything.

I'm going with the treatment plan of "acute abdomen" which allows us to transport to the nearest facility. In questioning our patient she meets all the criteria for an ectopic pregnancy except one.
Sexually active with boyfriend - check
Abdominal pain LLQ 10/10 with guarding - check
Pale, diaphoretic - check
Low BP - check

Female - ...wait a minute...

The question that made me take notice was as I was taping up the IV.
"When was your last cycle?" I asked.

From most female patients I get a response in days or weeks or a look of dread when they realize they're late.

This patient simply looks up with a blank stare. I repeated the question and got a faint shrug of the shoulders and I began to take better notice of the features of my new client. They're doing marvelous things with plastics these days but other features don't add up, the hyoid for one.

"Are you male or female?" I asked bluntly, straightening up my shoulders on the bench.
"Why do you need to know?" was the answer that came back.

"Turn off the lights and siren and pull over, this is not an emergency." I told my driver. With the IV in place a borderline low BP, this was looking more like a "standard" abdominal pain rather than a possibly rupturing fallopian tube. We were only minutes out and I had already given a glowing code 3 acute abdomen radio report.

At the ER I advised the staff that since my radio report certain new facts had changed the course of my treatment and they just smiled and giggled.

Our friend was only weeks away from surgery and had completed all the tests and treatments and psych evals and now, apparently, the hormones.

By now she is living happily in her new role and I learned a valuable lesson to always ask bluntly that which needs to be.

Fool me twice, shame on me.