To anyone watching from a distance, they were both very much in love. Hands entwined, bodies linked at hip and shoulder, they clung to each other like moss to a tree. Her eyes sought his for sustenance, energy, approval; their movement along the corridor and into the office was sinuous and choreographed. Synchronized swimming came to mind.
After I shook their hands and introduced myself, they moved the two available chairs together and sat, linked by wood and sleeve across from me.
I glanced at the consultation request from her family doctor and smiled to welcome them. Pain was what the doctor had scribbled in barely legible letters across the page -no other explanation, no other information- as if the word itself was justification enough for a consultation. I looked up from the almost-empty page and saw them staring at me.
“What does it say?” He sounded suspicious, concerned; his curiosity was evidently dominant. Contingent.
“Well,” I started tentatively, “It doesn’t say much at all -just ‘Pain’.” He seemed relieved and glanced at his partner with a now-soft face. “Perhaps you can tell me more about it,” I said, pointing my eyes directly at her.
“She’s got pain all the time, doctor,” he responded, clearly used to being asked the question first. “It started out with her periods, but now she seems to have pain no matter when I ask her.” He looked at her as a teacher would his pupil. “Isn’t that right, Grace?” She nodded dutifully, perhaps relieved to have the substantive part of her history out of the way.
“How long..?” But he didn’t let me finish my question.
“It’s been going on now for…” -he glanced at her as if to refresh his memory- “What..? Six months now?” She smiled and said ‘Maybe’ to me with her eyes.
I nodded encouragingly, but groaned inwardly: taking the history was going to be painful. “Is that right, Grace?” I asked.
She looked up into his face, smiled, and then back at me. “Yes,” was all she said, and yet her eyes seemed troubled. Only her eyes…
He took over again. “I’d say six months, because that’s when we got into a little financial trouble; Grace is very sensitive to stress.” He turned to her and said, “Aren’t you, honey?” She nodded -of course.
I played with the pen I was holding. “So are you suggesting that stress might be playing a role in your pain?” The question obviously made her flustered; she didn’t seem to know how to answer. I thought I’d try to get at least some information I could use. “Where is this pain that you’re having, Grace?”
Again she looked at him. I thought I detected a concerned expression.
“Well…” She started too slowly and it gave him time to respond.
“She gets it in her pelvis doctor. Isn’t that right Grace?” She sort of smiled. “All over her pelvis… into her back, down her legs… It’s terrible.”
“I see…” But I didn’t. “And when did you say you get this pain, Grace?” I tried to direct my questions to her, but she kept looking at him for -what?- approval?
“She gets it with her periods, but also…” This time he looked at her and they exchanged knowing but otherwise undecipherable expressions. “She also gets it when we’re making love…” He stopped, feigning embarrassment.
This was obviously why they’d come; why he’d come with her… “Well, then I think I’m going to need to get a little background information.” He looked at me as if I was going just a little bit too far. “So, let’s start with when you first started having periods…”
I took what history I could get from her, but he kept interrupting and correcting her. And when I suggested that I needed to examine her he refused.
“She’s having her period now, doctor.” He stared at her, concern evident in his body language. “And anyway, Doctor Jonas said you probably wouldn’t have to.” He blinked nervously. “She said we’d only need to talk about it.”
I took a deep breath and put down my pen. “It’s pretty difficult to come up with an appropriate diagnosis without an examination.” My turn to stare at him.
He shrugged -triumphantly, I suspected- and put on an apologetic face. “Dr. Jonas was pretty certain it was Endometriosis…” I could almost see the capital letter in the word. He pretended to be tentative, but his manner suggested confirmation and agreement. “She thought maybe you could just prescribe something and see how it worked.”
“And did Dr. Jonas examine you, Grace?”
Another glance at him and a resigned sagging of her shoulders. “No. Jim…” She stopped suddenly with his quick almost-hidden tug on her sleeve and let her glance stall briefly on her feet before it again climbed his body to his face. “…I was having my period then, too.”
He smiled and blinked slowly -too slowly I thought- and then sighed. “We always seem to choose the wrong time for these appointments, don’t we?”
I sat back in my chair, and looked at them both for a moment. “Well, I’m not willing to prescribe anything until I have a better idea what’s going on.” I leaned over the desk and closed the chart slowly. “Maybe you should come back and see me next week when your period is over, Grace,” I said. “And you probably don’t need to take time off work to come then, Jim…” I added hopefully, letting my eyes rest on his.
They looked at each other, but this time her eyes were harder, sterner. She was about to say something when he squeezed her hand. “No, I don’t mind coming, doctor…” He gazed lovingly at her. “We go everywhere together.”