"I have never seen anything like this in my medical career."
This was not a reassuring comment.
"The MRI machine is free at 11am. Can you go then?"
Neither was that. Especially since I had only dropped into the women's clinic for a routine pap smear.
One of the big advantages of moving from Sapporo (in the north of Japan) to the capital in Tokyo was the access to services in English. The gynecologist I had previously seen in Sapporo had actually trained in Hawaii and spoke excellent English. However, the clinic operated in Japanese, meaning that I had to book my appointments in the native language. This wasn't too much of a problem if I was there in person and could supplement my rudimentary linguistic skills with pleading expressions and gestures at the appropriate box on a calendar, but calling on the phone to reschedule an appointment wasn't happening. This was an issue as the doctor was only available on weekdays where work could easily interfer, and she insisted on seeing me every three months if I wished to stay on the contraceptive pill.
(Since I had been on the pill almost continuously from the age of 16, I once suggested that perhaps I could come less often for check-ups. Not only was I roundly rebuked for such an impertinent suggestion, she brought the subject up for an additional round of scolding every time I visited for the next year.)
This had eventually become such a hassle that I decided to stop taking the pill. Remember this fact: it's about to become an important plot point.
Nearly three years had passed since I'd last visited a gynecologist, which made me due for the standard cervical screening test in the estimation of all the countries I'd ever lived in. In addition (and I have to admit, more poignantly) I was having problems. The muscular cramps associated with my menstrual cycle had been steadily increasing since I stopped taking the pill. My cycle was regular, but I had to endure two days of genuinely not feeling well. It was a time period long enough that I swore every month I would go back to the clinic, but short enough that it was promptly overwhelmed by my dislike of telephones once it was over.
However, I'd finally booked an appointment at a bilingual clinic in Omotesando in Tokyo. Both the doctors and receptionists spoke English and they even had appointments on Saturdays. I'd had the pap smear and --as was the way in Japanese clinics-- the doctor had swooped in for a transvaginal ultrasound, which is where the ultrasound wand goes up ... well. You can guess.
This was the point where I got packed off for the MRI.
"I'm due to fly to the USA next weekend for a two week trip," I told the doctor. "Should I consider cancelling?"
While the MRI machine was available on a Saturday, the radiologist would not be in to analyse the results until Monday. Then my gynecologist wouldn't be in until the following week. Combined with my own travels, this would mean it would be three weeks before I could receive my results and take any necessary action.
It would be a big disappointment to forgo the trip but somethings can't be helped. LIKE WHEN YOUR GYNECOLOGIST HAS NEVER SEEN ANYTHING LIKE YOUR UTERUS.
"No, no." I was reassured. "We can meet when you come back."
It was about 10am, so I stepped outside and into the next door 'Mos Burger'; a Japanese fast food chain, and ordered a packet of onion rings. If I was taking this all rather calmly it was because I --unlike the clinic-- was working with a knowledge of my medical history.
I had suffered from fairly debilitating menstrual cramps since my cycle had started when I was 13 years old. I was moved through a range of different and ineffective pain killers until I was 16, whereupon the doctor prescribed the contraceptive pill. (Because naturally, taking this at 15 would have made me dash off for copious doses of underage sex.)
After a few months, this solved the problem and I more-or-less stayed on the pill until about three years ago. I had stopped taking it a couple of times prior to this, but the same pattern had always occurred: everything was fine at first, but the pain each month would steadily increase until I thought "F*** this" and would go back to the doctor. These attempts had only lasted one year. This one had gone on longer either because the degree of hassle for prescriptions was so much greater in Japan, or I was just less prepared to take shit from anyone in my 30s, even myself.
The bottom line was that I knew something was wonky. My best guess, based on my doctorate in astrophysics and wikipedia, was endometriosis: a condition that affects the lining of the uterus. The symptoms were heavy bleeding and pain that fitted the description I volunteered to the cat and paintwork each month. There was even a possible link with IBS (irritable bowel syndrome) which I also suffered from.
My suspicion was that the diagnosis had been overlooked because being on the pill masqueraded the symptoms. The only times it would have been visible was when I was not taking the medication. Initially, tests such as transvaginal ultrasounds were avoided because I was so young. Later, no questions were asked: with the pill being mainly used as a contraceptive, there was no hesitation in offering it to me when I complained of cramps.
So here's the rub: if you suffer from a condition that many other people get in a mild form, it's very hard to convince anyone your symptoms are atypical.
I would have passed all this information on (perhaps with the exception of my expert self-diagnosis) to the clinic but oddly, there'd been no opportunity. The brief questionnaire I'd filled in before my appointment had asked only about medication and major operations. After that, nobody brought it up. Perhaps it ruined the fun.
Unlike the MRI I'd had for my head, the scan at 11am would be a body MRI. Upon returning to the clinic, I was passed a thin yukata (like a cotton bathrobe) to put on instead of my clothes, with strict instructions not to be modest and try and keep my bra on: the metal would make me regret my life choices.
The medic who put me through the MRI was friendly but spoke little English. This made it slightly disconcerting when I was bodily strapped down to the bed before being fed feet first into the cylindrical chamber. I hope never to experience what cremation would be like, but if I were to make a guess...
The scan took about 20 minutes. I closed my eyes, listened to the throbbing clicks and bangs through my earmuffs and tried not to breathe too deeply incase it moved key internal bits around.
Three weeks later, I was presented with the results on a CD.
"Endometriosis," the doctor told me. "More precisely, adenomyosis."
FEAR MY MEDICAL DIAGNOSIS SKILLS! I felt fully ready to sign myself up as an extra on 'House'.
The doctor put down his notes. "It's not cancer. I am very relieved."
WELL YOU KEPT THAT OPTION TO YOURSELF WHEN YOU TOLD ME TO GO SWAN OFF TO THE USA!
I'm hoping this was because the MRI was checked on the Monday by the radiologist and a phone call could have caught me before I left. As opposed to a thought of 'Oh poor soul, let her enjoy a last trip!'
"Going on the contraceptive pill will treat the issue. But remember..." the doctor eyed me across the desk. "You're taking this for medical reasons, not as a contraceptive."
The message was clear: stop quitting because you can't be bothered to get your backside to the clinic.
"Uh, yes," I promised dutifully. "Is there anything else I can do to help ease the condition?"
If there has to be pain and crying in my life, I'd rather it was restricted to a few days a month and done by me.
"How many months prescription can I request?" I asked, bracing myself for another lecture about coming in regularly.
"As many as you like."
... Uh. How many months until I'm likely to hit the menopause? That seemed a question that would lead to a lecture.
"... One year?" I asked experimentally.
I started to feel I was going to get on well with this clinic. The MRI CD will make a variation on the essential sharing of holiday snapshots.