On Doctors, Nurses, Triggers, and Self-Talk

Avid followers of my oh-so-fascinating account of my life in and out of therapy sessions may remember that I am experiencing a pelvic floor prolapse. I decided to go ahead with surgery, which will take place on Friday, December 11.My husband and I are soon leaving on an exciting vacation. We will return at 11pm on December 10, and I’ll have to be admitted to the hospital at 5:30am on December 11. Since there are just 6.5 hours between my return and the hospital, I had my pre-op appointment yesterday.

Those of you who are squeamish about bodily functions might want to stop here. If you, like me, have had children vomit all over you and hugged them anyway, or stayed in the ICU to watch when nurses removed tubes out of your husband’s throat, neck and belly, then read on.

My doctor is a urogynecological surgeon, which is good, because it mean basically most of what she does is operate on women’s private parts. She’s a specialist. She’s very experienced. She says she is motivated by the goal of enhancing the quality of women’s lives. She has volunteers with Doctors Without Borders in Africa. These things impress me.

To enhance the quality of one part of my life, on December 11 she will make an incision around my belly button and remove my uterus, possibly in two pieces because it seems to be enlarged. Fallopian tubes will go too, because (did you know this?) that is where most ovarian cancer starts. Ovaries and cervix will stay. Then several more small incisions to put in a y-shaped mesh to hold up the front, back and top sides of my vagina. Sacrocolpopexy, for short. Then a repair to the back wall of my vagina. Then a couple more incisions to put in a mesh sling to support the bladder, because sometimes when all this surgery happens, the bladder starts to leak, even it if isn’t now (it isn’t, in case you were interested). And it’s important to know something about the strength of different parts of the bladder and urethra. All that is background to explain why, on Thursday, I had to have a bladder study. And it’s the bladder study I want to talk about, because it triggered me in a way I hadn’t imagined.

This is how it works: You drink a lot of water in the morning. You come into the room and pee in a commode that measures how fast and hard you pee. You have privacy for that part, then strip from the waist down, climb up on the table, throw a small blue cloth over personal bits, and then the nurse comes back in. She needs to make sure my bladder is truly empty, so she sticks a catheter, ouch, in. Yep, only a few drops left.

Now the complicated stuff starts. A clean, new catheter hooked up (ouch again; it burns). Two long cottony sticks in the vagina to hold up the walls and mimic what it will be like after the surgery. Another pressure sensor in the vagina. All of these tubes hooked to a machine that hangs around my neck and has a wireless connection to the computer.

Doctor walks in, says a breezy good morning, how are you? Easier to answer cheerfully if you don’t have your feet in stirrups and miscellaneous shit stuck to/in your urethra and vagina, only half covered by a blue cloth smaller than your average bath towel. Nothing I say back will come out dignified so I kind of mumble something back to her.

Thanks to the nurse, I’m all ready to go, so they start slowing filling my bladder again from a bag of clear water. The doctor stands at the computer, reading the various monitors, and the nurse sits in front of me. The water feels cold when it goes in. After a bit, they halt the flow, and the nurse tells me to bear down like I’m giving birth and then to give three hard coughs. No leaking, great. Doctor reads the graph on her computer, good. So we keep going, more water, repeat. More water, most of the bag now. I’d really like to pee but that’s not on the agenda yet. We repeat the test. No leaking. Next I am supposed to stand up and repeat. Standing up means the minimalist blue cloth falls away, and so I stand in front of the doctor and nurse, naked below my shirt, very full of water, uncomfortable, with assorted sticks and tubes coming out of me. The nurse checks to see everything is in the right place, touching the unmentionable clitoris in the process, and now little explosions are going off inside my head. Bear down. Cough. Cough. Cough. On the third cough, some of the water comes spraying out.

“Good!” the nurse says. Good?!? What part is good? That technically I didn’t just pee on her hand and the floor since it’s clear water and nothing that ran through my whole system? The two of them seem pleased though. They take some more measurements and watch the graph on the computer.

Next I get to climb back on the table and to test the strength of the urethra, the nurse pushes the catheter in deeper. “This may be a little uncomfortable,” the nurse tells me. She is young and friendly and seems competent, but I’m not liking her too much at the moment. That is, I’m only half there, but the part that is there isn’t liking her.

But we are almost done, thank goodness. The sticks and probe and catheter come out. Now I will be allowed to sit on the commode and get rid of all that water (they leave the room, thankfully). I’m a little numb. I put my clothes on and go into the office to talk about the surgery. I manage to ask the questions on my list and hear the answers. My husband was in the room for that part too. We smile, schedule ahead for the post-op checks, pay the $250 co-pay, and depart.

By the time we leave the office, I am very quiet on the outside. But on the inside, those voices I dealt with all spring and into summer, the ones that say, “You are so bad,” and “You don’t even deserve to be here,” and “You are disgusting and dirty, you know that?”– those voices are starting up in my head, and they just get louder over the course of the day.

I’ve been learning coping skills in therapy (as well as from many of you, thank you). I know these voices are the result of the uncomfortable and embarrassing manipulation of parts that have been violated in the past. I know I am not really bad or dirty. I vow to be compassionate with the triggered part of myself. I take my body to yoga and breathe. But it’s not enough.

Later in the day, I long to shut up the voices by quickly burning my arm or leg, but I tell myself it is okay to feel upset. I can handle my feelings. They won’t swallow me up. Familiar self-destructive images played over and over again in my head (especially the gun-to-the-head one). I remind myself they are just old patterns of thinking that I haven’t been able to replace yet.

At bedtime, I try something I don’t usually do–I tell my husband how I am feeling and what the bladder study was really like. His surprise that the whole experience wasn’t designed in a way to better protect the privacy and dignity of patients is validating. I think about how the first time I was in that doctor’s office, there was a question on the intake form about whether or not I’d ever experienced any sexual abuse. I checked the box. It doesn’t seem to have any impact on what happens though, so maybe they just collect that information for statistical purposes?

When I try to tell my husband about the repetitive negative thoughts, however, he tends to say, “How can you think that? You aren’t bad! Not at all!”  And he hugs me. I appreciate his intentions, but that doesn’t help. I still haven’t fully figured out what does help. Just waiting it out? That seems to be what I’m doing now, and I can say I am better today than yesterday.

I emailed E. this morning about whether I could get a longer appointment on Monday. On the online scheduler, she appears to have time available both before and after my session. But she hasn’t replied. It’s easy to think, “uh oh, I’ve asked for too much, especially because I also emailed her on Tuesday; she’s probably aggravated with me.” I’m choosing to think “She’s probably busy, or maybe she has to think about whether she thinks a longer session is a good idea. It’s not something we’ve done before. There could be various reasons. I really don’t know why she hasn’t answered yet, and it doesn’t help to think the worst.” This kind of works, if I remind myself of it repeatedly.

I think this is connected to my recent posts about anxiety and the concern that I am still not good at boundaries. But what would it mean to assert a boundary in such a situation? Should I have done something differently at the doctor’s appointment? Was I supposed to protest more in the middle? Got up and pulled everything out? What should I have done differently? I think it was no big deal to the doctor and nurse, but they do it all the time, plus they weren’t the at the receiving end. In the middle of this procedure, feeling dismayed, “uncomfortable” and triggered, I didn’t know how to handle the situation and looking back, I’m still not really sure what I should have done.

I looked up more info about this procedure online today and saw that my doctor was missing one crucial piece of equipment, the cheapest part probably: some type of curtain. It would be good to have even a half curtain say between me, on the table (not pictured), and the doctor at the computer. Or something. I don’t think it’s too much to ask that medical providers think about how it feels to be a patient in their office.

bladder test

15 thoughts on “On Doctors, Nurses, Triggers, and Self-Talk

  1. Reading your description of that delightful procedure, it did occur to me that there was a suspicious (and clearly an unnecessary) absence of curtains… 😦 It might be worth raising this point with whoever is in charge of that practice, as it certainly does not sound right to me.

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  3. It makes so much sense that the invasiveness, the lack of privacy, and the various equipment and manipulations would trigger those feelings and self-harm urges. Here’s hoping you’re managing to keep yourself safe. Hugs if you want them.

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