Friday, August 20, 2010

Unfair Speculations.

thanks e. and b for getting me reflecting on this. . . . .

"When you talk to her
Talk to her
Like you'd want somebody to
Talk to your mama. . .

Don't get smart with her
Have a heart to heart
With her just like you
Would with your daughter. . .

Everything you do or say
You got to live with every day

'Cause she's somebody's baby
She's somebody's sister
She's somebody's mama."

from India Airie's "Talk to Her"

The other day I had just finished a teaching session with my small group of second-year medical students and was preparing to leave the School of Medicine. On the way out, I stopped to briefly chat with Elle and Bridget--a couple of other M-2 students from a different group. They were working on a project and wanted a little bit of "attending level" input. While I can't say that my "attending level" input is equivalent to that of say. . .a professor emeritus, it was nice to have been asked.

Anyways, the business part of the conversation somehow winded its way to a discussion of life experiences. Specifically, we talked about how life's little speed bumps shape the kind of doctor you become. For example . . . . . how patient or how gentle or how fierce an advocate or how fill-in-the-blank you are with your patients. . . .maybe it all has (much) more to do with the hand life dealt you before you started medical school than anything us "attending level" folks could ever impart in a classroom or on a ward.

Just maybe.

And so we got-to talking and I got-to thinking. I found myself telling them this story about an experience I had with a doctor when I was 16 (and a half) years old. A pretty unpleasant experience, actually.

Funny. . . .I hadn't thought about it in so many years. . .in fact, I'm not sure I ever properly processed my feelings about it. I discovered for sure that it was unprocessed when this wave of emotion tried to sneak up on me when I was sharing the story with them. . . . . whoa. . . .loose ends. Yikes. (Fortunately, this time I managed to fake wistfulness instead of just full on crying--thank you, years of drama lessons.)

Okay. . . . so here's my crack at really reflecting on this. Note that this is an attempt to process something that I now realize has a lot to do with who I am as a physician and how I treat my patients to this very day. To try not to assume anything about them. To try hard not "size them up" based upon what they look like or where they live--especially working at a place like Grady. This story factors into all that for sure. . . . and just maybe has a teensy-bit to do with me becoming a Grady doctor.

Just maybe.

me as a 16 year old Junior circa 1987
(rockin' the asymmetric mullet look--you know you love it)

The Story. . . .

When I was 16 (and a half) I was pretty much consumed with competitive cheerleading. Period. I ate, drank and slept herkies, toe-touches, and pyramid dismounts and spent every free moment I had choreographing a routine for the next half-time show or pep-rally. It was varsity cheer, all the time--and when I wasn't with the varsity squad, I was coaching freshman and JV cheer. I lived my life to an eight-count rhythm--jotting down potential formations in a spiral notebook with hearts and rainbows on the cover and considering every new song I heard on the radio fair game for a dance sequence.

Okay. . .so like many 16 (and a half) year old girls, I had a boyfriend back then, too. This really cute boy that my older sister Deanna had introduced me to during my freshman year (her boyfriend's younger brother, actually.) He was appropriately studious, yet regarded by most people as an A-list "cool kid." He became my "boyfriend" over the summer preceding my sophomore year and definitely upped my cool stock bigtime. Cute-boy rode next to me on the travel bus during basketball away games and walked me home from school and shared chili-fries and honey buns with me during second lunch. Cute-boy was pretty special and was the first to make my heart go pitter-patter.

I think, just maybe, I even loved Cute-boy (that is, for what I knew love to be back then. . . .)

Anyways, at 16 (and a half), I was a junior and Cute-boy was a senior. Our relationship involved lots of kissing and okay--sometimes really heated make-out sessions--but for some reason, it never got to much else. We're all adults here, so I'll just say it: We weren't having sex. Not even close, actually.

The interesting thing about it was that it was mutual. . . . just this unspoken understanding that we weren't going there. And it made me feel special since Cute-boy was one that could have easily secured a girlfriend that was more. . .errr. . .giving (which he eventually did. . . ha ha . .) but during this time, when I was 16 (and a half), he only had eyes for me. Me and only me.

As for the abstinence thing, I can't say that it was because of a fire and brimstone upbringing or some intense commitment to not disappoint my parents. (Sorry, mom/dad.) I'm not sure it was ever that deep. It just was sort of . . .not really on my radar. . .like. . .having a boyfriend was really great and Lord knows I was infatuated with Cute-boy, but my other relationship--cheering--sat squarely on the front seat between us like a bratty kid brother. It didn't take extraordinary willpower or anything like that to not "do it." It just sort of wasn't my thing.

I recognize that this was probably a bit unusual back then, and even now--especially in my neighborhood. In my Inglewood, California hometown and high school, teen pregnancy was viral. It was nothing for someone to be plucked out of the cheerleading roster due to being. . .well due. Case in point: my two senior cheer captains during freshman year both had children over the age of 1. Umm, yeah.

Several of my peers were sexually active back then, but there were definitely a good number of us that weren't. And some how, contrary to what you'd guess, the seasoned girls never picked on us novice girls. . . .we all just sort of happily coexisted. Stretching on the grassy field before cheerleading practice. . . .some making loose references to "doing it" and others discussing the elements of the perfect back handspring.

One week after "two-a-day" practices leading up to our big Six Flags competition, I noticed a discomfort. Itching, to be exact. I dealt with it for a few days until it became rather unbearable. I did what a lot of kids do--told my mom.

"Mom, I'm itching. . .ummm. . .you know. . .itching."

"Do you see anything in your undies?"

"Eeeww, Mom!"

"Well, do you?"

"Kinda. Like whitish? I don't know, Mom!"

"Okay, I'll take you to the doctor," she replied. "It's probably from all that sweating you do with cheering."

I shrugged a teenage shrug and thanked my mom for being so responsive.

A day or so later, my mom and I rode to this doctors' office that I'd never been in before. As we walked into the building, I thought I'd get the lowdown.

"What doctor is this?" I asked Mom.

"The doctor for women," she said matter-of-factly. "Now that you're a young woman, you don't need to see the pediatrician any more."

"Uuuuhhh, okay."

And so I see this doctor. This forty or fifty something year old male gynecologist who promptly kicked my mom out of the room and got down to business. Steely blue eyes and wavy brown hair. A light on a band around his head.

"Where's high school?"

"Morningside High. . . in Inglewood."

Inner city, check.

"Do you have a boyfriend?"

(blushing) "Yes, I do."

Having sex, check.

"Pretty serious one?"

"Uuuuhh, I guess."

Definitely having sex, check, check, check.

"Okay. Put on this gown. Undress from the waist down. Underwear, everything."

"Uuuhhh, okay." Mom? Where'd you go? Underwear, too? Never had to do that before. Not too sure about this. Now feeling a little nervous about the doctor for women.

Undress. Try to put on paper gown. Hmmm. Open to front or to back? I don't know. Guess I'll put it on like a jacket. Open to front. Hope it's right.

No door knock, just walked right in, this time with a nurse. "Hi, I'm back. You ready?"

"Uuuuh, I think so."

"Okay, lay on your back, put your feet right here, and scooch your bottom all the way down here." Holds his hand at the end of the table. Stick my heels in these foot holders. This is odd.


"No, more than that."


Nurse speaks up. "Sweetie, scooch til' you feel like you are going to fall off."

::Scooch. Scooch. Scooch::

Doctor speaks again,"That's good. Okay, honey, I'm gonna need you to open your legs more than this." Pushes on my knees to make the point.

"Ummm, okay."

"No, hon. More than that."

Nurse: "Like a little froggy, sweetie. Open your legs like a little froggy, okay?"

Like a froggy?

Doctor sighs. "Come on, honey. Really going to need you relax these legs." Pulls on my knees a bit. Not sure how I feel about it. "Just. . .relax. . . these are just my hands. . just looking, hon. . .relax." Touches me. Feel gloves touching me. Trying to relax. Oh yeah, maybe tell him what Mommy said?

"My mom said it could be yeast since I cheer and run and stuff."

"We'll see." Don't think I like how he said "we'll" or "see." Like he thinks what I said was dumb or not important.

"Oh, okay. Just thought I would tell you."

"Look, honey, I really need you to open your legs more." Pushes both heels of his gloved hands on my inner thighs. Don't like this and don't get this. At all. Want to relax, but this is not relaxing.

Nurse: "Like a froggy, remember?"

"Like when you have sex," he added.

Like when I have what? I wasn't sure what to say. Felt embarrassed that maybe I should have been having sex? Like 16 (and a half) is kind of old to not be, right? But don't know what to say in response. Tell him I'm not? No, stay quiet. Wait 'til it is over. Will be over very fast. I don't think I like this woman doctor.

"You are going to feel something cool. That's this, the speculum." Raises his hand up in the air from the stool he is sitting on. I see something just above my knee for a fleeting moment. Some kind of metal thing that looks like a giant, steel duck bill. Have never seen anything like it in my life. What is he going to do with that? Not sure. But okay. Gonna try to relax.

"Okay. . . .pressure. . .pressure. . .just relax. .now I'm just going to open the--"


I bear down hard and sit up in sheer terror and surprise. Metal duck bill flies out, hits the tile floor.


Crying. Wanting to go home. Willing to live life with yeast or what did Mommy say it was? Don't care. Can't be life threatening. Want to leave. Shaking. Please. Just no cold pressure duck bill. Ever. Again.

Or "honey." Or "sweetie."

"Okay, listen, honey. We can't tell what's going on unless you--"

Nurse with arm on my shoulder: "Sweetie. . .have you ever had, um, an examination like this?"

"Nooooo-ho-ho-hooooo." Sobbing. Terrified. Shaking. Wiping face hard with hands. Kind of embarrassed. Didn't expect this. Wanting my mommy. Wanting my daddy. Wanting to go home. Never come back. Ever.

Nurse and doctor look at each other like, What's going on?

Doctor breaks silence. "Honey, when was the last time you and your boyfriend had sex?"

Tired of him calling me honey. Is that supposed to make me more comfortable? "Huh?" Still sobbing. Now confused. Shaking, too. This is a mistake. I am not a woman. I do not belong with the woman doctor. Where is my mommy? Go get her. Please. This is all a terrible mistake.

Doctor becomes a super-sleuth. "Sex. When was the last time you did it with your boyfriend?" Holds up hand and makes an 'o'. . .then gestures with gloved finger going in hole.

What is he talking about? I didn't say I did that. Why does he think that about me? When he looked and touched with those gloves was there something about me that made him think that?

"Umm, I haven't had sex with my boyfriend." Still shaking. Still kind of crying. Wanting this to end. Don't know when or how they got this idea. Okay, we kissed a lot, and okay it was french-kissing but I'm pretty sure that doesn't count. Does it?

Doctor getting annoyed. Nurse looking worried. Doctor going to get to the bottom of all this: "Okay, hon, then what about the last time you had sex with anyone?"

"Sir, I never had sex with nobody before."

Nurse gasps behind me, but I hear her. Feel the gasp, too, even though I don't see it. Nurse looks at Doctor. They mumble something to each other about being able to get something from metal duck bill to make a slide. They mumble a few more things in my direction but all I hear is "honey" and "sweetie" but not "sorry."

Pull the curtain back. We will be right back. You can get dressed. Here--tissue to wipe your bottom.

Crying while I get dressed. Crying and shaking and confused about this place for women. Am I a woman? I don't think so. Never want to see this kind of doctor again. Ever. Never. Used the tissue--a little blood. Oww. Get dressed. Want my mommy. Want to leave. Never come back. Ever. Next time, the pediatrician, okay? Never want to come here. Ever again.

Knock, knock but open the door at the same time before I can say, "Come in." Still buttoning my pants. Don't know where to throw away the blood tissue. Ball it up in my hand. Doctor starts talking. Headband with headlamp pushed back on his wavy brown hair like a hair accessory now. But light is still on. Weird.

"Your mom was right. Definitely looks like yeast. Be careful to change quickly out of sweaty clothes after cheer practice or running. That's why this happens. Cotton underwear can help keep you dry, too. Okay hon?"


"You'll take this medicine for seven days. You take this thing here, put this cream in it and just push it right inside your vagina, okay? Every night for seven days."

Inside? My what? "Okay."

"The nurse will check you on out. Your mom will be waiting for you in the waiting room."


Nurse--this time a different one--comes in and tells me the same thing. Any questions? Yeah, have many but too scared to say them out loud. Might act like what I said was dumb. Or unimportant. Really want to know if I can get something that I don't have to put inside my vagina because I am scared of inside. But that's okay--won't talk because I just want to leave. Never come back. Never. Ever. Ever. Get me to my mommy. Need my daddy. Leave this place for women because I am still a girl. A girl, do you hear me?

Nurse: "Sweetie, would you like some condoms and foam?" New nurse, same pet name.

"Excuse me?"

"Condoms and foam. Would you like some?"

"Uuhhhh. . .no, ma'am."

"If you do, they are in this bag, okay?" Sits a brown bag on the counter and pats it. Almost looked like she wanted to wink. Like it would be our little secret. But I didn't need a secret with her. Too young and too scared to know about reactions like, "This is bullshit!" or "How dare you assume anything about me!" Too young to know how to advocate for myself. Or fight like a woman. Because I am a girl. A girl, do you hear me?

Staring at New Nurse and saying nothing. Just thinking and shaking and wanting to leave that room with the duck bill and the foot stands. Get to my mommy, not my mom. Want to tell her and them I am not a woman. I am a girl still. See my mommy in the waiting room reading "Redbook." Gives me a big smile. Like maybe it was a rite of passage? Not sure. Want to tell her what happened. About how they thought I was a woman but I am a girl.

Mom puts arm around my shoulder after we pass through the exit. "How'd it go?"

Don't know what to say. Don't know how to be. Not sure how to feel. So say nothing.

Out of the building. California sunshine on my face. Warm and nurturing. Like my mommy. And like my daddy. Nobody saying "hon" or "honey" or "froggy" or "sweetie." No duck bill or pressure or scooching. Glad it's over. Just want it to stay over. . . .

Mommy got in the car and looked over at me as I connected the seatbelt. Her eyes were twinkling. "Well? How'd it go?"

Can feel the wheels turning under the car. Building disappearing behind us getting smaller and smaller. Decide I want this to disappear, too. . . . . hoping the memory will get smaller and smaller.

"How was it? Uh . . .fine, Mom. It was fine."


Now playing on my mental iPod. . . . 

Talk to her. . . . just like you would with your daughter. Take a minute to listen to this if you can.


  1. For the record,Mom. . .this was a failure of doctor-patient communication. . . .not you, okay?

  2. This is Mom (Mommy):
    As parents, we do the best that we know how to do, so I take no offense.
    During the time when each of you were born, fathers were kicked out of the labor room and the baby whisked away as soon as he/she was born, only to be presented fresh and clean when the mother was returned to her room sometime later. Your sister, JoLai, who was born prematurely, was over three weeks old before I was allowed to touch or hold her. Fortunately times have changed. I know from the conversations that we have now, that I have, too.

  3. wow, how incredibly traumatic! I can clearly see how that would define you as a physician and from what I see on here, you are clearly the opposite of that.

  4. Wow. Incredibly moving. Thanks for sharing. This reminds me how important it is to not only treat each individual person as the individual they are without assumptions, but teaching our residents and students how crucial this is as well. And I'm sure it's why I love my work in women's clinic and IMC with some of the most vulnerable situations or patient populations. Thanks Kim.

  5. OMG..why do we always seem to have had similar experiences in life....I'm sooo sensitive wrt that issue when I see the young college kids in the Rutgers Clinc and perform their first PAP..amazing how experiences shape us as doctors today...

  6. Just found your blog. Just read this post. Wow. I can *not* believe things happen like that. I mean, I know they do, but I still can't wrap my head around it...

  7. I have recently discovered your blog and cannot get enough. Never stop writing! Unfortunately, I had a similar (though no speculum involved). I went to a local indigent clinic for a simple sports physical. For some reason, the doctor insisted I change into one of those horrid paper drapes for a full-on physical examination. Having been a virgin and not having any experience similar (sports physical!), I started bawling my eyes out. Her first response was "are you afraid I'll find out and tell your mom that you're not a virgin??" Um, what?!? I was so traumatized I never went for a pap smear until I was about 25 and finally knocked some sense into myself. It's amazing how people can be so lacking in having tactful conversations, and I see that so much more in facilities that treat disadvantaged populations. Anyway, that novel on a blog post from almost 5 years ago to say that I love your writing and how you tie in your experiences to your practice.


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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