We entered the procedure room to find the final patient of the day, Ms. K, sitting upright on the examination table. She had already changed out of her own clothes and into the customary light blue patient gown, with a white sheet draped over her legs. Her manicured hands were clasped together, fingers wringing with uncertainty. “Hello, Ms. K,” my preceptor, Dr. L, greeted. “I have a medical student with me today. Are you comfortable with her observing your procedure?” Ms. K’s gaze shifted towards me, and after a moment of hesitation, she nodded slowly and said, “Sure. The more the merrier, I guess.” After thanking her, I gave my introduction, a routine practiced countless times during my two years of training.
My preceptor handed Ms. K two consent forms which clearly stated the risks and benefits of the procedure. I watched as Ms. K’s barely audible sighs accompanied the turn of each page as she read before eventually signing her consent. Soon after, we were joined by two nurses, bringing the room’s occupancy to a total of five. The procedure we were preparing to perform was an endometrial biopsy. Ms. K, a 58-year-old woman, had been experiencing postmenopausal vaginal bleeding for some time. In such cases, an endometrial biopsy is often an initial test for evaluation.
The procedure involves inserting a device into the uterus to collect samples to help determine the source of bleeding. Understandably, patients often find this procedure to be unpleasant and painful, which contributes to heightened levels of anxiety. Furthermore, the potential outcomes of the procedure only serve to worsen this anxiety. This wasn’t Ms. K’s first experience with the biopsy; she recounted her previous ordeal where inconclusive results left her disheartened and without answers. I understood her frustration at the entire situation, her escalating worry about her troubling symptoms, and her desperate need to finally have a diagnosis.
So did Dr. L, who gently held Ms. K’s hand and assured her that, while some discomfort was inevitable, she would do her best to minimize it. The reassurance brought a grateful, tearful nod from Ms. K, and the room’s atmosphere softened. The rest of us chimed in with words of encouragement, and I noticed Ms. K starting to feel more at ease. “Ok. I’m ready,” Ms. K said with a weak smile. While one nurse assisted Ms. K into the lithotomy position, the other organized the required instruments on a stainless steel tray. As the nurse explained the functions of the speculum, tenaculum forceps, Allis clamp, uterine dilators, and suction curette for my learning, I instinctively positioned myself to block Ms. K’s view of the instruments, fearing that seeing them would amplify her anxiety.
As we prepped, we engaged Ms. K in conversation about her background. We learned that she was born in the Caribbean. She spoke wistfully of the beauty of her homeland, painting vivid pictures of breathtaking beaches adorned with rolling waves and caressed by gentle breezes. She reminisced about cerulean skies and distant horizons that beckoned her each morning. Somehow, the conversation veered into light-hearted banter about handsome men from the islands, eliciting hearty laughter from all of us.
Her nostalgia momentarily distracted her from the impending procedure, but she was brought back to the present at the insertion of the speculum to visualize her cervix. She winced, a soft whimper escaping her lips. “Would you like one of us to hold your hand? You can squeeze tight if it hurts,” Dr. L offered. “Just try not to break our medical student’s arm,” a nurse quipped, and more laughter reverberated through the room with Ms. K joining in. In that room, where tension and camaraderie were intertwined with one patient at the heart of it all, I felt a strange sense of kinship among strangers. Once again in my training, I was reminded of how connections could be found in the most unexpected places.
Throughout the procedure, we continued to offer words of encouragement and lighten the mood with jokes. Ms. K kept her eyes tightly shut, breathing shallowly through pursed lips. Occasionally, a faint smile crossed her strained features. I wondered if behind her closed eyelids, she envisioned scenes of deep blue waters and golden sands from her childhood. When the procedure concluded, I bid farewell to Ms. K and made a mental note to follow up on the biopsy results. I hoped they would provide the answers she needed and bring her the relief she deserves.