Saturday, June 22, 2013

First do no harm: medical stories

Look at me 

"Which looks clearer: 1 or 2?"

Anna concentrated as Dr. Bartholomeu clicked the lenses into place, first 1, then 2. The tiny translucent black worms that haunted her vision throughout the day swam as she focused on the pyramid of capital letters and numbers. 
The truth was that they both looked the same.
"Um... maybe 1? But it's close."
Dr. Bartholomeu didn't seem surprised by this. Perhaps many of his patients said the same thing. Perhaps it was the correct answer.
The office felt too casual; she had expected more formality, more solemn pomp or something. There had been no other patients in the waiting area when Anna had arrived for her appointment at 4 p.m. on a Thursday. Dr. Bartholomeu and the receptionist, Monique, had been joking, and Monique was wearing jeans and not sitting behind the desk. Dr. Bartholomeu was young, probably fresh out of medical school or residency or whatever optometrists have to do before they start seeing patients in their very own offices next to the LensCrafters store.
Monique was comically outgoing. In the short five minutes that Anna spent filling out her form, Monique had asked Anna whether she was single (she was), and had shared, out of the blue, that she had a baby but was dating someone who wasn't the father. She had solicited Anna's opinion on which used car to buy, the silver one (the color Monique wanted) that had 80,000 miles on it, or the beige one (yuck) with only 16,000 miles on it. Monique had seemed to be leaning toward the silver one, so Anna told her to go for that one. "It'll make you happier, even if it's not the most practical choice," Anna had said, uncharacteristically.
Now, sitting in front of the eye chart, in the chair with the steampunk-y lens contraption attached to it, Anna picked up on a contrived quality to Dr. Bartholomeu's easygoing "buddy" manner. He asked questions but didn't listen to the answers, and his jokes seemed pre-cooked and re-warmed.
"So you do data entry, huh? I guess that means a lot of time staring at the computer." He was reading what she'd written on the line after "Occupation" on her form. He said "data entry" with the slightest condescending lilt, a fake enthusiasm that only revealed his boredom and disdain.

His past unfurled in front of her, spelled out like the orderly ziggurat of letters on the eye chart. East Coast prep school, following in the footsteps of his illustrious father, a mother who would never think any girl he brought home was good enough for him, college someplace with Gothic buildings and autumn leaves, a fraternity.  

This office in Roanoke was only temporary. He didn't belong here, and he didn't want to be here. Just a year or two, and then on to a real city with traffic and skyscrapers, taxis ferrying him and his equally anointed friends to crowded wine bars or faux-Irish pubs to meet girls with graduate degrees and straightened hair and bleached smiles. City streets, stepping confidently in front of cars as part of a boisterous herd ignoring the "Don't Walk" signal, car exhaust illumined by headlights, his Armani trenchcoat flapping in the wind and his laugh a plume of frost in the winter air. 

But for now he tries to ignore the cows on the hillside when he drives to the airport to fly to his parents' house in Philadelphia.
Anna found him repugnant but wanted his approval, wanted to show him that she wasn't some hick who was only good for drone jobs.
"It's my summer job. I study anthropology at Virginia Tech."
Actually, her major was Sociology, but "anthropology" sounded better.
She could have said anything, could have said she was training to become a rodeo clown, or a Druidic priestess. It didn't matter. She was the last patient of the day, and his elite boredom was seeping through his populist act.
"Mmm hmm." He wheeled his chair over so that he was facing Anna. He shined a narrow beam of light into her left eye, peeking at her eyeball through the lens. "Look straight ahead."
Anna's eyelashes brushed against the lens. She could see a faint reflection of her eye at the same time that she saw the beam of light.

Just a few minutes ago, before he had led her into the room with the eye chart in it, Dr. Bartholomeu had won a tiny but decisive victory over Anna. He'd walked into the little anteroom where Monique was administering the air-puff test that Anna ordinarily both dreaded and enjoyed: the terrible anticipation, then the freshness of that waft of air on her bare eye, and an adrenaline rush afterward. This time, however, Anna was concerned -- Monique didn't seem to know what she was doing. (Anna wondered, Should a receptionist be aiming part of a machine at my eye? Is she trained for this?) Monique kept adjusting the device, and at one point she actually laughed and said, "Oops." "Oops" was not something Anna had ever wanted to hear in any sort of medical context.
"Look right at me," Monique had said, and then Dr. Bartholomeu had walked in, and Anna's glance had subconsciously flickered over to him instead. "Keep looking at me," Monique had said sternly. Dr. Bartholomeu's back was turned, but Anna was sure that he had been smirking, that he'd been thinking she had been checking him out. Thinking that of course this plain bumpkin couldn't resist checking out the gilded preppy guy from the Big City. That wasn't the case at all, and Anna tried to make this clear with her aloof, objective demeanor throughout the rest of the visit.

Now, suddenly, Dr. Bartholomeu reached over and pressed a fingertip to Anna's browbone, lifting her eyelid slightly to get a better look at the entire eye as he continued to shine the light at her.
Anna realized that he touched her skin gingerly, almost hesitatingly. She wondered if he was pleasantly surprised by the rose-petal texture of her eyelid.

As he lifted the other lid and peered into the eye, she thought about her trepidation at being touched in general. She'd dated a few guys, but had never had sex. It boggled her mind, the thought that people did that.

Last week she was standing in line at Rite-Aid buying saline solution for her contact lenses. The guy in front of her was buying a six-pack of Miller Lite, a two-liter bottle of Diet Pepsi, and a package of Trojan condoms. He laid his merchandise on the counter. She noticed that he was sly, respectfully placing the other items in front of the Trojans to avoid brandishing them to the other people in line, but he was also matter-of-fact, as if they were milk or bread, something he bought often, a necessity. She'd stared at him, at his tall, strapping form and his unexceptional but friendly countenance, jeans, a baseball cap. Some regular guy.

Images like scenes she'd seen on late-night cable at her parents' house flashed in her mind, bodies in motion bathed in a red light, and it seemed incredible that he would use these, that he would unroll them onto his penis and penetrate someone. Unbelievable. Too weird to imagine here in the brightly lit, humdrum environs of the Rite-Aid.
The idea that she might have sex someday was abstract, like when she was little and a grown-up would ask what she wanted to be when she grew up. She usually said, "A ballerina," or later, "A veterinarian," but she never really believed herself, even then.
It wasn't that she didn't want to be touched. Many moments during the day, in class or at the dining hall, or lying in the loft bed in her dorm room, or at her data-entry summer job, her mind strayed to vague sexual daydreams. It was always a rough outline because she was unable to fill in the details. She thought in terms like "making love;" her daydreams were gauzy with good cinematography, the light always that golden tone of Tuscan sunsets.

She had nagging questions about many of the technicalities. Furthermore, she was afraid that in real life her body would somehow seem abnormal or repugnant to the other person, especially if he had been with other, better women before. What would her body feel like to someone else? What would it feel like to a guy having sex with her? What would he think about the texture of her skin, the way her skin and hair smelled, the way her lips tasted? She was sure she would do something wrong, commit some breach in etiquette or protocol, that she would just not do it right.
Anna felt a little sorry for doctors, having to touch her and other people as part of their jobs. They had that in common with prostitutes, it occurred to her now. She had never been to a gynecologist, out of fear and embarrassment, but she'd had to get a rudimentary physical before attending college. The nurse had given her a quick, brisk breast exam. The nurse, kneading each breast, had expertly distracted Anna's attention from her hands by making small talk and telling Anna how to perform self-exams. The nurse was cheery, and ignored the humiliating moment when Anna's nipples instinctively hardened on impact.
Even going to the dentist had always seemed to Anna a mildly and mutually humiliating event. As she lay in the dentist's chair, her teeth bared obscenely like a hostile gorilla, the dentist would sigh through his surgical mask and peek at the watch above the elastic band of his rubber glove to see how much longer he had to do this until he could go home.
It wasn't this way for everyone, surely. There was a place at the mall, a Chinese massage and acupuncture clinic filled with cots and potted bamboo. One afternoon Anna had stood in the mall corridor across from the clinic, leaning on a railing, watching what was happening inside. An elderly Chinese man massaged the legs of an obese middle-aged man. The Chinese man hadn't seemed repulsed, stroking the man's calves lovingly. Maybe the Chinese man was thinking that the obese man didn't get lovingly touched enough, and maybe was trying to make up for this.

There were more minor defeats before the end of the visit with Dr. Bartholomeu. He asked whether Anna wanted a prescription for contacts only or if she wanted one for glasses, too (she didn't; she looked terrible in glasses). She could have sworn he'd smirked when he'd said, "That's probably a good thing -- if you wore glasses, they'd be pretty thick." Four-eyes, nerd. And later, when trying out a pair of contacts in her new (worsening, as always) prescription, she'd attempted something like a low-level joke after putting the new lenses in, saying, "Ah! Now I can see," as if she'd been bat-blind before putting the new contacts in. He'd smirked again, conveying that it was a waste of time for her to venture anything personal, anything other than, "1 looks better, definitely 1," or, "Looks like A...F...2?...D, or maybe O..."
She drove home wearing a sample pair of contacts in her new prescription. The world was clearer, everything sharply delineated; each leaf was crisp, even on the faraway trees. A flock of swallows pirouetted across the sky and alighted on a power wire.

Watching the birds and their antics, her vision clouded over with despicable tears. She hadn't told Dr. Bartholomeu about the phantom black worms that plague her vision, and that she's sure are abnormal. Or about her fear, irrational but real, that she's slowly going blind. She hadn't felt close enough to him to be able to say something like this. 


A few minutes after one o'clock on a Friday, she was sitting in a doctor's office alone, naked from the waist down with a rumpled sheet of gauze over her lap for the illusion of modesty. She had never been to a gynecologist, but she could not find the contraceptive sponge inside her after hours of disgraceful poking and prodding in a restroom stall at work with a make-up mirror; this was a panicked last resort. Her appointment had been at 12:45, but the doctor was running late; they'd worked her in at the last minute, so she waited in uncomplaining patience. 

The walls were a dusty pink, and there was a framed mass-produced photo of a child holding a bouquet of flowers with the corny caption, "Secret Admirer." She looked out the eleventh-floor window at the generic office-park buildings and the sluggish traffic. She rested her bare feet on a ledge as she sat on the politely gauze-covered reclining chair. She looked at two Kermit-green pads covering the dimples where you rest your feet as the doctor examines you. The pads were printed with ads for some sort of pharmaceutical solution. She breathed in and out, trying to calm down. She thought, "Man, they'll stick ads on anything," trying to make herself laugh. She closed her eyes and tried to hear some of the music they had made love to.


His name was Dr. Siegel, but until she took a business card on her way out of the appointment, she had envisioned it as being spelled "Dr. Seagull." Waiting for him, the sheet over her lap, she looked down and saw that her black lace-edged panties were crumpled on top of the jeans she had hurried out of, not having been sure when someone would enter the room. She thought they looked vulgar, carelessly on display like that. She thought of getting up and off the reclining chair to stuff them under her jeans, but she didn't want to be standing, even with the sheet in front of her, when he came in. She had agreed to see a male doctor under the circumstances (it was Friday, doctors' offices wouldn't be open again till Monday, and the sponge had already been inside her past the 30-hour limit; the spermicide could be toxic if left inside her for another day or two, the box had said).

When she'd put it in her, it had gone in so easily. She hadn't known her own body, but the thing had slipped right into place. It had been comforting, made her body seem knowable. Like she was a simple doll made of simple parts. Later, when she couldn't find the sponge, the terror had somehow gone beyond what it should have been, passing into something existential. Reaching into the unknowable abyss of her own body, she had groped in the darkness, finding nothing. It felt inevitable.


He walked in calm, looking at his clipboard. Asked her why she was here today. In a clear, articulate, teacher's-pet voice, she told him that she was unable to remove her contraceptive sponge. When she explained about the time limit on the box, the way she said it sounded educated, logical. She wasn't a crying dumb mess. As a medical professional, he appreciated that, her logic. There was a tremor in her voice, though.

He said, "We'll get it out. Don't worry."

She babbled then, about how she knew it was a weird reason to come in, how she was sorry to have to make a last-minute appointment. Still looking at the clipboard, he asked her when she'd had her last Pap smear.

There was a pause, and some new crackle in the air. She told him she'd never had one.
"I've actually never been to a gynecologist." She sounded ashamed, as if she'd had to delicately insult his religion.

Not missing a beat, and without admonishing her, he casually encouraged her to make an appointment for a Pap smear the following week. With the sponge and its toxins having been inside her for so long, the results would probably come back abnormal if he did it today. "We'll do the breast exam and the whole deal." He could see that she was blushing. It was easy to see because her skin was fair, translucent. He could see everything going on underneath.

He told her to lean back in the chair, and when she did, it was obvious she had not done this before.

"Bring your bottom all the way to the edge," he said, using an innocuous word, a word that a parent would use with a child, instead of something crude like "butt" or something as alarming or snicker-inducing as "buttocks." Somehow this comforted her, the word and the warm, soft way it ended with an "m" sound, like "mom."

The sheet was long, and had been puddled up over her feet when he'd come in. She ruched it up above her knees, bunching it up so that he could see to do what he had to do but she could not see herself. He told her to open her legs. Trembling with uncontrollable small muscle spasms, she opened them a little but not enough. So he had to ask her to open them wider. He did this in as even and friendly a voice as he could muster.

He explained everything to her logically. In his rubber-gloved hand, he held up the gleaming silver device he would insert into her, that would open her up for him. She was 29, and had seen such devices in movies, mostly comedies about pregnancy, but he explained it to her as if she hadn't, without condescension. He inserted the cold metal thing into her, and saw that her muscles tensed even more. He saw that her hands formed fists that gripped the sides of the chair. Her breathing accelerated to an almost alarming, nearly histrionic pace. It was an extreme reaction that belied her earlier attempted rational-patient manner when explaining why she was there.

Why was she there? Not the medical explanation, but the other one?

He glanced at her face once and saw that it was contorted in a grimace, an expression of physical and emotional torment out of proportion with what was happening in the room. Her body shook as he used his gloved fingers and plastic sticks to expertly remove the sponge and drop it into the lidded wastebasket nearby. Her heart rate was high, and she made something that could only be described as a soft crying sound.

He cleaned some of the spermicide out of her, then squirted a cold gel into his hand to insert his finger and feel around her uterus, pressing his lubricated finger up against her belly from within. He assured her that everything felt perfectly normal.

As he worked, he wondered about her. Because he was a human and not a medical machine.

The sponge meant she'd had sex, or had at least anticipated having sex. He wondered: As nervous as she was here, now, at her first and long-overdue (and only because of a minor emergency) visit to a gynecologist, what had she been like during sex? He imagined that her expression now might be an indication of how she had been hours earlier, with whomever she had been with -- or at least, how she had been internally. She'd probably tried to pretend that everything was fine. He saw the black lace-edged panties. She was a girl who would wear lacy black things in bed. This was a clue about her sexuality, her eagerness to be conventionally "sexy," to fit a man's fantasy.

She was like a fragile, frightened bird here in the examining room. What could explain this weirdly amplified fear? He guessed it went back to a hyper-religious upbringing, maybe a strict or sexually shaming parent. There was the exaggerated modesty with the sheet. The flutter of apologies for the last-minute appointment and its bizarre circumstances. Yeah, it was probably something like that.

He felt that the fog of his recent existence had temporarily cleared, and that here in this room was everything.

Here in this room was religion and guilt. Here in this room was desire, which had impelled her to buy and use a contraceptive sponge, to wear and remove lacy black underthings.

Here in this room was a person who was terrified of having anything inside her, yet who had apparently let someone in. Why?

Why else? To be loved.

He thought about biology and dogma. He thought about the cycle that keeps the human race going, and the one that tries to keep it in check.

At only one point during the visit had his professional demeanor slipped. In his line of work, he often saw women in trouble, and he was always reassuring, sometimes fatherly. But to this girl, trembling and quietly sobbing, her body clenched in pain (the chemicals, and probably a lot of intense sex, had inflamed her cervix), he said: "It's OK, honey." He had said it the way he'd say it to someone he cared about, someone in his real, away-from-work life. It surprised him that it had come out, especially with the term of endearment attached to it, a rare and risky thing in these litigious and politically correct times.

After he removed the sponge -- that evil object she had tried, for hours, to find inside her uncharted body, contorting herself into different positions like it said to do on the sponge website she'd visited in desperation on her work computer -- she thanked him sincerely. He had the feeling he'd just performed an exorcism. But then, her heightened emotional state had thrown his rationality out of hitch.

He talked to her about birth control, told her to consider the pill but to be aware that it alters your hormonal balance. He told her to take care, then added a stern, professional "Be good" that he later worried had sounded judgmental.


After Dr. Seagull closed the door behind him, she rose to get dressed. She continue to hold the sheet around her even though no one was there to see her. She knew it was too much, that it would seem melodramatic to an onlooker, but for just a few seconds she leaned against the wall of the room and cried with relief and gratitude. Still shaking, she hurried into her lacy panties and the too-expensive, low-rise jeans she had bought to make herself sexy.

He thought about her for days.


  1. I'm sitting here with tears streaming down my face. I don't know why but this story touched me so completely, more than anything else you've ever written. (That's saying a lot because a lot of your stories touch me.) -aspl

  2. Your attention to detail is exquisite.