The 27th finally came. Lindy notifed me that Jesse had arrived for her 3:15 appointment. Additionally my 4:30 appointment for that day had cancelled. I confess I was somewhat relieved in case anything more came up during Jesse's examinations. Even though I found her so interesting and attractive, I was now far more determined to find the cause of her pain and distress. Even if we never developed the friendship, or perhaps more, that I thought about so often, my concern for her health and well being was now paramount to me. I had done these procedures hundreds of times before, but today I felt a small sense of nervousness. I knew there could be some discomfort for some patients during the biopsy and more than anything, I did not want to make her anymore miserable. I only wished now to use my training and skills to help her. Lindy came to my office and told me Jesse was now in the medical suite getting undressed and preparing for the ultrasound and biopsy procedures. I took a deep breath and headed down the hall. I knocked softly on the door and heard her acknowledge me. When I entered, I tried to be upbeat and positive, but she looked pale and drawn, and it startled me. Well, hi. How are you doing? She was sitting on the end of the exam table with the sheet around her waist. Not so good, she answered. Really? I tried to hide my own distress now. Are things worse? Tears were filling her eyes. Jesse, is it that bad? She told me how she had gotten so ill at Christmas, and how very depressed she was feeling. I was unable to keep a more professional distance now, and I put my arm around her shoulders and asked her to tell me more. As she spoke I began to realize there were other factors at play in this poor woman's unhappiness. Yes, her physical health was a very large part of it, but there was something else. Her name was Taylor and after nearly ten years together, Taylor had grown unsympathetic about Jesse's condition. She left shortly before Jesse first came to see me. I stepped even closer and she leaned towards me and placed her head against my chest. I'm so sorry, Jesse. No wonder you are feeling so bad. She wept quietly for a few moments and then sat up and apologized for her "breakdown". I shook my head and with a very small smile assured her that I understood (which until now I don't think I did), but I promised that I would help her get well, and then we would find someone especially trained she could talk to. And . . . She could always talk to me whenever she wanted. She relaxed and we both seemed to suddenly remember why were there, and why she was wrapped in a sheet at the end of the table. Our eyes met, and we smiled and laughed just a little. Are you up to this today?, I asked. I guess, she said. Okay, so let's get started and find out why you feel so crumby.

I explained what I was going to do first with the transvaginal ultrasound. She layed back and I helped put her legs in the leg rests. I went to the sink, washed my hands and dried them well, gloved up and returned to the ultrasound unit. I showed Jesse the transducer and prepared it with the gel and condom, reduced the lighting in the suite and began. I only partially lifted the sheet, trying to make her as comfortable as possible, parted her lips slightly and put in the probe. I placed my left hand on her abdomen now and then, locating her internal organs. I kept a running dialogue on each thing I saw and asked her if she was doing okay. She answered my question that she was and was pretty comfortable too. It took about 20 minutes and I was satisfied that we had a good exam that the radiologist and I could review together in a day or so. I slowly removed the probe, and looking at her face now, I was convinced she was still pretty relaxed.

I asked her if she would like a little break before the biopsy and she said no, she was still okay. We also talked briefly regarding when her last pap was and we decided we would wait and do that when she came back for her follow-up. I cautioned her a bit though that this next procedure might not be as easy. Explaining the steps to her I included that sometimes going through the cervix and taking the cells from the uterus might be somewhat painful, crampy. She assured me that she had taken ibuprofen as instructed before her appointment. I had the lights up higher in the suite now and had moved a tray of instruments along side of where I was going to be working. I had already checked with Jesse to make sure she had emptied her bladder before the ultrasound, but I offered her another opportunity now before we started. She assured me she was still alright. I was anxious to get this done so as not to extend her time in the leg rests any longer than needed. I moved to the sink once more, regloved as usual and sat down on the stool. I apologized that I needed to wipe away some of the gel from the transducer. Then I stood and did the pelvic exam to determine the placement, size and shape of her uterus. We looked eachother in the eyes and again I explained why I was doing yet another pelvic exam on her. There was a little smile and the familiar nod. I removed my fingers from inside her and sat back down pulling off my blue gloves and uncovering my tray. I first picked up a packet of antiseptic and used it on my hands, took the sterile gloves and put them on, and then picked up the speculum. This was the first time I had specced her and I hope it would not cause her anymore discomfort. After she was opened and I had a small but very intense light pointed at her cervix, I picked up the cotton ball with the tongs and poured betadine over it with which I cleansed her cervix. I used a cervical sound to sound her cervix and I heard her take a deep breath. Now I carefully aimed the pipelle at the os. Jesse, brace yourself now, I told her. Another deep breath, and I pushed the pipelle in, pulled back the plunger and began moving it around in her uterus. I was aware right away that she was experiencing the cramping; no more deep breaths. Just holding her breath now. As quickly as I could I finished using the pipelle and carefully removed it. I put the contents into a formula jar, closed it, and turned back to my patient. We're done, Jesse. I could hear shallow breathing now. Good. I removed the speculum, being very careful not to let it pinch her, put it on the tray and covered the whole thing, then switched off and lowered the light by her leg. Off with the gloves again. I pulled the sheet between her legs and went to the sink.

Her legs were still in the rests, and I pulled out the extension at the end of the table and layed them down into a straight, flat position covering her completely with the sheet. Still cramping? The nod. How bad? Not as bad as at Christmas. We went through the post-procedure stuff and as we did, I reached under the sheet and put my hand on her abdomen. She looked surprised but not unhappy at my touching her again. I gently rubbed her lower belly and told her to use a heating pad that evening, and, of course, not to be surprised by the spotting for the next couple of days. I wanted her to rest a little longer there before she got up. But mostly, I wanted to leave my hand on her stomach and gently massage her. As I started to remove it though, she reached out and took ahold of me. I'll be okay, she said. And I can't thank you enough for your kindness. I put my arm around her and helped her to a sitting position and made sure she wasn't dizzy or light headed. She stepped down still hanging onto the sheet, and when I was sure she was alright, I went to a cabinet and got out a pad. When I looked again she was just pulling on her underwear, but she was not embarrassed. In fact, she took the pad before she pulled them up and placed it in the crotch. I am her doctor anyway, and I had just been well inside of her. She finished dressing and we agreed that she would come back in two weeks for a follow-up. I opened the door of the suite for her and we smiled a good-bye for now. Boy, was I glad 75 year old Mrs. Blake couldn't make her breast and pelvic exam that day!