The Sentence is Pronounced

26 April 2008

Yesterday, I met for the first time with my gynecologic oncologist. It was a nightmare.

The first bus I had to catch was ten minutes late, which meant that I probably was not going to be able to catch the second bus to get there on time, and which meant I would have had to stand in the middle of nowhere for at least 30 minutes waiting for the next bus. I was freaking out when I called the bus company. Luckily, I got ahold of my quasi-friend there, M. She and I have talked a few times, and she calls me “Pearl” because there is a street in my city called Pearl which she swears is on the map but doesn’t exist in reality. She sounds like an older black lady, and has a wicked sense of humor.

This time, we weren’t joking around. “M., it’s ‘Pearl’. I have my first meeting today with my oncologist, and the bus was 10 minutes late, and I don’t think I can make it. Is there any way I can?” “Well, hon, hang on, just let me see what I can do,” she said. She got on the line with the supervisors as I watched the stops coming and going.

For ten minutes, she was on and off the phone, as I kept her updated on what stop I was at when. She told me the best they could do would be to hold the bus for one minute. No more. And it didn’t look like I would make it. But as she tracked my bus and the next one, somehow, I was suddenly at the stop I needed. “Hon, are you off the bus? Now look down the street – do you see a bus coming?” she asked. I can’t see much of anything most of the time; I’m about blind as a bat. “No,” I said, crying. “Wait – I see one!” I said. As it came closer, I saw it was the one I needed. “M., bless you, bless you, bless you, you are wonderful! I said to her.” “Well, if you want to tell my boss that, that would be a good thing,” she said. “You bet I will,” I told her. And I will. First thing Monday.

I got to the clinic, and it was as cold and sterile feeling as possible, in spite of the fact that they had put up bookcases with books, and two computers. They had no signs, and the computers were off, so I was afraid to use one or even to ask. It felt sterile. It felt disconnected. It felt all wrong.

I waited. I played Sudoku. I waited. I read “I Know Why the Caged Bird Sings.” I waited. I went outside and smoked. I waited. I waited close to an hour and a half to even see the doctor, by which time I was a teary, shaky, mess.

Gynecological matters freak me out. I’m sorry, I am just one of those women who curls up into an emotional ball every time I have to get a Pap test (and quite frankly, I often go years without one; in recent years, I’ve had to keep up with them, because I also have an ovarian cyst, and my gynecologist wanted to keep a close eye on it for a couple of years, so they happened in conjunction with each other.). I feel violated. I feel abused. I feel humiliated. I feel raped.

I don’t know why I feel this way, but I do. Perhaps it is because I have been raped, and of course, one of the things that happens after that if you report it is that you must have a gynecological examination. Perhaps it is because I had to have a gynecological examination when I was a young child. The details are unremembered; I vaguely seem to think I had a very bad staph infection throughout my body, and somehow or another, that required a gynecological examination. I really don’t remember well enough to know. All I know is I was about six or seven, and it was a terrible trauma, made worse by my mother being there, wringing her hands and repeating over and over “Oh, she shouldn’t have to go through this so young. Oh, God, she shouldn’t have to.” Or perhaps it simply is a humiliating, invasive examination, and I am hardly alone in feeling the way I do. I do not know.

I do know I have spent years avoiding male gynecologists. For many years, I got my exam from an LPN at a low-cost clinic; I called her my “Gyno-Nurse”. She was a Quaker, and a lesbian, and very gentle and calming. And she was about the only reason I was able to get through a number of Pap tests over 20 some years.

But here I am, with no female gynecological oncologists on my insurance list. Why aren’t there, I wonder? Why is it that there are a disproportionate number of male gynecologists, period? I do not understand this. The old “Saturday Night Live” skit, “Mel Gibson, Dream Gynecologist” aside (which even I admit was very, very funny), I can’t imagine most women wanting strange men poking around in their most private areas, with their too-large hands and lack of gentleness.

I am having a meltdown by the time I am called in to his office. I have gone prepared, complete with a list of my meds, a list of my medical problems, copies of my family trees with ages and causes of death and medical problems, a list of questions, and a cover letter explaining what I do and do not want. He shuffles paperwork, and does not even look me in the eye. He asks a few questions, and gives my answers to my questions too quickly for me to write them down. He draws a very bad graphic to show me where the area is that will be removed. This does not make me feel any better, as it is involves not just my vulva, but part of my vagina as well. He tells me there will be scarring. He tells me there is a high risk that I will go through all of this again, as it will come back. If I do nothing, he says, and do not quit smoking, I will have a 90% chance of this becoming cancerous within 10 years “and believe me, you do not want that,” he says darkly.

He cannot do a laser surgery because of where it is located. It will have to be by incision. I have clearly stated in my letter that I want to be completely knocked out by anesthesia and be completely unaware of anything, yet he seems to misunderstand that, and tells me I will likely have a spinal anesthetic and won’t feel anything. I not only do not want to feel anything, I don’t want to know anything. Luckily, I remember that I found out a few years ago that I have spina bifida occulta, and I tell him this. “Oh,” he says. “Then you probably will have to have a general anesthesia.” Which is what I told him specifically I wanted in the first place.

He clearly is angry that I am demanding that there by no student observers during this procedure. “This is teaching hospital,” he says (yes, I think, didn’t I say that in my letter? “I do realize this is a teaching hospital, but . . . .”). “They have to learn. This is how I learned.” He is clearly annoyed, and it doesn’t help when I burst out in tears saying “I don’t want some pimply-faced 20-year-old idiot watching this!”

This is not going well at all. I have been here for close to two hours, dreading the inevitable exam, and it has not yet happened. I am pure nerves; I am barely here, translucent skin and no bones.

It is time for the examination, and I am a wreck. I am not told ahead of time what to expect. Right off the bat, he tells me he will be applying vinegar for 30 seconds; he does not tell me why. It doesn’t register in my mind how very, very painful vinegar on my vulva could be. I nearly scream and vaguely am aware that I am holding the nurse’s hand and feel I am having an out-of-body experience. He is murmuring “I am sorry to have to cause you pain,” but I wonder if he means it. My skin on my vulva has grown so thin with age, that when he pulls away the vinegar-soaked cotton, some of my skin comes, too. I bleed. He tells me I will be bleeding for a few days most likely. I feel deliberately harmed and mutilated yet again.

There is, of course, always a speculum involved. They are never pleasant; they are always cold and at the very least uncomfortable. For an over-50 woman with a broken pelvis that has probably not healed yet or healed right, with osteoporosis, whose bones have moved tighter together, whose skin has grown thinner, whose vagina is dry and tight with age, it is a nightmare. I nearly scream and cry again from the pain. I am still throbbing from the vinegar, and still don’t even know why he did that.

Finally, it is time for the finger examination. Even that hurts, his too-large digits poking around my tight, thin, diseased opening. And it is humiliating. No one but a spouse or a lover should be there, should see this, should touch this way.

I am done, and sobbing as I get dressed. I feel dirty. I feel like I need to wash off the awfulness of this day. But I am not done.

I have agreed to my own mutilation. Three doctors have told me it is the best way to deal with this. I feel that I have no choice. They have hung that ugly “C” word above my head like a Sword of Damocles, and I look up and see the sharp point of cancer, and look down, and see the mutilated being I will become.

I wonder why it seems that mutilating women is such a big business with male doctors. Pregnant? Let’s cut it out with a C-section so I don’t miss my golf game. Breast cancer? We’d better make sure and cut off your breast, just in case. Some little problem after giving birth? Let’s cut out all your inner female organs. Cut, cut, cut. Do they get some perverse pleasure in feeling they are striking back at women? Do they hate us that much?

Now I must sit with someone else and make appointment plans and get information. I am emotionally and physically exhausted. I want only to be home, so I can cry on my bed, wash myself off, and try to feel human again. But paperwork must be handled, and the deed must have a date.

May 21^st. That is the date of my mutilation. That is the date I no longer will be the woman I am, or once was. That is the date after which, I will always wonder if anyone will ever want to touch me or love me again.

Ironically, I have an appointment with my psychologist that day. I tell them, and they snap “That is the only day he can do it.” The only day out of 365? That seems rather odd to me. But, like the good little girl I was brought up to be, I do not question. I write it in my little calendar, trembling, sealing my fate.

I am the last patient to leave. I have missed both buses I had schedules for, so I am lost in time, not knowing when one will show. I sit in the grass, and wait until one comes, some 25 minutes later. I wait another 15 minutes for the second bus. I should have taken a different bus, gone to the ATM, gotten out some cash, but I cannot face anything right now. I just want to be home.

The second bus driver is alone on the bus. I have had to start using my cane again, because I have begun to fall again. Before I can even sit down, he starts the bus, driving quickly, probably as late as everyone else was that day. I have had enough. He stares at me, and before he can tell me to move behind the line, I say “I cannot move well with my cane, so I am waiting until you stop again before I sit down.” He snaps that it will be a long time before he stops again, mumbles something under his breath, but pulls over for about two seconds – barely time enough for me to sit down. I want to smash his head in.

I finally am home, and shakily walk up the steps. I wonder why I am acquiescing in my own destruction.

Barely inside, I notice Cosmo has managed to dislodge the tube in his ear. I cannot take this. I cannot take anymore. But he is my baby, and I have to deal with his medical problems. I look at his ear, with a sick feeling in my stomach (a sick feeling I have carried with me since being at the clinic), looking at open flesh in both the top and bottom sections. I call C., the vet tech, and tell him what has happened, asking him if that will be a problem, since I was planning on bringing Cosmo in on Monday to get the tube and stitches out anyway. C. is one of the gentlest, sweetest guys I have ever met. He accidentally hangs up on me. Of course. I call back, and he apologizes, and says he hopes I forgive him. “Never!” I say. “I will be mad at you for the rest of my life.” He catches the tongue-in-cheek nature of my comments and laughs, then tells me as long as the openings in his ear stay open (in other words, I need to keep using the medication) and it keeps draining, it should be all right.

I have no extra money to spare, but this night, I do not care. I pay the fee to get cash out of the ATM I can walk to, and I pick up a 12-pack of Rolling Rock and go home again to order a pizza and watch the second version of “The Wicker Man” that I picked up the other day for $5. (It’s not worth it, by the way. The original is so overwhelmingly better, this Nicholas Cage version is almost truly awful. The only bright light for me was that Ellen Burstyn was in it.).

I know drinking isn’t the answer. I know all it will do is make me feel lousy the next day. Which it does. But somehow, I don’t care. I am shattered into pieces and desperately clawing to find my dignity and humanity again. I have been stripped bare emotionally as much as physically. I will strip myself further until there is nothing but raw emotion, and I will let it out safely at home, sob and scream and allow myself to mourn this coming death.