TMI alert for anyone who gets squirmy about vaginal health.
I popped in for a gynecology visit yesterday fearing I have a UTI. I figured it'd be a quick cultures-and-done visit, and that I'd leave with a prescription and happier lady bits. And then, once there, I remembered that it's still 2017 and healthcare hasn't been "solved" yet. Things would definitely not be so simple or streamlined.
For a few minutes of blissful ignorance, I lay there pantsless under the perpetually-too-short-to-cover-my-ass sheet and checked my emails while waiting for the doctor. She came in, and I remembered how much I like her. And then, 30 seconds later, I decided that I don't.
I explained the situation: urgency, frequency, and a raw vulva. I figured she'd jab me with a Q-tip, send it to the lab, and carry on with her day. She looked through my (admittedly voluminous) file and surmised that something "more complex" is going on. She said I may be a good candidate for some kind of clitoral procedure that she'd share more about later.
No, I'm normal now.
I told her that I've actually been totally pain-free for a long time now. I work out 5 days a week. Before the nurse told me to take my pants off, I was wearing undies and yoga pants. I'm fine. My pain's not back. I'm here for a normal issue, and I want it treated as such. I am not defined by my former illness, and I hate being treated like it's always hiding in the rafters of my reproductive system. It is indeed possible to have normal lady health issues without it being an echo of a significant health episode that's now two years in my rearview mirror.
She grabbed a few cotton swabs and had me recline on the table. Before I did so, I sought reassurance: "Only swabs today. No needles or scopes or clitoris things." She nodded and agreed, and after scanning the items in her hands, I was reassured that she didn't have the tools for a more invasive adventure even if she wanted one.
She poked and prodded at me. I flinched and (involuntarily) slid my own hands down beneath the sheet to protect my lady bits from her. She dragged each swab uncermoniously across my vulva and then stuck it into a test tube for shipment to the lab. The third one hurt the most. Involuntarily, I scolded her: "FUCK!" and sat straight up in my most true-to-form sit-up to date. She popped the final swab in its tube, and I saw it turn the solution red with blood. from. my. tender. tissues.
She coaxed me back into a supine position so she could do an internal exam, which begat more flinching and cursing (without apology this time) from me. And then, just when I thought things couldn't get worse, she sat down so we could talk.
When the talking is the worst part.
There was talking, but there was no listening.
She began by telling me about a conference that she recently attended, and she shared a hypothesis about how my clitoris may have adhesions. She asked about my medications and why I hadn't tried something different. She suggested I use suppository medications and, potentially, that I return for a minor procedure that will involve 3 different numbing agents applied to my clitoris while somebody uses a vulvoscope to examine and prod the area. She also thought that nerve blocks may benefit me (but that I'm "not quite there yet") and that some vaginal suppositories would be a good treatment.
Now's a good time to relay some really important info. There is an incredible irony about this experience.
Here's the ironic thing: I was going to speak at said conference, and I may speak at said conference next year. However, this particular conference has been resistant to allowing a patient to speak, fearful that I'm just coming there to whine. The irony was not lost on me that, had this doctor heard me speak at this conference about bedside manner and relationship-centered care, it may have dramatically impacted my appointment and experience today. Instead, she learned about this new clitoral-exploration procedure in a patient-free vacuum.
When she left the room, a single tear fell from one of my eyes, I lay on the table for a few moments, and I slowly got up, got dressed, and exited the clinic. I walked to my car, sat in the driver's seat, called my husband, and started crying. I felt like I was starting from square one again. Are my medications not working? Do I have clitoral adhesions? Do I have some weird infection or inflammation or problem that they can't find? Is it happening again?
My husband was incredible. He reminded me that I'm in a better position than most to put today's visit in perspective. I know that this is a case of poor bedside manner, and I also know that I don't have any scary and undiagnosed medical condition. I did yoga that morning, I'm healthy, and I have a medical team that I trust. This woman's opinions and suggestions are simply irrelevant to me.
He's right. And this experience reminded me that the way a provider delivers information to a patient is often more important than the information being conveyed. Yesterday didn't have to be a difficult day. I could've left that appointment, run errands, grabbed some coffee, and gotten back to work. Instead, I'm on the sofa with my dog, Crosby. When I pee, it's painful because I'm scratched raw from her swabs. My entire crotch is sore and I feel nauseated from the stress and discomfort of it. Plus, I feel scared, because some small part of my brain wonders if she's right about my body being broken again.
And here's the thing: that fear makes me angry. No one will call my body's health onto the carpet again. No one will suggest that some novel new procedure, let alone nerve blocks and suppositories, is the answer to my problems without spending the time to get to know me and hear about how my life is impacted by my health. No one will leave me frightened on the exam table and ever again see me in their office.
It's not a privilege to be seen and treated by a physician. Back when I didn't have access to medical care, I often felt like it was -- like those who had access to doctors were lucky. Instead, I think that providers are privileged to treat patients. They're privileged to be in a line of work that's challenging and rewarding and of their choosing. They're privileged to do work that matters and that brings positive change to people's lives. Patients are privileged to be treated by those who demonstrate clinical and interpersonal excellence. But when the provider isn't excellent, I think we as patients would often be better off with no medical intervention. Because not all "intervention" counts as healthcare. And yesterday, while I saw a doctor and received an exam and had some tests run, I wasn't cared for. And it felt like shit.