Opinion
Volume 1 Issue S1 - 2015
An ordinary case from ordination
Oliver Šulović*
Department of Gynaecology and obstetrics, Dom Zdravlja Hospital, Serbia
*Corresponding Author: Oliver Šulović, Department of Gynaecology and obstetrics, Dom Zdravlja Hospital, Serbia.
Received: December 17, 2015; Published: December 21, 2015
Citation: Oliver Šulović. “An ordinary case from ordination”. EC Gynaecology 1.S1 (2015): S1-S2.
I’m Dr. Oliver Šulović, gynecology and obstetrics specialist for 26 years. Thus, a soul of a writer much longer. Talented, perhaps; it is difficult to judge yourself. Strayed in medicine or it was meant to be, who knows?
That is why this case report from my office will be presented a little differently and might not meet the criteria of this competition.
I have been working in the Health Center in Nis, the second largest city in Serbia. In the health care system of my country, maybe the only in the world, there is a system of a chosen doctor in gynecology and obstetrics.
The patient said she is 43 years old, and she looked as if she is over 10 older; she has five children and her visit was due to the absence of menstrual cycles more than three months. Very often while patients are ready for review in my head I alter several differential diagnoses. I immediately told her that it was possible that she was pregnant, but she denied and said that she was already old.
When she lay down on the gynecological table, I noticed the signs of vitiligo across the skin. Her naturally dark skin was white in places, rough and coarse. She reminded of an old woman. I went through a gynecological examination and found that the uterus is firm, the size of a newborn, mobile and almost to the navel. This is not pregnancy, I thought, quite sturdy uterus for pregnancy.
A curious doctor is always directed towards an accurate diagnosis so I told her immediately that I would do an ultrasound examination. We came in the ultrasonic cabinet and of course coffee in the service of a doctor “sets” of diagnosis. The fundus of the uterus showed myoma 50 x 50 mm and pregnancy of 14 weeks. The embryo is formed, the normal anatomical structures with positive FSF, movements, twisting and playing in the womb.
Every time I see this little creature, less than three months old, fully formed, I’m truly delighted as I was when I first watched the ultrasound of a pregnant woman as a young doctor in residency. I informed her about what I had seen, and she began to cry. “Doctor, what am I to do, I already have five of them and I cannot feed them. I do not care for this tumor, this child…I cannot give it birth”. The epilogue of the case was that she was sent to a tertiary institution where she underwent an artificial termination of pregnancy, a fibroid was not removed but was advised further monitoring. The case was closed and questions remained lingering.
The woman in 43, when many other women are slowly entering the perimeno break, a women with fibroid and with vitiligo, a rather neglected wife in every way was pregnant. Maybe it’s not a lot strange, but a long time afterwards I wondered about other women, educated, groomed, clean, with perfect results, with husbands with normospermia, women negative for Chlamydia and Mycoplasma, HCV and CMV, the toxoplasmosis, with proven ovulations and passable fallopian tubes? What about women who could raise five children, who live in huge homes and drive expensive cars but pregnancy does not occur. Why?
What is the message passed to us from nature, God or fate? We doctors are helpless and the judge is the one who decides in whose hands the child would cry. It is so powerful and perhaps we the doctors are not asked.
God’s justice, nature or chance, I really do not know. All I know is that this wannabe writer, perhaps the artist in me, doctor, gynecologist, remained thoughtful and deeply saddened by this case. Therefore, this may not be adequate account for your contest but I wanted to share my experiences with you.
In the end though, I greeted my patient with a slight enigmatic smile, since life is just because of its unpredictability and diversity beautiful and we need to respect it and enjoy it every single day.
Copyright: © 2015 Oliver Šulović. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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