It had been about 45 minutes since I had left my newest patient restrained on the table to cry it out. I feel I have given you sufficient time to deal with your emotions, now back to the work at hand. I enter my patient’s room without knocking. “I’m glad to see someone has gotten their emotions in check. Let’s continue, shall we?” I appreciate that there's no yelling of profanities as I approach, just a glare that I believe is intended to look intimidating, and might have worked if you were upright and clothed, not naked and restrained to a table. “Let’s see, where did we leave off again?” I ponder aloud while flipping through your file. I know exactly where we left off. “We’ve completed an echocardiogram, hysteroscopy, ah, yes, your rectal exam.” Now you’re looking frightened again, pressing your knees together as if that could bar me entry, legs shaking. “With the abnormalities found in your pelvic exam it’s only the logical next step to examine the rest of your genitourinary system. This is really just what any good Doctor would do.” I’ve assembled a wide array of tools onto a tray, most of which you couldn’t name if you tried. “Come on, open up for the Doctor!” I say with a patronizing tone as I’m setting up the stirrups. The uptick in my voice drops when you refuse. “Always taking the hard way.” I sign as I uncuff and manhandle one leg at a time into their rightful place in the stirrups.
“Much better!” I announce before walking away to wash my hands at the sink in the corner of the room. I return in another procedure gown as I’m working long white gloves up my forearms. You can hear the loud snap as the gloves find their resting place. “Just so you’re aware, your cooperation goes a long way in making your time in my clinic more enjoyable. If you would have committed yourself to my care willingly, for example, you might not have to be restrained. Just something for you to chew on. See if you’d like to make some changes to your behavior.” I stood over the slightly raised head of your bed to make eye contact as we speak, when I am caught off guard by, what was that? I piece it together, your pursed lips, now your smirk, the wetness spread across my face, the spots on my glasses. You spit on me. “You ungrateful little bitch!” I grab a wipe intended for cleaning up my patient from the tray to wipe my face and diligently clean my glasses, taking my time to center myself before I do something equally hasty and regrettable. I’m becoming thankful I chose a gown for myself to protect my favorite tie.
I replace my glasses on my nose and rummage through a drawer, returning to your bedside with a bite block. “Let’s not make that mistake again. Open up.” I command despite knowing from your track record that you’ll refuse. No matter, all I have to do is apply some targeted pressure on your jaw and you can’t resist your mouth opening against your will. I quickly have the bite block secured in place via a convenient strap around the back of your head. While your attempts to shake the block loose look pretty cute and pathetic you quickly realize it’s accomplishing nothing. The grunts and groans you make are laughable as well.
“Oh, I’m sorry, was there something you wanted to say?” I ask with faux sympathy. “You should have thought about that before choosing to spit. Remember what I told you about uncooperative patients? I still get my way. The only person who suffers is you.” I take a moment to analyze the EKG readout on the monitor behind your head as the beeping has been signifying your increasing heart rate ever since this spitting and fighting nonsense started; I’m pulling an oxygen mask over your airway, conveniently cleared by the bite block. “I need you to take some slow deep breaths…Don’t make me breathe for you.” I add when you hesitate to follow my instructions. After a couple deep breaths your stats begin to return to a more normal range. “Good job. Now let’s get back to your exam, your health is very important to me after all.” I change into fresh gloves and take my seat between your uncomfortably spread legs. I’m quickly back to being the kind yet detached medical professional I was when you first met me the day before.
“I’m going to start with a digital rectal exam and the rectovaginal exam, you’ll feel my fingers in both orifices at the same time so I can assess muscle tone and look for any defects of the perineum.” You let out a small guttural moan in protest before I’ve even begun. I rub a lubed finger around your asshole for a good thirty seconds waiting for you to relax momentarily for me to make my entry. I could have just forced my way in but I was trying to be kind, a deed that will surely go unappreciated. I can see how much you despise the intrusion already. “This is only one finger, you can take it…It will only get worse from here.” I find no abnormalities notable to me after a couple minutes of manual examination, I insert a second finger to probe slightly deeper and am still satisfied with what I'm feeling. I watch you jump when you hear the snap of me removing my soiled glove, but I'm afraid you are not getting off the hook that easily. “You’ll feel me insert one finger into your vagina now then another into your rectum, I understand it can be uncomfortable but it is quite an important exam…here we go.” and both fingers are in. Simultaneously I use my other hand to apply moderate pressure on your lower abdomen. This can be mildly uncomfortable but is still one of the lesser invasive tests of today. “You’re okay, shh. I’m almost done.” I reassure when I hear your whimper. After another moment I withdraw my hands.
“All good news there! I did not feel any lesions or scar tissue, everything seems to be where it ought to be except for your uterus hanging a little low in your pelvis although that could just be an incidental finding. I will know more once I’ve analyzed the samples I took earlier. Any questions?” I hesitate for a moment, surprised by the lack of a grunt or groan, you have been so vocal thus far. “...Oh, that’s right. You forfeited the privilege to ask questions or have a voice in your care when you spit on me.I hope you are rethinking your choices.” I rise from my stool between your legs to get a better view of my patient’s face when I ask: “Do you plan to behave civilly if I take the bite block out? You may nod or shake your head.” you nod fervently, I can’t help but smirk to myself as I return to my seat. “Good. But I’m not sure if I believe you just yet.” You can hear the metallic clink of tools out of your view, I can see the goosebumps forming on your thighs. “A little bit of cold now.” I warn as I begin insertion of a well lubed, ice cold anoscope into your quivering bottom. I engaged in a preparation I find corrective for unruly patients, preparing the speculum or scope by placing it in an ice bath for a couple minutes prior to use. Oh how my patient squealed! “I’m sure you remember the vaginal speculum that we all know and love. The anoscope is quite similar, sometimes even referred to as an anal speculum. Now that it’s fully inserted, I can use the instrument to open you up…” I slowly click open the scope inside my nervous patient “...Like this.” I punctuate as I lock the scope in it’s open position. You make some adorable high pitched panicked noises as you’re spread open, shaking your head back and forth again. I’m sure it’s quite a novel sensation.
“You’re doing so well.” I reassure as I pull the light in closer, you groan in response. These lights let off a lot of heat, I’m sure you can feel the warmth on your skin, a stark difference to the ice cold speculum. Upon visual inspection nothing seems amiss. I take a couple swabs to test for cancerous cells but I’m doubting we will find any. It’s just a standard precaution. I remove the scope and use a wipe to tidy you up a bit before snapping off my gloves and standing to see eye to eye. “Good news. Everything in your bottom was as it should be. Unfortunately I can’t say that you have a clean bill of health until I get some results back from the lab which might take a couple of days, but don’t worry you’re in good hands until then.” I can see my patient’s gaze following me as I move about the room.
I stop next to the head of the bed, looking down at you. “Now, are you ready to behave?” You nod enthusiastically pleading with your eyes and make one last pathetic groan before I remove the oxygen mask then the bite block. I take a step back to be out of spitting range in case you are still feeling rebellious. “I take it you learned your lesson about spitting?…A proper response please.” I am satisfied when you speak up to answer with a quiet “yes Doctor” I give you a smile that doesn’t quite put you at ease. “Good. I hope you are coming to realize that this is all for your own good. You looked so tired when I first met you, so unwell. Finally someone is giving you the care you need.”
I’m freeing my patient’s legs from the stirrups and getting them comfortable on the bed again. This time there is no kicking or fussing. Defeated and subdued. I pull a sheet over you and have a seat by the counter working on your chart. I hear the sniffling you’re trying to hide coming from the bed. I continue working, pretending I don’t hear to give you the illusion of privacy. But as the sobs grow more intense I move to dim the bright exam lights and sit by your bed. I just watch you for a moment while you look down at your lap, imagining you’re somewhere else. I take a handkerchief from my pocket and dry your eyes since you are unable to do so yourself. I lower the head of the bed so you’re laying flat, “There, there, you’re tired, you’re just tired, close your eyes and take a rest. I know you have questions, we can go over all of that after while.” I speak softly as I run a gloved hand through your hair. As much as you hate it you lean into my touch, you need the comfort I can provide. I can see you try to fight sleep only briefly before giving in. I stay by your side speaking calmly until the sniffling has turned into soft snoring. I get up slowly so as not to wake you and turn off the volume on the heart monitor you’re attached to so as to not disrupt your sleep before I excuse myself to my office across the hall.
A new info-graphic for the toilet room at the clinic. This is right in front of the patient when they are giving their urine sample. I think it spiffs up the place nicely.
Hello, reader. It's been a few days! Life has been busy, but I am ashamed I used that as an excuse not to write. The idea is a daily writing habit, after all. Today, I would like to talk about what I found out yesterday. It is personal, and I will be including a few details that may make some uncomfortable.
Yesterday, I packed myself in the car, drove around the block, and picked up my mother at the corner. Apparently, she was on her way to our abode in order to save time. It was an overcast morning full of birdsong. She put her cane in the back and climbed carefully into the front passenger seat, pulling her legs in slowly. After she buckled her seatbelt, I found directions to the Medical College of Wisconsin, Milwaukee, and began to drive. We live about an hour and a half away and we filled that time with pleasant conversation, reggae music playing quietly in the background.
The roads led us past cornfields and forest that gave way to suburbia, the buildings progressively getting bigger as we got closer to our destination. For two ladies from a rural town, the traffic was a bit scary and the roads confusing. We were, however, on time. I dropped Mom off at the door and parked in the large parking structure attached to the hospital. This was only our second time there, and I thought my doctor was in the gastroenterology department. She was in an entirely different wing!
We followed the signs for the Cancer Center. That wing of the building overlooks a pond that rests just across the road. There were geese rummaging through the grass, heedless of the cars that occasionally rumbled past. The water reflected the damp towel clouds above.
After checking in and the usual formalities, we were escorted into an exam room with two chairs, an exam table, and a low-droning machine with a monitor in the corner. The nurse checked my weight and vitals and handed me an enema in a box. I had never done this before, but I dutifully took the bottle with me to the bathroom and did the deed. Walking back to the room, Mom smiled up at me encouragingly and squeezed my hand. I sat next to her and waited; waiting usually involves a lot of crossing and uncrossing my legs so that I can cross them the other way, slouching and then sitting up straight, bouncing my leg, resting my elbows on my knees so my hands can prop up my chin, finger wiggling, and a lot of sighs that imply more contemplation than impatience. If there is one thing my mother taught me especially well, it is the art of patience. Luckily, we didn't have to wait long.
Due to my lateness, the doctor was ready for us not long after I came back from the bathroom. She and her assistant instructed me to pull my pants down past my knees and lay on the exam table, knees tucked up to my chest. She put on gloves and probed my rectum with a scope. She was looking for tumors, but, thankfully, all she found were polyps. She found a lot of them, all different sizes and pink, like the inside of a cheek. (You might remark that this is, sort of, the inside of a cheek, and you would be right.)
If you are wondering why I needed a rectal exam, (I am certain you are) I have Familial Adenomatous Polyposis (FAP), which is a hereditary disorder that occurs from a change or deletion of the fifth chromosome. It means that I may develop hundreds to thousands of adenomatous polyps, a kind of polyp that can become cancerous. I am also at a slightly higher risk of other cancers, such as thyroid or stomach cancers.
When the doctor was done with my exam, she helped me up and allowed me time to put myself together before beckoning me into the consultation room across the hall. When we were all seated, she explained what needed to happen to reduce my chances of cancer. My whole colon will need to be removed, and the small intestine will be fashioned into a reservoir called a J-Pouch, which will function similarly to my rectum. Since my colonoscopy isn't until next month, we are waiting until the results come in before we discuss things further. If everything goes as planned, I can have my colon removed as soon as the middle of October.
If you are wondering what I think of it all, then I will just say that I intend to rely on the wisdom of my surgeon. Logically, I know what must be done. Emotionally, my mind has not caught up yet, and it may be some days before I finally see an emotional reaction. I looked at myself in the mirror and imagined myself with a stoma bag and a scar, yet it all seems too surreal to fully put into picture. All I can hope for is that I can rely on my family and friends during all of this because I am scared. I can't feel it yet, but I am.
Thank you for reading this really long and detailed ramble. I hope your day is as beautiful as you are.
Imagine being part of the prison’s medical staff. You’re not afraid of Spyder Rudner because you give him physicals, which include examining his prostate. And he likes it.
