The Crown Jewel


 

Ahh, those were the days! The days when naivete reigned. The once-upon-a-times when my practice was young and everyone around me seemed old. They spoke a language I had not anticipated in my training; they seem to have subscribed to different dictionaries, or the words were smudged so they did their best with what they could make out. I began to wonder if my background in the prairies had hidden me from modern descriptive English. Cloaked me in innocence. After all, it was the place where I was assured by a teacher in grade three that Winnipeg was the only place in the world where we did not speak with an accent.

Of course, since then I have lived in many places, and my vocabulary has expanded accordingly -but it is the jargon of common things by and large: words we might use with a person in the office, or a friend at a coffee shop. Every day things… Doctors generally do not unwrap their esoteria in public, and their user-unfriendly descriptives for particular bodily parts or conditions go largely untranslated. Unappreciated in the main. And anyway, most people have their own names for the stuff.

But when you’re first starting and building a practice, the world is freshly scrubbed and terminology an adventure. I quickly discovered that patients are wont to try new doctors in a never ending quest for clarity –someone whose explanations they can understand. Someone who doesn’t have to resort to pointing at the area in question. We are all under somebody’s microscope.

*

It was only my second month in practice, and I wasn’t very busy.

“Doctor, I hope you can help me,” the olive-skinned woman said as soon as she sat down. Her long black hair was carefully pinned on her head, but as she gestured, little strands would escape and cross her eyes like windshield wiper blades. Far from annoying her, she hurried the transit in a trained fluid sweep of her head as if it was an integral part of her everyday speech.

She was a heavy woman, but dressed in a stunning green blouse and black jeans, she wore her weight, like her height, as a gift. The most striking feature about her, though, was her eyes. Intense and brown, they prowled the room in search of prey, then fastened upon me like a cat, and once engaged, stapled me to my chair.

I struggled to disengage and tried to focus on her chart for a moment. Usually there is an explanatory referral letter, but there were only three words scrawled in pencil –hurriedly, I think, because they were almost undecipherable.

My face must have fallen, because she unlatched her eyes, scanned the upside-down letters, and said, “Dr. Edwards is a man of few words, eh?”

I looked up, embarrassed at my inability to decipher the letters, and turned the page so she could read it. “Any idea what it says?”

She studied my face to see if I was kidding. “He was kind of puzzled by my stuff, so he told me to explain it to you… Anyway, it says ‘something quadrant pain’ –whatever that means.” A mischievous look snuck onto her face and her body shivered ever so slightly, the movement slowly descending like a wave. “I’ve got pain in my parts… My private parts,” she added quickly, concerned that fancy might draw me to more public venues.

“And when do you get pain… there?” I asked, hoping for more clarity.

She thought about it for a moment. “Well, mostly during my monthlies I suppose, but occasionally during his act.” I must have looked blank, because her eyes dropped briefly as she searched for a more apt description. “You know,when he… walks through the door,” she said, and sat back in her chair convinced she had simplified the term.

She struggled through her history with a litany of words I had never heard before. Things like ‘tweenie-legs’ and ‘bloaty-stuff’ surfaced briefly, then sank just as quickly after I’d made a stab at translating them into something I could dictate to her doctor.

But when we’d plodded through the symptoms and I’d had a chance to examine her, it seemed likely that she had endometriosis –a painful condition where some of the endometrial cells that normally line the uterus and are expelled during menstruation, are forced back through the Fallopian tubes into the abdominal cavity where they can grow.

The condition is usually diagnosed and treated with a laparoscope –a telescope inserted through the belly button under an anaesthetic. Pretty standard stuff. But this seemed to worry her more than the condition itself. “I’m kinda worried about my crown jewel,” she said, her brown eyes watering.

I smiled and assured her that I would not be taking anything out of her. I had heard the expression ‘crown jewels’ before but always in the plural, and never referring to women. But, summoning up a vague memory of trash talk in the YMCA locker room, I assumed it was a code for ovary and not wanting to become entrapped in another of her semantic vortices, I left it at that.

*

The last thing she said to me in the OR before the anaesthesiologist put her to sleep was “Careful of the crown jewel, eh, doc?” I touched her shoulder reassuringly and watched her close her eyes as the medication took hold.

“What was that about?” the scrub nurse said as she was prepping her adomen.

I shrugged. “I was hoping I was the only one who didn’t understand…”

Belly buttons are interesting areas, I have come to realize. They exist in all sizes and shapes. Their contours run the gamut from vertical alignment to transverse and since the laparoscope has to be inserted through it, the incision has to be similarly tailored so it is inapparent after it heals. Hers was distorted, however, so I found I had to be creative. I ended up cutting a short horizontal line about as long as my little finger nail on its lower edge much to the surprise of the resident doctor who was assisting me.

“I’ve only seen it cut vertically,” she said with some hesitation evident in her voice. It wasn’t exactly a criticism –residents don’t usually criticize their staff- but I could hear the implied judgement in the tone. I smiled beneath my mask, and said something to justify my decision. But it was a bluff; I recognized my heresy all too clearly. If it healed with a ridge, or a scar, there might be complaints. It made me all the more determined to leave her ovaries unharmed.

And then, after dealing with the endometriosis, and dictating the operative report, I promptly forgot about the navel issue. Until, that is, she returned to see me several weeks later.

*

She sat down opposite me as she had that first time, but her eyes were so intense I could barely see her face. “What did you do, doctor?” she said in an accusatory tone before I could even open her chart.

“Do you still have the pain?” I asked carefully –almost shyly, given the spotlight of her eyes. I felt naked in their allegation. Like I had done something wrong.

She turned down the wattage and I could finally see the smile that had been in possession of her face all the while. “No, of course not…”

‘Of course not’? I took a deep breath as the memory of her umbilical incision rose slowly and painfully into my chest; my resident had been right.

“How did you do it?” she said a little too loudly, her eyes firmly grasping my head. “My friends all noticed; everybody’s been commenting.”

“I’m sorry,” I managed to mumble, my cheeks no doubt red with the effort. “I don’t underst…”

“The belly button!” She interrupted and then almost jumped across the desk in her frenzy. As it was, she leaned so far she was almost touching me. Then she relented and retreated slowly into her chair. “You know what I do, don’t you?”

Actually, I didn’t –in those days I rarely noticed if a profession was written on the chart- but I could hear the word ‘lawyer’ humming softly in the background.

“I dance professionally,” she said. “I specialize in the danse du ventre, to use my favorite description.” I think I must have accidently raised an eyebrow, because she rolled her eyes impatiently and added “A belly dance!”

“I still don’t…”

“My crown jewel,” she said, carefully enunciating each word as if speaking to a slow child. “I wear a ruby in my belly button as part of my act.” My face stayed blank. “It always falls out unless I glue it in. Those kittens are heavy, you know. Especially when you’re moving everything around.”

“So..?” I didn’t know where she was going with this, so I tried to stay neutral. Sensitive.

“So whatever you did worked… Sits in there like a baby in a blanket now.”

I allowed myself a smile.

“The girls in the troupe are all impressed,” she said, positively beaming. “I told them to pretend they had pain in their parts so they could get to see you.”

Well, I guess it’s a start, eh?

 

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