Monday, December 14, 2009

Adventures in gynecology

For the past six weeks I've been on an outpatient rotation, which means seeing patients in the office from 8-5. My weeks consist of family practice, pediatrics, and obstetrics/gynecology all intermingled together. This afternoon was a gynecology afternoon. Incidentally, this is at one of the top hospitals in the country according to U.S. News & World Report.

My second patient of the afternoon was a pretty, prim and proper, professional white 30 year old woman, the kind you'd expect to meet at happy hour at the yuppie bar near the local office park. I saw that she had a hyphenated surname and heard the nurse mention that the patient didn't want us to use the stickers with her name on them because she was changing her name. I walked into the room and introduced myself.

Me: Hi, Miss Hyphenated-Surname?

Pt: Yes.

Me: I'm Dr. Abooboo's medical student for the afternoon. Would you mind if I go over some history with you before Dr. Abooboo comes in?

Pt: Sure.

Me: So, I hear you're changing your name, is that right?

Pt: Yeah, actually the name they have on there is wrong, my last name is Similarsounding-HyphenatedSurname, but I'm getting married next week, so it'll be changing anyway.

Me: Oh, congratulations. So, what can we help you with today, do you have any concerns, are your periods regular, when was your last Pap smear, etc., etc.

Pt: Blah blah blah, yakity scmakity.

Me: OK, let me go find Dr. Abooboo and we'll be back in together to do the exam.

[I should say here that the patient was very nice and pleasant, but I don't have the ear for conveying that in dialogue.]
Enter Hermes and Dr. Abooboo.

Dr: So, I hear you have some big plans! Where are you getting married?

Pt: Well, we're having two weddings, actually. The first one's in Turkey. My fiance is Turkish.

Internal dialog of Hermes of 5 years ago: (Oh, isn't that nice, I'm happy for her.)

Internal dialog of present-day Hermes: (Another one bites the dust.)

(Sometime later)
Dr: what do you do for a living?

Pt: I'm a management consultant. My fiance is too; we both work for the same company.

So this nice, pretty, highly educated and accomplished six-figure-earning white girl will marry a six-figure-earning Middle Eastern immigrant, probably have one mixed-race baby and deposit him in day care, then spend the rest of their lives blowing their combined six-figure income on a big house in some white-flight development with a name like "The Hunt at Glen Run," a couple of BMW's in the driveway, and international luxury vacations until they die in a nursing home. If their marriage lasts.

Later in the afternoon I saw an 18-year-old white girl who was there with her mother to discuss the results of a Pap smear and colposcopy. (Colposcopy is the screening test done after a Pap comes back negative, and often involves cervical biopsy.) She was cute, freckle-faced, with slightly eccentric mannerisms, the kind you can tell is a theater chick just by looking at her. She was wearing one of those knit wool caps with the brim that sticks out which theater chicks always wear. I don't know what they're called. Both mother and daughter were quite irate because they had had multiple Paps and colpos done at one of the other big hospitals in town and had never been able to get the results. They were both quite nervous about the fact that she had had an abnormal Pap. I looked in her chart, and saw that she had already had five colposcopies. Five. This girl was a freshman in college, and evidently she had already spread her legs for enough bad boys--or maybe one who was really, really bad--that HPV had already crawled in, put its feet up, made itself right at home, even built a little bungalow and had a party going on.

Call me naive, cultural leftists, but I'm pretty sure my grandmothers wouldn't have had five abnormal Pap smears by age 18.

This girl was not happy about the prospect of future Paps and colpos. "I'm deathly, irrational afraid of needles," or something equally eccentric, she said with typical theater chick melodrama. The doctor suggested she get the HPV vaccine. She immediately blurted out "I don't believe in vaccines." Her mother feebly expressed hope that if she were with one steady partner, maybe her future risk would be minimized. This normal, white bread, suburban mother, who took it in stride that her unmarried 18-year-old daughter was sexually active, was not wearing a wedding ring.

The fall of Western Civilization continues unabated. Gynecology clinic is the front line.