Ask Me About My Uterus Page 21

  PAST MEDICAL HISTORY:

  • RIGHT-sided lipoma in lower back, not believed to be clinically significant

  • DX LAP 2010—endometriosis of the posterior cul-de-sac and LEFT paratubal ovarian cyst, aspirated and wrapped with Interceed. Torsion of LEFT fallopian tube

  • Significant unintended weight loss > 30 lbs

  • Hx of depression, anxiety, currently on Zoloft and in psychotherapy

  • Chronic nausea, early satiety

  • Chronic pelvic pain

  • Pelvic peritoneal endometriosis

  • Dyspareunia

  One of the first questions I started asking was why I had such a specific and constant pain at McBurney’s point—the palpable location of the appendix—if imaging had shown no appendicitis. Granted, medical imaging was not perfect: after all, back when I’d had that cyst—the one that twisted my fallopian tube all about—they hadn’t seen hide nor hair of it on an ultrasound or CT scan. Besides, how could someone possibly have appendicitis for two years?

  I figured I should start with what I already knew was in there, which was endometriosis. The next logical question was, could endometriosis slather itself all over your appendix and cause trouble? Although there wasn’t a lot to read about endometriosis in the academic literature I had access to, there were a few studies that seemed to back this theory up. Certainly locations that were near reproductive organs—which are many, probably more than most women realize—could be vulnerable to lesions. Or could I have lesions on my intestines?

  The appendix hypothesis was a rather nerve-wracking thought: If my appendix was covered in endometrial tissue, would I eventually develop a more acute case of appendicitis? Or would it just simmer on and on, slowly leaching infection into my body? In either case, I’d need to do something about it. Or rather, convince someone with a scalpel and a license to practice medicine to do something about it. And would removing my appendix even solve the problem? Maybe if it was removed, the tissue would just come back, filling up the space where it had been.

  Once I got a proper handle on the medical library, I had access to more databases and academic journals than I’ve ever had since—the benefit of health-care-system employment that surpasses even affiliation with an academic institution. I started looking for phrases like “chronic appendicitis” or “smoldering appendicitis” in my search for clinical evidence. What I found initially was that most medical professionals didn’t believe it was possible for an appendix to be chronically inflamed. An appendix could get cancer, sure—that’s what killed Audrey Hepburn—but the term “chronic appendicitis” was limited and hotly debated. The idea of subacute appendicitis, though, led me a little further down a path toward an answer.

  Appendicitis seems common because it’s a fairly regular pop-culture trope: if you need a sudden, nonfatal, but disruptive medical event to befall a character, appendicitis is a good option. It can start and be resolved over the course of a single twenty-minute episode.

  Recall that your appendix is that little worm-like organ that hangs off the end of your large intestine, the part called your cecum. When an appendix becomes inflamed, the pain tends to start around the belly button. Then it progresses down toward the right hip bone (though not always) and lingers about midway, at McBurney’s point. As you might expect, like many terms in medicine, this one is eponymous. Charles McBurney wrote about palpating this area as a diagnostic tool for appendicitis. However, medical historians don’t seem to agree on whether or not he was the first to identify it—or just the first to write about it.

  In any case, I thought about McBurney’s point a lot—because it was exactly where I had this very particular, unrelenting pain. I certainly had pain in other areas of my pelvis and my lower back, but it was more diffuse. In this one spot, however, even back in the emergency room in New York years before, I had insisted there was something. Sometimes it felt like a heavy, hot stone. Other times it was like a balloon that was near-bursting—particularly when I walked at a good clip or attempted to run. I assume that, had I not already been forced to give up dance, any twisting or torquing of my body would have been equally offensive.

  Even a light jostling—like going over a bump in the car—made it flare up momentarily. I’d often press my hand against the spot, a breath of air hissing through my teeth as I waited for it to calm again.

  Intercourse was becoming intolerable for the same reason. Not only did it cause a deep, radiating ache in my pelvis and lower back, but each thrust felt as though it was jabbing whatever thing was inside of me. The pains, while distinct from one another, were in a sort of dance—a searing duet. Sometimes they happened all at once, a cacophony of heat and pressure and dull aches that I couldn’t seem to parse out. Like there was a tangled ball of string pulsing in my core, and I couldn’t peel away each individual string. I couldn’t untie it. Then, other times, one would fade away into the background, like a hum. A shadow of something more demanding, more attention seeking. It would whisper in the shadows somewhere behind a bone while the other stepped forward, grabbing my ribs and yanking down. Grabbing my guts and twisting. And in those moments I could tell you where the pain was, I could point and press—but I couldn’t tell you what it was. I gleaned little helpful information from anatomical drawings and three-dimensional plastic models. What I wanted to do was slice open my belly and have a little look-see.

  And then, one day, an opportunity presented itself as I was wheeling my jingly little metal cart through the hospital corridors. You know, like a shopping cart with a rickety wheel? I had a little metal cart like that, and I’d push it through the hospital to collect records first thing in the morning. I would clank my way through the different departments picking up consents, lab requisitions. Sometimes they’d be unsettlingly stained; sometimes the shaky signatures would turn out to be the last thing a person ever wrote. I would hold the stacks in my arms a moment, pressing them to my chest, acknowledging that what was in those pages was privileged. That things wound up in a person’s medical record that would never be shared over Christmas dinner, or in the early morning, before teeth-brushed whispers to a spouse—secrets that maybe, like mine, landed with a dull thud in the middle of a therapist’s office, or between the pages of a well-hidden journal. Of course, people lie to their doctors, too, but they usually lie to themselves first.

  I was making my way down one of the narrow back hallways, headed back to my office with my cart of paper secrets, when I happened by the office of one of the lab managers, a jovial older woman named Martina. We’d often chitchat as I made my rounds, and she’d often asked about what my future plans were. I was, after all, considerably younger than the other women (and it was all women) in my office. I was one of the youngest employees at the hospital, period. Naturally my presence there was a little disconcerting, but Martina took an interest in where I saw myself beyond being a literal paper pusher.

  I’d mentioned a bit about my health and explained my research. I’m sure she took this as a sign that perhaps I’d go back to school, go to medical school even—and though our conversations were never long, and certainly never heavy with expectation, I did ask her if there were any opportunities that she knew of within the hospital that I wasn’t yet taking full advantage of. I’d gotten certified in everything from Basic Life Support to HAZMAT ops, I sat on several committees, and I’d taken health literacy training at the Dartmouth Institute. I was generally always ready to learn something.

  There was one thing I hadn’t done, however, and depending on how long I kept working at the hospital, it might never come to pass that the opportunity would arise: observing an autopsy. A real cadaver—the highlight of every first-year medical student—could potentially present itself, and should it, Martina said, she’d be more than happy to put me on the pathologist’s list as an observer. This announcement on her part came with the caveat that it very rarely happened that a body ended up in the morgue that needed an autopsy at our hospital. Usually they would be sent to
the state crime lab.

  I stood in the doorway to her office, my heart beating wildly in my ears, my leg shaking and making the cart jangle even louder, echoing down the empty, white hall.

  “I didn’t know we had a morgue,” I said, trying not to sound too excited.

  Martina gave me a knowing look. “Oh, well yeah,” she said. “It’s down at the end of the hall—next to the cafeteria.”

  I laughed, but she looked over her glasses at me. She actually wasn’t kidding.

  I took a short detour on the way back to my office, careening down the hall beyond the mailroom, beyond the supply closet, beyond the offshoot that opened up into the cafeteria. There, right at the end of the hallway, when I could walk no farther lest I walk straight out onto the loading dock (which I now wondered about: Had I seen them with sacks of potatoes or dead bodies?), was a practically unmarked door with a tiny sign that said “Morgue.”

  I tried not to get my hopes up. Martina had pointed out that it was a rather unusual thing for an autopsy to actually happen in the hospital. And besides, it wasn’t something that I would have wished for—someone having to die and all. I sighed, vowing to more closely inspect the salad bar should I eat lunch at work in the coming weeks, and headed back to my office.

  A FEW WEEKS LATER, MARTINA’S number showed up on my desk phone. When I answered, her excitement pulsed through the line before she even spoke.

  “I know I said this never happens, but they’re performing an autopsy this afternoon, at one o’clock. If you run up now, you’ll just make it. They have to gown you up and—”

  I practically shot up from my chair and looked down the row of desks to the other woman in my office who had also been on the pathologist’s list.

  As we jogged toward the morgue, and I realized that I didn’t really know her that well. Certainly not what motivations she had for being there in that moment. What kind of conversations had she had with Martina? How long had she been waiting for this bizarre series of events to coalesce? What secrets were hidden in her medical record, between the sheets of her bed, under her skin?

  The door to the morgue opened a little too easily for my sensibilities. I’d expected it to be much heavier, much more of a challenge. One minute I had been standing in the busy corridor of the hallway, among the living, and then suddenly the door closed behind me and I was in the land of the dead.

  It was an extremely small space—Martina hadn’t lied about that. Directly in front of where we stood were several large drawers to keep bodies chilled, but not that many. A heap of sterile blue gowns, masks, booties, and caps was just out of reach, as well as a large bin. A slender doorway led to a bathroom. Then, to the left, the door that led to the room where the autopsies took place.

  An eager woman—not the pathologist, but her assistant—came out to greet us. Her cheery disposition, her pure love for her job, was a little jarring, given the otherwise still, silent air of the space. Later, I’d be grateful for her fervor. She instructed us to “suit up,” showed us the bathroom, and said that we could come in “when we were ready,” as the pathologist had already started the autopsy.

  We hurried in, masks tightly strapped to our faces, our bodies covered from head to toe in scratchy blue, and were confronted immediately by the sights and smells that accompany these peculiar situations. Given how small the room was, although we stood with our backs pressed up against the wall (in case we fainted, so we’d slump down rather than fall face-first into an instrument tray), we were still perhaps a foot from the table on which the cadaver lay.

  I have since learned who the pathologist was who conducted the autopsy, but at the time, walking into that room, I knew nothing of that person. Just one of the mysterious, masked figures who spoke little but worked quickly, arms reaching, hands tugging, heads nodding as cuts were made. The pathologist could have been anything beneath those layers of blue drapery, of plastic gowns; could have been death itself for all I knew.

  Much to my chagrin, no sooner had I arrived than did I realize that I had to step out to use the nook-and-cranny bathroom. I was on my period, it was heavy, and I was cramping. The words “could take five or more hours” shocked me into a certain responsibility: I’d better change my pad sooner rather than later and hope that I wouldn’t pass out from blood loss later on.

  I’m sure they all thought I’d left to puke rather than address my monthly exsanguination, which I was determined would not ruin the experience for me. If I bled into my pencil skirt, so be it.

  When I returned, the pathologist was explaining what little they knew of the cadaver and why they were conducting an autopsy. In the event that his family ever happens across this book, I won’t share any information, other than to say it was a male. This disappointed me because I desperately wanted to see a uterus in the flesh. Eventually, I’d have the opportunity to observe surgeries that would satisfy my curiosity—no dead bodies required.

  I didn’t have a clue what I was walking into, but I understood on some primal level that it wouldn’t be anything like seeing a body at a wake or watching a CSI marathon. Being in the presence of death—not just death, but very fresh death—is an assault to all of your senses, even with full garb and a mask. Everything smells. The smell of blood is what you’d expect—that hot, metallic scent. The viscera itself is more earthy, almost muddy, like your backyard after a hard summer rain. Fecal matter smells the way you remember it, and of all the offensive scents, it is the least. The bile from the gallbladder, when the organ is lanced, is what made my stomach churn momentarily. Probably because bile is a fairly important component of vomit—a scent I’d become eerily familiar with thanks to my mother. If Mum had died when she half-died, when her heart gave up and greedy doctors brought her back, what would have rinsed from her digestive tract? No food, certainly. Watered-down guilt, perhaps.

  There are also a lot of chemical scents, and frankly, the formaldehyde (preserving fluid) was what had me feeling light-headed. The pathologist and the technician—who mostly stayed at the foot of the table, rinsing the contents of the intestines into the sink—were so accustomed to the scents and sights and sounds that at times, both of them hummed, as if they were trimming their hedges or making a pot of tea.

  Speaking of hedges: the one thing I remember the pathologist saying was in regard to the tool they used to open the ribcage. It looked like a pair of hardware store hedge clippers—and that was because it was.

  “The single best way to remove the ribcage,” the pathologist said between cracks of bone, the ribs splitting with a vulnerable crunch, “is with a set of hedge clippers from Home Depot.”

  The whole thing took several very long hours, but I was held in rapt attention the entire time. Suddenly those images from the textbooks that I’d been leaning over were flush and vibrant before me. I understood in a way I hadn’t before that the caverns of the body are not as deep as they feel, that whatever pain I felt was closer to me than it seemed. Just beneath the surface—a little skin, a little fat, a little muscle—were these saturated, throbbing, pulsing organs that kept me alive. We hold inside of us a small ocean that gives life to the organs that give us life. Mine, like yours, sloshed about inside of me, moving and twisting with me as I’d danced and run and jumped, carrying on in their work. The patchwork of nerves and veins that had once kept this man alive, now so easily sliced with a scalpel, were such tenuous threads of life. Inside of me, a heart still beating pumped blood around my body, nerve impulses shot from my brain to my spine to the tips of my fingers twitching inside their powdered latex gloves.

  The brain took the longest to be revealed—which seemed fitting to me, even then, because it is the organ that holds all the mysteries of what it means to be us.

  The pathologist cut around the hairline, delicately slicing through the scalp, and folded the skin of the forehead down over the face. I almost laughed at the absurdity of it: it was like a curtain being pulled down over the final act, obscuring the star player. The man’s features, the
odd expression of surprise he wore, the way his sightless eyes fixated on something that fascinated him on the ceiling, were no longer relevant. I did wonder, and I still do, what that man saw last. What he thought. What he heard. What he felt.

  An enormous, loudly whirring saw cut through my reverie as the pathologist worked to cut off the top of the skull. Sometimes a small hammer is used to help the lid of the skull “pop off”—it looks sort of like an ice chisel and works about the same way.

  Even once the bone was removed, there were still meninges to cut through, all the while being very mindful of the delicate tissue just below. Maybe mindful, too, of the memories that haven’t yet dried up.

  I was somewhat surprised, after all that set-up, that the brain was simply lifted up and handed off. Turns out the brain can only be examined minimally when it’s first removed; it has to soak in preservation fluid for two weeks before it will be ready to be sectioned and examined more deeply. It’s because of this that autopsy reports always include, “Results pending.” The brain takes the longest to examine, and many times that’s where the cause of death lies. So, the other organs are returned to the body (in a bag, kind of tossed in like you’d toss a load of laundry in your hatchback on your way home from college for the weekend) before it’s sewn up, so that the body is as complete as possible for burial. The brain gets sent off to the lab, taking all its mysteries with it.

  That night, I couldn’t sleep. Being confronted with my own mortality in such a vivid manner does that to a person, I suppose. As I lay awake, staring up at the ceiling, watching shadows dance across the room, and hoping no skeletons would run in my dreams that night, I realized I wasn’t afraid of dying. What I feared was living with this kind of inescapable depth, this shaking, screaming, writhing feeling. It’s that place between life and death that haunts you, as you watch someone rotting in real time, see in their eyes that last flicker of themness, the final mutter of life. When you watch the hull drape itself over wingback chairs and hospital beds, trying to decide whether to stay or go.