Clinic Day

This summer I have an internship at an endocrinology unit. The truth is that most of the time I just sit around and play games on my computer (I am getting very good at Solitaire), but every Wednesday I go with Dr. Finche, my supervising doctor, to visit patients in the hospital clinic.
We manage to cram into the tiny elevator with strange padded walls, and we hit the button for the third floor. We stop on the second floor too, and even more people squeeze into the tiny space.
The clinic is nice, though slightly cramped and absolutely freezing. I don’t believe that it is ever more than 65 degrees in here. I shiver as Joseph, the young doctor I am shadowing, interviews a patient. She tells him that she has PCOS (Polycystic Ovarian Syndrome), thyroid problems, cold sensitivity, and a wealth of other symptoms that make me suspect that she is also a hypochondriac.
The next few patients have either just had abortions, or else have irregular periods. Joseph is kind and explains everything well, but the treatment for all the patients is pretty much the same. Joseph orders more tests and delivers bad news.
Then our fourth patient comes in with her husband. We deliver the good news before she even has a chance to sit down. She is finally pregnant. The patient, a young Hindu woman, looks shocked and disbelieving.
“Are you happy?” Joseph asks. She nods, too overwhelmed to speak. He gives her directions and orders for a new battery of tests to ensure the fetus’s health, and the couple is gone in a minute.
Our next patient is different.
She is young, only 17, which makes her only a year older than I. She has had quite the day today, since she was sent down to the pediatric clinic in the morning, and then sent back up to general endocrinology later. She has been waiting for over three hours for this one appointment, and I wonder why she hasn’t just left yet.
Joseph calls her into the room, and she enters with her mother. I live in a fairly homogenous community in terms of race and religion. Most of us are white, and most of us are either Christian or Jewish. There isn’t too much in between.
But this is the Bronx, and the two women who enter the room are chocolate skinned and covered more completely than anyone I have ever seen. As an Orthodox Jew, I believe in modest clothing which means skirts to my knees and shirts that have sleeves and don’t show cleavage. But this is something else altogether.
The girl’s mother is dressed in a black burka that covers everything except for her hands and her eyes. Even her nose is covered by the lightweight black fabric. In her hands is a smartphone with a broken screen. She looks down at it, answering a text as she walks into the room.
The girl herself is tall and thin – towering at least three inches above my five foot six frame. She is dressed somewhat differently from her mother, in a long black dress with intricate beading down the front and animal print on the sleeves. Blue jeans peek out from under the ankle length dress. She also wears a spangled scarf over her hair, but her heart shaped face is not covered at all. Around her neck are pink Beats headphones, which connect to the iPhone she is carrying.
I try not to stare as the girl and her mother settle into their chairs, but they are so different from what I know. The mother speaks a language that neither I nor the doctor has ever heard of, and we are not able to find a translator through the hospital’s phone service. Instead, the daughter (who speaks perfect English without any semblance of an accent), translates for her mother.
Joseph turns to the girl. “How old are you?”
“17.” The words are clear, and she meets his gaze steadily.
“And you’ve never undergone menses? Never had any type of period?”
She shakes her head, and her mother says something that I can’t understand. The girl’s reply is just as unintelligible.
Joseph nods and asks a few more questions before printing the file.
“I’m just going to confer with my attending doctor,” he tells them, standing up and heading to the door. I follow him, and we exit the room, leaving the woman and her daughter to sit together in a type of hospital purgatory.
Joseph presents the case to Dr. Finche, the attending, and she confirms what we already know.
The girl is infertile. We can give her treatment to slow her perpetual growth and help her undergo menses, but she has no eggs. She will never be able to give birth to children of her own.
The news is sad, but I am not focused on it. I am already thinking about what I will have for lunch. Maybe I’ll buy a yogurt, or possibly a roll of sushi. Joseph and I return to the room and he releases the verdict.
“It is very, very unlikely that you will be able to have children of your own.” He addresses the girl directly, and openly. “But you can have another woman’s eggs implanted in you, when the time comes.”
The girl nods, but does not say anything. Her face betrays no emotion, and I know that this is not the first time she has been told. She relays the words to her mother, who responds in clipped tones.
“She said ‘Is there any chance? Any medicine for it?’”
Joseph takes a deep breath, and I feel bad for him. “We will give you medication so you will get your period and stop growing, but you won’t be able to have children with your own eggs. I’m sorry.”
She translates, and her mother’s face grows paler. I think I see a tear slip out from the corner of one eye, but it falls beneath the veil before I can be sure.
“One thing I would like to do is a breast examination,” he tells them. “I need to confirm what stage of puberty she has gone through. Is that okay with you?” He addresses this question to the mother.
The girl translates and the mother nods immediately. Joseph seems surprised.
“Are you sure?” he asks.
The girl translates, and the mother nods again.
Joseph looks carefully at them. “All right,” he says. “Take off your clothes, and put this on.” He hands her a blue hospital gown. “I’ll be back in a minute.”
We leave, and go back to where the attending doctors sit. Dr. Finche is gone, probably off with another patient, but Dr. Batalov, a grim Russian man, is there. I sit down in a chair while Joseph explains what is happening.
“And the mother said yes?” he asks. I can tell that he is just as surprised as Joseph was.
Joseph nods, and Dr. Batalov stands up. I stay sitting. I am sure I am not supposed to go with them. Not for a breast examination. But then Dr. Batalov looks down at me, and motions for me to follow.
I get to my feet, confused. There is no way the girl will want me there. I wouldn’t, if I was her. It is enough to be naked in front of a doctor, let alone a random intern. But Dr. Batalov wanted me to come, so I follow him and Joseph back to the room. The girl is wearing the blue gown and sitting on the examination table.
Dr. Batalov looks at the mother. “You know what we are going to do?” he asks.
She nods.
The two doctors look at each other, and then pull on gloves. The mother stays in the room, but they put up a curtain to give her daughter privacy.
Then they tell me to come to the side of the curtain with the exam table. The side with the girl.
I walk slowly across the white-speckled floor, my shoes clicking too loudly against the tile. The girl’s face is calm and composed. She has left her head scarf on.
Joseph asks her to open the gown, and she does without any complaint. They circle her, staring at the two small circles on her chest, hardly bigger than quarters.
I feel like I should look away, but they brought me behind the curtain for a reason. My eyes dart to the floor and then back to the girl. I thought they were only going to look, but now Joseph is pressing down on her chest with the pads of his fingers while Dr. Batalov looks on. Their gazes are calm and clinical, and the girl is unfazed, but I am blushing red.
Dr. Batalov and Joseph speak to each other, throwing around words like “budding” and “areola”, while I try to figure out what to do with my eyes. I peek around the edge of the curtain and look at the mother. She is sitting stiffly in the chair, eyes bright and alert.
Suddenly, Dr. Batalov pulls the curtain back. I am relieved to see that the girl’s gown is back on.
“We would like to do a pelvic examination,” he tells the mother. “It will involve inserting a speculum,” he shows her one, “into the vagina.” He pauses, to give the girl time to translate.
The mother nods.
“That’s okay with you?” he asks.
She says something to the girl, who nods. “Yes,” the girl says.
Dr. Batalov turns to the girl. “I need you to take off your underwear, and lie down on the table.”
While he is talking, Joseph is busy extending the stirrups attached to the table. They pull the curtain back, and tell the girl to put her feet in the stirrups and spread her knees.
She does as they say, though her legs are only half open.
Joseph tells her to relax and pull up the gown. She does it slowly, and I turn away. I hear the doctors talking to her, telling her to relax, but I don’t want to look. This is too private, too personal.
Until she moans and my eyes snap back to her.
Joseph is sitting on a rolling chair, his eyes level with the girl’s legs, and Dr. Batalov is bending over her. They are pressing gently on her knees, telling her that it won’t hurt if she can just relax. I look at her face – tightened with pain – and it is clear that she can’t.
They push the speculum farther into her, and she cries out.
I take an involuntary step closer to her. In that moment it doesn’t matter that I am white and she’s black. It doesn’t matter that she speaks a language I have never heard of, or that she wears clothes I wouldn’t even know how to buy.
All that matters is that she is a woman in pain, and so am I. Her eyes are screwed shut and she is contorting with pain, her legs spread open as she is poked and prodded in the most intimate places.
I look at her, and I know that there is nothing in the world that could make me switch places with her right now.
But there is also nothing that could make me leave.

Michal Leibowitz, Age 16, Grade 11, Yeshiva University High School for Girls, Silver Key

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