Wednesday, April 29, 2009

Snuffed but not forgotten: Ignatius, the large, dead fibroid

After an MRI and a couple of weeks of indecision (fear), I scheduled a uterine fibroid embolization (UFE) for August 18, 2008. The target: an 11.7 cm by 16.2 cm by 13.9 cm fibroid dubbed Ignatius, perched like an conquering emperor atop my uterus—incidentally flattening my bladder into a pancake with a slight bulb at one end. If I seem to disappear into the ladies' room excessively, Ignatius is the cause. There isn't much bladder to my bladder.

The UFE went according to plan, although my system is still a little confused. I had spotting in January, light periods in February and March, and, to date, a delayed one in April—a delay which has made me feel lousy and in perpetual PMS mode, achy, tense, and cranky. Crankier than usual.

I've felt a little better since the UFE, but not dramatically so. I'm not surprised Ignatius didn't strike me as the type who would "go gentle into that good night." I was supposed to have a follow-up MRI in three months, but put it off until it was past eight months later, that is, until Tuesday, April 21, 2009. The question: How much had Ignatius shrunk without its blood supply?

I went to a different place at Northwestern Memorial Hospital than I had for the first MRI, and there was virtually no wait. The moment I'd completed the forms, I was called and shown where to disrobe by a no-nonsense, humor-impaired nurse. I'd barely touched the seat of a chair when I was called by the technician.

Before we could begin, she had to check my fit in the MRI equipment. I arranged my arms, the left one not too bent because of the IV, in the traditional pose of a corpse, she pushed the button, and in I slid.

Partway in the slab's movement stopped, leaving me nose to ceiling with the machine and nowhere to go.

I could feel my heart and breathing rates accelerating, as though gearing up for a full-blown panic attack. Once, many years ago, I'd had a closed MRI scan on my head (the problem: a persistent sun-induced migraine) and at first had thought it was not so bad. About 20–25 minutes into it, however, I realized how completely immobilized and trapped I was. It, too, was a tight fit, and it occurred to me that if an atomic bomb fell, I did not have enough leverage to get myself out without help. Suddenly, it wasn't so easy to breathe deeply.

You must admit that, despite the irrationality of the idea I'd survive a nuclear weapon attack only to die trapped in an MRI scanner, at least I was practical about my lack of means of escape.

At this point in my reminiscence, the technician, as though reading my mind, assured me that my head would be out (partly, as it turned out—I was still nose to ceiling with the tube, but if I rolled my eyes up I could see the room behind me. She backed me out, fitted me with hip pads, fussed some more, and put me back in.

Previously, I'd been given orders not to breathe/to breathe through noise-blocking headphones, which worked well. This time, however, I was given earplugs to block the noise. I didn't breathe or not breathe on command, however, although I thought I was following her muffled instructions pretty well. Surprised that she hadn't noticed how many times I had asked her to repeat herself (which she may be used to, as English is not her first language), I told her that I'm hard of hearing. At that, she left the earplugs hanging uselessly and most uncomfortably out of my ears; still, they didn't cause nearly the discomfort that the wedgie I'd managed to give myself just before I had come into the room.

And so I spent approximately 30 minutes trying to ignore the wedgie and to breathe in and out on demand. At one point the technician backed me out again to have me center myself better, but on the whole I thought it went well.

She had a different opinion, which I soon heard about.

The moment she retrieved me, she began to berate me for not requesting the larger MRI scanner. (Honest, I don't not do these things on purpose.) With the smaller scanner, it took longer, she said, and it was harder on me and on her. She told me the name of the machine to ask for. As if I had not gotten the point the first time, she told me a dozen more. When she returned me to the no-nonsense nurse, she said the same thing to her a half dozen times (the nurse: "Oh . . . hmmm."), then she wrote the name of the machine on my paperwork, lest I forget.

I had a distinct sense of, "I don't ever want to see you at my machine again [until you've lost 100 pounds]."

Of course, I'd like not to have any more MRI scans, which would solve her problem and mine.

After getting dressed (an important step given the that the next stop was at another building), I wandered over to Doctor Atomic's area, where I picked up a pager and sat in an area where I was the only woman among the middle-aged men. One flipped his way through a selection of reading materials from his briefcase—the Financial Times, Fortune, Money. I wanted to ask, "Say, you don't happen to have Scientific American, National Geographic, or the Utne Reader in there, do you?"

Soon an elderly woman came along and asked a more casually dressed man if she could sit next to him. He agreed warmly, but returned to his own reading even as she tried to strike up a conversation. She asked him how long he'd been waiting and mentioned that she lives nearby. After she finished a cup of coffee, she asked him where she could throw it out, and he gallantly took care of it for her just before he was called in. After that, whenever she heard a pager, or a staff person came to the door, she thought it must be her turn. When they called a nonfunctional pager number, she struggled to read hers. just in case And, wouldn't you know it, she did have one of the nonfunctional pagers. A number was called, and she had to ask if it was hers. She reminded me a little of my dad in his old age, when he thought always that he must be next. I used to think it was a form of self-centeredness peculiar to the very young and very old, but now, especially since I've lost some hearing ability, I wonder if some of it is simply compensation for sensory deficits—you can't hear and can't see well, so you worry that they called you or buzzed or lit up your pager and you missed it. That, combined with heightened respect for time, can make elders seem impatient. We all have to be mindful of how we interpret and judge the actions of others.

My pager buzzed next, and I left [soldier of] Fortune to his capitalist dreams (there I go, interpreting and judging). I talked to the nurse for a bit, then waited for Doctor Atomic. I'd met him twice before, the day we discussed my previous MRI images and the day after the UFE, when he came in with a resident to make sure I was still breathing and resting uncomfortably. When he arrived this day, he shook my hand and methodically went through my symptoms, some of which I didn't remember. Frequent urination—mildly improved. Bulk feeling—mildly improved. Lower back pain—mildly improved. Bloating and gas—wait, had I said that? I must have. By now, I was feeling badly that the procedure didn't appear to have been a resounding success, so I assured him that the symptoms I couldn't remember were much improved.

We turned to the before/after images. Seen at a comparable angle, Ignatius has shrunk from 13 centimeters to 12 centimeters, or just one centimeter. It's still large. It's still making a pancake of my bladder. But, as Doctor Atomic noted, we'd done what we wanted to do—we'd killed it. It's just a solid gray mass on the screen, with no blood supply. It's dead, Jim.

Now I have two alternatives, which means I have only one as a hysterectomy short of malignancy is not an option for me. The other, Doctor Atomic suggested, is a laparoscopic myomectomy, in which Ignatius's remains would be cut up and removed laparoscopically. Because of my weight, an abdominal myomectomy isn't a good option. Doctor Atomic said he would consult with Dr. M, a gynecologist, and let me know if he thought the laparoscopic approach might work for me.

And so on Monday, the 27th, Doctor Atomic called to tell me that Dr. M had seen my images (now there are two men who have been exposed to the more elusive bits of my reproductive system), and he thinks a laparoscopic myomectomy would do the trick for me. Yesterday I called Dr. M's office and made an appointment for June 16.

Truth to tell, I'm less nervous now about another procedure than I am about taking another two-week medical leave in this unforgiving economy and environment. You might think that, in troubled times, people would be more supportive—after all, we're under the same pressures in the same leaky boat. Difficulty can bring out the best in people, but I'm also seeing how it can bring out some undesirable qualities, too—including defensiveness and inappropriate competitiveness. Two weeks of leave may open the door further to attack, and who knows what I will find when I return?

Why do I get the feeling the late, unlamented Ignatius is laughing at me even as its remains weigh heavily upon my mind—and my bladder?


  1. As a guy, I feel funny commenting here, but I'd feel like a heel reading and saying nothing. I hope all goes well for you, Diane. We're lucky to be living with laparoscopy.

  2. Thanks, Michael. It's not serious. I'm being a drama queen for no reason (no good reason). I do feel lousy lately, though.