Gynecological diagnosis II

Continued from Gynecological diagnosis I

At the office the day of the follow up appointment, the receptionist said “routine exam?” I said no, it was not routine. I started to tell her the short version of the hospitalization story but she had shut the window.

A few minutes later, she opened it and said “The doctor had an emergency call to labor and delivery. He should be back soon.” Over an hour later, I was ushered into an exam room. The nurse handed me the paper gown and told me to get changed and wait up on the table for the routine exam.

“I’m not here for a routine exam” I practically growled at her. “Oh, well, uh, ok” she said and left the room fast, understandably looking a little on the defensive from my rotten attitude and tone. It wasn’t her fault. I knew that. But I was still pissed off.

After she left, I sat in the corner fully clothed, glowering and waiting for the doctor. When he arrived, he looked puzzled not to see someone on the exam table, sunny side up, waiting for him. He scanned the room quickly, finding me sitting in the corner. I saw his eyes shift a little once they found me. They took on a focus, an aspect that isn’t usually there in the “routine exam” context, something personal. If life had sound effects, his would have been this.

He said “So what’s going on?”

We went over why I was there and I explained I was NOT having ANOTHER pelvic exam unless it was necessary and I didn’t see why it was necessary so he was going to have to tell me what the HELL was going on first. At his suggestion, we adjorned to his office. He sat behind his desk and used words like “endometriosis” and “ovarian sites” and “small amount of blood in the cul de sac”. I had some idea of what he was talking about, but nowhere near enough to understand even what questions to ask at this point. He concluded by telling me that I probably would never be able to get pregnant. I realized even at the time this was an incredibly irresponsible if not plain old stupid thing to say to a 19 year old sexually active young woman.

Then he wrote two scripts and sent me on my way.

Back in my dorm, I called my mother. I read her the scripts and she told me they were for a diuretic and a psych med. I threw them out without filling them.

It’s many years later now. I’m 35 and I just had my second laparoscopy. The first one, in 2002, confirmed the endo diagnosis.

In Spring of 2002, after exhausting the resources of my primary care physician (I found out over a year later that he’d been dealing with his own personal case of refractory Lyme Disease – which was why his office kept canceling his appointments at the last minute) and after having lost my patience with my grad school infirmary’s health care providers, I finally went to my regular routine Ob-Gynecologist. She was one of the very few left practicing in my area due to a combination of the region being somewhat rural and the apparently quite high malpractice insurance costs in the state.

I wasn’t certain it was gynecological at first. Having had a history of both GI and GYN problems, I guess I made the same mistake my doctors had made in the past. I assumed pain between my pubic bone and diaphragm was probably GI. Especially when that pain came with a heavy dose of nausea.

What lead me on the 2002 trip through the GI/GYN maze and eventually to that first lap was that I’d been sick for nearly 2 months. I had persistent pain in my right side, sort of in the middle. That’s an odd way to phrase it, isn’t it? But I say “middle” because the issue of latitude (so to speak) came up when the infirmary’s nurse practioner ordered an ultrasound.

“A pelvic ultrasound,” the infirmary nurse said on the phone “for right upper quadrant pain.” Although I could only hear her side the conversation, I knew enough from calling in these test myself what kind of hell she was getting from the radiology department’s scheduling clerk on the other end.
“Well, it IS a pelvic ultrasound!” she said into the phone. I said “not when the pain’s above my belly button it’s not…” She ignored me.

The nurse practioner and I hadn’t hit it off. My opinion of her immediately sunk after she asked me “How much work are you missing because of the pain?” “I’m in pretty much every day, but I find myself walking to my building looking for where I can stop and puke if I need to. I mean, that’s like how I get from the garage to the building, one trash can and bathroom at a time. I feel bad all the time, every day, and sometimes I feel even worse.”
She said “It can’t be that bad if you can get up and go to work.”
I answered “I’m a PhD student working as a research assistant. I don’t GET sick time. I have to go to work, so that’s not a valid measure.”

I’ve found that doctors and nurses really don’t take that kind of tone or response very well. I resolve, every now and then, to find ways to temper my tone in such situations. I won’t temper the terms, but I could at least try on the tone. Unfortunately, when I’m not feeling well, I’m not at my best. And when I’m not at my best, it’s hard to implement that resolution.

The nurse eventually managed to order an ultrasound which would cover the areas of interest. She sent me off saying “it’s probably just a stomach flu”.

The ultrasound showed nothing. My follow up appointment with her ended with a diagnosis of “stomach flu”. I left and made an appointment with my gynecologist – an appoinment which couldn’t be scheduled until several weeks from then.

In the meantime, the pain persisted. Three things about how I felt concerned me deeply. One was where the pain was. It had started in my pelvis – quite acutely one day at breakfast. I was at Bickford’s. I remember very well. I was eating an omlette, which I didn’t make it through. I have occasion to look back on the days before that breakfast as the last few days I felt genuinely GOOD.

When the pain started that day, it was central and in a sort of column up, starting about 2 inches over my pubic bone but stopping abot an inch or so below my waist. Genuine pelvic pain. After a few days, it radiated up and around my side, nearly into my back, and there it had remained for months.

The second this that concerned me deeply was that I felt so baaaaaadd. I was constantly nauseous and run down, like I had the flu. I had an elevated temp, never reaching the standard for a fever but high for someone who’s normally hanging out in the high 97 area.

And lastly, I was starting to fall behind in my school work. I would have liked to be as dismissive about this illness as the infirmary nurse, mostly because I was getting tired of feeling like the chronically sick girl. When the hell was I going to get better? It was very frustrating, it wore on me. It made me cranky and a little sad. I had never been a super active person, but I enjoyed walking, it was not unusual for me to take a five mile walk on a day off. Also, I was typically a rather animated and energetic person. And I am smart, verbally quick, and usually somewhat funny. I like to socialize. But it’s hard to be your walking, energetic, smart, chatty, funny, sociable self when you feel so run down, sick to your stomach, and in PAIN all the time.

I had no idea pain could be so exhausting.

The day of my appointment with my gynecologist, I was in an immense amount of pain. I’d been taking ibuprofen in doses even my mother the old battle axe nurse would have disapproved of (she tended to see the maximum doses on most OTC meds as mere suggestions – except for acetaminophen), but I was barely able to lie flat on the exam table.

My gynecologist said she thought it might be the endo but that she couldn’t be sure without a lap. I said, somewhat to my horror, “then do the lap.” I needed to know and I needed this fixed. I could live like this, but I certainly wasn’t going to be able to live well like this. I was 30 years old and, despite the occasional, isolated, and those days quite rare acute pain/poop/puke/passing out episodes, I was pretty darned healthy.

I took a stats exam the day we decided to do the lap. I did not do well on the stats exam. I ended up taking an incomplete in the class. This was not unheard of, but I had done very well in Stats I, and to take an incomplete in Stats II was something of a mark of shame in graduate school. Especially in my program, which was heavily analytical.

(to be continued)

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  1. Gynecological diagnosis III « Final Trick

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