Finding the courage to talk about cervical smears
Since the #MeToo campaign, I’ve been thinking about how sexual assault has an impact on women (and men) and something that I’ve thought about as a doctor, is how the trauma of sexual assault continues to have wide ranging impacts long after the actual assault. I’ve wondered how my own experience of sexual assault as a teenager has impacted on my decisions, my self-belief, and my ability to speak up and be courageous.
The last week of January (22-28th) is Cervical Cancer Prevention Week, and I’ve been wondering about all the women who might avoid attending for a cervical smear because they have experienced sexual assault in the past. I’ve always hated having cervical smears. I always felt that it was a test designed by men, and I have found it invasive, uncomfortable, and slightly humiliating. However I want to tell you about someone I met 18 years ago, who changed my view.
In 2000 I was working as a gynaecology doctor in a city hospital. One evening a woman in her early thirties arrived to be admitted to the ward. I greeted her and her husband. She had a lovely clear complexion, twinkly eyes and a sporty physique. Her husband was quietly supportive and polite. We chatted a bit – she was a climber, they had a 6 month old baby girl, he was clutching a file of letters. Despite their polite friendliness and the light hearted chat I could sense their underlying concern. They had been sent from a more rural area, quite some distance to travel.
That evening I heard her story. Her cervical smear had been slightly overdue when she fell pregnant, so she had been advised to postpone the smear and attend six months after her baby was born. Despite having had no previous problems, this time they found an abnormality on her cervix. It was at this point that she had mentioned to her GP that she had a small lump in her neck, something that had recently appeared, and hadn’t particularly worried her.
When I examined her I was shocked to find a large hard lump in her neck. This was why she had been sent to us. She needed an urgent MRI scan to assess the lump, but already I had a terrible feeling. The lump felt like stone – I knew that to have reached her neck, the cancer must have already spread throughout her body. The MRI scan the following day confirmed the awful truth. She had cervical cancer, so widespread that it was in her spine and major organs. No treatment was possible and she died just 3 weeks later.
I learned so much from caring for this young couple. It wouldn’t be an exaggeration to say that I found it traumatic, and to this day I still feel emotional writing about her. It was terrifying to see this young sporty woman become so ill, so quickly. For me personally the tragedy was more deeply felt because she was the same age as me, and because I couldn’t bear the idea of dying from cancer when I had a young baby. But even if she had been twenty years older than me, the tragedy wouldn’t have been any less. Once she realised she had widespread cancer, she was hit by pain and anguish, and it was terribly difficult to manage her symptoms. For several days she was so agitated that she required high doses of medication to ease her pain, but then she was too drowsy to hold her baby and we felt helpless seeing her struggle. I had long conversations with her husband and parents, who couldn’t grasp how this could be happening. It wasn’t the “done thing” but I wept a little with her parents and husband, just from a feeling of shared humanity, as we all struggled to manage the situation.
In the end it took the bravery of one doctor to change her medication to something more “risky” which gave her a full day of clarity and pain relief, enough to spend a few hours with her baby girl. She died peacefully the next day, and I vowed I would learn more about cancer and supporting families better. I have thought about her, and her husband and baby girl many times over the years. The baby will be an adult now, and will never know the huge impact her lovely Mum had on me.
After seeing what this couple went through I now view my cervical smear quite differently. It’s the best test we have currently. It’s the best chance we have of picking up early changes, before symptoms or before there is even cancer. I make sure that the GP knows I find the test difficult, so that I can breathe and take my time. I don’t feel apologetic for that. I hope that in the future we will find a better way to protect women from cervical cancer, or diagnose it earlier. And I hope that the #MeToo campaign will encourage more women to be open about having suffered a sexual assault in the past. Maybe it will also make some health professionals consider the reasons so many women feel anxious. Being anxious about a smear is quite understandable, and by talking about this openly, perhaps we can support each other to get it done. For me it has become a feminist issue: I’m getting my smear done on time, every time!