Thursday, March 28, 2013

Horse Training and PAP Smears

Horse Training and PAP Smears
By Kris Garrett

If you’re a guy, you might as well move on to someone else’s blog. You’re not going to “get” this.

If you’re a woman of a certain age, you’ll get it. Read on. And yes, I really did title this one, “PAP Smears.”

What the heck does horse training and a pelvic exam have in common? More that you might think. Perhaps I found a connection because my mind is still cooking what I’ve learned from Tom this week. Whatever the reason, his horse training concepts are coating everything in my life like cold winter ice on the branches of a pine tree.

There are few things more unpleasant than submitting oneself to a PAP smear. I personally have a phobia of the procedure. So much so that I’ve not had one since my son was born, and he’s a couple of months away from being able to legally buy whiskey.

I wasn’t sure where my phobia came from until today. I’m not feeling well, and I finally submitted my name to a doctor’s scheduling book. On the way to the doc’s office, an unwanted memory cracked through the wall of my resolve and left me shaking and nearly in tears. I wasn’t kidding when I begged John to turn the car around and take me home.

It was thirty years ago. I was young and brave and determined to save the world. It would be many years before for my rosy-colored glasses were to be cracked beyond recognition. I was going to make a difference. I wanted to be important. I was going to do something that mattered.

I was good at taking employment tests, and was offered jobs by three police departments at the same time. Aurora P.D. was first on my list, so I showed up at Aurora Presbyterian Hospital for my pre-hiring physical, very fit, excited, and ready to go. Thirty years ago women cops were as rare as buckskin Andalusians so it was not surprising that people stared. Back then, even other officers stared. The waiting room stank with testosterone from the fourteen male recruits as they gaped at the one female recruit walking to my place in line. I turned my attention inward and ignored them.

The Doc must have been former military. He marched in all serious and ramrod straight like a drill sergeant. He shouted out names and broke us into groups like we had just arrived for boot camp. One group was to get chest x-rays. One group was to get blood drawn. One group was to get a treadmill ECG test. Once done, we would then switch. He walked down the line of nervous young cop wanna-bes, handing out medical orders printed on yellow paper.

Then he came to me. “Hummm..” he hummed, brow pinched. “I guess you should have a breast exam and a PAP. You want me to do it, or do you want a female nurse?”

“Ah…uh a nurse, I suppose,” I stammered. I was not prepared for this. Treadmill, sure. Blood, sure. But spread-eagling to a total stranger had not been on my mental agenda for the day. But I was young, determined, and mentally tough, so I buried my angst and squinted my eyes to a single narrow slit. I could do this. I’d just suck it up and deal with it. I’d prove to them that I was as tough as any guy. I’d be a “man” about it.

I was pulled from the line and led to an exam room just off the waiting room. The foot stirrups poking out of the front of the table made it look like a medieval torture rack. My breath stuck in my throat. I pushed my anxiety a little deeper into my body.

”Take your clothes off and I’ll send in a nurse,” the Doc demanded as he stuffed my file in the plastic holder on the door. I found a too-small gown on a shelf and slipped it on over my nakedness. I could feel sweat running down my bare sides, even though I was shivering cold.

A woman walked in, introduced herself, and told me to lie back and put my feet in the stirrups. With a gulp of air, I promptly did as ordered. She quietly poked and prodded while I stared at the ceiling counting the little holes in the tiles. I was trying hard not to hold my breath. Suddenly, without a knock or warning, the exam room door popped open. I didn’t mean to squeal when I saw the Doctor standing in the doorway, my knees framing his surprised face. Behind him was one of the groups of young police recruits, several with virginal eyes popping out of their heads. “Oops. Sorry,” the Doc muttered as he quickly closed the door.

I went numb. I was so horrified, I refused to even think about what had just happened. I stuffed the humiliation deep inside my mind where I didn’t have to feel it. I clasped a chastity belt of steel over my reeling psyche. In a few minutes I’d have to stand in that line again, face those men eye to eye, and I could not afford to show that I’d been damaged. I had to stay anesthetized to my shame. I stopped caring if I held my breath or not.

I don’t recall the rest of the day. Not one minute of it. I know I passed all the tests, but when it came time to pick a job, I did not pick Aurora. I picked less money, less prestige, and a lousy retirement plan, but I picked a place where my face and my private parts were unknown.

Thirty years later, I still can’t bear the thought of being hung in a doctor’s exam table stirrups. Even going through childbirth and all the unavoidable exams and drama that entails did not acclimate me to that most vulnerable of positions. I’d rather be dragged through the desert cactus from a dangling saddle stirrup attached to an angry wild mustang. Cervical cancer is less frightening to me than a PAP test. For two decades I’ve simply refused to submit.

So what does this have to do with horse training?

With my dear hubby holding my hand, I made it to the Doc today. I was x-rayed and ECGed and poked and prodded. When the young, dewy skinned nurse asked how long it had been since my last PAP, I blushed. “Oh, about twenty years or so.”

“Well, we should make you an appointment for that,” she said through a smile as she checked off something on the chart. “Our nurse who does that will be here next Monday.”

“I thought that was part of today’s exam,” I stammered, feeling a sense of both panic and relief. I had been dreading that part of the exam for weeks, and now I just might be off the hook. But, that meant another wait, and another week of dread.

“Oh,” she replied. “I guess I can do it. I have time today,”

Panic returned. I steeled myself. “Okay, let’s get this over with.” I knew if I left without getting the test, it was not likely that I’d be seeing her pretty smiling face again. Ever. One doctor’s visit a decade was my limit.

What I didn’t’ realize until we began was that she was as nervous as I was. She was shy and hesitant with her verbal requests and her physical movements. She fumbled with the instruments. She asked me over and over if I was okay, as though she was not sure that she was okay. She moved excruciatingly slow, like a predator sneaking up on its prey.

When we finally got to the point where I was counting holes in the ceiling tiles, I realized that this must be how horses feel when the person who’s supposed to be in charge is nervous and unsure. I had accepted that the nurse was in charge, I gave her power over my body, she had me in a completely defenseless position, and SHE was the one who was afraid. It was sheer torture.

Her angst was amazingly contagious. I wanted to get up and leave. I wanted to kick her in the head with my naked foot and take back my personal space. I held my breath and counted holes, losing count over and over. Her hesitation and insecurity really scared me. Did she actually know what she was doing? What if she did something wrong? Did she have any clue what was going on down there? I found myself wishing that she was stronger, would move faster, and yearned for her to demonstrate some confident decisiveness. Only then could I trust her to take care of me.

As I lay back in that most vulnerable of positions, I gave up counting holes in the ceiling and closed my eyes tight. I floated away to another place and time, far from pokes and prods and cold metal instruments. I thought about my horse Feldspar and how nervous he got if I took him away from home. I remembered that I was always nervous too, away from the safety and familiarity of our private arena. Perhaps if I had been stronger, more decisive in my actions, more assertive in my commands, he’d have felt like I knew what I was doing, Perhaps if I’d had some self-confidence, it would have rubbed off on him.

I was a street cop for ten years. I was afraid, plenty. I won’t deny it. But I learned real quick not to show it. I got really good at stuffing how I felt. I had no idea how much damage that was doing behind the strong brick emotional wall of my mind, but that’s another story for another time. My job was to be the safe harbor in the storm, the rock, the one the public could count on to make it all okay. When I was in uniform I was the very symbol of safety, security, and protection. And people in trouble clung to me like a lifeboat in a hurricane.

It became more than just pretending to be brave. After a few years and some pretty intense successes, I WAS brave. My confidence grew with each triumph over evil. My self-assurance rose with each victory over the bad guys. Even being shot at (he missed) and then catching the guy myself as he tried to run, made me feel strong and absolutely invincible. For a while, I felt like I was WONDER WOMAN! I could do anything!

Could I find a way to be that again, only this time for my horse? Could I resurrect the cop-me to be present for my four-legged friend, or had age and too many disappointments and failures killed off that brave young woman?

Surely that part of me is still alive somewhere deep in my psyche. Surely I can mentally put on my make-believe gun and my pretend bullet-proof vest and take charge when my horse feels threatened, be it real or imagined.

In the mean time, my once every two decades PAP test is done. My heart indicates I’m going to remain on this side of the grass, at least for a while longer. Now I just need to work on making that grass a bit greener so I really WANT to stay on this side of the roots. I believe that will require the presence of horses.

-Kris

1 comment:

  1. What happened to you all those years ago was inexcusable. Do you think it was deliberate? So many women have been traumatized by pap testing, false positives, excess biopsies and over-treatment and sadly, most of this anxiety and damage was/is avoidable.

    Australia seriously over-screens women which provides no additional benefit, but greatly increases the risk of a false positive and potentially harmful over-treatment/excess biopsies. We have ignored the evidence; our program is now being reviewed, shamefully long overdue. I fear excess will be protected though, rather than women.
    I'm 55 and have never had a pap test and recently also, rejected mammograms, both informed decisions. It was the numbers that
    didn't work for me, as a low risk woman my risk of cervical cancer is near zero, while the lifetime risk of referral for colposcopy and usually a biopsy or treatment here is a whopping 77%, the risks were too high for me. The lifetime risk of cervical cancer is 0.65%...
    For this who wish to test however, there are far better ways to deal with this rare cancer. Since the 1960s the Finns have had a 6-7 pap test program, 5 yearly from 30 to 60 and they have the lowest rates of cervical cancer in the world and refer far fewer women for biopsies etc. We "treat" more than 10 times the number of women, thanks to serious over-screening.
    The Dutch have the same program as the Finns, but will shortly scrap population pap testing and offer instead 5 HPV primary tests at ages 30,35,40,50 and 60 and ONLY the roughly 5% who are HPV+ and at risk will be offered a 5 yearly pap test. (until they clear the virus) This program will save more lives and take most women out of pap testing and out of harms way. The Dutch are also, already using a HPV self-test option, the Delphi Screener. (also, available in Singapore and elsewhere, and it can be ordered online by Australian women)
    The fact that may interest you: women who test HPV- who are also, confidently monogamous or no longer sexually active might choose to stop all further testing.
    So very few women can benefit from pap testing, while testing exposes them to risk and higher risk with over-screening. We do everything to maximize risk, we test too early, too often and for too long.
    I hope this information helps you...Delphi Bioscience Singapore can provide information on the Delphi Screener. HPV Today, Edition 24, sets out the new Dutch program.
    Be careful with breast screening as well, the Nordic Cochrane Institute, an independent and highly regarded medical research group, have produced an excellent summary of all of the evidence. (you'll find it at their website) australian women are denied evidence based cervical screening, and informed consent, our legal right, is denied in both screening programs.
    Kind Regards
    Elizabeth

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