Friday, March 25, 2011

The Importance of a Good Gynecologist, or The Story of My First Ultrasound

I want to share the story of my first ultrasound and my experience with my old, terrible gynecologists--Dr. D and Dr. S's--office. I haven't really felt up for writing it out yet, but I feel ready now.

It's important to me that I share this story because I know so many young women my age who don't have strong, trustful relationships with their gynecologists. When you're young, healthy and don't have many problems, it's easy to go in for your annual pap smear or your latest birth control prescription and be on your way.

I found my old gynecologists through two search methods. First, their office showed up in a location search on insurance provider's website. Their practice was two blocks away from my work office. Second, I Googled one doctor (Dr. S) and found she had a handful of positive reviews on Yelp. The glowing five star reviews, in retrospect, describe the bare minimum of what a gynecologist should provide her patients: answered questions, made patient feel comfortable, handled the birth of a child.

Good enough for me, I figured at the time. I thought Dr. S, upon meeting her, seemed way more manic than the reviewers had suggested. I felt a bit rushed and like Dr. S might be taking some kind of upper in the breakroom, but she was nice enough, my vag was in good condition and all was well.

But all didn't stay well, as I explained at length in another entry. It took a plethora of vaginal infections to discover that Dr. S and her colleague who I preferred, Dr. D, did not have an approach to women's reproductive health that was holistic or systemic. They were fine for your annual pap, but that was it.

(In fact, around the time that I had these ongoing infections, a Yelp review went up that explained, more or less, "If you have real problems or issues with your reproductive health, then this is not the practice you want to go to.")

This winter I found a new gynecologist, Dr. T, who I saw one time and loved. I couldn't shut up to anyone who might listen about how great she is, how wonderful her approach is, how the entire office is more like a spa and less like a cold clinic.

Naturally, when I got those two pink lines on my at-home pregnancy test, I called Dr. T's office. Here is how my call with her office went:
Dr. T's Receptionist:  Hi, this is (Your New Gynecologist's Office at This Awesome Women's Health Institute). How can I help you?

Me:  Hi, I'm a patient of Dr. T's, and I just took a pregnancy test. And it's positive.

Dr. T's Receptionist:  Okay, when did you want to see Dr. T?

Me:  As soon as possible. This isn't a planned pregnancy, and I'm really concerned about how far along I might be.

Dr. T's Receptionist: Okay, let me look... Dr. T is out of the office until next Monday. She can see you that morning.

Me:  Oh. (It's Thursday afternoon at this point.) Uh, I guess that's going to have to work.
Dr. T's Receptionist:  I'm really sorry about that. I've got you marked down here, and she'll be able to go over everything with you.

I was very, very disappointed. When I broke the news to my boyfriend and we discussed our concerns that I might be far along (as I was), he urged me to call my shitty former gynecologists' office to try to squeeze in an appointment the next morning. We talked about how I had come not to trust these doctors but agreed that we wanted to know as soon as possible how far along we were and what our options would be. Time was of the essence, and since it was already after 6 PM on Thursday evening, I would have to call first thing in the morning and take care of it. After all, how bad could going to their office possibly be?


I rose early Friday morning. Before I called, I took the second at-home pregnancy test in the box. Positive. Shaking, I called Dr. D and Dr. S's office. Here is how the call to their office went:
Dr. D and S's Receptionist:  Hi, this is (That Really Terrible Gynecologists' Office You Used To Go To).

Me:  Hi, I'm a patient of both Dr. D and Dr. S's. I would like to schedule an appointment with them as soon as possible. I took a pregnancy test, and it's positive.

Dr. D and S's Receptionist:  Ooooh!!! Congratulations! You must be so excited!

Me:  (Silent, breathing.) Um, this isn't a planned pregnancy, and it isn't wanted. I need to find out how far along I am quickly. Dr. S prescribed me a three month birth control cycle, and I'm concerned that I am really far along now.

Dr. D and S's Receptionist:  Oh. (Silence.) Well, our first available appointment is next Wednesday.

MeNext Wednesday?? (I have never had to wait this long for an appointment with this office.) Nevermind. (I pause for a second, feeling extremely upset with this receptionist, who I've dealt with multiple times in the past and has always seemed pretty clueless.) You know, both Dr. D and Dr. S have told me that if I ever had any issue that was pressing, I could be fit in. This needs to be taken care of quickly. I need to know as soon as possible how far along I am, but if your office can't do that for me, then fine.

Dr. D and S's Receptionist:  Uhhh... Let me check with the doctors real fast. (I'm put on hold for a minute.) Ok, they can see you today at 11 AM.

Later that morning, sitting in the tiny waiting room at Dr. D and Dr. S's office, I felt a panicky fight or flight reaction. My trust in this place was gone.

The same receptionist called me to the front desk.

"We need you to pee in this cup to confirm the pregnancy," she said loudly, shoving a cup at me.

I stood stock-still for a moment, horrified that the quiet but full waiting room was aware of why I was there. Then, I realized that this receptionist had rolled away from the window on her chair without telling me where the restroom was! When I called her back and asked her, she gestured through the door that leads to the private clinic area. Why couldn't she have brought me through that door, away from the waiting room, handed me the cup in privacy and gestured to the restroom that would have been right next to me? Why did she announce my situation to this roomful of strangers?

When I returned to the waiting room, she did the exact same thing to another woman, also about my age and (seemingly) unmarried. She, too, looked horrified. I returned to staring out the window for forty minutes until I was called back around 11:45 AM.

A nurse walked back with me to an exam room I'd never been in before. She took my weight, height, and I explained to her why I was there: I've never been pregnant before, and my home test is positive. I am pretty sure I want to terminate the pregnancy, if termination is still an option.

The nurse seemed awkward and stumbled through her usual questions.

"Smoke? Drink? Drugs? Ever been pregnant bef--?" She halted mid-sentence and then looked at the floor. "Uh," she said, marking her chart.

"Nope, first time," I reminded her, almost laughing to keep from crying in front of her.

She asked me when my last pap smear was, and I explained that I was now seeing a new gynecologist who had recently done a pap smear with normal results.

She told me that Dr. D would be with me shortly. The pee-cup test was positive too, she added before leaving the room. I would need an ultrasound.

An ultrasound.

I hadn't even considered that part of the process until now. What do I know? I've never been pregnant before. Can they not tell how far along the pregnancy is from the urine? Of course I'd need an ultrasound. Why hadn't I thought of that? As I sat on the table in the cold exam room, I wished I had brought my boyfriend with me.

Up until this moment, ultrasounds lived as happy moments in my imagination. Enough movies and television shows had helped me develop a fantasty of what my first ultrasound might be like.

I would be at my wonderful OB/GYNE's office with my husband. We'd have been married for a few or several years at this point. We'd have been trying to get pregnant, and it wouldn't have taken us long to do so. We'd happily look at the image on the screen, huddled together and closer than ever before, admiring the little healthy life that we'd wanted to bring into the world.

Instead, I was now sitting in the ultrasound room, alone, freezing and staring at my blue wool socks that I'd kept on my feet. I avoided looking at the massive ultrasound machine that hovered close to me like an unwelcome and imposing visitor.

Dr. D breezed into the room and talked with me about the situation.

"This is unexpected?" she asked. "Unwanted?" She asked me how I was doing, and I cried just a little.

She explained to me that she'd do the ultrasound to estimate how far along I was.

She pointed out a phallic-looking ultrasound wand. "Most likely, we'll need to do an internal ultrasound because you'd have to be further along for the abdomen ultrasound. It will feel like a pelvic exam," she said. "But why don't you lay back, and I'll first try to see if I can use the abdomenal wand instead."

I knew she wouldn't need to do the internal ultrasound. I was suddenly very certain that I knew how far along I was, and it would show with the regular ultrasound. I was almost angry with Dr. D for suggesting reassuringly that the regular ultrasound would be unnecessary. Why say that? Why conjecture? Why plant any hope or expectation in your patient's mind?

"Would you like to see it?" she asked before she started the abdomenal ultrasound.

"No," I said very quickly. "I don't want to see it."

Dr. D squeezed jelly onto the wand and pressed it against my abdomen. She slid it against my skin, paused, slid again, paused. I stared up at the flourescent lights, my eyes burning, and then squeezed my eyes shut.

I felt faint, nauseous, and my heart was slamming around in my chest like it was trying to break free from this room, from this situation.

"Okay, there is a pregnancy that I can see," she said. "We won't need to do the internal."

I exhaled and sucked air back in, realizing that I hadn't been breathing.

"It's healthy," she added.

Dr. D explained she'd take a few snapshots to measure the fetus. I kept my eyes shut and waited until she was done.

"Okay," she said. "It looks like the pregnancy is about twelve weeks along." The room spun, even with my eyes closed.  "You can go ahead and sit up."

I sat up and opened my eyes. To my right, the hovering ultrasound glowed, its screen facing toward me still showing the image of the fetus inside of me. I only saw it for a moment, just long enough to register a little head and nose, arms and a body curled up and facing left.

It looked like a baby.

It looked exactly like the ultrasound that I had imagined for my future.

"Can you please turn that off?" I said weakly, my eyes shut again.

"What?" Dr. D asked. She had rolled away on her chair to toss gloves into a trash bin. "Oh!" she said, sounding startled.

I heard the machine clicking.

"You can open your eyes," she said. I glanced at the screen, now empty of any image. "I'm so sorry," she said, placing a hand on my knee.

I was angry with her, I wanted to scream and cry. I wanted to ask her how she could be so negligent, how her staff could be so unprofessional and insensitive, how it could be okay to run a practice like this. But instead, I said nothing. I looked up at her, and she repeated that she was sorry. I nodded, and she left me to change back into my clothes before we discussed my options.

I've thought a lot about this moment since then. I'm still shocked, though I no longer become viscerally upset when I think about it.

Every single person I have told--my boyfriend, my best friend, my therapist, my parents--has immediately said they each think that Dr. D left the image on the screen intentionally as a subtle "forgetful moment" to make an impression on me.

That's possible. The pro-baby feel of that office was pretty obvious the whole time I was there and was hammered home with that unwarranted 'Congratulations!' when I made my appointment.

But I think that all these people jump to the conclusion that it was intentional because it is so hard to imagine a female gynecologist, dealing with a patient who is so clearly shaken by her situation, making that mistake. Mistakes happen, but this mistake shouldn't have.

I will never know why I saw that image, if it was a human error or an intentional move. But I have to accept that it happened and move on.

Dr. D returned to the room and explained what options were open to me. She asked if I was sure termination was right for me, and then said I'd probably have a dilation and cutterage procedure. She would be wrong about that guess too.

She apologetically explained she could not do the procedure for me. "My hospital network does not allow me to do second trimester abortions, except in cases of danger to the mother's health," she said. Again, I don't know if it was her intention, but I suddenly felt a wave of guilt for my decision: For this procedure, I wouldn't get an OB/GYNE I'd seen for years because I was making a choice that is unsupported by her employer.

But I also felt like saying, 'Hey lady, it's okay. You have done enough already. Trust me.'

When I left Dr. D's office that day, the receptionist, seemingly in an effort to fully botch the entire experience at this appointment, forgot to give me some of the information I was promised on who to contact for abortion services. Again, what was probably a mistake felt somewhat like an intentional move to influence my decision by keeping me from full access to the information I needed.

As I left, the receptionist also told me that I might receive a survey in the mail from the hospital network they are associated with, and yeah, I am looking forward to receiving that survey.

If I don't get the survey in the mail, I plan to write a letter about my many experiences with that office to the hospital network and to Dr. D and Dr. S.: An unprofessional and seemingly incompetant staff who mixed up prescriptions and appointments for years; Contradictory statements from the doctors and shallow, non-systemic approaches to reproductive health; Intentionally or unintentionally showing an upset patient who wants to terminate her pregnancy her first trimester ultrasound; Neglecting to provide a patient with full pregnancy termination information material.

It's absymal, and I wish I could get on Yelp and share my experience there with every woman who might look at that site for guidance.

The great thing is that I never have to go back to that office again.

I kept that Monday appointment with my new gynecologist, Dr. T, and told her what happened with the ultrasound. She shook her head but, like the professional she is, kept her mouth shut and her opinion to herself. Her staff, from the receptionist who first scheduled my appointment to the nurse who took my vitals, reserved their felicitations or regrets on my pregnancy, like the professionals they are too.

I told Dr. T that former OB/GYNE Dr. D had told me I would have a D&C. Dr. T quickly said that she would not make any guesses about the procedure. "It could be a  D&C, but it could also be a D&E," she said. "I don't know, and only the physicians who will do your procedure at the hospital can tell you that. They'll make the choice that's best for you."

I should also add that Dr. T asked me if I would be interested in an IUD after the procedure and why I hadn't had one implanted before. I explained that, when I had asked her a year prior, former OB/GYNE Dr. S told me that a woman who had not been pregnant could not have an IUD. Dr. T responded that that used to be the case, but for the last five years or more, more and more doctors have moved toward IUD implantation for all women. I sighed and said that I wished I had gone to her a long time ago.

At that appointment with Dr. T, I felt safe and calm for the first time since finding out I was pregnant. I felt confident in my choice and in my doctor.

Shouldn't it always be that way for every woman?

That's why I am writing this post--to share my experience and urge any woman who might have stumbled upon my blog to be sure their doctor is one they trust. I had my doubts about that first office. I brushed them aside and stuck with them for months, years. In pushing down that doubt, I trusted these doctors to handle my health, my body and me with a respect and professionalism that they and their staff obviously lack.

I learned the hard way that my instincts were right. I deserved better, and thankfully, I now have it. I hope that anyone reading this entry has the best health care providers she deserves too.

2 comments:

  1. You are not the only one who has such bad experience there are many others but good to read that at-least you shared your experience and guided other!

    ReplyDelete
  2. Choosing the right prenatal provider and birth attendant is crucial to a woman's pregnancy and childbirth experience. Gynecologist Boca Raton

    ReplyDelete

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