I want a great-grandchild

Recently I took care of a 16 year-old who stated she was experiencing vaginal bleeding and had not had her menstrual period in “about 2 months”. The patient was accompanied by her grandmother who stated the patient had a positive result on a home pregnancy test taken 2 days ago. “It was the best money could buy!” Both the patient and her great-grandmother were concerned for the vaginal bleeding. Since the timing of the patients last menstrual period and her current vaginal bleeding raised my concern for an ectopic pregnancy, an evolving pregnancy that is growing outside of the uterus, which is a dangerous life-threatening condition, I ordered some blood work and a pelvic ultrasound to assess the patient’s condition. As I interviewed the patient I inquired if this pregnancy, her first, was planned or unexpected. Both the patient and the grandmother (who looked like she was about 50) assured me that this pregnancy was planned. “She’s getting married in 2 months!” the grandmother informed me. Upon further questioning the patient had dropped out of high school, earned her GED, was planning on marrying her 16 year-old sweetheart, and they felt they were ready to start a family -- even though neither one of them had a job. Grandma didn’t appear to be rolling in the dough either. I was supportive and I congratulated the patient on earning her GED. I also encouraged her to go back to school to gain a marketable skill after her current pregnancy. After an hour when the patient’s studies had been completed, I returned to the exam room to inform these ladies that the patient had no pregnancy in her uterus, no pregnancy outside her uterus, and, furthermore, had no circulating pregnancy hormone in her blood. The patient was not pregnant despite the reported positive test at home. The patient took the news well, and I told her that since she wasn’t pregnant it might be a good idea to start birth control and get a career started before starting her family. Unfortunately grandma was not interested in that advice and she told me “I’m ready for a baby!” Then she proceeded to reassure her 16 year-old granddaughter she could start trying to get pregnant right away. I walked away literally shaking my head wondering why grandma was pushing so hard to get this teenager pregnant and thereby assume an enormous responsibility that would last the rest of her life. Why not let this girl enjoy the rest of her childhood before reproducing. At least let her get a job so that she could support the child rather than expecting the government to provide care. A few minutes later my nurse came to tell me that grandmother had really blown up when the nurse had repeated my advice – this nurse had also been a teen-aged mother and knew what she talking about. Apparently grandma was tired of having other people tell her grandchild what to do – that was her right – and she and the patient stormed out of the ER. Presumably to go find the patient’s future baby daddy and get back to work attempting to reproduce.