The Unexpected


What I like about the unexpected is that you never expect it. It’s a surprise. A gift. And the world is filled with this stuff. Each day at work –I’m a gynaecologist- there are little treasures hidden within appointments, presents in names. Especially the unpronounceable Persian names that unravel when I try to work at them one syllable at a time to call some nervous woman from the waiting room. But she inevitably understands my bumbled attempt, smiles, and when she sees my embarrassment, immediately forgives.

And there are cross cultural surprises that don’t anymore. Surprise, that is. There are some people for whom a question has to be asked with a lot of forethought. It cannot merely trip off of the tongue; it must be planned well in advance. A simple query in taking her history such as “You’re not married, are you?” might elicit ‘yes’ –meaning either ‘Yes I am married,’ or ‘yes, you are correct in saying I am not married.’ I love it.

Or consider the argumentative patient who doesn’t want to tell you why she is there. Her name provides no advance warning, nor does the note from the referring doctor. The first clue is usually the defiant, silent stare, and the arms tightly enfolded across her chest as if to prove that coming to see me was definitely not her idea. I suspect the behaviour is a punishment, although for whom I’ve yet to determine. And what do I usually do? I ignore the theatre and simply ask her why her doctor sent her. If that doesn’t work, I sit back in my chair and smile at her, hoping the time will allow her to acclimatize. Relax. Sooner or later, of course, she realizes she has to do something  or pay for extra parking, so she will sigh, undo her arms, unlock her eyes and either apologize or leave. I never know which way it will go.

But sometimes I am caught off guard. Something unexpected happens that even I did not anticipate. That something happened only a few months ago in fact: a movie star. Well, sort of…

It was just before lunch, and my stomach was rumbling. I had only one patient to see before I could escape for the morning, so I quickly glanced at the referral note. ‘Pain’ was all it said. Damn! I suppose the family doctor was in a hurry, but even an adjective, a descriptive, might have pointed the word in a more helpful direction. I shrugged mentally and then let it go –after all I was the detective, not him.

I walked down the corridor to the waiting room rehearsing her name. “Jojo?” I said with a little uptick at the end to indicate that I wasn’t entirely sure I’d got the name right, or whether it was a name only her closest friends used.

An unsmiling woman with short hair stood up and walked over to me. She shook my hand, but I could tell she didn’t really want to touch me. She wouldn’t make eye contact either. That made me a little nervous, but I assumed that she was just shy and understandably anxious. But I have to confess that apart from that, my initial impression of her was, well… absent. Nothing about her cried out for attention. She was average height, average build, with a pleasant but decidedly unstriking appearance –we are all beautiful in our own ways, but sometimes it is easier to notice, I suppose. I dislike the adjective ‘plain’ when applied to people, but occasionally it’s difficult to find another word without seeming patronizing. Let us just say she was neither attractive, nor unattractive but somewhere on that hazy continuum verging on, well, average.

She sat rather primly on the chair opposite my desk, eyes fixated on something on the wall to the left of my head. I fought the temptation to turn and see what she was looking at and distracted myself by asking her why she’d come to see me.

“Pain,” she said simply, without moving her eyes.

I waited what I thought was a polite interval for her to continue, but when she didn’t  I fidgeted with a pen on my desk -a signal, I hoped.

She glanced briefly at her hands and then her eyes flew back to their accustomed branch on the wall. “It’s been interfering with work lately,” she said, as if she had unlocked a door.

I felt I was getting somewhere. “In what way?” I asked, smiling to reassure her that I would understand.

She stared even harder at the wall and said, without a hint of embarrassment, “I get terrible pain when he…” I could actually see her adjusting words in her head. “When he enters…” She seemed pleased with the word she’d chosen and smiled for the first time –at the wall, mind you, but I figured it was a rapport starter. Suddenly she appeared to reconsider. “No, not ‘enters’ exactly… when he’s, uhmm…” -this seemed to be a real challenge for her- “…you know, in there and looking around.” I could tell she wasn’t exactly happy with her description, but she didn’t offer any more metaphors and resumed the neutral expression she had worn coming into the office.

I assumed I had simply misinterpreted the temporal juxtaposition of  her personal life and work, so I let it pass without further comment, although I did make a few mistakes typing it into the computer. The rest of the history was easier for her and even the subsequent physical examination, despite the pain, didn’t appear to bother her unduly. After she had come back into the office from the examination room, she seemed more relaxed than I’d seen her. “You found it, eh?” she said after sitting down and making more comfortable eye contact with the now familiar space on the wall behind me. “The part he hits,” she added to make sure I knew what she meant.

I smiled and nodded in agreement.

“So, what do you think?”

I’d felt a rather large and tender ovarian cyst in her pelvis -probably from endometriosis, judging from the rest of her history. “Well…” I tried to frame my response in a non-frightening fashion, but it was difficult. Ovarian cysts are always frightening. Threatening. “The area that was the most tender was around your left ovary. It seems larger than it should be –a cyst, maybe…” I thought the ‘maybe’ might diffuse the fright I could see in the eyes that now sought mine. “I’d like to get an ultrasound first, though, before we decide what to do.”

“You mean, like it might be… cancer?” I could tell it was difficult for her even to fashion the word in her mouth.

I smiled disarmingly. “No, more probably endometriosis.” I was about to elaborate on the word when her face turned sour and her eyes fled to the wall again.

“So, if it is a cyst, what are you going to have to do about it?” She sounded angry, but her face grew expressionless.

“Well, if it is a cyst, we’ll have to remove it.”

Her eyes immediately saucered and focussed on the front of my shirt. “You mean surgery?” I could almost see the italics. “Sorry, I don’t do surgery, doctor!” Her face changed; it was no longer unreadable.

“Why don’t we just wait to see what the ultrasound finds and then decide what we…”

But she was already putting on her coat. “You don’t understand, doctor.” She was having trouble fitting the two sides of the zipper together, so it gave me time to ask why she seemed so upset. She sighed, left the zipper for a moment and actually looked at me. Me -not the wall, not my shirt, not her hands- me. “It’s my work… I can’t have any scars for my work.” She stood up and walked to the door, still unzipped.

“The scars from a laparoscope are really quite small, Jojo. I…”

But she stopped at the door and turned to face me as she interrupted irritably. “Any scars. I can’t have any scars! That’s what they told me…”

“Who told you?”

“My producers.” I couldn’t keep the concern off of my face, so she continued. “No scars –that’s what they said.”

My face relaxed. “Producers? So you’re an actor? In the movies?” I must have looked impressed because she nodded modestly and leaned seductively on the door frame. “But… they’d be tiny little scars. And most of them would be lower down on your abdomen. Even the skimpiest little bathing suit would hide them.”

She cocked her head and allowed herself a tiny smile before she left. “I never get to wear one for very long,” she said as she disappeared down the hallway.

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