Leveled-Up


1 September 2021


Leveled-Up


It felt like a stare down. Dr. Dominic's eyes were steel as he asked, “Who is this doctor, again?”


“Camila ______ – she’s a psychologist,” I said.


His expression remained dubious: “Well, I’m going to prescribe you something else instead.” His tone told me he did not trust women practitioners, a common theme in androcentric Spain. My eyes narrowed.


“It’s the Cadillac of antidepressants,” he said as he opened his drawer and pulled out two papers.


Ever reluctant to be labeled “clinically depressed,” which to my core I felt was a misdiagnosis, I balked and said, “But it’s situational anxiety, not depression. I think that’s why Camila recommended the sertraline.”


He waved his hand at me: “Depression and anxiety involve the same chemical imbalance in the brain. Pristiq is a newer option and most patients who take it think it works very well for anxiety.”


Was he deliberately prescribing an alternative just to undermine my psychologist because she’s a woman? For some reason, it seemed not only possible, but likely. Dominic was a nice guy, but his ethical code was sometimes a bit fuzzy when juxtaposed with American medical standards. In retrospect, such flexibility was commonplace in Spain – everywhere. Yet, it seems that precisely because of his elastic ethics that our American families appreciated him. He made our lives easier – not only by speaking English, but also by greasing our access to medical services.


That is not to say that Dominic was himself greasy or untrustworthy – or even unlikeable. In fact, he was perpetually meticulously dressed and coiffed – as most Spaniards are (even though he was not Spanish-born, himself). He had a fantastic bedside manner, was socially amenable, and generally provided pleasant company.


Yet Dominic never once took my blood pressure, temperature, or weight during an exam – not even when prescribing medications. Instead, he casually asked my weight as he scribbled out the prescription and then passed across his desk a quick health questionnaire for me to complete. At least there was that!


The questionnaire was standard: Surgeries? Illnesses? History? Family histories?


Such questionnaires are quick for me. I’ve had no major illnesses and my only family pattern of medical issues is breast cancer. Easy peasy. I handed the questionnaire back across the desk with my messy signature at the bottom.


He reviewed the questionnaire for a moment, then said, “Mm. Ok. Tell me about the breast cancer – who has had it?”


I rattled off the rather long list of matriarchs in my family who have had breast cancer.


Dominic looked at me for a moment, then said, “Ok. Well there’s nothing here to prevent you taking Pristiq; however, there’s a lot of breast cancer in your family. You’re 38. Have you had a mammogram yet?”


“No,” I said, “Military medical providers don’t do mammograms before 40.”


That stunned Dominic silent for a moment. Then he smiled and shook his head as he said, “Well, the good news is that you live here in Madrid, and not only is this not a military medical provider, but it is public health. I’m referring you to gynecology for a regular pap smear (those are good for five years, now), and ultrasound imaging for your breasts, ovaries, and uterus. And, if we can swing the referral through your insurance, let’s get your genetic testing for breast cancer done here before you move back to the US.”


It was my turn to be stunned.


He shuffled a handful of papers, then slid them across the desk to me. “Here you’ve got the referral slips and the prescription for Pristiq for three months. Stop with my secretary on your way out to schedule a follow-up a month from today to discuss how the prescription is working for you.”


My fingers fumbled up the small stack of papers and my legs carried me out to the waiting room as I stammered my stupefied thanks. No wonder everyone loves him – but this was a lot. Two specialty appointments and a trip to the pharmacy…was a lot when it all needed to happen in Spanish.


In the waiting area, I chatted briefly with Dominic’s secretary (another new one, he never kept them long) about scheduling my referrals. We’d chosen the University Hospital precisely because they have a robust international department with a few dedicated English translators. The secretary rung up the international department, who sent a representative to escort me to schedule my appointments.


The international department representatives were always tidily dressed in dark blue – and this one was no exception to that rule. She wore low black heels with her pinstripe navy suit, a white shirt evenly tucked, and a whimsical (but don’t let that fool you – it was required) silk scarf tied around her neck. Above her kind, deep brown eyes and heavy chestnut brows, a navy hijab sat high over what must have been a pile of thick hair.


She was sweet, smiling, and I wondered – what do they pay her? Spanish culture is a no-tip culture, so she didn’t work for tips. Why is she being nice to me? It just felt incongruous. I was nobody – nobodier than nobody, really. Yet with perfect patience considering our linguistic limitations, she worked to schedule all my appointments with me.


“When you go for the gynecology, will you need a translator?” she asked.


“Oh yes, please. I don’t know what I’d do…” I stammered, thinking of how awful it might be to misunderstand any doctor directing ultrasound imaging. Yikes. Yes, I’d need help.


“Ok then, no problem. Let me just put this in here, too,” she said, clacking at her computer. “Yes, no problem, then. So I will meet you at the office – “


You will meet me?”


“Yes, I am scheduled to be your translator on that day. I can meet you there – or do you want to meet here and we drive there together?”


“Oh – well, where is the appointment?”


She peered at her computer screen, “The gynecologist is at our other location, across town.”


“Oh, no need to go together, as long as I have the address, I can meet you over there,” I said, hating the thought of inconveniencing this caring soul.


“Yes, it is easy to find, and the address is here,” she tapped the paper, “so I can meet you in the waiting room before the appointment.”


“That sounds good,” I said.


After a few more minutes of small talk and some more clicking on her part, we’d also scheduled the genetic testing appointment – to take place within the hospital another day.


I walked out of the international department offices afterward, headed to the stairwell down to parking, and stopped in my tracks by the wall: my breath was too shallow, my face felt hot, and my heart galloped like a stallion avoiding capture. Before descending the steps, I needed to process and to breathe. This was a lot, but it was going to be OK. It would be OK.



Sundry days later, the morning of my gynecology appointment had arrived, carrying all sorts of trepidation in a conspicuous satchel along with it. Though Camila was chagrinned at having her expertise undermined, she approved for me to begin taking the medication Dominic had prescribed. I’d started taking Pristiq with near immediate relief of my anxiety symptoms, but no dose of anti-anxiety meds can stave off the terror of an approaching gynecology appointment – go on, I defy you to disagree. You know it’s true.


One way to generally assuage my butterflies approaching any given situation is to arrive early. So as my car pulled past the address on my nav, I noted I had a full twenty minutes to find parking – that was smart. Then, compounding my relief, I discovered free public street parking within two blocks of the clinic – so I walked with a bounce in my gait, feeling rather good about myself, rather confident. My translator would be there when I arrived, and everything was going to be lovely despite my jitters.


All those good feelings abruptly dissipated, however, when my translator was not in the waiting room as I entered. Fuck. Hesitantly, I approached the registration counter. The office assistant did not acknowledge me, and my heart drummed in my chest: what if I’m not supposed to check in like this? My eyes darted about the room. Is there somewhere else I’m supposed to check in? No; there was no other reception desk – just a small room lined with cheap chairs, a few other patients, and two monitors mounted just above head-level displaying rows of numbers. One additional screen above the check-in desk displayed highlight reels from a football game between two Spanish cities I’d never heard of. Behind me marched a long hallway pocked with doors – eventually twisting off to the right and out of my line of sight.


“Sí…? Puedo ayudarte?” Her words were clipped, but after a year of working my way through the language, I knew that was just a tendency of most Madrileños; such terseness rarely, if ever, had anything to do with me.


I spun back around to face the receptionist, smiled plasticly, opened my mouth to speak, forgot my words, and then slid my appointment paper her direction across the counter. Then, it came to me: “Creo que tengo una cita…?” God, I’m an idiot – I flinched at myself and hoped she understood and/or could help.


“Ah Megan Vlaun…” she said, pronouncing the name very Spanish-ly. My eyes lit up. At least she recognized the name. She rattled off some very fast words at me, handed me a slip with a number on it, then gestured toward the waiting room. I snaked my appointment paper back off the counter and crept gingerly over to a seat as if the sound of my footfalls might wake a slumbering giant. Where is my damn translator?


I waited. Fifteen minutes slinked off the clocks displayed alongside the numbers on the monitors: it was now exactly the time of my scheduled appointment, and my translator still hadn’t arrived. My armpits were growing damp despite the cool industrial sterility of the room. My leg jittered, and I couldn’t make it stop. Why bother trying? At least my number isn’t up there, yet.


Five more minutes fell away, and the pressure shifted in the room as the door to the street opened: it was my translator, finally. I huffed my relief straight from my pit of stomach and raised my hand to wave sheepishly at her. She nodded and directed her steps toward me.


“I am so sorry I am later than I thought,” she said, “I had another patient.”


“Oh really, don’t worry, it’s ok,” I lied, completely not ok, but better, now.


“Let me take your number and I will check with the clerk,” she said.


I handed her my numbered slip; she took it and walked to the counter, had a brief conversation with the receptionist, and then sat back down next to me, as tidy and composed as she was at the Hospital previously.


“Ok, so we wait for your number to appear,” she said, gesturing at a monitor.


I guess some universal procedures transcend language. “Ok,” I said anyway, still grateful for her presence.


Another fifteen minutes slipped by. I wish I’d realized how late they’d be – could’ve saved myself some stress, I thought.


Then – a bell sounded on the monitors, and my number finally appeared.


“Ok this is you!” said my translator, her eyes bright below the hijab. “This way.” She stood and walked along the tight hallway, and I followed her like a terrified kitten, so glad for her compassion and company.


She stopped abruptly at the end of the hall before it turned off to the right, and I almost rammed into her: “Here is the office!” she waved to the door ajar directly at the end of the hallway, in front of us and asked, “Did you still need me?”


I stammered, “I mean – um – yes?” I was bewildered – why have her there at all if she wasn’t going to actually translate for me? Of course, I still needed her!


“Ok, then I will come in with you…?” She looked me dead in the eye, nodded her head gently, as if to ask, are you sure?


My eyes flew wide – I had no idea! What did she mean? Didn’t she normally help like this? “I mean – if that’s ok with you, then yes, I’d like you to come in and translate for me.”


“Ok, then I will come with you,” she said, bowing her head, and turned to open the door and pass through. I followed her into the brightly lit room.


Oh but how naïve and silly am I? Even when I entered the room, I still did not understand, because it was behind me…


We walked in and were greeted by an older – 50-something – man whose slick black hair was shot through at the temples with silver. He wore glasses to read the papers on the desk before him but removed them when speaking to me. He sat at a rather disorganized desk facing the door we had just entered. Behind him, on a wheeled practitioner’s rotating stool, sat a poised young man: he was tall, lean, blonde (Spaniards aren’t blonde!), and frankly fucking hot. Against the wall at the back of the room, just beside the window, a young woman (who I barely recollect for reasons you will soon understand) sat at a computer: a transcriptionist. The doctor gestured to the chairs opposite his for my translator and myself to sit.


“It’s nice to meet you…Megan? I am Dr. _____,” he reached out his hand to shake mine.


“Wait – you speak English?” my hand shook his on autopilot as I processed this information.


“Ah, yes. I am from Brazil, originally, but studied sometime in the United States,” his English was heavily accented, but accurate enough and quite comprehensible. My relief was instantaneous. Based on what I know of Brazilians, he may not find what he was used to down there, but at least he spoke English and had some experience in the US.


“Oh, I am so glad!” I said, my whole body felt lighter in my seat.


“Yes, so I see you have a translator,” he nodded at her and she nodded back, politely, “are you not learning Spanish?”


I flushed. “Estoy intentando,” I said. “…pero mi español es un poco infantil, and this is a doctor’s appointment, you see…”


“Claro…” he said, his lip curling up a little to the right, “Hablas como tienes cinco años.” I grinned unselfconsciously; why be offended when it was the truth? He looked back to the papers before him. “Well in my file it says you need ultrasound for breasts, ovaries, and uterus. It calls also for a pap test.”


“Yes,” I said.


“Well,” he breathed, “we are a learning hospital, for the university, you know. This is Dr. ______ in residency; he will observe, today.”


“What?” I guffawed. Dr. Hot-as-fuck was gonna observe my – situation? All of that levity evaporated; my stomach dropped hard. Nope nope nope. “Ok, I guess?”


“Alright. You can undress and go on the table,” Dr. Brazil lifted his eyes and pointed behind me. Reality slowed to a crawl as I turned in my chair; sure enough, there it was, reaching out from the wall behind me into the middle of the office: long, tall, white, pleather, metal stirrups and all – the examination table.


What…the…fu…


I stumbled up out of my seat as the look on his face implied that I should.


This is an OFFICE. Where is the separate examination room? Where is the changing closet? Where is the stupid gown, “open at the front!” Why isn’t that window covered? WHAT ABOUT ALL THESE PEOPLE!? Is everyone gonna stare at my – junk?


All of the puzzle pieces began sliding into place in my head. No wonder my translator was so hesitant. She did not want to be here any more than I wanted her here. She knew but she didn’t realize I didn’t know – ooh my god. I looked at her with stricken eyes, and she looked back with compassion and gentleness akin to someone handling a baby bunny – she hates it, too!


“Do you want to – ?” I asked.


“I can wait outside if you prefer?” The relief on her face said it all.


“Yes – that is fine. He speaks English, after all. I will be OK.” That poor woman! I wanted to hide, I was so embarrassed, but instead of hiding – it was time to become my absolute most vulnerable – in front of three people I did not know, one of which is quite intimidatingly handsome – no, you can’t think like that anymore, Meg. It’s clinical. If you’re going to survive this, you have to set that mindset aside. It’s just two doctors and a transcriptionist.


I will not provide any more details than I must, here. Suffice it to say, I arrived fully clothed and so the examination required removal of all clothing excepting only my socks. Later, a Madrileña friend told me, “I wear a loose dress those days,” for both ease of access and a touch of modesty (wish I’d known that tidbit beforehand). The lubricant was not warmed either, I should note. Yet another little luxury we take for granted in the US.


Within minutes, Dr. Brazil was using some kind of ultrasound wand-thing on the inside (transvaginal ultrasound, it turns out), and pressed down with his palm from outside my abdomen on the right. Suddenly, what was very clearly an ovary appeared on the ultrasound imaging screen beside the exam table. Whoa.


“Holy shit, that’s cool!” I blurted out, unthinking.


Dr. Brazil’s eyes widened and shifted from the monitor to my face.


“Yes,” he said, “Here,” he pointed to the monitor, “this is your right ovary. We are looking for any abnormalities or lumps – your physician wants me to check for precancerous cells.”


He moved the wand and his palm slightly to check from different angles, then said, “This ovary looks beautiful, actually. I see nothing.” He prattled off a bunch of technical medical Spanish over his shoulder, and the transcriptionist clicked quietly at her computer by the open window.


Everything – everything – uncomfortable around me disappeared into nonexistence. All that I knew from that moment forward was the images that appeared on the screen and Dr. Brazil’s English words: “I see nothing. Your organs are perfect.”


On that screen I saw both of my ovaries, my fallopian tubes, and my uterus. Afterward, with a different device, externally, I saw both of my breasts with all their associated subdermal marvels: ducts, nodes, lobules, all of it. And I heard, “I see nothing. Your breasts are perfect.”


By the time he reached for the speculum, the tension in my body had completely unwound. My organs are perfect. Dr. Brazil sure knows how to talk to a woman, I thought with sincerity. Even a speculum couldn’t steal my joy at that point – or so I imagined.


After the ubiquitous “scoot down further” scenario, Dr. Brazil swabbed – and came up with blood.


“There is a little blood still here – when was your menstruation?” he asked.


“Oh. It ended two days ago. I didn’t expect…” Ooh no.


“Well we will try with this sample, but it may have too much blood.”


Oh god, please let it work, I begged.


“You can get dressed and wait out front. It will take some minutes,” he said as he carefully slid the long swab into a tube and capped it, handing it casually to Dr. Hot-as-fuck, who took it and left the room. He pulled his gloves off, tossed them into a lidded stainless canister with a foot pedal, then walked around his desk and sat composedly in his chair to complete my documents.


My eyes darted back and forth around the room as I perched, skittish, at the end of the exam table.


Dr. Brazil’s eyes looked up to me without moving his head – peering at me over his reading glasses: “You can go now,” he prodded.


“Oh!” I said and jumped clumsily to the floor in my socked feet. My hands were all thumbs and my feet were all left as I self-consciously scrambled back into my clothes. It dawned on me slowly that letting someone watch me dress…might be one of the most intimate things I’ve done in my life. I kept glancing toward Dr. Brazil and the transcriptionist; they were both preoccupied with their endeavors – much to my relief.


Once dressed, I scuttled out of the office, nearly crashing headlong into my translator, who had waited the entire time just outside the door in the narrow hall. Oh lord, this poor woman, I thought. Seriously, Spain needs to consider being a tipping culture: she deserves gold. We wandered off to the waiting room together, then waited…and waited…


After what felt like an epoch, the clipped receptionist garbled out my name again, and my translator and I approached her counter. She rattled off a long, fast thread of Spanish, of which I captured and comprehended perhaps 30% - not enough to process any real meaning.


My translator turned to me: “She says you have to come back in a week.”


I stared back at her blankly. All I could think was, claro que sí. At least she and I had finally reached mutual understanding regarding this situation.


“Do you want for me to come with you again?” she asked, her eyes full of meaning.


“No; no, thank you. I will be fine.”


The following week, I wore a loose dress to my appointment and carried with me my perfect organs a whole new level of experience.


I had leveled-up.

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