Observations from a darkened room

Lying down on an ultrasound table can be a meditative experience.

The last few weeks have been a flurry of emotional turmoil after the identification of polyps on an office ultrasound I had.  Two blips, that looked like giant ghost pills on the screen, led me to be a part of an ongoing discussion with my insurance provider.  Because all of my fertility treatments are paid for out of pocket, it seemed that the insurance provider would only schedule me for what was described as the necessary procedure of a hysteroscopy through that office.  Though it was a gynecological issue, treated in an office, that should only require a co-payment of around $40, the office wanted to schedule me for an in-hospital surgical room/procedure, which would cost me a minimum of $3000.  Because of the location and booking an operation room, I would most likely be expected to pay double or triple that.

An issue that the doctors had perhaps caused with prescribing me a particular problematic medication and could have been addressed in a previous fertility cycle before it got potentially worse was delayed.  I was told that I would have to make an appointment with my doctor to make an appointment with a specialist.  I was put on birth control (stopping my fertility process entirely).  I also engaged in about two weeks of calls and emails and tracking down of doctors who would duck me, to finally decide that I would go back to the care providers I used to see, 30 minutes away, meet with a gynecologist there and get another opinion.

When I described what was happening, the gynecologist ordered a more detailed ultrasound to determine if I even needed a hysteroscopy in the first place.  Our 10 minute in-office consult, that I drove over an hour roundtrip to get, was the clearest appointment I had had in months.  When I told her that my grandmother died, ultimately of colon cancer, but it started out as uterine cancer, which spread to the ovaries, then the stomach, and finally the colon, hence my urgency in treating an issue, she believed me and added the information to my file.  While uterine cancer, I've learned, does not present a genetic link, you are more likely to have uterine cancer if colon cancer presents in your family.  No one, in all these years, had asked me about my family's history of cancer, let alone specific cancers that might affect fertility.

A few days after my gynecological appointment, I had an ultrasound:  abdominal and transvaginal.  The appointment took about a half hour in a darkened room.  No one gave me any preparation directions, but I had read online that ultrasounds are most effective when the patient is examined with a full bladder.  I drank about a thermos and a half of water in the hour before the appointment.  Lying on the table as the technician pressed against my belly in various places, I felt like my bladder would burst from my abdomen.  I imagined what a character in Alien might have felt with that heavily jawed and sharp-toothed creature growing from within, gnawing at the stomach to get out.

I thought of other things, too:  how to breathe into pain to breathe out of pain.  It's a technique I learned as a dancer years before, how pain can be the body telling us to breathe, that the cells are hungry for oxygen in their strain.

I thought of how many doctors in women's health have pictures on the ceiling for women to distract themselves from gynecological exams.  I prefer the patterns of a ceiling, though I like to explore what the pictures reveal about those who placed them.  Why a bullfighter?  What a picture of the Eiffel Tower? 

 I thought of all the other tasks on my to-do list, and how it was better not to think of them.  I have to write new items down immediately as writing cues my memory.  My overextended brain sometimes thinks that thinking is enough to remember, though thinking alone always has me forgetting something.  My memory is tied to visual and tangible cues.  I have to write it down to remember.

I thought, too, of the music of beeps and what they might reveal.  The technician had the screen turned towards her, and when prompted, would not say anything.  I joked, Would you tell me if you saw a unicorn?  She responded, she'd tell me and invite others to see it, too.  I started to dread the beeps - so many - so I told jokes to deflect.

After the abdominal ultrasound, I got to go to the bathroom and let out all that water.  I felt jagged, a pained relief, a sameness with cliff rock beneath a waterfall ... forgive me the waxing poetic a moment.  I'm a poet in love with image.

The transvaginal ultrasound allowed me to continue mental mechanics:  how many dots are there up there?  how can I calculate the passage of time without a ticking clock?  Does time matter while staring at a ceiling?  How might this moment be a metaphor for life?  And, how many children were named Sadie (the technician)?  What has that song, "Sadie"?  Do I remember some of the words?  And then I hummed ... and stopped myself.

The technician at one point played aloud the sounding of the machine.  This is what my heartbeat sounds like from the inside.  How often does one get to know the sounds of one's literally inner self?

I thought a number of things.  I prayed, too.

And one of my prayers was that this would all come to nothing, that the polyps would disappear.

They did.

On review, the radiologist reports lots of "normal" and the appearance of a miniscule fibroid, nothing at all to worry about.

I don't need that hysteroscopy after all, though the gynecologist and I will be following it every three months or so.

What does it say about my insurance carrier that, when I called them, they couldn't set up an appointment for me?  Or that I had to call and email my doctor and then the insurance carrier for over a week before I was told why they were avoiding me, that I was caught up in a problem that would affect many women?  What does it say about the insurance that they would charge women at a fertility rate for a gynecological issue?  What does it say about their ethic of care?  What does it say about the belief in the human dignity and regard for the intelligence of a patient that I had to ask three times for detailed information about the studies about polyps that a doctor mentioned in an appointment (with no details); referred me to another doctor to answer my questions about dates, methods, sample sizes, race and ethnicity and access to care; gave me a canned response from a medical newsletter with no information; and then finally gave me a list of studies (that still did not answer my questions about race, ethnicity, and access to care)?

To me it says that as a woman of color who has been paying out of pocket, I am looked at as a cash cow who deserves no explanations and who cannot be a partner in care because to them I am a number and not a human being.

I am not a number.  I am a human being.

I am also preparing to seek other options than this insurance carrier.

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