As his hand caressed her silky brown hair, she closed her eyes and pursed her lips, quickly moistening them by a flick of her tongue. He wrapped his arms around her, and they passionately kissed. When his left hand brushed across her breast, she moaned and reflexively arched her back.

A scene out of a romance novel? Nope. This woman was a patient in the ER, and the man was her stepfather. Yes, stepfather. She was a frequent patient in the ER, and he was invariably at her side. Her mother—his wife—was never around. Some of the ER staff speculated that she was stuffed into a freezer years ago, so as to not interfere with their apparent romance. On prior visits, I'd seen them holding hands and talking baby talk, and him stroking her hair, hour after hour. Unusual, but no proof beyond a reasonable doubt that they were sexually involved. However, after this display, I began to give some credence to the conjecture about the freezer.

Some readers may think that their relationship is none of my business. True, she was over the age of 18, but not by much. While everyone is entitled to privacy at home, I think that public behavior is fair game for analysis. Especially in an ER, where patient behavior is often an invaluable diagnostic clue.

Since this woman presented with abdominal pain, I ran an appropriate series of diagnostic tests. All but one came back negative. As I discussed the results of the tests with the patient, she smiled. The stepfather seemed startled for a second, and then exclaimed, “We're going to have a baby!”

“We're?” I wondered. Not wanting to pass up such an opportunity, I said, “I bet you can't wait to tell your Mom.”

A few seconds of silence. She glanced at him, and he glanced at me. Angrily. I'd touched a raw nerve, no doubt. “Uh, my Mom left us a few years ago. She, um . . . she ran away.”

To me, the “uh” and “um” spoke volumes.

I know that it isn't my job as a doctor to judge people, but hey, I'm human. Their behavior was so glaringly out of the norm that it was bound to draw attention and provoke suspicion. Besides, everyone in the ER thought that patient was a crock, and the overly solicitous behavior of her stepfather was closer to foreplay than it was to the normal ministering that a normal stepfather might do for a normal stepdaughter. I have seen lots of behavior in the ER that I thought was weird, but this duo regularly did things that grated against my sense of propriety in a way that nothing else did.

Others were equally repelled by their antics. Nurses who witnessed those two carrying on would often grimace in disgust, shake their heads from side to side, or say things like, “Eeewwwww, creepy!” Or all three.

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