A Conversation or Two

A sample of typical telephone calls I get at work:

The phone rings, I pick up the receiver: "Women's Clinic, hello."

(Breathless voice on the other end, usually calling from a mobile phone with bad reception or she is in the noisiest intersection in town, and it is obvious she is holding an infant, since the baby's screaming is considerably louder than the woman's voice): "Hello, is this the Women's Clinic?"

I affirm that it is, thinking that it has hardly changed from my greeting not five seconds before, but too wise to say that, as it would lead to impossible complications in explaining why it was the same clinic it was five seconds ago.

Patient: Well, what I wanted to know…my doctor is overseas/on vacation/not available/only has office hours once a week and it isn't for a few days yet…what I wanted to know…you are a nurse, aren't you? You see, I did a pregnancy test today and I want the result, what I mean is that I've got the result from the internet but I don't understand it…" (This is said usually without pausing for breath, which is one problem, since it is usually very hard to understand what she is saying, as if the bad connection and the screaming kid isn't enough)

For reasons known only to the kupah lawyers, who work out of Tel Aviv and have never had any contact with patients, we are not supposed to give lab results over the phone. Kupah members can download results from the internet, but no one ever understands them, which is predictable, since they are patients, not medical professionals. Most of the names of the tests are either abbreviations or in Latin or English, and all are written in the Latin alphabet, which also poses a problem for certain sectors of the Israeli population. Hence, the need to call us, even if they do have the results in their hot little hands. I tell the woman I cannot give her the results over the phone (this often provokes a discussion in which I have to defend the kupah's ostensible regard for patient privacy. That can waste 10 minutes right there, and, btw, shows just how misguided the policy is, as some doctors give their patients instructions to go to hospital, etc. depending on certain lab values) But this lady to whom I am talking has her results in front of her, although I suspect she's probably finding it difficult to juggle her cell phone, her baby, and the page with the results.

Me: All right. Look for the line that begins H.C.G., followed by the word Q.U.A.N.T., 'quant' …

Patient: What? Where? Oh, I see it says " if less than three, negative, if more than 25"…

Me: No, above that.

Patient: What's the "less than three"?

Me: Those are the normal parameters. A result of less than three units means a negative result, more than 25 units means a positive result. Look for the line immediately above that".

Patient: Where it is written 'HCG'?"

Me: Yes. (I'm beginning to get pressure behind my eyeballs) After 'HCG QUANT' and 'S' in parentheses, what is written?

Patient: Negative.

Me: Negative means you are not pregnant.

Patient: Are you sure?

Me: Yes. (the headache is definite by now)

Patient: Why not?

Well, madam (or miss), I'm sure I don't know (no, I don't really say that)

Repeat this conversation, or a variant thereof, at least 5 times a shift. Another interesting fact is that I now know exactly how badly math is taught in Israeli schools. Unless there is no human chorionic gonadotropin to measure at all, the result is given in numbers. A perfectly incredible number of women do not understand the meaning of a decimal point, and vehemently insist that they ARE pregnant, because the result is 0.69 and "69 is more than 25". I've actually been told that I don't know what I'm talking about when I insist that 0.69 is less than 1. I would attribute this to a natural desire to have a positive result, except that I've gotten the same response from women who are anxious not to be pregnant.

Here's another:

The caller has an elderly sort of voice, combined with a strong Middle Eastern or North African accent. She wants to know if her daughter is pregnant. After going through a whole "we can't give results over the phone" spiel, the woman triumphantly says that she has the results in front of her, and her daughter is standing by, but is "unwilling" to come to the phone. The woman also says that she can't read the results, but after mangling several abbreviations, it is apparent that she does indeed have some lab results in front of her. I pull up the exam on my computer, since I don't know precisely to what she is referring. I note that the young lady who had the tests done is 18 years old. I also notice that no pregnancy test was done, only a blood count, which is normal. I tell her mother that. Officially I shouldn't, since I'm talking to a third party, but there's no harm in telling her that her daughter is healthy.

Mother: Why can't you tell if she is pregnant? She had blood drawn.

Me: But not for a pregnancy test.

Mother: What's the big deal? You can't tell from the lab results? Blood is blood, after all.

Me: There are several hundred different kinds of tests that need blood. The doctor did not order a pregnancy test. He ordered a blood count, which tells him several things, such as if your daughter needs to take iron, which she does not.

Mother: You can't tell if she is pregnant from a blood count?

Me: No, I can't. And Madam, I wouldn't tell anyone but your daughter if I did have that result. So why don't you either put her on the line, or ring off? Obviously, I don't say that out loud, either.

Mother: Make a guess. Surely you can tell something from the results. Why else would the doctor order a blood test?

Oh Lord, give me strength. Or give them some intelligence. For a long time, my idea of purgatory was being locked in a room with Elizabeth Schwarzkopf singing lieder endlessly. I'm beginning to reconsider that, in favor of an unending stream of such telephone calls. I think that might be a lot worse than La Schwarzkopf.