Bruised

by NotDownOrOut

I had an appointment with the gynecologist on Friday. It was my first “serious” examination since I underwent a hysterectomy in October of 2011. The only other time that anyone has examined me internally was in December of that year when I was in the emergency room for a rip-roaring bladder infection and the doctor wanted to take a “look-see.” At that time, it was less than three months after my surgery and a day after my twenty-fifth radiation session. If my bladder and bowel were burnt to a crisp by radiation, then the narrow length of flesh lying between them was still smouldering.

Back then they tattooed a big black “X” on my body and used it to line up their equipment. I know what that meant. My vagina was under direct attack. Back then I was glad that my mom had fled the ER before the doctor inserted his speculum because I screamed in pain. The last time I screamed like that I stood up in a theater and screamed because the alien had attached itself to a man’s face in the movie Alien.

I moaned and begged God for mercy during the aftermath of radiation when my bladder was racked with cramps and blood clots. I recall a long, keening sound coming out of me as two nurses struggled to insert a catheter into my body when nothing would pass through the urethra and I thought my bladder might explode under pressure. I have yelled while driving in my car. But, in that tiny bay in the ER, I screamed with so much fear and agony that I still cannot forget it.

So I was terrified at the prospect of another internal examination. I realized that I had time to heal. It could not possibly be as bad after a year of recovery. But fear is not always rational.

On Friday morning I got up at 5:00 a.m., showered, dressed, and headed out. It was cold outside–about 25 degrees outdoors. When I got to the hospital I sat in the car to wait for the elevators to open at 7:00 a.m. By the time I went inside I was frozen. But I forced myself to get moving because I told myself to face my fears and get over them.

I waited for the elevators to open. I was there so early that I had to wait for a nurse to open the doors to the waiting room. A receptionist greeted me and checked me right in. I was so tense and there was a young woman waiting there for an appointment with the Orthopedic Clinic. She suffered from a mental disability that prevented her from speaking in words. Instead, this young woman in her early twenties babbled. She shouted startling sounds. She ran around the waiting room. Her family was there to try to cajole her into staying in a seat. When she stood they tried to encircle her. They would pet her hair and shoulders as if she was a toddler. They comforted her when she cried. After she escaped their loving circle and curled up in a corner on the floor, a father figure huddled beside her with his arms around her.

I was thinking how doctors in the suburbs have a door for well children and another for sick children. What do such doctors do with healthy children with profound difficulty speaking? I have never seen a young adult in a public place with such a difficult-to-cajole personality. Her family’s love was so inspirational. One family member looked to be a younger sister. She wore white leggings and a white sweatshirt, like someone had pulled her from a cheerleading squad meeting. When the sister would run, this young woman bolted after her. It was like guarding in the NBA.

Young people’s dignity can be so fragile. This girl drew so many stares. I wondered what it must be like to be so visible when you felt awkward about what you were doing.

The same nurse who had so much trouble taking my blood pressure on Monday came out and we tried again. On the second try the machine worked. Again my blood pressure was uncharacteristically high. The nurse took me back to an examining room. She explained that the doctors were attending a “tumor” meeting and would be along shortly. Medical students would be the first to arrive. They would perform an internal examination. Then the doctor would stop by to meet me. It was cold in the examining room. She suggested I wait fifteen minutes before undressing and climbing up onto the examining table. There was a pad covering the step I would use to climb up. There was a paper gown to put on with the front open so that the medical student could examine my breasts for signs of cancer. There was a blue plastic blanket to spread over my lap while I waited.

She left me alone in the room. As always, I had papers to grade. But my nerves were getting the better of me. My teeth were chattering. My jaws ached from my efforts to clench them.

After fifteen minutes of waiting with my fears for company I undressed and climbed up onto the examining table to wait. I felt so vulnerable as I waited. This was going to happen. I wanted it to be over.  After another fifteen minutes the nurse came in and announced that I needed to move to another room. The paper gown was hardly adequate cover. It was open from throat to my knees. I needed the blue plastic sheet to shield the naughty bits of my body. I wore socks but no shoes. The nurse gathered some of my stuff, but not all of it. So I clutched my shoes and underwear, my paper gown, and my blue plastic sheet with nerveless fingers.

The nurse headed out into the hallway. I walked with the certainty that nothing was concealed. It was worse than when I walked around the Radiation Department with my cloth hospital gown caught up and my lower torso bared to the amusement of male patients. At least I was drugged with Benadryl that day.

The nurse instructed me to take a seat in another examining room until a third became available. “Don’t sit on the chair,” she cautioned. “Get that blue sheet beneath you so you don’t catch something.”

The cloth seat of the chair had a big black stain on it. I only had one free hand and it was holding that thin plastic sheet for dear life. Somehow I got it around my waist.

Several minutes later I followed the nurse back out into the hallway and down the hall to a third examining room. The effect that this had on my nerves was not pleasant. A slender woman in a white lab coat introduced herself to me while I held onto my clothes, shoes, purse, paper gown, and blue sheet. The nurse had set my book bag on the extra chair in the room. The physician’s assistant (“P.A.”) introduced herself and insisted on shaking my hand. To do that I had to let go of something. It was the last of my dignity.

“Get up on the examining table,” the woman instructed. “I’m going to get some information before we start. Then I’m going to examine you. Then I will present your case to Dr. Y. He may come in and meet you after that.”

Well, it was difficult to get up on that examining table when I was feeling a little demoralized. But I did my best. It was not good enough. She came over to direct me and we ended up tussling over the paper gown and the paper that covered the bottom of the examining table. The gown gave up the ghost. “Don’t worry about it,” she said. “As long as your posterior is on a covering so you don’t catch some infection.”

My feet did not quite touch the step after I was seated. I discussed the experience with Barb today. She said I should never have agreed to get naked before I met the doctor and felt comfortable. I think that would have been better than sitting there with only the blue sheet across my lap and the paper gown hanging from one shoulder. The rest of the torn paper gown was trapped beneath me.

I am direct. I said, “I have to tell you that I am terrified of having this exam today because the last time I had an internal exam it was too soon after surgery and radiation. It was so painful I screamed. I just want to get this over with.”

“You’re in the best of hands,” she assured me. “I’m very experienced at this and Dr. Y trusts me to handle matters. We’ll take good care of you.”

However, it turned out that the P.A., likes to get a thorough medical history. She started asking questions and checking for data on the computer. According to her there were no doctors’ notes to explain my history. I have watched as doctors entered notes, but no one asked as many questions as she did. I kept telling myself that she was being thorough. I was getting really good care. It was going to be okay. But the truth is that she was not easing my fears. I was becoming more nervous.

I was cold. My nose was starting to run. I had goosebumps on the red splotches that covered my limbs and torso. My back started to hurt. I thought my left foot was going numb.

When was my first period? When was my last? Had I been regular? Had I ever taken anything for that? How about hormone replacement therapy? What was the longest time I ever went between periods?

Had I ever had a child? A pregnancy? How did it end? Had I had a D&C?

How had my cancer been diagnosed? Did I have a biopsy? How much blood had I lost? How much blood did I take by transfusion? When was I admitted? When was my surgery? Who did the surgery? At what hospital was I treated? How did I end up at the county hospital? Who referred me to Dr. Y?

She asked about my surgery. What type of tumor was it? Size? Location? Secondary points of spread? Staging? Grade? Prognosis? Lymph node results?

What was my post-surgical experience? Had menopause begun within as few as 48 hours? How long did it last?

When did I start treatment? What was my treatment? Did I have external beam and/or internal radiation therapy? How did I respond?

She asked all the other questions one asks. She wanted to know about my medical history and the medical histories of my dad, mom, sister, and brother. “Do you know that you have gallstones?” she asked.

I nodded.

Thin as a rail this woman was, but she said to me in the heavyhanded manner of someone who enjoys being in charge, “We can’t have all the fatty fried foods we love so well, now can we?”

I resent the implication that being overweight makes me stupid, too. I don’t own a fryer. I have one small bottle of olive oil in my home. I doubt that I have touched it in nearly a year. I have been using the same tub of Smart Balance for more than a year. There’s a package of Snack Well cookies on my shelf that I bought last summer. There is not a french fry in my freezer.

“I see you had a recent blood test. Let’s see what we learned. Oh, I see your cholesterol is very good!” She turned to give me an encouraging look. It was difficult to be sure, but I started to get the impression that condescension was setting in. This was serious condescension. “Hmm, blood sugar safely normal. Surprising really.” She noted that my blood pressure was 160/95 twice that week.

“I am terrified of hearing the cancer is back and even more scared to be having this exam today,” I explained. “I just want to get it over.”

She ignored my nervousness. She had dozens of additional questions about my two medicines, my ongoing physical complaints, my weight, my height, the umbilical hernia that I have. My goosebumps had goosebumps.

In between bouts of questions she told me about herself, her brother who died of leukemia, how she started in brain research at University of Chicago, how she began handling trauma cases, and how she had gone from the brain to the reproductive organs (as if someone had flushed her life down the drain). Our birthdays are coming up. I am two years and four days older than she is. How the doctors were tough on her but helped her hone her skills.

Oh, even as I relive the experience my muscles are taut as bowstrings. I felt so vulnerable sitting there naked while she went on and on about her business. She was so cheerful. It was maddening. I was not myself.

Did I smoke? No. Did I drink? No. Not even a social drink? “No, I have had one sip of champagne for a friend’s birthday in the last three or four years.” She looked skeptical. Was there a problem with alcohol? No. What about prescription drugs? We again reviewed my two prescriptions. Marijuana? Other illegal drugs? No. She turned around to look at me. “I have to ask. You’re sure it’s nothing?”

“Nothing,” I answered. “I am a law professor. I wouldn’t dream of it.”

“Hmm.” She went on to explain that there was big bowl of candy on a piece of paper towel beneath her desk because her brother liked candy. This is how she keeps his memory alive. She keeps candy around.

She decided to refer me to a primary care doctor to discuss my high blood pressure, which she described as “out of control.” She decided to refer me to a surgeon to have my hernia repaired.

I never asked for these services. I just wanted to get the tests over with.

“Married or single?” she asked.

“Divorced.”

“Ever been a victim of domestic violence?”

“No,” I answered. She turned to look at me like she thought I was hiding something. “Really?”

“Really,” I was trying to get my mojo back, but the tension was not easing. “Both of us were lawyers,” I commented. “We abused each other legally.” It was a joke.

“Did you have any of the following?” She started with STD’s.

I said, “I’ve been abstinent since 1986.”

“That’s twenty-five years,” she commented as she clacked at her keyboard.

“More. Long enough to have avoided all those issues,” I said. “The only thing I’ve ever had to contend with is the cancer.”

I had been sitting there for half an hour and we had not started the examination. I wanted to demand we get it over with, but fifteen months of waiting for doctors’ care has taught me patience. And I was still so conscious of being naked. And I thought I was doing an adequate job of using my words. And I was afraid of the moment when she would insert the speculum. The suspense was unravelling my sense of self.

I met a woman while I was in law school who reminded me of the P.A. She was in my study group. She volunteered at a local animal shelter. She used to take in animals to nurse them back to health. We only met at her home once because it was unnerving to see all the sick birds and other animals roaming about the house. The other thing that made us uneasy was that she spoke so often about euthanizing animals that could not be placed with families.

I don’t know the P.A. well enough to say she is a sadist masquerading as a healer. But we did not get to the examination until she was good and ready. That is only one of three reasons why, after I got home that afternoon, I took two showers and went to bed for the rest of the afternoon. (Part II in the next installment).