Day 71: Letter to Gynecologist after Today's Appt
Please forgive this long letter.
Today you cared for me. You didn't just treat me. You cared for me. I was frightened and trembling, but you were calm and reassuring. It has taken months of preparation for this appointment today. I want to tell you how it went for me and thank you and your staff for making it a healing experience.
You scheduled me as the last appointment of the day to allow plenty of time for the appointment and for me to recover afterward. That made me feel you are concerned with my well-being, not just my body.
Before going into the exam room your assistant (nurse?) asked me if I would prefer the room be set up for the exam before I came in or if she should set it up after I was in the room. I wasn't sure and asked if she would take me into the room. I wanted to see how I felt in the room. I stood there and took stock. I felt my heart rate increase and I felt dizzy. But, I didn't feel panicked; and I didn't feel numb! I told myself it was OK to feel what I was feeling. I told her it was OK to set up the room before I come in to be examined.
You put a cloth sheet on the table for me. I am incredibly thankful to you for that. It was a great relief to not have to deal with the trigger of the paper on the table. You doing this also felt like my well-being mattered. Furthermore, when I was lying on the exam bed, I didn't have a flashback. So, I think using cloth achieved the purpose it was supposed to achieve.
You talked to me for a good while before the exam. You went through my labs and discussed options. You engaged me intellectually. That helped calm the symptoms in my body. Before you came in I was feeling nauseous and dizzy. As we talked my heart slowed and I felt increasingly comfortable with you. I felt like I was talking person-to-person, like we were having a conversation. I wasn't just a chart.
You and your assistant both reminded me it was OK to stop at any time. We talked about stopping if I asked to stop; and we talked about stopping if I became nonresponsive. You were OK with that. I felt compassion from you as we talked.
You let me decide the sequence of the exam. I didn't know what would work best, but on instinct I decided to go with the breast exam first. You listened to my heart and lungs. You told me each thing you were going to do before you did it. You showed me the stethoscope and checked the temperature of it against my forearm. Taking a few moments to do that helped me feel less afraid of what was coming next.
When you went to do the abdominal exam I instinctively grabbed your hand and pulled it away to protect myself. We talked about the three areas of my abdomen that are painful. I felt embarrassed about grabbing your hand and I apologized. You told me it was OK. I felt better when you reassured me. You were very careful with the abdominal exam. You noted no masses, which was helpful and reassuring to hear.
At one point you said you were going to stop talking. I can't remember when that happened. Maybe it was during the abdominal exam? I was having a hard time. You were right to stop talking. It was as if you were reading my mind. It was just what I needed at that moment. Also, I am sure you needed to attend to what your hands were feeling. You were focusing on doing the best job possible to assess me. This was another message that said you cared about me.
I was really scared when I laid back for the breast exam. You checked in with me before you started, and while you were examining me. We talked about the fact that I nursed both of my children and how it was easier the second time. I was a little dissociated at this point. I was really scared as you examined my breasts. But, you kept talking to me and checking in with me; and I pulled back to focus. The breast exam didn't hurt. It didn't feel like you were taking pleasure from touching me, which was a sub-conscious (and irrational) fear. My step-father took great pleasure from my breasts. Years of his abuse has made me incredibly uncomfortable with anyone touching them. I felt my stomach turn as you completed the exam, but it was OK. You were very gentle.
Getting through the breast exam made me feel confident we could get through the pelvic exam. Although I was scared, I felt safe with you. Although my body was reacting with symptoms of anxiety, your touch was reassuring. I knew without any doubt, you would not hurt or humiliate me. I was scared, but I wasn't dreading what was coming next.
When you had me move into position for the pelvic exam, you told me you were going to move my feet into the stirrups. You told me before you touched each foot. You made sure I could see you by having the assistant move the pillow behind my head. I watched you so I could stay present. And, you reminded me to look at you. I was glad you said that, it assured me you weren't uncomfortable with me needing to see you. In fact, you said you always make sure patients can see you. That told me, again, how compassionate you are and it helped me feel ready to have you perform the pelvic exam.
When you began the pelvic exam, as you did throughout the appointment, you told me what you were going to do before you did it. First you did just a visual inspection. You described what you saw and what it indicated. It helped me stay present with you for you to describe what you saw.
Then, you told me you were going to touch me. You placed your hands carefully. Because of the years of sexual abuse, I was afraid my body might react with arousal. (I feel like I should explain this. Some of the sexual abuse I experienced as a child included sexual arousal. I have felt intense shame about that, but I am learning it was just my body's normal response. I couldn't control it. Nonetheless, I was afraid of having that response during the pelvic exam.) But your touch was nothing like other touches I have received down there. I didn't experience arousal. I also didn't experience pain. Next, you examined the labia. When you opened the labia I felt exposed. I felt the most afraid at that moment. I was afraid of having a flashback. But, you were still very gentle and you asked how I was doing. I took a breath and realized I was still doing OK. I was still present. I still felt safe with you.
You then asked for the speculum and showed it to me. You told me it was small. That was reassuring to me. You asked if I was ready for you to proceed before you inserted it. You said sometimes there is pain with this part because of my condition. I was OK with that. I've always been able to handle pain. But, I also knew you would be careful.
You inserted the speculum gently and rotated carefully. You got through this part pretty quickly and told me everything looked healthy. Then you removed the speculum as gently as you inserted it. I felt relieved because there was no pain and the findings were normal.
You then proceed with the bimanual exam. It didn't take very long. I was worried it would be painful, but it wasn't at all painful. Also, it was not arousing, as I had feared it might be. It was OK.
I wanted to ask you to palpate the area on the right side where I experience the pain. But, I was afraid to extend the exam and longer. So, I didn't ask.
Afterward you asked how I was doing. You asked if I wanted to lie down for a while. I admitted I was feeling dizzy and thought it would be a good idea. You told me you or the assistant would be on the other side of the door and to call out if I needed help. We talked for a few more minutes before you left the room. I decided I was ready to sit up and see how I was feeling. Your assistant took my hand and helped me sit up. I took a few deep breaths and realized I was OK. I wasn't going to pass out or throw up.
Then you smiled warmly and you took my hand in a high-five. I felt affirmed by that. It said that you were proud of what we just accomplished. Then you asked if you could hug me. I realized that I would like that. I wanted to share my thanks and to feel comforted. Your hug felt genuine and it touched me very deeply. I almost broke out in tears on your shoulder. You said you could feel me trembling. I smiled at that because it was yet another way you demonstrated you were attending to the whole me.
You gave me time to gather myself. I cried for a minute or so when you left the room. I have never cried about the things that happened to me. I have only cried a handful of times my entire life. I wasn’t allowed to cry as a child. Today was the first time I felt safe enough to cry about any of this. How ironic, I find it, that I felt safe enough to cry because of a gynecologic exam. I think that is very powerful! I want you to know how significant this is for me on many levels.
Because of how caring you were I felt safe to feel what I was feeling. I didn't feel ashamed. I can't tell you how big a deal that is for me to not feel ashamed of myself about my emotions or my needs.
You did something far, far beyond taking care of my body and my health. (I'm actually crying right now as I write this!) Your compassion and gentleness told me I matter. I deserve to be treated kindly and gently. I never believe that. I never feel that way. I have always felt ashamed of wanting compassion and tenderness from another person. This is a very deep wound for me; and what you did for me today helped treat that wound.
I'm so glad I found you; and I’m indescribably thankful that you are the kind of person, the kind of doctor, that you are.
Thank you for caring for me so well and so genuinely! Thank you!