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September 07, 2005

My Boob, Like My Dignity, Is Damaged. Also, Lumpy.

I behaved somewhat badly at orientation yesterday.  I arrived late and caused a commotion knocking things over on my way to find a seat at the far end of one of the two long, long conference tables.  My bag was exploding stuff,and  it took me a while to collect myself and get settled.  Iasked questions about health insurance that caused the HR-bot tobacktrack and repeat herself because she misunderstood what I wasasking, and then an obnoxiously slick-looking, pastel-button-downwearing youngish man who, if I overheard correctly, is an English Ph.D.with a teaching post (figures) had to translate my question for me andask it again.  I kept getting up to go pee and causing a rumpusand I stole handfuls of post-it pads that were set out in littlebaskets on the conference table so we could mark up our packets andbrochures as we followed along.  Because I didnot feel the need to pay attention to the slide shows about all thewonderful perqs Stanford has to offer and because the lectures on HRAs,retirement plans, and long-term investing was both painfully boring andutterly beyond my powers of comprehension, I unfocused my ears, pulledout my laptop, and turned my attention to the html and css I waswriting.  Essentially, I was behaving at any unbearably boringStanford lecture. 

Aside from a few conspiratorialsmiles I got from a fat, sassy older woman in a colorful blouse acrossfrom me who I assume was some wise-cracking humanities appointee freshfrom an east coast institution, recognising me as one of her own kindand sending me her tacit approval, everyone else clearly dissapprovedof me.  A young Asian woman, irritatingly tidy (she was eating her scone with knife and fork) and preppiliydressed, was sitting across from me, right next to Prof. Sass and keptshooting me looks that were if not nasty then at least mildlydisgusted.  On the rare occaision I lifted my eyes from the laptopscreen, I would catch her sort of tsk-tsking me with her eyes. Then she'd quickly glance away.  They all thought I was a young,dumb, ill-mannered brat.  As well they should have.  Mydress, which I had grabbed that morning without thinking, wasinappropriately low-cut.  I didn't notice how ho-baggy I lookeduntil mid-morning when I spilled half a thimble of half-&-half onmy lap.  I looked down to survey the damage and saw my cleavagelooking back up  at me, smiling.  No, not smiling.  Itwas smirking.  Smirking menacingly.

Neither surprising nor entertaining, my boredom and impoliteness at anHR function.  But you will need to know all this for later on.

Because my insurance is not all set up, I was told by the hospitalyesterday that the quickest way to get seen was not by scheduling anappointment but by calling this morning and requesting a same-dayvisit.  I did.  This morning, I called and was given a 10:20appointment with a general practitioner.  Brett drove us becausewe'd both slept in a little late and because I'm picking him up latertoday anyway; I snoozed in the car.  Brett grabbed me some Googlefeed and I drove back up to P.A..  It was 10:07 by the time I wason Campus Drive, but the street I was looking for was not where Iremembered it to be.  I was driving at a crawl, reading streetsigns, looking, feeling abused and shaky.  I turned into adead-end road to pull a U when I noticed the red and blue lightsflashing behind me.

"Do you know why I pulled you over?"

"No."

"You ran a stop sign."

He asked for my licence, registration and proof of insurance. License? No problem  Registration?  There was shufflinginvolved, the glove compartment unleasing its contents into the rest ofthe mess and filth on the floor, but eventually I found a square ofcarstock whose numbers and words were printed in an old sans-seriftypwriter font and which looked out-dated and inefficient enough to beproperly beaurocratic and offical (think: Weight Watchers,pre-computerized booklets, when we had actual paper, alphebetized filesto carry up to the scales with us so the staff could write a numberin); I asked if it was my registration and it was. Insurance?  Sorry.  No go.  I lose.   He wasnot impressed when I offered to show him the electronic copy on mylaptop.

I got a moving violation for the stop light and for the insurance, anappointment in Palo Alto traffic court where I have to prove that I dohave insurance by producing "just a print-out of that thing."

I was sniffing back tears as he explained to me what I could do toclear my record (traffic school) and how it wasn't such a big deal.
He was extremely nice, actually.  I wasn't upset over the tickets,I was just feeling late and ill-treated by the universe and he seemedso competent and kind as he gave me directions to the clinic I waslooking for that I lost my hold of myself just a little.

I pull into the parking structure about twenty minutes after I wasscheduled to show up at the office and immedeatly proceed to drive mycar into a parked tow-truck.  Hard.  But I finished pullinginto the spot and didn't pause to check the damage on my own car as Ihurried away.  In the wrong direction. 

I don't know how late I was when I got there.  In the exam room,the nurse took my vitals.  I knew I'd been off the wagon a lotlatelly.  I avoided going last week because I didn't want toweigh-in, and I don't know what I was expecting, but it wasn't142lbs.  I mean, that can't be accurate.  I was 136 a weekand a half ago.  I want to be 130, which is what I was this timelast year.  But I keep failing, failing, failing.

The medical assistant looks over my chart and asks questions.  Sheasks, "so the reason you are here [pause] is [pause as she adjusts herface] a blump?"

A blump?  I stare blankly at her for at least fifteen seconds as Itry to understand what she is saying.  A blump?  What? Could that be the medical term for--

She interrupts my thought: "A lump.  A lump in your breast."

"Oh, yes," I say.  "Right."

"Your right breast?"

"No.  Left one."

She leaves.  The doctor comes in and she's young, which already Idon't like.  She's young and she's preppy and she's Asian. She looks somewhat familiar, but then there are a lot of doctors andresidents at Stanford that are young, preppy and Asian.  I don'tthink much of it.  She's looking at my chart, asking me morequestions.  All of a sudden she interrupts herself; "Wait, youwere at the orientation yesterday, weren't you?  Yes, I wassitting directly across from you."

Of course.  My dissapprover.

My confidence in this doctor is dealt another blow.  Strike two.

I rattle off my list of medications: Zoloft, 150mg; Wellbutrin 100mgtwice a day; Ritalin, 20mg three times a day (though it is actuallyususually four); and birth control.  "And who writes theseprescriptions?" she asks, and it seems like she is asking, "and what isthat person doing with a medical licensce?" too. 

"Dr. Harriet R---" say I.

"And who is Dr. R--?" she asks.

"Um, a doctor.  A psychaitrist."  She looks at me like I'vejust told her I take pills given to me by my imaginary friend. "I've been seeing her for, like, four and a half years."

"Oh, that's good.  That's greaaate."  Her voice ispurposefully soft and ingratiating and she speaks slowly while noddingher head with what I suppose is meant to be understood ascompassion.  She is incredibly condescending.  Strike three,but it's not over.

I had written A.D.D. as one my medical problems on my historysheet.  I see her looking over at it and then she asks, "So, theRitalin you take, is that to help with conentration" --I am about toanswer yes, when she continues-- "or do you actually have A.D.D.?"

What the fuck is that?  "Um, both?" I stutter, dumbfounded. It can't be possible that she doesn't know what A.D.D. stands for, itjust can't.  Is she implying something, the preppy bitch?  Iso do not understand what she is asking.

"And what kind of birth control do you use?"

"Ortho Tri-Cyclin,"

"How long have you been taking it?"

"About four or five years.  Well, for a very brief time I was onOrtho TriCyclinLo, but that was disastrous, it totally did not work. "

"In what way was it disastrous?" she asks.

"Oh, in the way that I, you know, got pregnant."

"Maybe it was too Lo!" she says.  Then she giggles.  ha ha.

"And do you smoke?" she asks, even though she knows I do, the goddamn sheet I filled out is right in front of her.

"Yes," I say.  I know exactly where this is going.

"How much?"

"I don't know exactly.  Maybe seven or eight cigarettes a day."

"Who writes your prescriptions for the pill?"

I tell her I don't know her name, but it's the nurse-practitioner atVaden whose latexed digits have paid call to nearly every studentvagina.

"Vay -der," she sounds out very slowly.  "What's Vader?  What's that?"

I have to explain it's Vaden, and it's the student healthclinic.   She asks about my visits with nurse at Vader(meaning, she asks howthey could possibly continue to write prescriptions for the pill),until I realize she must think I go there and get a new prescriptionevery month.  Which is retarded.  I explain to her that birthcontrolprescriptions (in my experience) are prescribed by the dozen, so I onlyhave to see the nurse once a year and then every month I just have topick up a pack from the pharmacy.

She tells me that smoking in combination with the pill is risky, thatsmoking while on the pill puts me at risk for blod clots.  I knowshe has to say these things, but I thought she was a little over thetop.  She kept saying how she would never have prescribed contraceptives for me and how she neverallows patients who smoke to take the pill.  And how, if I wereher regular patient (by now, of course, I'm thanking my stars that I'mnot), she would take me off the pill.  She asks me if I've triedto quit and said yes, I had, but hey, I'm smoking again.  She frowns disapprovingly.  "For now, I won't change this, butnext time you're here, we'll have to discuss this.  I don't let mypatients smoke and take any contraception at all.  It puts you atsuch a high risk for clots."

I realized later, that it wasn't the Vaden nurse who had prescribedthis round of B.C., it was the gynocologist I saw last winter, when Igot pregnant, who I trust infinately more that this woman.  Iunderstand smoking while on the pill increases the risk of blood clots,I really do, and I know that blood clots are nasty and bad.  Butthe idea that she would have me on no hormonal contraceptive isidiotic.  Beyond idiotic.  I am twenty-two.  I have lotsof sex.  And, AND, I GOT PREGNANT WHILE ON THE PILL (with PERFECTUSE).  Duh.  I just told her that I got pregnant when theydropped me down to a lower dose of hormone.  Taking me offcompletely?  Bad idea!  Big, fat, shiny, in-flashy-lettersBAD IDEA.  Bad, bad, don't-even-think it idea.  Reducinghormonal birth control = horrible idea, already tested and proved to behorrible. 

The thing is that the doctor I saw today, Dr. Dumb, is just soyoung.  I know what she was suggesting is probably, techincallywhat she is supposed to say.  She was probably taught not toencourage women to smoke on the pill and she's just following what shelearned in class and in her textbook.  But the thing is, thattelling me to stop taking the pill because I smoke is inane.  Ofcourse my risk factor is higher than it would if I didn't smoke, but myrisk factor of getting pregnant if I'm not on the pill is so great,it's not even a risk.  It's a flat-out guarantee.  The gyno Isaw was an older woman, very business-like and matter-of-fact. Her brusqueness was very reassuring, like she'd seen it all before,like she was just too solid and competent to bother to slow her speechor otherwise condescend.  The gyno knew I smoked and after shescraped my uterus with what looked like a shoehorn and hoovered theproducts of conception out of me and into a glass jar, she wrote me aprescription for a B.C. pill with a high dose of hormone.  Shedidn't suggest I cease taking hormonal B.C.; in fact, she was all butfrisbeeing the disks of pills into  my throat (orsomething).  Because if some one is twenty-two, has intercoursewith a man or men, is fertile as all fuck, as has been proven by arecent unwanted pregnancy that happened while on the low dose pill, andnot only doesn't want to be pregnant but also would be medicallyadvised against pregnancy (i.e. psychiatric illnesses + medication+  fertilized human egg  = dolphin fetus), then  theincreased risk factor is  worth it.  Duh.   I'm notsaying it's optimal, but it's reasonable.  In fact, it's theonly  choice that's reasonable.

Jesus gay this is a long post, and I'm not even up to the breastexam.  I bet Dr. Dumb loves PowerPoint.  Dr. Dumb totallyloves PowerPoint presentations.  And uses (blech) comic sans for afun, informal look.  Whimsy!  I don't know how I know this,but I do.  It's the feeling I get.

Anyway, what was I talking about?  Oh yeah, my tit.  Iexplain that last week, I noticed what I thought was a bruise, but thatthe color had gotten darker rather than lighter as the week wenton.  Then I was poking around a couple nights ago and noticed abump.  It's a sizable bump, near the bruise, just north of mynipple.  Dr. Dumb asked me how I thought I had bruisedmyself.  Had I had a bump or a hit?  I told her no.  Sowhat did you think it was from?  "Well, I thought it was a, uh,hickey.  But then I was out of town for the holiday weekend, awayfrom my boyfriend, and the skin darkened and reddened, so I had secondthoughts about its bruiseness."  She asked family history, and Iexplained: my mother's sister has breast cancer; my father's mother hadbreast cancer when she was my age.  She asked about my immedeatefamily.  Neither of my parents has cancer, and I have nosiblings.  "Technically," she said, "traditionally, the extendedfamily-- your aunt and grandmother-- don't count, they don't increaseyour chances of having breast cancer."  She poked my boob alittle, but the more I think about it, the more I think she did areally poor job of feeling me up.  It was the quickest breast examI ever had.  Even the Vader nurse takes more time.

"It looks like it's probably a bruise," she said, "if you were poking,it's possible you irritated or inflamed some tissue.  Have youever had a breast nodule before?"

"No."

"Well, it's a benign lump.  Most lumps in women your age arebenign.  So what I'm going to say is just to go home and keep aneye on it.  If it's just a bruise, it might resolve on itsown.  If it doesn't, then you should call and come back."

"Ok," I said, completely not trusting her.  "Well, what's going to happen in a week if it does not go away?"

"Then we'll do a sonogram to find out if the mass is solid or if it'sfluid filled.  But it is highly unlikely for a woman your age tohave breast cancer.  Younger women tend to have lumpy bumpybreasts.  Some growths do cause changes and discoloration to theskin, but that is probably just a bruise.  Given your age and thatyou have no family history--"

"But I do have family history.  My grandmother had breast cancer very young."

"Techincally, that doesn't count.  There is no history of cancer in your immedeate family."

"But," I said, "the is only one other person with breasts in my immedeate family."

I did not want to wait a week, I said.  "Well, that's what we do,"she said.  I was still unhappy.  "It's a good sign that thelump appeared suddenly, though."  I explained that I only noticedit a couple days ago because I was intrigued by the bruising andprodding.  I don't do regular breast exams. 

"Well, if it is a tumor," she said, "it is probably not going to matter if we wait just a week."

No, really.  She said that.  She finally relented, "Ok, shesaid, since you are so concerned, I will see you in three days. Well, on Monday, because for Friday there is really no point.  I'mmaking an exception for you.  Normally I would say in a week ortwo.  But because I don't want you to worry, I'll let you comeback earlier."

Well, gee, thanks.  

She was getting ready to leave and she asked me, "oh, by the way, isthis weird for you?  I mean, that we met at the thing yesterday?"

"No," I said.  It wasn't weird for me because we'd met.  It was bad for me because I didn't like her.

Most likely, it is just a bruise.  I was a little frayed the pasttwo days worrying, but I'm not freaking out right now.  It isprobably just a bruise, but I want to hear that from someone other thanDr. Dumb.

Tonight: insurance forms!  Tomorrow: quest for a new physician!


--------

Posted by hissycat at September 7, 2005 01:58 PM

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