GYNECOLOGY CAN BE FUN
or "TMI"

2 November 2002

I've always loved the technical terminology. It was what attracted me to medicine in the first place. Wrapping my tongue around words like cholecystectomy (the woman who taught me medical transcription told me that when I could spell that without having to look it up, I'd be a real transcriptionist. Of course, now I'm so advanced I don't have to spell it. I type in "chole" and the auto correct on WordPerfect fills in the rest for me).

I will admit that there are a lot more words that I can spell than I can define. For example, don't ask me what a cholecystectomy is. I only know how to spell it.

However, as a bungling office manager/janitor/medical assistant wannabe, I am learning to match procedures with some of those technical words and I thought I might enlighten those with stronger stomachs on what actually goes on behind all those high-falutin' terms. It's been kind of a revelation for me, even. Until I started working for Dr. G, my only direct experience with things gynecological had been from the "other end," meaning I knew that I'd lie on a table somewhere and there would be a sheet around my bottom half and I could see the provider's head and feel stuff happening, but now I'm at the business end of things and I can explain a bit better what is going on, for those who haven't had a big plate glass mirror to check what's going on "down there" during exams.

Let's start with the simple Pap smear. I love The Vagina Monologues when it talks about "duck lips." The speculum does indeed look like duck lips. Eve Ensler has her actresses cry out "warm the duck lips!" Actually, we're high tech. We have a warming drawer in the exam table, where the duck lips are kept in nicely warmed condition. If somehow the wrong size duck lips are missing (did you know they come in different sizes and shapes?), Dr. G sends me off to get them elsewhere, which means they are cold and I get to run them under warm water, so that the patient won't have to have cold steel duck lips shoved up her vagina.

Sizes. Yes, there are different sizes. They are wide and short, or long and narrow, or wide and narrow or short and thin. One size does not fit all in the world of duck lips. There is also one which has an opening on one side, thru which Dr. G will stick various and sundry things in special procedures.

So after all the hands-on-body stuff takes place (listening to the heart beat, massaging the breasts like one would knead some bread dough, palpate the abdomen looking for all the internal organs, etc.), then the patient assumes what is called the "lithotomy position." This is another word for saying "spread em, sister" and the patient assumes the appearance of a Thanksgiving turkey ready for stuffing.

Now come the duck lips. After assessing whether he needs short, long, thick or thin, he finds just the right set and lathers them up with clear gooey jell to make the insertion (don't you just love that word?) smoother. Once inside, the duck lips are expanded and a little screw tightened to keep them open, leaving the doctor use of both his hands to take a little brush, or a little "broom" (depending on which he wants to use), which he then inserts somewhere into the nether regions, twirls it around, and then removes it, breaks off the tip, sticks it in a little jar of fluid that I'm holding, and I send it on to the lab.

Piece o'cake. The fun stuff comes with other procedures.

There's the ever-popular cryotherapy, which is the removal of a vaginal lesion_a wart. Well, you don't put Compound W there, so you have to find some other way of removing it. After the insertion of the duck lips, you stick this wand up there and squirt it with some liquid nitrogen, which causes an ice ball to form. (Now mind you, I haven't seen this ball forming-there's not a whole lot of space for two of us to peek in, and for me it's just curiosity, so I just sit back and wait. It's done with a freeze-thaw-freeze procedure. The freezing time is about 2 minutes, which can be a long time when one is lying on the table with legs spread wide apart and someone else is down at the other end with a metal rod forming a ball of ice up your insides. They chat about the weather and the latest baseball game, and vacation trips-anything to pass the time while the magic wand is doing its thing.

One of my favorite procedures is the Marshall Marchetti procedure, or cystourethrogram. This is a fun one. The patient empties her bladder, then the doctor inserts a catheter, a long red rubber tube, into the urethra-since the opening where you pee and the opening where you have more fun are close together, in some women this can be cause for confusion. But you know you've hit pay dirt, so to speak, when more urine begins to drain out. And thus the bladder gets emptied. But then comes the fun part. Dr. G inserts a tube, attached to which is a huge syringe. I have a bottle of about 1 pint or more of distilled water and I begin to pour the water into the syringe, which in turn transfers it to the bladder. "Let me know when you feel you have to go," he instructs the patient. "Now," she says. "OK-now I'm going to add more water and let me know when you feel you're about to burst." I pour in more water. (For the first patient, I used more than a pint--she had a very large bladder.)

NOW!!!!," cries the patient, and we stop pouring in the water. "Now, hold it, and get off the table," Dr. G tells the patient. She stands there on an absorbent pad while he gets down on the floor on his knees, sticks his hand up inside (it's sort of the milking-the-cow position) and jiggles her bladder to see how much leaks out. "Hmmmmmm" he says. Then he jiggles some more. The patient begins to look a bit green around the gills. Finally he sends her off to the bathroom to empty her bladder.

It's quite a sight, I have to admit. I've helped with a few of these now, and since women with bladder problems tend to be older, the procedure is usually done on a fairly reserved, dignified older woman. I'm sure my day will come (except that I don't expect to ever be reserved or dignified--just older).

And then there's the impressive sonohysterogram (and no, that's not a singing hysterogram!). This, near as I can tell, requires about 16 hands, all of them attached to the doctor and one very inexperienced office manager/janitor/medical assistant wannabe. All the paraphernalia is in play. Duck lips clamped (only this is the open-on-one-side kind. First you take a long metal thing and "grasp the cervix" so it doesn't move. Thread in an eency weency catheter, jiggle it around a bit while the patient grimaces and you insert some air to blow it up like a small balloon. Then to the catheter, add the wand from the ultrasound machine, so now you have tucked inside this little opening two ducklips, one catheter, one wand and a partridge in a pear tree. Now comes the multi-handed part. The doctor needs to inject some liquid (lidocaine, which, fortunately, is also a numbing agent, so the patient stops grimacing) and track its progress thru the uterus using the ultrasound machine. That requires two hands to draw the lidocaine into the needle, one hand for the ultrasound wand, and two hands to work the ultrasound machine. As he only has two hands, I am given directions and hope that I don't screw it up. We seem to have managed, but I felt about as competent as an elephant on a bicycle.