Of Pap smears and mammograms

Of Pap smears and Mammograms..

I can understand why cancer is not detected in time for most people.

As part of my annual medical examination I had to undergo these tests among an array of other tests completely paid for by the Government, as proof of my fitness and suitability to continue to be in their employ, or maybe as a rap on the knuckles to do what every individual above the age of 40 should be doing, viz. checking that all their systems are at ease as opposed to disease so that rectification can start early.

I turned to Google before I went for my test. WebMD.com immediately popped up, telling me how important it was that I take the test and how if detected early, cervical cancer may yet be beaten.

They wrote.. And I quote,

“A Pap test, also called a Pap smear, is an exam a doctor uses to test for cervical cancer in women. It can also reveal changes in your cervical cells that may turn into cancer later.

What Happens During the Test?

It’s done in your doctor’s office or clinic and takes about 10 to 20 minutes.

You’ll lie on a table with your feet placed firmly in stirrups. You’ll spread your legs, and your doctor will insert a metal or plastic tool (speculum) into your vagina. He’ll open it so that it widens the vaginal walls. This allows him to see your cervix. Your doctor will use a swab to take a sample of cells from your cervix. He’ll place them into a liquid substance in a small jar, and send them to a lab for review.

The Pap test doesn’t hurt, but you may feel a little pinch or a bit of pressure.”

I have a few problems with what is written under the heading “What happens during the test”

1.     It’s done in your doctor’s office or clinic and takes about 10 to 20 minutes.

17 minutes out of the 20 minutes that I spent at the clinic that I went to, were taken, by them understanding why I was there, me explaining that it was a pap smear that I was there for and not an MRI (they almost had me undress for the MRI, they were so convincing), the paper work and the doctor just making me feel uncomfortable. Take off your salwar and yes, your panty too (she seemed almost surprised that I wore one). Then she prepared for the kill by wearing her gloves, taking out her weapon, a 4inch plastic or was it metallic swab (I could have sworn it was 6 inches) and then telling me that she was going to insert it into my vagina. Of course, before she started she asked me where I was posted (As though that might have influenced my result in some way) and if I had any problems (I thankfully understood just in the nick of time that this question was with specific reference to my test and had nothing to do with my boss and stopped myself from pouring out my work woes to her). I had this sinister feeling that I was consenting to rape, which is not to undermine the crime in any way, of course. But then, for the legally uninformed, I must clarify that I would be wrong to feel so as Exception 1 to Section 375 excludes medical procedures from qualifying such. Also, the doctor was a woman.

2.     You’ll lie on a table ………….. and send them to a lab for review.

So feeling as I was, naked from waist down, insecure and terrified, I tried to focus on the terrible smell that permeated the room, which was in the middle of a construction mess in the basement of the diagnostic clinic. She saw me cover my nose and by way of explanation, informed me that they were expanding their base, literally. Little did she know that I was covering my face so that I could not be recognized ever again if we did meet socially. That would be so embarrassing. I barely got enough time to collect my thoughts on what chemical I was inhaling when she started to insert the speculum into me. She explained (while I wished she would just shut the hell up) that she was going to probe in further to get the best sample. I am competitive, yes, but this was going just too far.

3.     The Pap test doesn’t hurt, but you may feel a little pinch or a bit of pressure.

After the initial shame was overcome and I had reconciled to the cold tip of the swab, she suddenly went rogue and pushed boundaries that I had no idea existed. I soon realized that her alignment was all wrong and I protested. You are pushing in the wrong direction, no, that came out wrong. You are poking into my skin, it hurts, I said as firmly as I could without screaming in pain. (I am a police officer, I am not allowed to acknowledge pain). She said, “Bas bas, its done. (like I was some 4 year old wailing about my first inoculation) She then proceeded to presumably store my sample while I continued to lie there spread eagled. And when she was satisfied that she had me completely bereft of any human dignity, she conceded boredly (there is such a word) “you can get up now”. I got up, wore my clothes, pieced together my dignity and left without saying thank you. The pain has stayed with me for 2 days now and urinating is an ordeal still.

Just as I was leaving the clinic, she handed me my papers and asked if I had any test left. I said I was going to get my mammogram test done in their branch a few hundred yards away. I could have sworn that I saw a glint in her eye and her lips curved up in a sadistic slant for that one fraction of a second. I hurriedly shook her off my system and proceeded to the last test in my list.

A couple of blocks down the road and I entered the mammogram room after slip sliding up a checkered ramp built specifically to guard against slipping. It was clearly not made for kolhapuri chappals, I noted with disdain. For every one step up I slipped 2 steps down. So, do the math. Suffice it to say, that I should have known that the universe was trying to say something to me and I was clearly not paying attention. In the mammography room some minutes later, I waited while a lady brought me a blue hospital gown open down the front with no hooks or tassels to tie the two together. She informed me that I was to take off my kurta and my bra and wear the gown. She indicated a seat where she said I should wait till she got her weapons out of the armoury. While I stripped down to my waist, I reflected on how, within a span of 30 minutes, I had taken off every piece of my clothing in instalments in front of complete strangers whose only defense was that they were part of a medical procedure and were women (whose gender preference was not, as a norm, in question). And now I was beginning to feel that I had consented to participate in a striptease ritual.

By way of preparing myself for the inevitable, I quickly turned to WebMD for help on what was going to happen to me.

They wrote.. and I quote,

“Mammograms are performed as part of a regular physical exam to provide a baseline reference for future comparison or to evaluate any unusual changes in the breast. Mammography is your best defense against breast cancer because it can detect the disease in its early stages, often before it can be felt during a breast exam. Research has clearly shown that mammography can increase breast cancer survival.

What Happens During the Test?

Registered mammography technologists perform the test. Most mammography technologists are women. A doctor specialized in interpreting imaging studies (radiologist) will interpret the X-rays.

You will be asked to stand in front of an X-ray machine. The mammography technologist will place your breast between two radiographic breast supports. The supports will be pressed together, gently flattening the breast. Compression is necessary to obtain the clearest possible picture with the least amount of radiation. You may feel some discomfort or slight pain from this pressure, but it will only last for a few seconds while the X-ray is being taken. Your cooperation for these few seconds is important to get a clear picture. If you feel that the pressure on your breast is too great, tell the technologist performing the exam. To minimize discomfort during compression, you may want to consider scheduling your appointment seven to 10 days after the start of your period, when your breasts are least likely to be tender.

The breast will be imaged in several positions to enable the radiologist to see all breast tissue adequately. For a routine breast screening, two pictures are taken of each breast. This exam takes about 20 minutes. Many centers also do 3-D mammography. This is similar to regular mammograms but many more pictures of the breast are taken at various angles to produce a 3-D picture for the radiologist to check.

After examining the digital images, the radiologist may ask the technologist to obtain additional images or a breast ultrasound for a more precise diagnosis. This is a routine measure.”

As you might have guessed by now, I have a few problems with what is written under the heading “What happens during the test”

1.     Registered mammography technologists perform the test. Most mammography technologists are women. A doctor specialized in interpreting imaging studies (radiologist) will interpret the X-rays.

So the lady who had been talking to me over the telephone over the past couple of days to convince me that my annual medical examination was actually not over,  was the same who fixed my appointment and called in to change the date and time twice, was the same one who greeted me when I took the last step up the ramp (and heaved my other leg up to stop sliding down two),  was the same one who ushered me into the mammogram room, brought me my gown and lo and behold! She was the same one who said she would conduct the test. So, yes, she was a woman but was she a registered mammography technologist? And when you are already naked down to the waist in an ill-fitting blue hospital gown, it might be considered inappropriate to ask for proof. After every few minutes, she would take the X ray plate and go away for a while only to return with another one (or so I believed). I was left with no choice but to visualize a radiologist taking those plates from her and actually interpreting the images. I was too afraid to ask lest she told me that she was actually just giving the plates some air after they had been crushed down with the weight of my breasts brutally flattened with metallic plates.

2.     You will be asked to stand in front of an X-ray machine………….when your breasts are least likely to be tender.

The less said the better. With my lower parts already feeling like I had just finished a dressage competition, my upper body was contorted, twisted, slammed to get the innards penetrated with rays that could then presumably read if my body had had enough of them and needed correctional intervention or not. Before she started the process, I cooperated by volunteering to place my own body parts wherever she wanted me to. When I had successfully done so the first time, I felt an itching as I removed myself from the machine and felt some dust when I tried to see why. I asked the lady whether the plates were clean. I had visualized a sterilization process before every new test which turned out to be mere wishful thinking on my part. She hurriedly cleaned the rest of the plate (that was not already cleaned by my breast) with her fingers and then wiped her fingers on my gown (at this point I can think of a few emoticons which would be apt to describe my mood). I made a mental note to go home and bathe as soon as I could. I crumbled under the pressure of my situation and let the session begin.

 At the instant when the x-ray was being taken, yes, that time of intense pressure when she had sandwiched my breasts within the plates till they could no further be compressed or then till I screamed for mercy, (she did tell me, “bahut dard hota hai to batana”), whichever was first, she would ask me to turn my face away and look to my right and left alternating with the breast being x-rayed. As I grimaced with my jawline facing the camera, I thought, wildly, in that instant, what if someone was actually taking a photograph? How absolutely grotesque these poses would look. Even the mere thought repulsed me. Up, down, left side, right side, angular, the lady went wild with creativity. I thought about how much unwelcome attention my breasts were receiving and tried to focus on spirituality and out of body reflection to distance myself from what I was physically being subjected to. Did it hurt? My pride and prejudice prevents me from admitting it in public.

3.     After examining the digital images, the radiologist may ask the technologist to obtain additional images or a breast ultrasound for a more precise diagnosis. This is a routine measure.”

And so, she continued, plate after plate, till she finally said the magic words, “Bas. Ho gaya. Gown utar lijiye” (Personally I would have preferred “Kapde pehen lijiye” but I guess she was worried I might walk out with hospital property, so, exercising abundant precaution, she made it clear that I had to remove the gown before wearing my bra and kurta.

Once dressed, I emerged from the room into the waiting area before stepping into the doctor’s room for my diagnosis. In that fleeting half a minute, I saw a few ladies exchanging knowing glances and one or two looking at me, with something that might qualify as pity writ large on their faces. I suddenly understood what ‘been there done that’ meant. I hurriedly stepped into the doctor’s room only to be told that I should step out, remove my slippers and step in again. I noticed that the doctors inside had their shoes on and I could have sworn one of them had some of the construction debris from the other branch (of my pap smear fame) on her moccasins ( I am a police officer. I notice) but then I was too terrified to complain. They had the power of my annual medical examination in their hand. They could make or break me. I involuntarily shuddered as the thought hit me and I lowered my cannon as a motor movement, in consequence. My instant obedience seemed to please them and they smiled at me. There could be more than one reasons for their benign cheery faces. One, that I was fine and my breasts had passed. Or was it that she could see my contorted profile in the series of negative photographs in front of her and she had been laughing hysterically before I stepped in. Or that she was actually not the doctor and she knew that I had no way of confirming that. Or that she had actually seen me playing Word Trip on my mobile while inside the mammography room and she was wondering if I sent a request to my friends on Facebook in order to earn coins.(try and convince me that there was no secret camera inside the mammography room). Or then I was the last patient in and she was just plain happy to end her day. At any rate she had an excuse to smile. Why the other doctor sitting next to her was smiling at me, I had no way of guessing. She asked me if I still got my periods or was I in my menopause. I thought that would have been a question the pap smear warrior would have posed me but the clinic had proved me wrong before. I thought to myself, my breasts told her that? When I later shared this with a friend of mine, she told me that when she went for her test, she was asked if she was single and sexually active. I told her, of course, that since this had absolutely no connection whatsoever to the test in question, I could surmise without a doubt that the doctor was only checking if she was available for a date. The doctor was, in today’s parlance, hitting on her. But the doctor was a woman. It is amazing how much can be achieved behind the cloak of apparent womanhood. And then I shuddered once more. The lady at the pap smear, the lady at the mammogram, what if? And to think I had voluntarily asked for a lady doctor. That was one day of consents gone terribly wrong.

Adequately demeaned and defeated, I slid down the ramp into my car with nothing much left to qualify as self-esteem. She called out after me saying, “Madam, we will send your reports to your house tomorrow”. She knows where I live, I thought, mortified.

Do I have cancer? Thankfully, no. Of course, I would like to selectively believe the reports even if they emanated from this nightmarish experience. But I think to myself, if the testing process for detecting cancer itself is so trying (for want of a better word for hellish), then is it a surprise that cancer is not detected in time for most people? We have made progress with simplification of pregnancy tests. Ladies in white coats, it is time to train your guns on pap smears and mammograms next. Wait. Isn’t that what you just did?  You know that is not what I mean, though. Don’t you?