There is No Calming Picture on the Ceiling

By Brianna Halek

The first time I had a gynecological exam was in 2009 with a female MD. She used something that looked like a long Q-tip to do a pap smear, and she kept going in and out as if she was trying to saw something off. It wasn’t a pain type of a feeling, but it was intensely uncomfortable and seemed to go on for a long time. I never felt that again during future appointments, although I also never went back to that doctor. I have learned that health professionals don’t always leave medical school with the best technique. I recently read an article that said some medical students are being trained in gynecology by using robotic female reproductive systems. This enables them to more clearly know when they are being too rough. It’s as if a prayer has been answered.

That experience influenced all the future ones. Being prone to anxiety had me pretty much convinced that these exams would always feel that way, that they would always be something to be afraid of. I do not know if it’s possible for anyone to be unfazed by it. It’s not like anyone would enjoy it. The thing about vaginas is that they are not exactly designed to have anything inserted in them unless if they are aroused, and aroused sufficiently. That’s the best-case scenario. But of course, being worried about pain and discomfort increases feeling those sensations. So, cue in taking one to two Lorazepam to dissolve the fear. I didn’t want to avoid taking care of my health, so a tiny pill was the best, easiest idea I could reach. Doing this once a year to get myself to go to an annual exam wasn’t awful, but further into my adulthood I became a more frequent patient.

It was 2015, I was 25 and not long after I got my first abnormal pap smear results did the APRN I’d been seeing for my annuals retire. She was always so pleasant, her voice calm and friendly which made me feel more at ease. Although maybe a bit too at ease.

With those results, I had to get a colposcopy done, which is a magnified look at the cervix that can detect precancerous cell changes. I did that, although on three Lorazepam that time. It felt uncomfortable for a few seconds, but then I soon asked the doctor something about his Summer vacation. I remember laughing.

Previously, my APRN had said to me that I would be fine because this kind of HPV infection usually goes away in a year or two, but to make an appointment for a follow-up pap smear in a year.
 
It didn’t go away.
 
The year goes by and the words and their meanings: HPV, pap, and cancer were in my mind, but I wasn’t obsessing about it. I get the next pap test done and it’s still abnormal, which was not what I was expecting to hear. I have to make an appointment for another colposcopy with a biopsy. Taking Lorazepam doesn’t seem so important anymore. Instead, I took two Ibuprofen. This time a different male doctor did the procedure, since the other one hopped on the same retirement train as my favorite APRN. It’s interesting when they look like they could be close to your age. I can’t imagine having the responsibility they have. Or the tact. He took two or three biopsies of my cervix. I said “Ow” loudly on the second one. I moved the blank stare I had been holding on the sheet laid over me to where the female assistant was, seeing a fat Q-tip soaked in my blood. He said, “You felt that one, huh?”. I wasn’t sure whether he was trying to be calm about it so that I would be too, or if he was too cold about it.

My results came in about a week later. I got a voicemail from the doctor while I was away attending a funeral for a family member who died from breast cancer. I was busy so figured I’d just call him back in a day or two.
“Adenocarcinoma in situ of the cervix”. I was crying while still on the phone with him, asking if this meant I had cancer. He said, “very early cancer”. I got off the phone with him confused about how afraid I should be, not knowing if early cancer is another way to say precancer. Researching online showed that the answer was yes, and that some people also call it Stage 0. The doctor who did my surgery a week later said it was “a step before cancer”. He said there was ¾ of a chance that without surgery it would develop into Stage 1 cancer. All of this was too many medical terms and numbers for my one head to hold.
 
December 31st, 2016. Four days before the surgery, I got really drunk at a New Year’s Eve party. Gin and tonics. Never have I ever walked that ungracefully. I almost threw up on the grass next to a KinderCare building. Threw up later instead in that classic friend-holding-your-hair-back way in front of a proper toilet. During the party, I contemplated wishing my ex-boyfriend good health, thinking maybe that’s why he contacted me, maybe he has this too. But I didn’t have his number or a smartphone.

I was so afraid of the surgery itself that I made a very short living will after the operating room scheduler asked me if I had one, and after my doctor asked me if I give permission to receive a blood transfusion in the rare chance I lose too much. But to me, rare means risk and that I’ll be the unlucky one. I already believed I was.

A feeling of calmness was surprisingly noticeable on the day of surgery. I suppose I accepted that I could either freak out or give up the need to feel control. This was going to happen, I had to do it for my health.
My doctor met with me beforehand. He smiled differently than when I had first met him. A lot of people are involved in making just one surgery happen, and everyone I met acted so happily. I’m thankful for that.

A week later I learned that no cancer was found in any of the tissue that was removed, the precancerous cell changes were cut out.
A whole year has passed since the surgery and all of my follow up pap smears have had normal results. Nothing has disappeared from my mind though. Sometimes I wonder if the abnormal cell changes may come back or if HPV will lay dormant in my body. Should I avoid sexual activity with people, and am I supposed to tell future partners? What if I’m more susceptible to getting other HPV infections that my immune system won’t take care of?

It’s funny in a twisted way. I can’t recall ever being educated about the risk for HPV at gynecology appointments until I found out I had it. The first time I was asked if I wanted the Gardasil vaccine was when I was eighteen, during a physical exam with my primary care physician. I got it but never followed up with the next two series of the shots. The second time I was asked if I wanted Gardasil was during another physical exam seven years later, and not long after my HPV diagnosis. I let out a little laugh and said how I recently found out I have HPV so I thought it wouldn’t matter, plus it wasn’t covered by insurance anymore because of my age.

I get a physical and a gynecology exam every year but no one ever took the time to explain why it was so important to get the vaccine, yet I recently got a whole speech from my doctor on the flu vaccine. Until now, the most education I had about HPV was from the Gardasil commercials. “I want to be one less, one less!” the kids in it sang. I remember thinking it was silly, but that was because I didn’t understand its importance and I wasn’t given enough information to change my perspective.

But no doctor or health professional would shy away from making sure you have the best health possible just because it relates to sexuality… Right?

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