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Romance, Hypotension, And The Little Blue Patch

A patient was brought in around midnight as a “possible stroke.” She was a 60-something woman who had suddenly become unresponsive.

She and her husband had been making love at the time, and he noticed that she was no longer conscious. Unable to revive her, he had called 911. She looked bad — but it was strange.

She was groggy and semi-coherent, but there was no asymmetry to her neurologic exam. She was profoundly hypotensive, with blood pressures of 60 to 70 over 30. Whenever she tried to sit up, she became light-headed and lost consciousness (not that we allowed her to sit up!) We had her bed inverted, in the trendelenburg position, and pumping her full of IV fluids we were barely able to bring her blood pressure to acceptable levels.

Eventually we had to put her on inotropes to support her circulatory status. But we had no clue about why she was abruptly so sick. Apparently she had been feeling fine prior to becoming amorous with her husband. No chest pain and no cardiac abnormalities to suggest a primary heart issue. No fever or source of infection. No belly pain or signs of bleeding. No neuro findings. Just unexplained, severe, persistent hypotension.

Then her husband showed up. He quite sheepishly admitted what had happened which perfectly explained his wife’s situation.

“You see,” he said hesitantly in a thick Ukranian accent, “for a long time now I have had trouble getting an erection. Dr. Sergei said that I could not take the Viagra because of my heart and my nitroglycerin. But Dr. Sergei is very smart, and he had a solution for me. I would take one of my nitroglycerin patches and wrap it round the shaft of my penis. Then I could have an erection and I could have sex again. This has worked well for us for many years.”

I wish I could’ve seen my own face as this man was telling me this. It must have been priceless.

“Tonight, after the paramedics left, I needed to clean up before I could come in to the hospital. I was throwing the wrapper for the nitroglycerin patch into the rubbish and I realized that I did not know where the patch had gotten to. I think I might have forgotten to take it off, and I think it might have come off inside her.”

I had the hardest time suppressing my laughter, but so wretched did the poor old man look that I put on my most consoling face and thanked him for this very important information. We went back into the room and five minutes later I triumphantly produced the offending patch from her vagina. It took a while, but she began a slow, steady improvement from that moment. We admitted her overnight for observation, and she went home in the morning feeling well.

I don’t know if there’s a moral to this story, beyond the fact that people will do almost anything to have sex. I suppose it could be: “Don’t inadvertently insert a nitro patch into your wife’s vagina,” but that doesn’t seem to have as much general applicability.

*This blog post was originally published at Movin' Meat*


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