“So you just turned 40, I want you to go have a mammogram,” says my doctor at my annual physical just after my 40th birthday.
“That’s not necessary is it?” I scrunch up my face.
“What, it doesn’t hurt, don’t be a wimp,” she replies.
“Oh, you’ve had one?”
Fucking doctors. Who’s with me on the idea that every general practitioner should, during their medical training, have to experience every test they could potentially send a patient for? Not the actual mammogram with the scan, but everything up to that point, including the boob sandwich (male doctors too), as well as a colonoscopy, and a partial toenail removal.
“So how do you know it doesn’t hurt?”
She sighs. “I don’t, but you have a family history of breast cancer from your grandmother, so let’s be safe.”
I can’t honestly remember now if my grandmother had breast cancer or not. I think she did, but she had so many other cancers, along with pneumonia, diabetes, and tuberculosis at one point, that, sure, better to be safe than sorry. And it can’t be that bad, right?
My doctor’s office at that point was at Toronto Western Hospital, part of an organization called The University Health Network. By default, my mammogram was to take place at Princess Margaret Hospital, which was good, in theory, because it was a world-renowned cancer hospital, full of staff with expertise and experience.
The logistics were not exactly on point, though.
After making my way through the warren of hallways that make up this hospital, I find the breast screening department and enter from the hallway through a door that is left propped open. This open door is important, don’t forget this point. There is an outer waiting room where I sit for a few minutes before being handed a clipboard that I’m told to keep with me, and then directed to a change room where I’m told to remove everything from the waist up and to store it in a locker, but not to leave my purse in the locker, because there are no actual locks. I’m handed your typical blue hospital johnny shirt and told to put it on backwards, with the ties in the front. This is ostensibly to make it easier to access the breasts while still allowing for a bit of modesty. Unless you are large-breasted.
I change as directed, and then, juggling my purse, the clipboard, and the book I’d brought with me, while also trying to hold the johnny shirt closed across my breasts, I sit down in a smaller waiting room where a dozen other women are all trying to do the same. Many of them are visibly upset.
Because, think about it, while I had the luxury of knowing I was only there so my doctor could bill the government the referral fee, many of these women were sitting there because they had found lumps and were fucking terrified. Others still were there because they had an official diagnosis of cancer and were in the midst of treatment. This is not the place where any person should be treated like cattle, or a number, or with anything but genuine care and sympathy.
We joke about our predicament with strained smiles, the more endowed of us fully aware that those whose shirts don’t gape open across the chest might well be because they’ve already undergone surgery.
Finally my name is called and a tiny woman escorts me back to the outer waiting room. She gestures to a seat facing that door to the hallway and explains that we’re now in the queue for a screening room, much like planes waiting for the signal from air traffic control to approach a runway. Although her hands are free, she has not offered to take the clipboard from me and seems oblivious to my struggle to hold my shirt closed while juggling all my shit.
I look up to see a man walk past the door. He slows down, peering into the waiting room. Another man does the same thing. Then another. It becomes comical, this sad, pathetic attempt at getting a brief glimpse of titties. I elbow the technician beside me.
“Does this happen all the time, this thing with guys trying to get a look at women’s breasts popping out of their tops?”
“Oh yeah, I guess,” she replies, clearly not concerned. “Just ignore it.”
“If you all know this is happening, is there a reason why you haven’t changed procedures? Maybe closing the door, at least?” I ask.
But then it’s our turn and we have to hurry, and do the actual screening as quickly as possible, because there are other planes, I mean patients, behind us. My breasts are too large for the plates she’s chosen and she is frustrated at the delay, with snide comments about my “extra large breasts”.
I walk out sore, frustrated and vaguely humiliated.
Yes, it does hurt, at least when the technician cares more about meeting a quota than whether the patient is comfortable. I am bruised and tender for a good week, and I find myself crying on the streetcar on the way home.
“You’re due for a mammogram.”
“Again??” Fuck me, come on.
“It’s been 5 years. You actually should have had one last year.”
It would be an understatement to refer to me as cynical. And you’d be full on incorrect if you said that I wasn’t pessimistic. But I put these normally “bad” character traits to good use in planning, and figuring out how to make parts of my life more organized and efficient. So in the approach to the next mammogram, I look at ways to make the process more efficient and pleasant — for me. Because I believe that you have to be your own health advocate, and it’s clear that the staff at the screening clinic at PMH weren’t going to do that.
I intentionally book my appointment at the end of the day on a Friday, in the correct assumption that it won’t be as busy. When I arrive, and the receptionist tells me to go into the locker room and change, I reply that I’ve come in a t-shirt and sports bra that can be easily removed and will not be changing into the johnny shirt. This woman who was just moments before smiling and laughing suddenly glares at me. It reminds me of the expression of someone who is about to get up, stalk across the room, and kick a dog.
“MA’AM, YOU NEED TO WEAR THE SHIRT!”
“No, I don’t. I can remove what I’m wearing quite easily.”
‘BUT YOU’LL BE EXPOSED DURING THE SCREENING.”
“Uh, the technician will see and touch my breasts during the process. It doesn’t matter to me if she sees both breasts at the same time. The shirt tied at the front is not comfortable and is too exposed when you’re sitting here waiting to go in. Unless you’re willing to close that door…” I gesture to the door to the hallway, where even now, when the room is empty, men are slowing down to peek in.
“NO, WE CAN’T DO THAT. YOU CAN WEAR TWO SHIRTS, PUT ONE ON SO IT TIES IN THE BACK.” She’s still yelling, although she’s also weirdly trying to do so through gritted teeth.
“That sort of defeats the purpose, doesn’t it? I’m fine wearing this.”
Clearly frustrated, she shoves a piece of paper at me, but doesn’t tell me what it’s for. “Here, take this!” I put it in my purse and proceed to the smaller, interior waiting room where there is one other woman waiting, clutching her gaping johnny shirt. “Where’s your shirt?” she asks.
“I told them I didn’t want to wear it.”
“You can do that?”
Allow me a digression, readers. A few words of wisdom that this event and others have made clear to me. You are the boss of your own body. You get to decide what treatments to have, whether or not you will have a certain surgery, whether or not you want to take certain medications. Obviously, the advice of your medical professionals is paramount and it is reasonable and wise to do everything you can to remain in good health, especially as you get older and especially as more and more little things come up. But you are the boss of you, and if you don’t want to wear a shirt with a big opening in the front and sit where strange men can ogle you, you don’t fucking have to. And no x-ray technician, or their mean receptionist, can make you. If more of us said “no” to shitty treatment from medical professionals, they’d have to fix it.
I look up to see a woman standing in the doorway, and assume she is my technician, but she gestures for me to sit. I’m about to get a talking to. I stand anyway.
“I’ve heard you won’t wear the gown.”
“Nope, no need to.” I explain that I have chosen clothes so I can undress quickly.
“But yo have to wear the gown. We only have so much time for each screening.” Aha, so there is a quota in place. Mooo, my lumpy-breasted sisters, you are no more than a number that turns into more numbers on a financial ledger.
I look around the near empty room pointedly. “I assure you, this will be quicker.”
“We’ve got rules.” Oh noooo… rules. Well, fuck, I’m in trouble now.
“Okay, well, this appointment is really just to keep my doctor happy. A bit of family history, I don’t have a lump or anything. So I don’t really NEED a mammogram. So I guess I’ll just go…” I move to pick up my purse.
“Fine! Nevermind!” she says and storms off.
The other woman in the waiting room clutches at the front of her johnny shirt and nods at me approvingly.
The actual mammogram takes 8 minutes from the time the door of the screening room closes behind me to when I open it to leave. I undress and dress in record time, but the technician has clearly been told that I’m a bad apple and rushes me through the process, at one point hitting the button to take the scan while I am still adjusting to the discomfort of the plates smushing my breast.
So I am not surprised when the phone rings early the next week and it’s someone from the screening office.
“There’s a problem with your mammogram, we need you to come back in to re-do it.” fuckfuckfuckfuckfuck
“What exactly is the problem?”
“I can’t tell you that.”
“I’m sorry? You can’t tell me?” I am scrunching one eyebrow at the phone, making my best you’ve-gotta-be-fucking-kidding look.
“I’m not allowed to. Your doctor will call you and explain it to you. But we need you to return right away.”
I’m not really comfortable re-doing the x-ray without talking to my doctor first, so I hedge and book the appointment for a few weeks in the future. And then I wait for my doctor to call. And wait some more. And then I call and leave a message. And then another.
I even go so far as to call the screening clinic again, to see if there’s someone there who can explain the scan to me.
“MA’AM, WE DON’T HAVE TIME TO EXPLAIN RESULTS TO EVERY PATIENT!” Guess who I get to talk to when I call? “We service all the hospitals and doctors’ offices associated with UHN, we don’t have time for individual consultations.”
As I hang up, a light-bulb goes off above my head. Where, I wonder, do you go for a mammogram if your doctor’s office is not associated with the health network? A private screening clinic, that’s where. Huh.
Ten days later, my doctor finally calls me back, annoyed.
“I’m not sure what I’m supposed to do for you. I don’t know how to read an x-ray.”
“Nobody there will tell me what the problem is, they say you have to do it.”
She sighs disgustedly, clearly annoyed, while she skims the notes. “There’s not much here. Looks like there might be a shadow under your left breast. This happens all the time, probably you just moved.”
And then I recall that there was one plate that had been done too quickly. And then I stop worrying that I have breast cancer. Because I had totally spent ten days worrying that I had breast cancer.
I wait until well after business hours to call and leave a message to cancel the screening appointment the gal had insisted I book for the follow-up mammogram. Many frantic messages are left on my voicemail in the following days, first business-like, then vaguely frantic, then almost threatening. As I listen to each one, I laugh and delete them.
I did eventually have follow-up mammograms and ultrasounds done a few months later at a private clinic and there was nothing of concern to be found. It took switching to a completely different doctor’s office in order to accomplish it, as the doctor I had been dealing with was only allowed to send me to the screening clinic at Princess Margaret.
Some people will undoubtedly think that I was a jerk about it all, that in a country like Canada, with free healthcare, we should be thankful for what we get and respectful of those who deliver it, regardless of how we are treated. I disagree. Health CARE is first and foremost, about care, and the difference in the lack of care I received at Princess Margaret and the genuine care I got from the private screening service was mind-boggling. People were nice to me. The change rooms were adjacent to the screening rooms so there was no trotting around exposing myself. There were robes, not awkward johnny shirts. While there were other women there for screenings, the time allotted for each one was longer so nobody ever felt rushed, or mistreated.
Whether you’re over 40 or much younger, you have the right to expect — and ask for — respectful health care that treats you like a human being, and that puts your health and well-being before quotas and costs. A clinic’s bottom line is not your concern, and you have every right to advocate for decent treatment whatever the treatment or test might be. And if you don’t feel as if you have the nerve to speak up on your own behalf, bring a family member or friend to act as a doula to speak for you; as sad as this fact is, I’ve had doctors treat me much more respectfully when my husband attended the appointment with me.
You are not cattle. You are a human being and you have the right to be treated respectfully at any health care facility where you are a patient.
A follow-up: Shortly after my 50th birthday, my new(er) doctor sent me off for another mammogram. I returned to the same private imaging clinic I had used previously. They put little metal pastie things over your nipples now and peeling the pasties off after the scans hurt more than the mammogram itself. Painless mammograms do exist, friends. Don’t stop looking until you find a place that treats you with gentleness, kindness and respect.