Discuss and debate the issues that mean the most to you.
“Your blood pressure is a little higher than I’d like. It’s 120 over 90. If it isn’t lower by the time I next see you, I’ll have to take you off the pill.”
I am 20 years old, and sitting in the office of a woman I’ve been seeing as my primary care doctor for about three years. In my teens, when I finally aged out of the pediatrician’s office I’d been going to my whole life, my father’s then-girlfriend had recommended this doctor with the highest praise.
My pediatrician had had an obsessive fixation with my weight. It began when he instructed me to start my first diet when I was eight years old, showing me a colorful chart that explained what size I should be, and pointing out that I was near the top end of the average for my height and age. He wanted me to lose, I believe, one and a half pounds. Maybe as much as two. Every visit -- even if I went in because I had a cold, or I had sprained my arm tree-climbing -- began and ended with discussion of my weight, and I what I was doing about it.
My pediatrician was the first doctor I ever despised. So I was cool with it when I was told I couldn’t see him anymore. And given that I would soon need someone to give me my first pelvic exam, I was relieved to get such a strong reference from my father’s girlfriend, someone I knew and trusted.
It didn’t work out quite as planned.
My new doctor was never the kind, warm, supportive practitioner that was described to me. She was terse, and often cold; she did not have much patience for questions, and usually seemed in a hurry to finish our appointments. When I went in for that first pelvic exam, I was terrified, as this was before you could look up the details of the process on the Internet, and my dad’s girlfriend was as unforthcoming with her experiences (deeming such matters inappropriate topics of conversation) as my own mother was blasé (she would unflinchingly share every facet of the experience, but always with the hand-waving caveat, “It’s no big deal, you’ll be fine”). I had no objective narrative.
I was shivering on the table under a tiny paper robe, 18 years old, when my doctor came in, my chart in her hand. She frowned down into the folder full of papers and inquired, “If you’re not having sex, why are you getting a pap smear?”
“...Because I’m 18 and I thought I was supposed to?” I had read this, numerous places, that women were supposed to start getting pap smears at 18. I didn’t see anything that said it was only for women having penis-in-vagina sextimes.
She sighed lightly, like doing a pap smear was a waste of her time. I tried to chill out. But the tone for the visit was already set.
Back to the beginning of this story: it’s true that by 20, I was going in to these appointments already tense and braced for a bad experience. I was young, and though I no longer lived in South Florida, I was still on my father’s health insurance. It had genuinely never occurred to me that I could just find a different doctor whom I might see in Boston, instead of trying to fit in physicals on trips home. I suppose I thought changing doctors only happened in extreme circumstances.
When my doctor threatened my birth control, I panicked. My stomach sank and my heart began racing. If you’ve ever been a sexually-active 20-year-old with a pathological phobia of pregnancy, you can imagine my freakout. I mean, I was ALSO using condoms, but I didn’t altogether trust them, so the idea of losing the pill seemed like a terrifying risk.
I gulped and tried to keep it together. “Why?”
“The pill can elevate blood pressure in some people. You’re very young to have blood pressure near the borderline range. I’ll have to take you off the pill if you can’t get those numbers down.”
Notably, this was the end of our conversation. She never actually gave me any suggestions for lowering my blood pressure. Nor did she suggest alternative methods of birth control we could try. She instructed me to lower a number I didn’t understand, apparently through sheer force of will, or else she would take my birth control away entirely. I left the appointment believing those were the limits of my options.
After that experience, I did go back for one more appointment with her, but following that I peaced out of her office for good -- although I carried away with me a newfound fear of having my blood pressure checked.
I kept my distance from doctors as much as possible for a few years after that. I went to a Planned Parenthood clinic in Boston for annual physical exams, but only so they would give me birth control pills. I paid for it all out of pocket, strolling past the bulletproof glass and the two sets of doors you had to get buzzed through, blissfully ignorant that just a couple years before, abortion opponent John Salvi had shot and killed two people, and wounded five others, at two family planning clinics in the Boston area. I thought it was just, you know, a cheap place to get the pill.
My experiences were slightly better at Planned Parenthood, but I never saw the same person twice, and thus never had much of an opportunity to build a relationship with anyone.
Eventually, in grad school, I got my own health insurance, and established myself with a regular primary care doctor. She was nice enough, but not long out of medical school, and her bedside manner was a little wobbly. She was fond of saying, “So, what are we doing about our weight?” like clockwork at the end of every appointment (who is “we,” exactly -- could I be fat because YOU are eating too many donuts?). She liked handing me pamphlets about nutrition and calorie restriction, although she never once asked me what my daily diet was actually like. When I inquired about why I might be getting pain in my right shin when exercising, she was incapable of discussing possible causes or treatments beyond "lose weight" -- and when I noted that, were I to take her advice, exercise would probably be a necessary component of doing so, she stared at me blankly.
Some of her efforts were hilariously ham-fisted. Like the time she inquired as to whether I had ever considered gastric bypass surgery, literally at the same moment as she was scraping my cervix. (Even today, I wish I’d had the muscle control to have shot the speculum right into her face. HULKGINA SMASH. As it was, I only laughed maniacally.)
My health insurance changed again, and I chose a primary care doctor at random from a large book in my employer’s HR department, mostly because I had walked past the clinic where he worked many times, and it was conveniently located.
I had avoided male doctors ever since my pediatrician. I’d bought into the idea that male doctors are always terrible and patronizing to their lady patients. Given my prior experience, I didn’t take much convincing on this point. But there weren’t any women doctors accepting new patients at this particular clinic, and I thought, well, I’ll just go with this random guy for now, and change it later.
Dr. R was soft-spoken, warm, and had a kindness about him that put me right at ease. On my first visit, I explained that I would prefer not to be weighed as a matter of course every time I came in, unless it was necessary for some specific purpose -- like to get the correct dose for a medication. I was willing to be weighed when needed, but my lengthy history of dieting and disordered eating meant the experience of getting on the scale caused such psychological upheaval that I would rather only do so when I really HAD to. I was literally trembling when I asked if he would be okay with this.
Dr. R, ever calm and measured, cocked his head to one side and asked, “How familiar are you with your body? Do you feel like you notice when things change?”
Familiar with my body? What does that even mean? At the time, I was sewing many of my own clothes, so that seemed pertinent. I explained that I knew my measurements intimately, and would notice if they changed, because it would affect my sewing. “If you wanted to MEASURE me every time I came in, I would be FINE with that!” I was selling this idea hard.
He laughed and told me that weighing individuals on every visit was mostly about tracking unexplained changes in weight, because that could indicate a problem that might otherwise go unnoticed. However, he said, “I think I can trust you to report any changes in your size.”
The shock and relief I felt took me days to process, and it wasn't just about not having to be weighed all the time. The notion of being trusted with my body was utterly foreign to me. I was in my mid-20s, and still partly convinced that I had no right to govern my own body, that I could not understand my own health, that only doctors could unravel those mysteries and I had simply to accept whatever they told me about myself. This is a common experience for many women, especially women who are fat, but I hadn't realized it had affected me so deeply until that moment.
I had never before met a doctor before who thought that my impressions of my health and wellness were as valuable as his own. This wasn’t a one-off thing, either. Over the decade that I saw him, Dr. R and I would routinely have discussions in which he would offer his own expertise, but then ask me how I felt and what I thought, and always in a manner that was sincere and interested. It wasn’t that he just went along with whatever I said, but he made me feel like I had the right to give input as the occupant of the body in question, rather than being dictated to, a passive and obedient patient.
In short, it felt like he and I were collaborating in my health, that I was an active participant in my own care. This was such a precious and magical gift, after all those years of thinking of my body as an aberrant monstrosity I was fighting, rather than an inexorable and valuable part of me.
I couldn’t have articulated any of this before I started seeing Dr. R. I didn’t know why I hated going to the doctor, why I sat in every waiting room feeling sick and powerless and grotesque. When white coat syndrome -- a relic of my earlier experiences that I’ve not yet overcome -- caused my blood pressure to surge when I first entered the exam room, Dr. R would recheck it at the end of my visit when I was calmer, to get a more accurate reading. He explained that using a too-small blood pressure cuff for your arm measurement can give a false high reading. He never made assumptions, but rather asked questions, posed hypotheses, ran tests, and worked to get the most accurate results possible. He preferred to operate within reality, and not vague generalizations. He believed me. He trusted me.
To put it simply, Dr. R treated me like a person worthy of dignity and respect, every time I saw him.
And that is what I said to his former PA last week, when she told me he had died a couple months ago.
I knew he had been sick. Dr. R had gone on medical leave a few years back, and then returned to work for a time, and then gone on leave again. Cancer.
His PA explained she didn’t have it in her to call every one of his patients to let them know, which I totally understood. I realized I was crying. Embarrassed, through sobs I told her that he was the first doctor I ever knew who made me feel like I had the right to be involved in my own health. I told her it really changed me, made me relate to healthcare in general and my body in particular not as things I tended to out of a begrudging sense of miserable duty, but because I was worth taking care of.
I wish I had told him that. He probably never planned it, or intended it -- he clearly wasn’t trying to be an activist in the exam room, or to give me revelations, or build me up or anything like that. He was just doing his job. It was just how he worked. And just being himself was enough to help people.
Compassion is not a prerequisite for practicing medicine. Obviously. Medicine has its share of practitioners who relate to their patients as bodies on an assembly line. And I can even understand this, given the state of healthcare in the US, and the fact that virtually no one is getting the support they need, on either side of the desk. Primary care doctors and nurses often work impossibly hard to help more people than they can feasibly handle, and patients often suffer as a result. Doctors and other medical practitioners are not bad people, but they don’t always have the resources to be the kind of professionals they would like to be, and years of working in difficult circumstances will make anyone a little jaded.
Early on in confronting my doctor fears, one of the first revelations I experienced was when someone suggested that your doctor is technically your employee -- if you don’t like the job she’s doing, you can fire her and find someone else. This idea helped me to learn to advocate for myself, but it also set me up to think of that relationship as adversarial; I was always waiting to be challenged, and in the panic of the slightest misstep, I would often have to decide whether to fight back (and come across as noncompliant) or lay down and let it go (and hate myself later).
And then I met a doctor who was truly, authentically compassionate and committed to asking questions, and testing and validating the facts, rather than moving forward with sweeping assumptions. And I realized that I didn’t have to hate doctors, or going to the doctor's office, and I didn’t have to hate dealing with health stuff. I didn’t have to see it as a fight. I didn’t have to expect to feel dismissed or attacked. I didn’t have to feel guilty or broken or wrong or bad.
I could just, you know, try to be healthy.