Pap Smear Results In Medicine

Schedule A Colposcopy

The smooth glass doors swooshed open, welcoming Jadin into the sprawling medical center. Chilly, hyper air-conditioned air engulfed her and washed over her bare arms. She briefly wondered about the energy bill to keep such a large building so cool even as the outside temperatures soared.

Jadin turned left and headed for the elevators that would transport her to the Gynecology (GYN) clinic. Her appointment was in 20 minutes. Pushing the up button, she thought about the phone call she received two weeks ago. She placed one hand on her abdomen to help with the jittery feelings that were building.

The words floated through her cell phone, "Your Pap is abnormal." 

Oh.

The result that every woman dreads and, here, the words were being said to her. Her cervical Pap smear result was abnormal.

Jadin entered the elevator and pushed the third floor button. Keeping her hand on her abdomen, she willed herself to take a deep breath.

"What does that mean?" Jadin gripped her cell phone with one hand.

Call It Colpo For Short

Her GYN nurse practitioner continued, "The results are low-grade. That means it's mild, but we still have to take a look to make sure. You need to schedule a colposcopy."

"A what?"

"A colposcopy," repeated the nurse practitioner through the phone. "It's a procedure. We take a few biopsies of the cervix and send them to lab for evaluation. It's really not anything to worry about."

Why did she always feel like she was dying when faced with any abnormal medical results? It’s easy for healthcare providers to say it's nothing to worry about.

As the elevator lifted her through space, she closed her eyes for a moment.

"We call it colpo for short." Her nurse practitioner spelled it out for her. "C.O.L.P.O. When you call the front desk to schedule your appointment, tell them you spoke to me and that you need a colpo. They'll know exactly what it is and get you set up. We'll see you soon."

Not-Always-Helpful Google

Once jadin hung up, she googled everything in sight regarding abnormal cervical Pap smears. Words like HPV, cancer, biopsy, and additional words like low grade, high grade, and LEEP swirled in front of her.

At one point, she stopped looking. The more she read, the more she was convinced she was dying of a wicked disease. She was pretty sure that was not true. She'd wait and ask questions at her appointment. 

The elevator doors opened. Her heart skipped a beat as she stepped out and turned the corner to enter the GYN clinic.

Those familiar "why me" feelings jostled their way into her thinking. Focus.

Check In For Your Appointment

Jadin stepped up to the front desk of the GYN clinic.

"Good morning. Checking in?" asked the clerk with a cheery voice. 

"Yes," Meagan put on a brave face that belied her true feelings. "I've got an appointment for a colpo." She felt oddly savvy using this word.

The clerk confirmed her identification and clicked and clacked her mouse at the computer. "Okay, you're checked in. Go ahead and have a seat. Your tech will call you shortly."

Jadin settled into a seat in the waiting room. She had both hands on her abdomen now to help with the increasing nervousness. 

The inner clinic door swept open to reveal a smiling woman wearing bright pink scrubs. 

"Jadin?"

Jadin stood up, keeping one hand on her abdomen.

"Come on back.” The technician guided her through several hallways that all looked the same.  “We'll get some vital signs and then set you up in an exam room."

"Don't worry," she reassured, noting the look of apprehension on Jadin's face. "Your nurse practitioner does these all the time. You'll be fine."

Jadin steadied herself and imaged a cosmic symbol in her mind's eye.

Into The Exam Room

The technician ushered her into an exam room which to Jadin felt like the proverbial lion's den. Medical instruments and cups filled with liquid were lined up on a tray like obedient tin soldiers. A large machine on rollers dominated the room.

A sinking feeling crept into the pit of her stomach as she contemplated that they were, indeed, going to take biopsies of her cervix.

The technician handed her a starched, green sheet to drape over herself during the procedure. "I'll step out while you change. Clothes off from the waist down, socks can stay on. Your nurse practitioner will be here in a minute. We'll take good care of you."

Jadin slipped off her clothes and patterned a spiral as she sat down on the edge of the exam table tucking the stiff sheet around her waist. She silently repeated words of encouragement to herself. 

"I can do this. I can get through this."

 

If We Break It, We'll Fix It

Incidental Findings

"You need a biopsy, Tara," the pulmonologist advised as he fiddled with his mouse to bring up the CT scan on his computer.

"Yes, a biopsy" he repeated, focusing on the flat screen. "The nodule in your lung has gotten bigger in the last three months." Clicking on the mouse, he enlarged one area of the black and white image. "See," he pointed to the offending nodule, "the ground glass aspect has a solid component in it now, measuring 5 by 7 millimeters."

An abdominal CT scan that itself was normal, turned up an incidental finding of pulmonary nodules. Incidental findings. Things you weren't looking for, but found nonetheless, and now required that you follow up.

They both stared at the follow-up scan that showed "significant interval growth" in just three short months. Localized to the right middle lobe of the lung.

Just A Biopsy

A lung biopsy.

A long needle pushed through your chest wall to gather tissue from deep inside. Not a simple venous puncture.

The overshadowing and unspoken fear? Lung cancer.

The frustrating part? She was a lifetime non-smoker.

Risks of the procedure?

"Well, the usual," he intoned. "Infection, but that's unlikely." Right. Any time something punctures your skin and digs into your body, you have a risk of infection.

"And a collapsed lung," then he quickly added, "but that really is unlikely. You're strong and healthy, Tara. It's not like you have COPD."

Tara wasn't feeling terribly strong or healthy at the moment. Her gaze fell on the lump of her black purse sitting on the floor beside her. She really needed to replace that. She had promised herself she would buy one that wasn't black, now that she was free to have any color that tickled her fancy.

With retirement finally reached a month ago, she dreamed of a new purse that wasn't "regulation." She hadn't gotten around to that yet.

We'll Fix The Complications

And in the unlikely chance it happened? A collapsed lung? What then? She pictured herself positioned on the CT scan machine, lying on her side in the midst of the biopsy, suddenly unable to breathe.

"Don't worry, we'll fix that," he stated as a matter of fact. "We'll insert a chest tube and admit you to the ICU to give your lung time to reinflate."

Tara had to smile to herself. Medicine is so linear and mechanical. If we break it, we'll fix it and if we break it again, we'll fix that too. Because that's what we do in medicine. We fix things.

For all the frustrations with reductionism in medicine, there are wonderful aspects. Broken bones that could handicap us for life are carefully mended with the use of ultrasounds. High blood pressures that could slam our hearts to a crashing halt are coaxed down to reasonable levels with pills.

Medicine puts us back together, extends our lives, makes us prettier.

Medicine also finds incidental things, especially with the myriad scans, x-rays and ultrasounds that we order. 

Sometimes, that's a blessing. We find something, we take care of it right away. 

Other times, it's nothing and off we run on a wild goose chase.

It was possible it was only inflammation. That's what her radiology report said, "inflammation versus malignancy." 

It's Your Move

She would need to hold space in her meditations for this one.

Tara was clear that her meditation didn't guarantee a rosy outcome. Still, the inner support comforted her. It was hard to explain. Unlike medicine, the richness of the support accessed was not linear or mechanical.

She supposed she could choose to do nothing and let nature take its course, whatever that may be. Cancer or not. Maybe this was the end of the ride. How do you know when it's time to say goodbye?

Taking a deep breath, she looked down and placed one hand in her heart for clarity with her choice. When she looked up, their eyes locked, and she nodded consent to the biopsy.

For some reason, not any particular one she could identify, today was not the day to do nothing. 

"We'll find out what those cells are up to," he nodded back for emphasis.

"Alright," Tara whispered when she added a final pen stroke to her signature on the consent form, "Let's do this."