I finally went to the OB-GYN last week. I hadn’t been since my post-partum check up, six weeks after my daughter was born. That was four years ago. The CNM scrunched up her face when I told her. “You haven’t had any lady care for four years?”
It pisses me off that people are often blasé about the fact that men in their twenties and thirties go to the doctor pretty much never but women who don’t go the the OB-GYN every year are seen as irresponsible. “I thought the USPSTF changed the recommendation for pap screening from one to three years?” It was half question, half half-hearted explanation. That wasn’t why I hadn’t been in, but it made me feel better. “Plus, I’m not on birth control,” I added, realizing I hadn’t adequately justified my hiatus from reproductive health. That one hit a little closer to the truth of the matter. I stopped taking hormonal birth control the year before I got pregnant and never went back on, and absolutely relished the freedom. Yes, I realize that the pill that tied me to a doctor and flatlined my sex drive is the same one that liberated me and millions of other women. I can hold onto both of these truths at the same time. The CNM tucked her leg up onto the chair, tucked a chunk of pink hair behind her ear, chiding me quietly as she pulled up a new chart: “That may be, but you still need exams.”
It’s not like I’d been neglecting my health. I am in tune with my body to an almost freakish degree and I love medicine of both the Eastern and Western variety. Almost as soon as I went back to work after maternity leave, my stress-induced TMJ flared up. I tried acupuncture first, but it didn’t do enough to justify ducking out of work for an hour at a time, so I turned to an internist who was so cute I decided he would be my first-ever adult primary care physician. What I wanted was painkillers. What I got was a referral for PT that ended up being exorbitantly expensive and inordinately time-consuming and not covered by my insurance.
Later that year, I went back to the internist about a strange rash. I made big plans to tell him about my anxiety, too, but couldn’t find the words. I’d never told anybody how my chest tightened up every day when I left the office, or how my stomach roiled before I left the house. Was that anxiety? Was it bad enough to warrant medication or did I just want to get high? What I wanted was to get the ball rolling toward a prescription for Xanax. What I got was a diagnosis of stress-induced eczema.
A few months after that I huffed a chemical inhalant in the middle of my work day. I think the high lasted a few hours but it was hard to tell when it wore off because my head didn’t come back to my body. I remained in a dissociative state that the internet told me was called depersonalization for six days. I remembered that I had a primary care doctor and called his office to beg for an appointment. A different doctor in the same practice group squeezed me in. “Are you under a lot of stress?” he asked, shining a light into my eyes. I nodded. He asked me to turn my head from side to side. “Do you find yourself crying?” “Mhm.” My eyes welled up. What I wanted was somebody to tell me I didn’t have brain damage. What I got was instructions to come back for a full blood workup the next week.
I went to a therapist instead.
I went through a round of CBT.
I got back to running.
In short, I started to get right mentally, physically, and spiritually.
Nine months after I quit drinking, I ran a marathon. A particularly severe bout of post-race tendonitis drove me back to the primary care physician. I’d sustained enough strains and sprains in my two decades as a runner to know that ice and rest would do the trick, but the pain in my hip was bad enough that I figured I could benefit from talking to a physical therapist who specialized in running injuries. Of course, I never would have booked the appointment if I didn’t think I there was a chance I could also get drugs. In the few minutes it took to schedule an appointment online, the pink cloud that had been carrying me for months dissipated. I went from happy sober person, chirping away in meetings about how great it felt to be so present for my family during the holidays to walking zombie. I went from wanting to get better quickly to hoping for something serious–a fracture or a tear. I didn’t think about calling my sponsor. I didn’t think about what I’d do when the pills ran out. I couldn’t think about anything but the possibility of getting high again. I obsessed about what I needed to do to make it happen. The next day, I hobbled to the office and told the doctor with a straight face that the pain was an eight. I told him I could barely walk. I got him worried enough that he wrote out an order for an x-ray, which is when I knew the jig was up because there was a minuscule chance I might be pregnant that I couldn’t ignore, given how long my husband and I had been trying to have a second kid. The doctor sent me home with no x-ray, no drugs, and prescription for ice and rest. “Come back if it still hurts when you get your period.” Fuck.
Once you’ve developed a taste for pharmaceuticals, every doctor’s office is a street corner, every appointment a seedy transaction, every honest ailment immediately supplanted by symptoms of the most plausible path to opiate relief. And when you are sober, every ache is an invitation to go back out. It’s easy to pretend you’re not flirting with relapse because sometimes people need medicine. With my history, the question of how prescription drugs fit into sobriety should be black and white but when I try to hold a picture of my sober life still in my head, there is so much blank space I start filling in the gaps with gray. Of course, most doctors aren’t handing out controlled substances like candy anymore. When you are an ex-pillhead, that almost doesn’t matter. The possibility alone is enough to throw you off course. It’s easier to avoid doctors altogether.
So that’s why I haven’t been to OB-GYN. I can’t trust myself to go in for a pap smear and not drum up enough undiagnosable premenstrual pain to walk out with a low-grade narcotic that will start the slow unspooling of my life. If you jump through enough hoops, the drugs will come. That’s how, last month, I ended up driving myself away from the hospital at 2 AM on a Sunday with a clean bill of health and a unnecessary prescription for Norco tucked in my bag, mind racing with thoughts like:
“A tranvaginal ultrasound is a steep price to pay for a week’s worth of pills;” and
“I guess nobody ever accused a junkie of driving a hard bargain;” and, most importantly,
“What the fuck am I going to do when these pills run out?”
The next 24 hours were mental torture. I had drugs, but I also had a head full of AA, which means I am utterly incapable of convincing myself that taking even one pill (or drink) is not a big deal. I know where one pill (or drink) goes. I’ve been there before and it’s hell. There is no easy way back if you even get a chance to come back.
Of course I was going to fill the prescription anyway. I went to four pharmacies that day. One rejected my (extremely common and accepted everywhere) insurance. The other three were closed, two of them within thirty minutes of me showing up. By 8 PM I had nowhere to go but my usual Sunday night candlelight meeting. Somebody said something about their daughter and I remembered (for the first time in days) that mine was turning four soon and that if I took those pills, I’d be drinking or using or withdrawing on her birthday. I knew enough about myself to know there was simply no way I would not be a fucking mess. I went home knowing what I had to do, knowing exactly how good I would feel when I did it, but still unwilling. The next morning I woke up early and, without giving myself time to think the decision through, turned on the stove and stuck my hand with the paper prescription into the burner. The night before, a doctor friend had told me to just rip it up, which I guess would have done the trick, but I needed this thing gone. The burn was not clean; I was.
The unexplained pain that had precipiated my ER visit disappeared that day.
I kept the OB-GYN appointment I had scheduled a few days earlier anyway. I’ve been trying to have another baby for two years and have reached the point that I can’t pretend doctors don’t exist. The CNM asked me questions as she filled in my chart. “What was the first day of your last period?” “How many days is your cycle?” “Do you drink?”
I looked up from the paperwork I was working on and looked her in the eye and told her what I’ve before never told a medical professional because I was not willing to burn bridges I might want to cross later: “No. I haven’t had a drink since January 30, 2016. I have a history of substance abuse, mostly painkillers and weed. I can’t mess around with that stuff.”
“Congratulations!” she said.
When I left, I felt relieved. Not because I think I am finally going to get pregnant but because I finally have a doctor I can go back to without tearing open my old wounds.