Like Jesus, I wept.

It was one of the few times I have wept over others’ misfortunes – especially my patients.

I went into a closet to weep very bitter tears.

The thought of others seeing me so heartbroken was unconscionable, one which I simply could not bear.

Why?

A nubile young woman had come into our service for a pre-surgical colonoscopy. She was unmarried, and nulliparous – had never borne children.

When one has a colonoscopy, the hospital gown is standard attire. Understandably, no undergarments are worn. Cardiac monitor leads are attached to the chest, and access to the colon is obtained via the anus. The patient is positioned on their left side, with legs slightly toward the chest, and knees flexed – as if you might sleep on your side. Typically, sedative-hynotic medications are employed to relax the patient, and induction into sleep is fairly rapid. Propofol is often used, though other combinations may be used, depending upon patient need, insurance payment requirements & physician choice.

The room is darkened to allow the video monitor screens to be more readily seen. That’s because the entire journey, from start to finish, is viewed upon a video monitor. Endoscopes are marvelous pieces of medical equipment. They are threaded into our bodies, around corners, over valleys, and through crevices. Imagine threading a garden hose from your front yard into your backyard garden from inside your living room. Now you have an idea of what’s going on. On the tip of the scope is a very bright LED light and camera lens to visualize the colon wall, and anatomical markers along the path to the cecum – where the small intestine empties into the colon (large intestine).

Naturally, examination of the patient’s body is important, and may reveal other associated, or underlying problems, and is an integral part of the procedure. Such examination may reveal external hemorrhoids, warts, other features or markers, or ancillary sociological and health-related clues… including signs of sexual abuse/trauma.

My presence had been requested if assistance was needed, so I was actively observing.

Appearing between her legs, around her genitalia was a rather large, protruding condyloma. It was quite visible because of it’s size – approximating that of a large cantaloupe.

The procedure was uneventful, and shortly afterward, I conferred with a colleague about details on the case.

The patient was scheduled to have a TPE – Total Pelvic Exenteration – the next day. TPE is not just major surgery – it is radical. Any time the bladder, complete reproductive system – uterus, ovaries, fallopian tubes, vagina – and portions of the colon are removed in one fell swoop, it’s radical.

She had advanced cervical cancer from HPV – Human Papilloma Virus – and every effort to save her life was going to be made. Tragedies like hers are preventable, and they’re complicated by the demons of low education, and poverty. But worse, they’re exacerbated by governors in states that refuse to Expand Medicaid. Often, one simply does not “go to the doctor” unless it’s already too late. By then, cases are where little can be done, except to “mop up.” Those whom claim to be physicians and governors who do not provide care only frustrate public health, but contribute to the demise of the people. There is reserved a special place in Hell for them, and others who do not care “for the least of these, My brethren.”

For her, TPE meant no possibility of sexual activity… ever.

For her, TPE meant pooping into a bag from a hole in her abdomen… for the rest of her life.

For her, TPE meant peeing into a bag from a hole in her abdomen… for the rest of her life.

For her, TPE meant continually purchasing gizmos and gadgets to care for the ostomies… for the rest of her life.

For her, TPE meant emotional upheaval.

For her, TPE meant social alienation and isolation.

For her, TPE meant the real possibility that she would forever remain unmarried.

For her, TPE meant her life – however brief it may be – was forever scarred by a failure of public health.

For her, TPE could mean depression, and possibly suicide.

For her, TPE meant living Hell.

I wept.