I was in the outpatient clinic. A new patient came in. An intern had written her history, which began as follows.
'History by Intern S.D. in SVP unit.
Complaint of heavy menorrhagia, associated with clotting, weakness and bodyache.'
I called that intern. She did not seem keen on seeing me, but that could not be helped.
"I called you to find out a few things" I said. "What is S.D.? They call me SVP as a convention in this hospital, which I cannot change. But why initials when you have a full name?"
She did not answer. I never learned what S.D. was for. I would not have written her name here anyway.
"Besides 'heavy' menorrhagia, are there other categories of menorrhagia?" I asked. "Like light and moderate?"
She would not answer that question even after I explained that twice in simple language. Finally she said she had written 'heavy menstrual bleeding', and changed to 'menorrhagia' when advised by the House Officer. it seemed she had forgotten to cancel the word 'heavy'.
"OK. Where does she have those clots? I am quite worried. Does she have them in her cerebral circulation, coronaries, mesenteric veins, deev veins of lower limbs?"
"In her menstrual blood" she answered.
"Oh!" I said. "I am relieved. "But every woman has clots in the menstrual blood. Blood always clots. Normally the clots are not seen because they are lysed in the menstrual blood. If one gets a heavy flow, there is not enough time for the lysis and she passes clots."
She kept quiet. My remarks did not warrant a reply, she must have thought.
"what do you want to do after internship?" I asked. "Ophthalmology?" she seemed the type who would become a good ophthalmologist, I thought without a good reason. Just thin slicing, as described in the book 'Blink' by Malcolm Gladwell. I was wrong.
"Obstetrics Gynecology" she said. I was so taken aback that I dropped my glasses and pen, which I was holding in my hands. When I used the now freed hand to hold my head, she smiled.
"Study well" I said and sent her away for further adventures in history writing.
