A Medical Economics Web Exclusive

Why Mrs. Svarno wouldn’t take off her bra

This doctor thought he’d seen it all–until he met one stubborn lady.

By Harold S. Jenkins, MD
Emergency Medicine Specialist/Madison, VA

"Dr. J, could you check the new asthma patient in room 12?" Ellen, an emergency department nurse, sounded as if the situation was urgent. "She’s pretty tight–I’ll order a nebulizer treatment."

I grabbed my stethoscope and headed down the hall. "Oh, Dr. J," Ellen called after me. "She’s Ukrainian and doesn’t speak a word of English."

"Thanks," I said, hurrying off.

"Hello, Mrs. Svarno," I greeted the patient. "I’m sorry that you’re so short of breath."

Her dark eyes seemed full of questions.

Loyal to one of my most irrational habits–chattering away in English to mystified foreigners–I checked the only medication container Raisa Svarno (not her real name) had brought. The empty inhaler was labeled in foreign words.

Mrs. Svarno, 32, had normal blood pressure and no fever. Her pulse rate was 132, and her respiratory rate was 28. The wall monitor told me that on room air her oxygen saturation was 93 percent.

I lifted the paper exam drape and listened to noisy wheezes in both of Mrs. Svarno’s lungs. She kept her bra on, and I listened around it to a heart that was rapid but otherwise sounded normal. Except for respiratory difficulty, Mrs. Svarno appeared healthy.

"I’ll check you after your nebulizer treatment," I promised. "And I’ll order a chest X-ray and a complete blood count."

Back at the desk, I was dictating a chart note when the radiology technician tapped me on the shoulder.

"Doctor, I’ll be glad to shoot that film as soon as the woman takes her bra off. I’ve exhausted my sign language, and I’m getting nowhere."

I stood up, pondering the limited repertoire of gestures that a physician can utilize to induce a patient to undress.

"I’ll go along with you, Dr. J," Ellen said. "Between us two old-timers, we can get anybody’s underwear off."

But it was not to be. After a barrage of pleas and warnings–verbal and nonverbal–Mrs. Svarno was agitated but unmoved. The bra was there to stay.

I asked the frowning technician to shoot the film anyway.

"Maybe Ukrainian women are more modest than us American gals," Ellen suggested, smiling.

The X-ray didn’t show any problem; it just documented the sturdy infrastructure of Mrs. Svarno’s bra.

After the first nebulizer treatment, the patient’s oxygen saturation rose to 97 percent, and the respiratory therapist said that she was improving. As I stepped into room 12 to see for myself, a tanned, muscular man arrived. Immediately, Mrs. Svarno let loose a torrent of Ukrainian.

Mr. Svarno offered a firm handshake, and in heavily accented English thanked me for caring for his wife. He sounded apologetic. He had warned Raisa not to run out of her inhaler, "but Raisa, she had not listened." Mr. Svarno arched his jet-black eyebrows–a universal gesture. What more can a spouse do in such unfavorable circumstances? his look implied.

By now, Mrs. Svarno’s lungs were almost clear. As I slipped my stethoscope into my pocket, she lifted the chest drape and reached under her bra. From its left compartment, she extracted a stack of $100 bills and handed them to her husband. She repeated the same procedure on the other side, with equally lucrative results. Then she unsnapped her bra, placed it on the bed sheet, and smiled at me.

Mr. Svarno whistled. Then he counted the money–$2,400 in crisp bills. He grinned, as if he’d just won the lottery. "The wives, Doctor! Who can ever understand them?"

"Not me, for one," I agreed, thinking about the surprises that keep my 25-year marriage interesting. "We’ll give Mrs. Svarno another nebulizer treatment, and then she’ll probably be ready to go home."

"Thank you, Doctor," said Mr. Svarno, as he pocketed the cash, which I guessed represented the savings of someone who doesn’t trust banks.

Walking down the hall, I smiled to myself, thinking about what’s behind some patients’ unpredictable, even bizarre, behavior.

I could hardly wait to tell Ellen what she’d just missed.

Harold Jenkins. Why Mrs. Svarno wouldn't take off her bra.

Medical Economics

2001;14.