Listen to Your Body - Softcover

Niels H. Lauersen MD

Softcover

ISBN 10: 0425061566 ISBN 13: 9780425061565

Publisher: Berkley, 1983

A noted gynecologist offers comprehensive, easy-to-understand answers to hundreds of questions about women's bodies and health

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About the Author:

Niels Lauersen, M.D., Ph.D., is a noted women's health care physician and a world-renowned fertility expert.

Chapter 1: Becoming a Partner in Your Own Health Care

A Doctor Is Not a God

The doctor's phone was ringing, patients were flowing in and out of the waiting room, and the doorbell was being pressed once more. It was an afternoon filled with activity, charged by movement everywhere but within the doctor's inner office. There the bustle evaporated into quiet. Sunlight warmed the mahogany desk where the doctor, sitting with his patient, leaned forward to hear her words.

She was an articulate woman with self-assured eyes and an easy smile. Ten years before, when she was in her twenties, she had undergone an operation that she later learned was unnecessary. After that, she haunted the local library and voraciously read books about her body. She wanted to know what questions to ask whenever she had a quirk or an ailment, and she shopped for a doctor who, during a visit, would set aside time to listen and talk to her.

This resourceful woman became the rarest and best type of patient. No longer did she view the doctor as a god. Now she saw him as a partner, an educated mortal who would help her stay healthy. Calmly, she asked her doctor/partner the things she wanted to know about herself. As she spoke, she glanced toward her lap and a sheet of paper with her handwritten questions. She had learned to be relaxed, to use this mahogany desk as a bridge toward more information. And the doctor responded. His forward gesture diminished the distance between them and placed them in the throes of a new movement.

The beginning of a real partnership in health care is at hand. He is one of many competent doctors and leading physicians who are beginning to change, who are trying to talk to, and not at, their patients and listen to their complaints. She is among the growing number of women who are becoming extremely health conscious and well-informed, very sensitive to the signs from their bodies, and genuinely more expressive. The old doctor/patient relationship can be overthrown and replaced by the give-and-take understanding of people such as these who are committed to better health care for women. But the message must be allowed to spread through women's networks to every feeling person.

The thousands of letters I've received after my lectures and seminars on women's health care have shown me that when women dismissed what their intuitions told them about their own bodies and the treatments they were receiving, they were often left physically and mentally scarred. Discovering the despair that this lack of proper medical attention has caused has been heartbreaking. If women had been more informed about and more in tune with their bodies, many lives would have been free from anguish and changed for the good.

Until all doctors decide to descend from Olympus, women can receive the health care they deserve only by learning about the intricacies of their bodies, by beginning to trust their intuitions, and by becoming active partners in their own health care. When I heard Karen's story, a truly shocking event, I thought that no one incident could more clearly illustrate what happens when a partnership doesn't exist and a woman succumbs to fear, rejects her instinctive feelings, and becomes a victim of medical incompetency. If only she had listened to herself.

Karen's Story

Karen was half undressed. She had started to peel off her navy blue leotard when she glanced in the locker room mirror. Now, with the top of her leotard dangling around her waist, she stared at her familiar, naked breasts. Her nipples practically touched the glass as she leaned toward her reflection. She wasn't imagining the lump. There it sat, high on her left breast, parallel to her armpit and directly below her collarbone. She pressed it with the index and middle fingers of her right hand. It wasn't mushy, like some of the lumps she had felt before her period. It was hard, round, and small, like a medium-size cultured pearl.

Usually, after teaching two exercise classes, Karen's face flushed to a radiant crimson. Immobilized in front of the mirror, she watched that rosiness fade to the color of a blanched almond. My God, she thought, but before her nervousness over the lump could escalate, she was distracted by Emily's sliding grip on her leg. Karen bent down and collected the four-year-old into her arms.

Has it really been four years since I left the dance troupe? Karen wondered to herself. She had intended to return, but when Emily was born with Down's syndrome, Karen, who was only twenty-six at the time, decided to stay home with the child. The experts had said that Emily was educable, and Karen wanted to give her the time and attention she needed for learning. Emily was so good-natured and cuddly that Karen and her husband, Don, eventually nicknamed her Precious. She captivated everyone, including the owners of the health club where Karen had started to work. They even allowed Karen to bring her to exercise and yoga classes. Karen considered herself lucky. She kissed her daughter on the cheek and tickled her behind the ear.

After she lowered Emily to the floor, Karen yanked a sweater over her head and finished dressing. She tried not to think about the lump. She would make an appointment with her gynecologist, ask him to examine her. She pressed the lump again. She was sure she had never felt anything like it before.

Karen is a pseudonym for a real, concerned woman. Since Emily was born she has been especially careful about her health because she feels particularly protective toward her daughter. If anything happens to her, Karen feels, Emily would suffer her loss severely.

The essence of her story, which I have momentarily interrupted, is well known by women. Gynecologists have heard many patients describe medical problems which they had thought were either "nothing" or "trouble" at first. Then something happened. Women listened to their bodies, but after they visited doctors, they listened to their doctors and those early body signals were forgotten. The medical checks-and-balances system tilted. Karen's destiny would have been different had she held her locker room feelings, disturbing though they were, in her mind.

Karen sat at the edge of the table, raised her arms over her head, and watched her gynecologist frown as he felt the lump from every angle. She was a young woman with no history of breast cancer in her family, but she knew those facts wouldn't save her from the disease. She also knew that the nugget in her breast matched descriptions of breast cancer symptoms that she had already read about in magazines. She wasn't surprised when her gynecologist sent her to a surgeon named Fielding for an opinion.

Dr. Fielding told her to take off her blouse and lie on the table. He could be positively sure that the lump was a benign cyst if he could aspirate it, draw out liquid from it with a syringe. Karen felt that she must have reached the outer limits of her courage if she could remain motionless on a table while a man injected a needle into her breast. Nothing happened. No liquid surged up through the needle. "It's cancer, isn't it," she said to Dr. Fielding, whose face, from her vantage point on the table, looked like a Mount Rushmore carving. "No, now don't jump to conclusions," he said. He appeared to have enormous girth, and his voice seemed to resonate with a commanding timbre. Of course he's right. I'm jumping to conclusions, she thought to herself.

"Well, we'll have to watch it, but I don't think you have anything to worry about," Dr. Fielding told Karen as she, now fully dressed, sat in his office. She watched him pull out a sketch of a breast from his desk drawer, pencil in a circle where her lump was located, and put the paper into her file folder. He asked her to come back in a year, and at that moment Karen decided to bury her sense of foreboding.

She continued to teach her classes. She was a former dancer and a health culturist who knew her body so well she could predict the arrival of her period practically down to the hour. She was aware of the lump's presence. Still there? Yep, still there, she would say to herself. Once in a while, when Emily grabbed her breast in play, she would shiver a little. Then she would remind herself of Dr. Fielding's words. Nothing to worry about. For Emily's sake, there should be nothing to worry about. When she and Don made love and he caressed her breast and felt the lump, she would joke about it. "I'm providing a new diversion," she'd tell him, but he wouldn't laugh. He wanted her to see another doctor.

Twelve months after her final visit, she returned to Dr. Fielding. This time he didn't aspirate the lump. He just felt it, said it hadn't grown, and told her he'd see her in another year. So Karen never paused in her activities. When she wasn't doing leg lifts or demonstrating yoga breathing, she was singing Sesame Street songs to Emily.

During the holidays, Karen feasted a bit too heartily and gained five pounds, but she amazed herself by dieting and losing more than she had anticipated. Ten pounds disappeared in four weeks. She hadn't been so slim since her dancing days. She felt lithe and sexy. One night she and Don made love in that indescribable way only two people who know each other very well can share. But afterward he looked troubled. With his head on the pillow and his gaze toward the ceiling he said, "There's another lump. Lower this time." Karen's right hand went to her left breast and she felt it. Her weight loss had made the second lump obvious.

Dr. Fielding reassured her that the second lump was probably nothing to worry about either, but he might as well take it out. He performed a biopsy on Karen in the office. While he was operating he kept saying that the lumps looked like nothing more than "little fibrocystic tumors." "I'm only sending this to the lab for procedure's sake," he mumbled.

When Karen returned to have her stitches removed, Dr. Fielding was as even-tempered as ever. The last suture out, he told her the incision had healed beautifully. Then he walked to the sink behind her to wash his hands. As she was midway through buttoning her blouse, she realized that Dr. Fielding was talking to her. She could hardly hear him over the sound of running water. And he was facing the wall to boot. He was telling the wall something about "bad cells." He was soaping his hands and garbling the word masectomy.

"What?" she cried out.

And finally he turned off the faucets, pivoted around, and repeated himself. "The lab found some bad cells. I'm afraid that we'll have to schedule you for an operation to remove the rest of them. You'll have to have a masectomy," he said, and walked into his adjoining office.

Karen lay back on the table and cried. He hadn't even said cancer. Didn't he think she knew what she had? For almost two years she had been walking around with a fatal disease. Letting it spread. She could have died. Maybe she would die right now. Who would watch over Emily? What would Don do? Why hadn't she taken care of this sooner? Seen another doctor? Why had she believed this Dr. Fielding? That day in the locker room she'd known it was bad. She'd known, but she'd let a cloud of fear cover her perceptions.

Karen underwent a modified masectomy, including the removal of two positive lymph nodes. If she had received the right treatment sooner, there might not have been any lymph node involvement at all. But these days, two years after chemotherapy and radiation treatments, she's still a star instructor at the health club, a loving mother, and she's becoming an optimist again. She says she won't feel really super, though, until she passes the five-year mark. (Then, her survival rate will officially change, because the odds are good that cancer won't return after five disease-free years.)

At the time of her relationship with Dr. Fielding, Karen had been fearful of her body's basic warning: a visible, touchable lump. She chose to transform Dr. Fielding's words into sacred scripture, when her instincts had told her that this lump was definitely something to worry about. Right from the start, she had intuited bad news.

Karen's success as a dancer and as an exercise instructor depended upon her body's fitness. And like a broker evaluating the Dow Jones Index, she could gauge the importance of every little and big change in her body. She recognized when she should slow down and when she should push herself harder. She really hadn't needed a doctor to tell her that the lump was an ominous sign; she had seen a portent of illness in the locker room mirror.

On her first visit to Dr. Fielding, however, this remarkably aware woman suspended her awareness. After the aspiration episode, she suppressed the throbbing knowledge in her brain and clung to the words of an incompetent physician -- a man who knew less about her body than she did. She was understandably scared, but she allowed her fear to override her intelligence. In a moment that was crucial to her well-being, Karen relinquished her role as a partner in her own health care. She listened to and abided by one man's judgment. And by permitting Dr. Fielding to become a god of sorts, Karen set up that old-fashioned kind of doctor/patient relationship that continually blocks better health care. The meeting of a woman and her doctor should be a time for sharing.

Doctors aren't gods and women aren't really mystified by their bodies. Even the women who were relegated to menstrual huts once a month by horrified tribesmen, even they surely knew they were healthy. If Karen had relied on her instincts, she would have thought I need a second opinion when she heard Dr. Fielding tell her that she had nothing to worry about and that he didn't want to see her for a year. She would have sought the right kind of care and avoided two years of harboring dangerous cancer cells and unrelenting emotional strain.

Whenever Emily touched her breast, Karen had shivered not so much from pain as from fright. She was afraid that she would have to face what she knew was true. She didn't want her husband to talk about seeing another doctor. Yet if she had consulted a different physician, she might have stopped the disease at a less worrisome stage. Early on, another breast specialist could probably have performed a lumpectomy to remove the lump, and then a plastic surgeon could have corrected any disfigurement with reconstructive techniques. The cancer might have been halted without the need for a mastectomy and chemotherapy, and Karen might not be anxiously awaiting the fifth anniversary of her surgery.

It's tragic, but Karen suffered the all-too-common double misfortune of not heeding her body's messages and of encountering a man who didn't do his job. There were clear mistakes made by Dr. Fielding. Even if he thought the lump was benign, he should have explained fibrocystic breast disease to Karen and told her to monitor the lump at home. A fibrocystic breast lump would have been slightly painful to her touch, and after her next menstrual period it would have changed shape and become less sore. In fact, it might have diminished in size and comp...

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