Sunday, December 6, 2009

Small Matters of Life and Death: An American Euphemism

The American Euphemism is an unnoticed art form except of course if, like me, you hail from a part of the world where blunt speech, unfettered sarcasm, and the art of the clever put down is as much practiced as the American Euphemism(AE). The AE has become more than a form of speech, it has entered American culture and cloaks all manner of bad news, human foibles, bodily functions and mannerisms, not to mention life as it really is.

The AE is what enables military commanders to consider the hundreds of thousands of civilian deaths in Iraq and Afghanistan to be collateral damage. It's what helps many Americans, particularly the congressional hawks, to overlook the 4327 deaths of soldiers in the wars in these countries. It is what allows health care panels to overlook the estimated 47,000 women who would die from breast cancer if they did not get a mammogram before the age of 50. It is what is killing the possibility of health care reform. The AE can be a deadly partner, it provides us all with a means for bypassing whatever we have determined to be ugly, unwanted, and terrifying.

The American Euphemism, however, gets unloosed from its deferential moorings with a rapid jerking motion when opportunity knocks - not necessarily opportunity for the greater good, but opportunity for self aggrandizement. When Terri Schiavo's husband wanted to end her life with some quiet dignity, all manner of euphemisms were ripped from hospital protocols, ethical conduct, political process, and especially from good manners. We were subjected to hellfire and brimstone rhetoric that seared the airwaves and the interiors of churches alike. There is no holding back when a political agenda is being waved alongside a flag. The AE is a resilient but high maintenance creature.

I find myself asking questions that challenge the AE simply because I can see through its veil of obscurity a little more easily given my no bullshit upbringing in New Zealand. Sitting in a new-to-me doctor’s office one Saturday morning recently I found myself asking questions that often appear in some form that contains the word man and a downturn of my mood.

“Would a man put up with this? Would a man even be asked to put up with this? How long would a man wait?”

I am sitting in the first of what would be many waiting rooms. The chairs are the same as the chairs I see in doctors’ offices and banks. They have been constructed so the back lines up exactly with the wall and the seat comes out at a right angle. They take up the minimum amount of room and appear as if they would be comfortable. But, the body does not recline well at ninety degree angles and it takes less than five minutes before the extreme discomfort of the chairs cracks through the fa├žade of comfort. There is only one other woman waiting in the small pleasantly nondescript room. I give my information to the receptionist and am given the inevitable forms-on-a-clipboard to complete as a first time patient.

By the time I have completed the forms a young couple have entered the waiting room. He is carrying several large manila envelopes, one about the size of an x-ray. He is tall and blonde, dressed like a professional on his way to work on this Saturday morning. She is of Asian heritage, unexpectedly tall, attractive, a pleasing open face. They sit quietly not talking. He looks at the nondescript wall. Perhaps he is trying to find a name for the orangey, mustard, tan, yellowish wall color. Another woman goes to the receptionist. I pick up a magazine. A woman bustles into the office. She looks like a woman on a mission. She is clearly bald under her pink headscarf. She goes through a door to the left of the receptionist.

I remind myself that this is an obstetric oncology office.

The young couple are called through. They disappear wordlessly through a door, manila envelopes clutched under the tall blonde man’s arm. The other women in the office are called through. I focus on “Everyday with Rachel Ray.” It is the only magazine there of any interest to me any more. My days of being interested in “Parenting” or “Family Fun” are gone. I pass over “The Working Mother,” which I first remember encountering as no more than a two page pamphlet. What mother isn’t working I wonder. There was once a time when I wanted to write for “The Working Mother,” I thought I had plenty to tell them about being a single mother in America, but I was too busy.

A cheery looking woman appears from one of the doors. She explains to me that they are not having people bump me from my turn for some reason or other that sounds convoluted and unnecessary. The door closes. A prim looking older woman enters the office. She too is given the forms-on-a-clipboard. She sits stiffly, well forward of the ninety degree angle, carefully completing the form, face pinched in concentration. My name is called. An elderly woman who rests her weight on the sturdy walking cane escorts me slowly to the scales and weighs and measures me. She escorts me to another waiting room and informs me that someone will be there soon to get me.

The young couple sit on one side of the room. He is staring at yet another wall. It’s a different color of nondescript. There is a bookshelf with an assortment of brightly colored glass globes in one corner. Beside it, firmly fastened to the wall is a double row of brochure holders. The brochures are all soothing shades of blue and white with titles that no-one wants to open. She smiles across the short space of the room at me. I smile back. The stack of manila envelopes is on the table between us, on top of the few magazines. All “Parenting” and “Family Fun.” I make a quick exit back to the original waiting room to retrieve my “Everyday with Rachel Ray.”

The young couple is collected by a cheery woman who leads them into the labyrinth of hallways, examining rooms, and waiting rooms. He picks up the envelopes. I wonder if perhaps they are his x-rays and results. Do men go to see an obstetric oncologist? I remember many years before when my husband took our nearly three-year old son to the obstetrician in Northern Cyprus where we lived. My son had slipped in the bath and cracked his chin open. The obstetrician was the only doctor available to stitch up his chin. In the process he sprayed the wound with a topical analgesic to which my son was apparently allergic. By the time I arrived home several days later my son’s face was one enormous brown scab from beneath his chin to just under his eyes. More tender than a woman’s perineum.

Cheery woman is back. She escorts me to an office where I am informed that someone or other will be right with me. Cheery woman number two, who is nearly indistinguishable from cheery woman number one, appears. She doesn’t have what she needs so leaves me to inspect the very small office. The desk is huge. It takes up most of the space. The uncomfortable padded chairs with arms have been replaced by equally uncomfortable padded chairs without arms. There are three of them lined up against the wall mere inches from the edge of the huge desk. To the left of the desk there is a large door. It is a pleasant light smoky color and I wonder what kind of veneer it is, maple or sycamore. I guess that it is the mandated handicapped accessible door to a bathroom. I note that there is no way a wheelchair will make it to the door without removing the desk, the three uncomfortable chairs and probably part of the wall.

Cheery woman number one informs me that she needs to ask me questions about my medical history and that these are questions they ask all incoming patients. I am not to be alarmed. These are questions difficult to couch in AE. They have to ask if anyone in the family has ever had breast cancer, colon cancer, ovarian cancer – all big killers. She takes a phone call part way through our question and answer session. She informs me that an examining room is free so we are going to get through the remainder of the questions as quickly as possible. When discussing the history of life and death matters on a leash shortened by time requirements, there is no room for AE. This is where reality is unadorned by veneers and padding.

I am led to an examining room with the inevitable table with clean paper and stirrups. Cheery woman takes my blood pressure. It is unremarkable but I tell her it is high for me.

“Probably the visit. We tend to have that effect on people.” Somehow I am not reassured. I am given my instructions.

“Everything off. Gown on with the opening in front. The doctor will be in in a minute.”

I do as instructed and sit in the chair rather than the paper covered table. There are no magazines. There are no brochures. There is no piped music. There is no clock but I know that way more than a minute has passed. I am left with my fears and morbid anticipation and the table with stirrups. The minute stretches, pulls, and warps around my left ovary and its unwanted visitor.

Finally the door opens. Cheery woman enters and slides to the side. A small middle- aged man in pale blue surgical scrubs enters. He snaps a salute at me and announces his name. He looks and sounds for all the world like Harry Morgan as Colonel Potter in M*A*S*H. I smile and instantly like him.

He is pleasant, brusquely efficient, and wastes no time with pleasantries. This is not a man who deals in AE in the examining room. He is clearly a man who has palpated thousands of women’s breasts, poked his fingers into their orifices, and searched for the fearful things lurking inside their bodies. His manner tells me one of two things; he has come to respect that women are far stronger than cultural propaganda and AE will admit or he doesn’t care about women’s strength and is there to find what is killing them. Either way, I find myself becoming willing to accept him as my doctor.

The examination is brief. I am instructed to change back into my clothing and go to the waiting room at the end of the hallway. As usual after an internal examination, I want to take a shower. I wonder again at the American lack of acceptance of such non-euphemistic appliances as bidets. A bidet for every table with stirrups. I adjust my clothing around my discomfort and open the door. Which hall, which way? I am directed down the hall to my right. The waiting room is not so much a room as a cul-de-sac at the confluence of two hallways. Several women are seated in the area. I recognize one woman from the first waiting room. Another is reading a book. A third has the only magazine in the space. There are no brochures. The lamp lighting reflects off the gray textured wall with barely distinguishable multi-colored flecks.

We wait. We wait with our thoughts and the Georgia O’Keefe print on the wall. Down the hall the door opens and the attractive Asian woman and her nervous husband appear with Colonel Potter. He talks to her. She talks back, earnestly and carefully. The husband says nothing. He still carries the envelopes. They leave and Colonel Potter approaches us.

“Who’s next?” He is cheerful, comfortable in his own skin and blue scrubs.

A man joins us in the waiting room. He is clearly on his own. Apparently a man would be asked to wait. Apparently men do visit obstetric oncologists.

“ We just seem to go from one waiting room to the next.” He is not complaining, just making an observation. The conversation with the woman reading a book is brief. The door opens again; the “next” woman was apparently in the wrong waiting room. Cheery woman is escorting her down the hall having a conversation over her shoulder with her. Colonel Potter waits for us to determine who is next. We know, he knows we know; he lets us choose. The woman with the magazine gets up. I put down my notes and pounce on the discarded magazine. Underneath it I notice what looks like a cell phone on the side table.

I bury my head in the Family Journal. The man and the woman with the book have begun a conversation about the new hospital being built behind the center. I don’t live in the area. I have nothing to contribute to the conversation. The tall blonde man with the manila envelopes hurries around the corner. He stretches out a long arm for the cell phone. I smile at him.

“I wondered if that was someone’s phone left behind.” Could I be any more inane? He looks at me directly. His eyes are the palest blue I have ever seen. He is handsome in an incredibly blonde, chiseled, Scandinavian way. His serious face looks relieved just for an instant. For this moment he is reaching for something he wants. For this moment he doesn’t have to think about what is inside the manila envelopes or his wife. He smiles back at me, scoops up the phone and leaves. The American Euphemism has its small moments of usefulness.