This Mortal Coil

TW for medical trauma

The Mirena coil that the surgeon has fitted during the operation doesn’t feel right from the outset. I tell her so, but she says that it will settle in time. It doesn’t. I email her on a fairly regular basis in the weeks and months that follow. “I am bleeding vaginally, with a lot of cramping and pelvic pain and grinding and sharp, burning pain where the ovaries were, particularly on the left side. A couple of weeks ago I bled heavily for about 4-5 days and was doubled over in pain at times.” A month later: “I’ve been bleeding very heavily again these last few days with intense pain, fever, nausea, vomiting and intense neck and face flushing.” I finally insist on being sent for a vaginal scan. It is four months after the big op.

One of the worst aspects of ongoing illness is the feeling of continually badgering to get what you need. It leans into so many stereotypes about women- that you are a nag, a shrew, a harpy. I am also blazingly aware that I am an educated, middle-class white woman. It’s impossible not to know that advocating for yourself almost inevitably pushes someone else further down the pile. The doctor doesn’t introduce himself when I enter. I am in a robe, knickers off, sweating with pain. I explain that I am bleeding and his nose wrinkles. ‘Well, at least you told me, I suppose,’ he mutters to himself. The familiar heat of humiliation floods my system. I didn’t think of what was happened next as a form of rape until a year later, when an empathic GP listens to my account of the examination and she says it sounds like I am describing serious sexual assault.

The purpose of the scan is to ascertain whether the coil has perforated the uterus. I already instinctively know that it has. He rolls a sheath onto the probe, squirts gel onto the long wand that looks like a dildo and jams it up inside me. I grunt in pain and swallow the sick that has risen into my throat. He is rough, impatient and fails to describe what he is doing to me. Silent tears roll down my face as he is inside me. I feel such a dark and primal shame and something in me wants it all to end, for me to end. It has been too much to bear. I know that I am being unceremoniously marched back to the other place and I don’t think I can face it again. As he pokes and jabs I look over at the chaperone. She is sat on the other side of the room in a curled up position, hunched shoulders, hands on her knees, eyes resolutely down. She may as well be wearing a T-shirt that says ‘See No Evil, Hear No Evil, Speak No Evil.” The probe is hastily pulled out and he tells me that there is no problem and that the consultation is over. I ask if it is the coil that could be causing the all the issues and the strangest thing happens. He tells me – categorically- that I have no coil fitted. I tell him that this is why this consultation is taking place- to find the coil. He says that he has no knowledge of this and that it was just a routine ultrasound. I explain that I absolutely know that I do have a coil and that’s what he was supposed to be looking for. He repeatedly tells me that there is no coil and that I am wrong. I lie there and wonder if I am going mad. But I know that I do have one- I felt the strings that morning- so I persist. Again, he says that there is definitively no coil and that I am wrong. I feel bone tired. The years of explaining, apologising, advocating- it’s enough now. But something in me is still fighting and I refuse to leave. Deep in me I know that it will only necessitate another gruelling visit and more penetration if I don’t get this sorted today. I insist that he does more tests to find the coil and he reluctantly sends me for an X ray and CT scans.

As I wait in the reception area I am still in a gown and I tell the receptionist that I feel distressed and shaken at what is happening. She asks me to sit in a side office and tells me that somebody will be with me soon. After a few minutes, the radiologist comes in, stands over me and said “I hear you have a problem with me.” Where should I shove the feelings of shock and outrage? If you know then please tell me- it would help. How to process the despair and rage felt about a man who thought that it was appropriate to directly confront a patient wearing nothing but a gown, a patient who he’d just subjected to a rough and painful vaginal examination, and who he’d wrongly diagnosed to boot. Who is this man? How has he learned this?

Matron arrives and she speaks to the doctor and then to me. When it is just the two of us she says that he had been unable to admit to me that he had been wrong and that instead of apologising he has doubled down into his position. They look at my CT scan and he finally accepts that there was a coil and I am told that it has perforated the uterus. He doesn’t apologise; instead he behaves like he knew there was a coil all along. If I had accepted his diagnosis that day then I would have left the hospital with a perforated uterus and no treatment plan. As it is, I email the surgeon to tell her about the perforation. This is her response.

I’ve spoken to Dr M. He thinks the coil has migrated downwards. It was difficult to see. Let’s catch up on Friday and reassess. Don’t worry.

I shake my head in disbelief. I have seen the CT scan myself and on it the coil is bent out of shape and the uterus is perforated. I write back:

Can we talk today please? The information I was given is that the uterus is perforated. It’s not so much about not worrying, as the intense pain that I’m in, the feverishness and bleeding. It’s been an incredibly difficult year and I don’t want to wait until Friday to discuss, so I’d so appreciate a call this morning please.

I am seen by the surgeon that night. The coil should be taken out surgically, so as to see the damage that it may have caused internally, especially as the uterus has been perforated for months now. It is also a procedure that should take place under general anaesthetic- a polyethylene spike is piercing through an organ after all. But I am on immunosuppressant drugs for Ankylosing Spondylitis and surgery can’t be performed for two weeks, after which the drugs would be out of my system. The surgeon decides that the coil must come out immediately. The decision is made so fast that I don’t have time to think what it’s going to be like. I am laid down on a bed. Dan, Matron and the surgeon are there. Matron is holding my hand. I have local anaesthetic gel rubbed up my vagina. The surgeon inserts her hand and starts to tug at the coil. I have given birth without any pain relief- that felt like I was being split in two. But this is so much worse, a pain like nothing I have ever felt. I am always too self-conscious to scream in medical settings but now a sound that I don’t recognise is emanating from me. A lamb to the slaughter. ‘Does it feel like someone is ripping your insides out?’ the surgeon asks me. ‘Yes!’ I sob, and I beg her to stop. Matron strokes my hair and tells me that it can’t stop until it is out. I have dreaded the other place, I have feared getting lost there and not being able to find my way back, but now I would give anything to slide into the fog. The pain keeps me alert and present though- the burning disembowelment howls for my full attention. I think my insides are actually being dragged out of me and I daren’t look down in case I see my large intestine writhing and thrumming sloppily on the bed. I am mad with pain. I no longer feel human. I think later of my history classes and learning of being hung, drawn and quartered. Am I a martyr? If so I wonder what my cause is. What sins am I atoning for? What violation have I committed that has wreaked a punishment as severe as this? Is merely being a woman enough to deserve such pain? The coil is finally rent from the pierced organ and it is over. The surgeon looks shaky and she holds my knees with a great deal of tenderness. ‘I’m so sorry’ she says. I don’t remember my reply but Dan told me much later that, wild-eyed, I brightly said, ‘Don’t worry, it’s because my father cursed me on his deathbed.’ After some time has passed, I ask her why she thought to question if it felt like someone was ripping my insides out. She answers, ‘because the same was done to me.’

A year later, when I am still bleeding vaginally, I am sent for another ultrasound at the same hospital. I think I’m okay but when the chaperone comes in and starts chatting about the weather, my voice starts to wobble. She is so kind and reassuring and it undoes me. I have requested a female doctor and when she comes in I start to howl, tears falling helplessly down my face. I am shaking. I explain to her what happened last year in this very room that now are in, and she listens intently and with sympathy. She is appalled by last year’s consultation and there is no question that she believes me. She says that it’s best to get the examination over with and then we can talk more. The chaperone sits next to me, holds my hand and chats to me soothingly. It is such a stark contrast to the crouched, detached woman last year. The doctor puts me in a completely different position. I tell her that, and explain how Dr M placed me last year she that she would never ask a woman to be in that position- that it causes the wand insertion to be unnecessarily painful. She says that she was placed like that once during a scan, very early in her career and swore that she would never do that to another woman. She asks me if I would like to insert the probe myself and I start crying in a way that shocks me. I am the stoic; a phlegmatic, stolid patient who can fold away her pain deep inside, wordlessly and without complaint. But that act of seeing me and the gift of agency releases something that I have kept so tightly held within me. Her witnessing starts to unravel the giant ball of shame that I carry with me everywhere. Throughout the scan she points to the screen and tells me what she’s looking at. This is in marked contrast to the last examination, where I was left in silence to fear the worst. She lets me cry and she doesn’t judge me for it. It marked a small turning point for me and I will always be grateful to her.