On Friday, I see my gynecologist to talk more about the surgery I’ll be having to repair the damage associated with pelvic organ prolapse. The point of this meeting is to talk about how my history of abuse affects what I need as I go through the surgery and aftermath. She waits for me to start. I fumble around. It’s Friday afternoon. I am tired and insufficiently prepared. This is a waste of her time, I begin to think, I should not even be here.

“Do you want to talk about the abuse?” She tries to say this in a friendly way, but it comes out stiffly. She presses her lips together and raises her eyebrows.

With you? Are you kidding me? Do you have any idea how hard it is to talk about with my therapist, who actually has skills and experience having such conversations? “No, I have a therapist. I just want to talk about how to feel emotionally okay about this whole thing.”

But then I don’t really know how to go on, what to ask for. The doctor seems to notice I’m stuck. “Do you want me to tell you exactly what will happen?”

I nod.

She talks about the check-in, the time in pre-op, who I’ll talk to ahead of time. She tells me what will happen when they bring me to the operating room, what meds the anesthesiologist will give me. I’ll be strapped down with various cushioning straps and blankets, so once I am unconscious, they can tip the table so my head will be down and my legs up higher. I don’t like the indignity of this part. I’ll be unconscious, I remind myself. I won’t really know this is happening. 

The anesthesiologist will give me a lot of oxygen and then intubate me. I really, really do not like this part. I think she can see this on my face.

She explains, “You need to be intubated so a machine can breathe for you. You won’t be able to breathe because part of the anesthesia will paralyze you. We need this so you won’t move at all during the surgery.”

“Do you want all the details of the surgery?” she asks me.

“Yes, tell me all of it.” Even if I don’t like all of what I’m hearing, I’d rather know.

So she does. A needle to pump a gas into my abdomen so there will be space between my organs. Five small incisions, the largest by my navel, where the camera will be inserted. Other instruments go in through other incisions. She describes the various steps–you probably don’t want the details, so I’ll spare you. She tells me which parts cause the most pain. I take notes, like I’m in a class.

After she finishes working the robotic arms through the five incisions, she will also do repair work in the vagina. Apparently that’s the worst part. Then she’ll stitch everything up, and the anesthesiologist will start reversing the medications to start to bring me back. Once I can respond to commands (“squeeze my hand”), they’ll see if I can start breathing on my own. Then the anesthesiologist will take the tube out of my throat. “Most women don’t remember that part,” she assures me.

Then we talk about what will happen once I am back in a regular hospital room. This includes a number of checks and a couple more invasive procedures. I tell her I don’t want anyone to touch me without telling me what’s going to happen and waiting for me to agree to it. She says she can tell them that, but I should also write a letter than can go in my file. I’ll do that, I tell her.

I ask her how many women are back at work full-time by the time of the two-week post operative appointment. “Well, some women are retired, so it’s not an issue for them. Of those that work, not many I guess. It’s better to take three or four weeks.”

“That’s not going to go over too well,” I reply. “Don’t forget I just had those three months off.”

“Are you likely to lose your job?’ she asks me.

“No, probably not.”

“Then take the time and take care of yourself,” she advises. I ask a few questions, and then have nothing more to say. So I thank her and leave.

Almost immediately upon leaving I realize that I haven’t done a good job. I haven’t at all communicated my feelings that she and her office need to educate themselves more on how frightening and even traumatic it can be for some of us to be on the receiving end of some of what they do on a regular basis. I became tongue tied in the office. I go home and crawl in bed, my refuge whenever it’s all a bit too much.

Luckily my husband is home again. He makes me dinner and we have a quiet evening and go to bed early. I tell him about the conversation with the doctor and all the details. He listens but doesn’t really understand my feelings about it. He is calm and even-tempered and has never been anxious about anything. I love that about him, but it makes it hard for him to understand something things.

By Saturday morning, there’s a lot of noisy chatter in my head and feelings without names rolling through me. Deep breath. E. has told me not to push them away, but to listen to them, so I try, and I can hear what some of them want to say.

Anxiety says: You are going to destroy your reputation at work. you’ve just been off for three months. And now you are supposed to take three to four weeks off after the surgery? How do you think that is going to go over? It isn’t. People are going to think you are not committed to you work. They’ll think you aren’t serious.

The little girl inside me says: I do not want those strangers to touch me. They will put their hands and stuff inside me, and I do not not want that. Don’t let them do that to me.

The wise woman who is able to see the big picture tells her: We need to get this problem fixed and I’ll do everything I can to take good care of us.

Suspicion frowns and says: I don’t like that doctor. She pretends to be nice and dedicated to women’s health, but it’s only words. If she really meant that, she and her nurse would know more. They wouldn’t be so awkward talking about a sexual abuse history. They wouldn’t make it so awkward for us. They wouldn’t have run that bladder study the way they did.

Something deep in me, something without a name, says: I hate myself, I am sick, I am horrible. I am bothering the doctor and nurse for no reason. I need to cope better. What happened to me is not even that bad. Why am I making a fuss at all. This is so unnecessary.

The little one says: I do not want anything stuck down my throat. Do not let them do that.

The political advocate in me asserts: All doctors should inform themselves about the potential needs and sensitivities of survivor sexual abuse, given than an estimated 20 to 25 percent of adult women have such histories. Why should it have to be so hard for us get our needs met? Why should it all have to come from us, to talk about something sensitive and try to articulate what it is we need? Surely many of us need the same things. Why aren’t there any protections already in place?

Anxiety says: But how can I take more time off? 

The little one is still upset: I don’t want anyone to touch me. Can’t we just leave it. it is gross. it is scary. Do not do not do not touch me.

My teenage self says what she often says: It doesn’t matter. What is the difference? I don’t care what anyone does. Plenty of others have had their hands and other parts in there. It’s just body parts. Whatever.

And the unhappy one hidden under them all says: I am disgusting, I am some kind of receptacle for other people’s shit. And I shouldn’t expect that to be any different.

The wise woman answer that saying: I know that isn’t right. But I also know there’s a distrust that wasn’t appeased by this meeting. We’ll keep working on making all the parts feel cared for and protected before the surgery.