As I left the diagnostic imaging center after a particularly disturbing mammogram, I wondered why men are allowed to be obstetricians and gynecologists. It never made sense to me. And I wonder why Western medicine assumes that it is perfectly appropriate for male physicians to be involved in women’s breast care, and that women should not question that assumption. We are not given a choice as to whether we are comfortable having male physicians examining our breasts, at least in my experience. When a woman signs the consent form for such procedures, I have not noticed questions asking about her trauma history, particularly around sexual assault or molestation. I wondered if men are given the option of having female urologists or oncologists in medical care involving their reproductive health. I know nothing about testicles or penises, and I cannot imagine understanding the physical and emotional implications of compromised reproductive and sexual health in males.
The Spa Mammogram – How mammograms should be
I enter the diagnostic imaging center where I hear soft music and notice the comfy sofas and chairs. The receptionist invites me to sit down and help myself to herbal tea, or water from a big glass dispenser with slices of lemon, orange, and cucumber dancing amidst the ice cubes. I am invited to help myself to some healthy snacks, perhaps some almonds and raisins, other dried fruit, or mixed nuts. The atmosphere feels gentle, from the wallpaper to the lighting, right down to the selection of current magazines. I could choose from “O” Magazine, or “Real Simple,” instead of magazines that would assault me with stories about children being separated from their families, none that could make me feel ashamed of my toenails, or my wrinkles, just little tidbits about products that sheer leaves off of cilantro, or ideas about how to organize my spices.
A nurse comes in and sits beside me, and tells me her name is Sally. I notice that her scrubs have pink and red roses and green leaves on them. She goes over the Informed Consent Agreement to be sure I understand the procedure, and I sign the form. She tells me exactly what to expect, and asks me if I need any more information. She shows me into a dressing room and tells me I can select a gown and a nice thick cotton robe and some slippers, so that I would be warm.
When I enter the room with the ominous, humming machines, I notice that great effort had been put into making the rest of the room feel safe, even welcoming. The walls have murals of gardens and forests, and the lighting is soft. There are small windows to let the light in, and I can hear still hear the music over the noise of the equipment that would tell me whether the lumps I had felt could possibly kill me. Sally treats me with great care, explaining each step, and helps me to relax and breathe as tears well in my eyes. I feel silly, given that the lumps are probably nothing, but the nurse affirms my anxiety, and says it’s perfectly understandable to feel anxious. She positioned me so that my teensy breast would be available for the machine’s plates to close in on it, affirming my experience of being invaded. Why can’t there be another, less punishing way of seeing into breast tissue that would not make a woman contort herself into positions that practically break her ribs? My cheek was pressed against the cold metal, my arm trying to grip the handle to hold myself steady against the force of the huge machine. It took several tries.
Once finished, Sally invites me to lie down on a soft massage table with a warm heating pad underneath soft sheets, and she tenderly covers me with a blanket and gives me an eye pillow while I wait for the radiologist to examine the mammogram pictures.
“It will be about ten minutes,” she says, holding my hand and making eye contact, her eyes shining with kindness and compassion. She puts a little button right next to me “in case you need anything,” she says.
I try to breathe, tears inching down the sides of my temples. I can’t help but worry. The lumps are real. There are actually two, one in each breast. I feel both just to make sure I wasn’t just imagining it. Nope, they’re still there, little hard lumps like tiny pebbles. I’ve had these before, but the biopsies had been negative. But what if this time, they weren’t? I had a granddaughter on the way, and I was really enjoying my life as a healthy, very active sixty year-old woman. I would handle it with grace, I told myself. Of course I would. I could do anything once I was clear on my plan.
Sally came back and explained that the radiologist wanted an ultrasound to look more closely. For me, this did not sound promising, but still it could just be the same result as the times before when the lumps turned out to be benign calcifications.
The ultrasound tech tells me her name is Harriet. She took me into her room and asked me to lie down on the table, which was also warm and soft. She warns me that she is going to squirt gel on my breasts, but that it had been warmed so as not to be shocking. When Harriet was finished, she told me that the radiologist would want to evaluate the results, and that it would be about ten minutes. She sat down next to me on her stool, asked me how I was doing.
“Can I get you anything? Some water or maybe something to read?” I allowed the tears to fall, and she fetched some tissues and rubs my arm, affirming that my anxiety is quite appropriate. She assures me that I can press the button if I need anything. I wondered if I might throw up, or have a panic attack, so having a button in my hand felt comforting. I look around the room to see where the door is, just in case I just can’t take it anymore and need to escape. I try to read the magazines that are on the little table with the tissues, but I can’t focus .and my hand is shaking After about ten minutes, Harriet came back and sat beside me.
“Dr. Lily would like to have her medical student come in and observe as she looks more closely with the ultrasound machine. The student is a male and you have the right to say “no.” Just check “yes” or “no” on this Informed Consent Agreement where it asks for your permission.” I checked the box “no,” and told her I was not comfortable in an apologetic tone, which she quickly noticed, and told me it was my absolute right to say “no,” to anything that felt like a violation of my boundaries. I signed the form. She asked me to get on the table and gave me a blanket. “Just stay covered so you’ll be warm until the doctor comes in, “ she said.
Dr. Lily then entered the room and sat down next to me. She introduced herself and told me exactly what she was going to evaluate on the ultrasound screen as she maneuvered the device over each breast. “You can let me know at any time if you’re uncomfortable,” she said reassuringly. As she moved the ultrasound head, she spoke to me in language I could understand, rather than using medical jargon.
“I’m going to turn the screen towards you and show you what I’m seeing,” she said softly. She told me that the lump in my left breast was nothing to be concerned about, just normal thickening due to some scar tissue, and the lump in the right breast was not in the breast tissue, but just under the skin and could be a clogged sweat gland.
“I would like you to watch it, and if there are any changes, I want you to tell your primary care physician and we will evaluate it again here in our imaging center right away. Do you have any questions?”
She took my hand and gave it a gentle squeeze and said goodbye. The nurse brought me a towel to wipe off the ultrasound gel, and I was taken back to my dressing room and offered something to drink. I chose the cool water with the fruit floating in it. I took my time. I hated to take off that lovely, thick robe, and wished there was a room next door where I could get a pedicure, and then maybe a massage.
The Industrial Mammogram- How it really was
A mammogram was ordered specifically to determine whether two small lumps I had felt were cause for concern. I was greeted by a receptionist and asked to sit down. The receptionist told me to help myself to tea or water, and snacks that were in a basket, an assortment of packaged cheese and crackers, packaged cookies, and candy bars. I think there may have been some bags of peanuts.
“They’re running about ten minutes late,” she said not looking up from her computer screen. She was chewing gum. I opened an issue of “O” magazine from several months ago, overhearing a nurse discussing scheduling changes with the receptionist. Something about moving this person over there because it wasn’t that urgent. “Maybe that person was like me, not that urgent,” I thought to myself.
After twenty minutes had passed, I went to the receptionist and told her I had clients scheduled after my mammogram, and would need to reschedule them if it was going to be much more than a few minutes.
“Oh it’ll only be a few more minutes,” she said.
“I was told it could be an hour and a half if the doctor wanted an ultrasound,” I said.
“Yeah, but we should be done in an hour. Once you get in there, it goes pretty quick.”
I rescheduled my clients anyway, so I wouldn’t worry about it. I was already anxious enough. A nurse came out and introduced herself, seeming a little firm or maybe just tired of her job. She had bad breath and she did not smile. I was taken into the dressing room where she asked me a few questions about where the lumps were. She put little sticky dots on the area and told me to undress from the waist up and meet her in the imaging room. She told me to put on the “cape” which looked more like a handkerchief, and a robe, which was nice because I was already cold.
I was positioned, repositioned, and told to relax my shoulders (impossible for me), step to the right, no, a little bit more, now back, relax my shoulders (she sounds annoyed). She took my breast as though it were a piece of dough and used a rubber spatula to cram the poor little shriveled thing that had fed two babies and ballooned to fourteen times it’s normal size during that period between the two plates which were closing in to sandwich it securely. It wouldn’t cooperate, and kept trying to escape the plates. It took several tries to get it positioned. There was no inquiry as to whether it hurt anywhere, which it did. My ribs were pressed up against the machine and my neck was contorted in a way that wasn’t comfortable, but I was tough. I could handle it for a few seconds. So, why were the tears welling and why the sob stuck in my throat like a wad of bread and peanut butter?
After she was finished, she told me to wait while she showed the radiologist the results. I stood there with the pathetic little cape opened, both breasts reddened and angry that they were not treated as the precious and beautiful miracles they were. They had once been like tender apricots, perfectly round. When I was nursing, they were like over-ripe cantaloupes. When I stopped nursing, they had shrunk back down, and now hung like little dried apricots, happy that they had done their work well.
The nurse didn’t tell me anything that could help me understand what was next, nor did she inquire as to whether I felt anxious and make an effort to put me at ease. She handed me a magazine about country living that was several months old.
“Here you can read this.” she said and walked away. I couldn’t focus, but I tried to look at the clever country table settings with napkins shaped into cows and pigs, but my heart was racing and I was trying to slow my breathing. Hard to read when one is in fight/flight. After about ten minutes, she came back into the imaging room and told me that the radiologist wanted an ultrasound. I was told to go out and wait in the main reception area until the tech came to get me. I went back to “O” magazine, and tried to read about how to do something better, or how to avoid panty lines through my yoga pants.
The tech came to get me, and asked me to lie down on the table, which was at least covered with a layer of something soft, but I was cold. I needed a blanket, but she seemed like she might get annoyed if I asked her, so I just wrapped the thin handkerchief cape around me. She told me to keep it open so that both breasts were exposed and she cold squirted gel onto them. I heard her click onto her keyboard…click, click, click…..click. I wondered if each click meant there were masses I had not felt, or lumps that only the imaging equipment could spot. I thought about my first grandchild, due December, and my daughter who counted on me to be available for support, comfort, and reassurance. My mother had long since died, and my journey through pregnancy was lonely and anxious. I was rapturous that I had this opportunity to be with my daughter and was savoring every moment. I couldn’t die. I couldn’t be too sick to be present. I just couldn’t. Tears welled and rolled down my temples and onto the sheet. I was trying to choke back sobs that stuck in my throat like a wad of bread and peanut butter. I wanted her to notice spend a few seconds comforting me, but it seemed she was focused on her clicking, and I would probably irritate her by slowing everything down.
When she was finished, she told me to stay on the table and leave the cape open while she went to discuss the results with the radiologist. After several minutes, the doctor came in followed by another younger man.
“Hi there, I’m Dr. Whatever. Welcome to the breast center.” he said thrusting his hand at me. I didn’t know who the other guy was. Maybe he just followed Dr. Whatever into the room from the cafeteria. Dr. Whatever sat down on the stool and began talking, but I wasn’t sure if he was talking to me. He looked at the screen and commenced to run the ultrasound device over my right breast. He looked at me for a few seconds. “Now where exactly are you feeling the lump?” he asked. I was thinking he should know where it was, but I touched the spot with my finger. He continued to talk, using medical terminology I didn’t understand, except for when he referred to one lump as, “just curds and whey.” Then he moved to the other breast and asked me to show him where the lump was. He continued to talk, but not to me. I felt like a cadaver. Dr. Whatever was the star of the show, flanked by his male medical student who worshipped him as he poked around, Latin terms sliding off his tongue like the gel slid off my breasts.
“Now we might have reason to worry about this,” he said (not to me). “But I think it may be just under the skin, not in the breast tissue. Still, I’m going to look at it from a different angle just to be sure. Yup, pretty sure this is just a clogged sweat gland.”
He put the ultrasound device back on its hook, and spoke to me. “I think what we have here is just a clogged sweat gland, but I want you to watch it. If there are any changes, I want you back here, okay?” He told me to have a nice afternoon, and he left the room, white coat billowing after him, his medical student hurrying to keep up.
“You can get dressed now,” the tech said. “You’re all done.” She left the room. I got up off the table with gel covering my chest and looked for something to wipe it off with. There was nothing, so I used the handkerchief cape to wipe myself off. I felt like I was in a dissociative fugue, not quite present, and unsure as to whether I could function for the rest of the day. I hoped that being out in the light would help. Maybe if I could just rest for a while I would feel better. I said goodbye to the receptionist, but she did not look up from her computer.