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  1. In Praise of my OBGYN, Part 1

    Well, this is my first post on a Pandy's blog! I've decided to start posting here because I want the community. I've decided to start with this post because gynecological care is something that so many survivors struggle with. A little background info - I'm a survivor of numerous sexual traumas, each with a different perpetrator. One of the most damaging (perhaps THE most damaging) incident was when I was sexually abused by my doctor during what was supposed to be a quick sports physical. I was 13 at the time. Since then, I have live in absolute fear of medical professionals. That is gradually getting better, though I absolutely will NOT allow men to be involved in my medical care in any way. That said, I truly cannot find the words to express the kind of healing that has gone on in my relationship with my obgyn. And, actually, she's also a licensed massage therapist in private practice, so I've been seeing her as my obgyn for about five years and for massage for about a year and a half. I'm actually going to write this entry in two parts - one about my relationship with her as my obgyn and one about my relationship with her as my massage therapist. I'll only be seeing her three more times before I move back home - once as my obgyn and two more massage appointments. I never thought I'd say this about a medical provider - much less a gynecologist - but I am HEARTBROKEN at the thought of leaving her. (Though, at this point, I think she will continue to be in my life and that we'll stay in touch.) Since I've started seeing her for massage as well as for my gynecological care, we've gotten really close - let's just say that we're in each other's cell phones. I have especially gotten VERY, VERY emotionally attached to her. She really feels like a mother to me - except one that I'm more open with than my actual mom! I don't know if I've ever had a relationship with someone that has been as profoundly healing as my relationship with B. Of course, the relationships that I have with my dietitian and therapist have also been extremely healing and the work that I have done with them cannot be overstated. And, there's a different sort of directness in relation to healing from trauma when it comes to the work I've done with B. Though I wasn't super excited about meeting with ed treatment providers, I did not have a trauma history attached to dietitians and therapists when I started with them. I did have a trauma history attached to medical providers and medical exams when I started with B. To think that just three years ago I would be shaking and crying before she even came into the room when it was time for an exam, and now I regularly see her for massage during which I'm able to strip down to my underwear and allow her to touch my entire body without any fear or trepidation whatsoever, . . . . To think that I was once so scared of her (well, not of her, but of what she represented) that she had to ground me before I could even talk to her, and now I communicate better with her than with almost anyone else in my life (except my therapist and dietitian, and B is on par with them). So, first, as an obgyn. She's an obgyn in the student health center at OSU, and I first started seeing her there about a year after I moved to Ohio upon the recommendation of a friend. Objectively speaking, B is an absolutely stellar medical provider. It's not just me that thinks this way. We practically have a B fan club at OSU because so many of us feel that she is far and away the most amazing obgyn that we've ever had. I've always preferred to see Nurse Practitioners, and B is everything I love about NP's to the max. She takes lots of time with her patients, she believes in giving her patients lots of information so that they can be full collaborators in their healthcare, she's an extraordinarily skilled and knowledgeable practitioner (she's the only one who's ever been able to do a totally pain-free PAP smear on me), and she's very attentive to her patients health in a holistic way. She's also very much a healer. She's one of those people who just gives off a healing, loving energy from the moment that you meet her. And she's so incredibly supportive and non-judgmental. I remember that one of the things I appreciated the first time I saw her was that she didn't bat an eye when my sexual history included men and women. And a friend of mine recently saw B because she was 30 and had never been to a gynecologist before. She was really anxious because she was worried that she would be shamed for never having gone, and I suggested that she see B. My friend said that B did not shame or judge her at all, and instead told my friend that she was a really brave woman for going to see her; when B says something like that, it's clear that she truly means it and isn't just saying it to appease someone. (B is VERY woman-centered - in addition to being an obgyn, I've only ever seen women at her massage practice - and she's clearly committed to empowering her patients. B is probably in her early sixties, and she's really become a VERY strong mentor for me in terms of helping me learn how to assert myself and make sure my needs are being met.) In terms of my trauma healing, I couldn't have asked for a more perfect obgyn. She's the first medical professional that I ever told about being sexually abused by a doctor, and she has been 100% committed to helping me heal from that, both emotionally and in terms of feeling physically safe. When I first told her, it was because I had finally started working on it in therapy and, as is so often the case, the ptsd got worse before it started getting better. I remember that appointment because I was shaking and crying and clutching my scarf by the time she entered the exam room. She was amazing. When she saw how scared I was, without me even having to ask, she said that we should delay my exam for six months so that I could do some more work in therapy. She actually said that she was "unwilling" to do an exam on me unless I felt 100% safe with her and that my safety was her absolute #1 priority. All of her actions have shown this to be true. When it was time for my exam, I met with her a week prior just to talk it over and make a safety plan. At the end of that meeting B said, "This is true for all of my patients, but I want to make sure that you hear me say this. During the exam, if you need me to stop at any point, for any reason, just say the word and I will stop immediately. I will never pressure you - or any patient - with things like, 'It's almost over, etc.' If you need me to stop, I stop. Right away." And she has absolutely stuck to that. Though I've never needed to stop an exam completely, B has always responded IMMEDIATELY when I assert a boundary (like if if I need a minute to take some deep breaths or if I needed to reschedule an exam because I needed a little more time) and I've never, ever felt like she's been frustrated with me for not being able to do something. The other thing that has been so healing for me is that she always, always asks consent. Whenever I have an appointment with her, I know that it's not assumed that there will be an exam. She always comes in to talk to me first - while I'm still fully clothed - and she always asks whether or not I feel like I can tolerate exam. The first time that she did an exam after I disclosed to her about the abuse by the doctor, she literally asked for my verbal consent for EVERYTHING, right down to, "Do I have your consent to lift up the back of your shirt to listen to your heart?" and "Do I have your consent to touch your throat to feel your thyroid?". And she would not proceed with anything until she had my clear verbal consent. I no longer need her to ask consent for those sorts of things (though she still informs me of everything before doing it), she still asks for my permission before touching anywhere that might be a trauma trigger, which I love about it. I think that B refusing to do an exam on me when she couldn't be sure of my safety and that appointment where she showed me that NOTHING was ever going to happen unless I was okay with it were huge turning points for me. I remember that when she said we should delay that one appointment, she told me at that time that she thought that, when I was ready, having a gyn exam where I didn't feel scared and where I knew I wasn't going to be hurt could be healing for me. I was dubious at the time, but it's really proven true. Though this doesn't extend to other medical providers yet, I am now able to have gyn appointments with B without any fear at all that I'm going to be hurt. One thing that B has always been VERY firm about has been communication. She seemed to catch on very early that when I'm scared, I don't talk. So, first, in our relationship, she always left lots of space for communication so that I could open up as I felt more comfortable, and she would always ask me specific questions to make sure that my needs were being attended to. Then, after she diagnosed my uterine fibroids, she really modeled and mentored me about how to communicate my needs to other treatment providers. When she needed to refer me to other providers, we would write the referral together so that it made the boundaries clear from the outset. For example, we would include that I had a trauma history and therefore needed to avoid certain kinds of procedures. And she would practice with me about how to talk to medical professionals and plan with me what to do if I ever felt uncomfortable. She also established ground rules for me - like never having an exam in a first appointment with a new provider, and making any first appointment just a talking consult so that I could see if I liked her and if she was responsive to what I need in a medical provider. B would always tell me that if ever I felt unsure after a consultation, I should simply say, "I need to think things over" and then immediately call B. And if a provider ever felt unsafe in any way to me, then "You just get up and walk right out the door. You don't owe them an explanation; just leave and call me." And whenever I have an gyn appointment with a medical provider other than Beth, there is the expectation that I will call B to talk it through with her, and if I don't call her, she will be calling me. Doing whatever needs to be done for me to feel safe in medical situations is absolutely a non-negotiable with B, and she will both practice with me and hold me accountable to following through. As I've gotten to know B better and have learned to feel safe with her, I've been able to really open up with her emotionally and even pro-actively ask for help when I need it. This means that I've been able to start processing some of the emotional scars of the abuse with her. Recently I managed to work up the nerve to share with her that I get scared that medical providers will be mad at me if I tell them I was abused by a doctor because they might think that I'm bad-mouthing their profession or even accusing them of something. B told me that being angry at me (she's clearly mad at the abusive doctor) had never even crossed her mind and that if a provider was angry at me, she felt that it was more an indication of that provider being insecure in their identity as a medical professional. She also pointed out that if ever a provider reacted in anger or frustration when I disclosed the abuse, and/or if they tried to proceed with "business as usual," then they don't deserve to work with me. I've also gotten to a place where I talk openly with her about my eating disorder and recovery process. Fibroids can grow so large that they are visible from the outside (causing women to look pregnant), which is obviously a MAJOR fear for me. A couple of weeks ago I had another ultrasound that shown that they had grown. B was out of the office the day I got the results, so I texted her and said they had grown and we could just talk about it when she was back in the office (though in reality this was me not expressing my need to talk to her). But no. B called me back and talked me through while I cried over the phone to her. She helped me come up with a list of questions I needed to ask my fibroid MD and gave me information about my options and reassured me. That was on a Friday. She told me to call her on her cell phone over the weekend if I needed her at all and to not worry about calling her at work after my follow-up with the doctor; to just go ahead and use her cell number whenever I needed her. Over the weekend ed started talking about how I could shrink my fibroids if I started restricting my food intake. On Monday, when those thoughts were still present and I was starting to struggle with my meal plan, I called B. Her response was perfect. The first thing she did was reassure me that the fibroids were in no way connected to what I was eating, and that they don't know what causes them but in my case there's clearly a strong genetic correlation. And when I shared what ed was telling me about how restricting food intake wouldn't give my body enough fuel for the fibroids to grow, B goes, "S, that would be like if we tried to shrink someone's cancerous tumor by starving them. Or if we starved cancer patients before chemotherapy, in which case their bodies wouldn't be strong enough to cope with it. It would only be successful in stopping the cancer growth because we killed the patients entire body." Touché. When I said that finally made sense to me, and then asked if I should be exercising more because some research indicates that it helps prevent fibroid growth, B pointed out that I'm already extremely fit and that any more exercise could tip the balance to it exhausting my body and weakening it. Then she said, "Right now, you are an ideal candidate for surgery. You are young, healthy, and fit, so you should be able to tolerate and heal quickly. But you have to keep your body healthy. You are no good to a surgeon if she can't operate on you because your body is too weak. It's your job right now to keep your body strong and healthy so that it will be able to cope with it when you do need surgery." And then I found out that B is someone who's allowed to ask me specific questions about food. As it turns out, she can even ask me what I've been eating and I will respond with specifics. (My therapist and dietitian are the only people who can ask this - even my PCP doesn't get specifics, and I only talk vaguely about body image with my fibroids MD.) When I saw B a few days later for a massage, she actually checked in about whether I had gotten back on track with mp (I had), and it felt very safe to have her checking in about that. When I told my dietitian about that conversation with B, she kind of FLIPPED OUT, in a good way. She was like, "Wait, that was really her response? It's exactly what you needed to hear! Who IS this woman? Can I refer clients to her? I need her info!" And as I recounted more of the conversation for my dietitian, she was kind of stunned at how much I communicated to B. She said, "You actually told her everything that you're telling me now? You opened up to her about all of that??" I have since given my dietitian B's massage card and assured her that B is amazing with trauma survivors, incredibly body positive, and can be trusted not to say anything stupid and triggering to people with eating disorders. I plan to warn B at my next appointment that she might have an influx of massage clients with e.d.s. Eep! I can't believe how far I've come with her. A few months ago, B and I were talking about it and she got tears in her eyes and said, "You've just blossomed in so many ways over the past few years." I feel like B has gotten to really see me and my personality. As I've gotten more comfortable with her, my candid sense of humor with her has come out, so there's a lot of laughter in our relationship now. I had one massage appointment where I was just feeling very tense and out of tune with my body, and when B asked me at the beginning of the session what was going on with my body, I just said, "I don't even know. Shit's just all fucked up and I'm a hot mess." She just laughed and went with it. Not only do I trust B 100% as a medical professional and mentor, but I have also learned to trust that she cares about me on a very, very deep level and I trust her clear belief that I am worthy and deserving of that kind of care. I may be moving 1000 miles away in a few weeks, but I'm not letting go of her. I'm hoping that she can continue to help me process things as I transition to a new obgyn and continue to figure out how to manage my fibroids. And, as she and I have talked about, she will always be with me in spirit.