Testing, Testing: The HSG

I have some good news and bad news about my hysterosalpingogram (HSG) test.

The good: my fallopian tubes and what they could see of my uterus look clear and unblocked.

The bad: it hurt like a motherfucker to find this out.

If you are scheduled to have an HSG and are reading this, know that it was the speculum used, and not the test itself, that caused me so much pain.

My HSG was yesterday, rescheduled from Monday when the radiologist told me I had too much dye from an earlier CT scan still in my body. Once again, I downed 800 mg of Advil an hour before the test, left the office to get to the hospital in time, and signed in at the front desk. The receptionist nodded at me.

"You were here the other day?" he asked.

"Yep, they had to reschedule the test."

He gave me two johnnies to change into, but when I got into the changing room, I realized he'd given me one gown and one pair of pants. Considering that this test has you lying in stirrups like a typical gyno exam, I knew the pants would only get in the way. But these hospital johnnies require an advanced degree to figure out how to wear one without having it fall open in the front, or have your ass hanging out if you're wearing it backwards. Typically, they give you two to wear: one forwards and one backwards, and it's like wearing a loose nightgown: shapeless but comfy.

With only one johnnie, I tied some oddly-placed ties as best I could, then held my winter coat in front of me to try to avoid inadvertently flashing anyone in the waiting area.

A nurse I'll call Seattle came to get me and brought me to the same testing room I'd been in two days before. We went over an explanation of the test, what brought me here, and a few other details. I pointed out that I'd been here two days before, that I had an insulin pump that I needed to clip out of the way, and asked if I could take more Advil.

"800 milligrams should be plenty," she said. "Some people don't experience any discomfort during the procedure, but others do."

(I am no medical professional, but this is my recollection of the test. For legal and any other purposes, my description only constitutes my experience and shouldn't be considered a doc's opinion or advice).

During the test, the patient lies on her back with her legs up not in stirrups, but in braces that hold your legs up, but let you bend at the knee so your feet hang down. A speculum is inserted so the doctor can see a clear path to the cervix. Once sighted, a small tube is inserted through the cervix and a small balloon is inflated, opening the area up. The doctor then injects a small amount of dye through the cervix to see if there are any obstructions in the fallopian tubes or at the first part of the uterus. They say the patient may experience cramping during the test or afterwards, and that infection or bleeding is a side effect. I signed a consent form for this procedure.

Besides nurse Seattle, I had a woman I'll call Barbados sitting in on my procedure. It was her first day training to be a medical assistant. I also had Dr. Radiology Fellow, a small woman with a cold-fish handshake, and Dr. Radiology Resident, a guy with glasses. Fellow and Resident were the same from Monday's aborted procedure.

"You're back again? I thought it was too late in your cycle," said Resident.

"My IVF doctor said day 11 of my cycle was fine," I replied.

Resident again had the same limp handshake. And again, she did an initial X-ray to see if there was still dye in my body. There was. It looked the same as the x-ray from two days prior. In fact, said Resident, it looked more concentrated than Monday's test because I had had a lot more water in my body that day.

Not again.

The radiologists consulted with the Attending, more senior radiologist outside of the test room, and decided to call Dr. IVF himself to ask whether it was worth it to continue the test, considering it was day 11 of the cycle, this was my second attempt, and I was lying there on the table ready to go.

During that time, I chatted with Seattle and Barbados.

Finally, Fellow and Resident came in and said Dr. IVF gave the go-ahead for the test, saying to just forge on and hopefully, the dye wouldn't get in the way.

Seattle positioned me on the table, and Fellow instructed me to keep my pelvis down, my legs opened wider, and my knees down while she inserted a speculum. Gyno tests have never been comfortable for me, so I clutched Seattle's hand with the first attempt and said, "Just talk to me about anything so I can take my mind off of this. Anything."

I learned that Seattle came from Seattle, now lived in my hometown, and had looked at 12 apartments in one day before settling into the one she lives in today. Her husband is a social worker that works in a drug rehab facility. We talked about the recent brouhaha over James Frey's A Million Little Pieces book and how Oprah had blasted him. (As an aside, I find that entire situation fascinating; I just read the book for the first time in December, and as a journalist, accuracy and fact checking are paramount to my career.)

Talking to Seattle and later, Barbados, helped me deal with the uncomfortable procedure, but Fellow kept muttering to my spread legs that she couldn't get the speculum in the right place to get a clear view of my cervix. "Please keep your pelvis down." "Please open your legs wider." Over and over again.

The speculum just hurt too much at times, and I asked if Barbados could stand at the foot of the table and hold my leg open wider, but Fellow said no. Finally, FINALLY, Fellow got the tubing inside me and started to inflate the balloon. This part I did not feel at all and there was a screen right near my head that showed what my insides looked like with the tubing and balloon within. It looked like a mass of gray and white to me, and not something I could identify clearly, but the radiologists knew what they were looking for.

But then Fellow said there was a problem.

"The balloon isn't inflating fully. We're going to have to do this again."

Can you believe it? I still can't. 

The second time I clutched Barbados' hand and asked why she would choose this kind of job as a second career. (It pays better than her administrative job at a nearby hospital.) Barbados came to the U.S. in the 1970s and has a 17-year-old son who's a basketball star. He doesn't have a girlfriend yet. I was just starting to ask Barbados about whether she was seeing anyone (she's separated from her son's father), when Fellow really started causing pain downstairs with her damned speculum. Like FUCK. For the first time, I addressed the male Resident, who wandered into my field of vision.

"Dude, why would you possibly want to learn these kinds of procedures as a guy," I spat through gritted teeth and anguish. He calmly replied that this was just one radiology procedure he was part of, and that there are all kinds of tests besides this one.

I moaned some more. YOUCH! I am hating speculums and the limp-handshaking Fellow right now. Where's her limp touch now?

Seattle told me to breathe in and out and try to relax, but it wasn't working. I was now crying and asked if we could just try this again next month. A new woman rushed into the room.

"Who are you?" I cried.

I don't remember her name, but she repeated that I really needed to try to relax, and that Fellow couldn't get a clear view. "Could you give me some kind of drug to relax?" I asked. The new woman, who turned out to be the Attending, or most senior radiologist, said there was nothing she could give me to relax the vaginal area. "What about a Xanax," I begged. "Will that calm me down?"

The new woman said no, she couldn't prescribe anything for me. But then she told the Fellow to try a smaller, more narrow speculum. "This one doesn't always allow us to get in to see the entire area," she told me, "but we'll try it."

Apparently the narrow speculum worked fine, though, because Attending got it inside, then threaded the tube and a new balloon into me without a problem.

"Your tubes and uterus look fine," the blessed Attending said. "There's nothing there."

Halle-fucking-lujah.

I was so relieved that I didn't think to ask if they could see everything with the smaller speculum. I didn't think to ask if the dye in my body obstructed any view. And it was only later, walking out of the hospital, feeling physically fine, that I wondered if perhaps the attending was just telling me everything she could see looked fine, just because my case had been difficult.

At that point, and today, half a day later, I don't care.

I called Mr. Lyrehca and told him the test fucking hurt, but that my tubes were clear. And to celebrate, I had a prosciutto-and-mozzerella grilled sandwich for a late lunch and later, for dinner, four slices of a pepperoni-and-sausage pizza. I haven't eaten that kind of pizza in years. My blood sugars were super low at bedtime, but super high when I woke up 12 hours after the pizza, but I still don't care.

At that point, I was more concerned about comfort than blood sugar control. I know I can live with a day of wacky blood sugars after that ordeal, but damn, if that's any indication of what it's like to give birth vaginally, just give me the epidural right now.