Fallen Through the Cracks

We did the exam, gave her the news and she was silent.
Did she understand? I thought.
Latina female, Spanish speaking.
it’s OK we speak her language.
Her face was still, unchanged from the beginning of the encounter.

Minutes before, the young woman in front of me was telling me her story.
She was talking and talking in circles filled with pain
And desperation.
Something wasn’t right.
I felt it in my stomach as a nervous tickle.
But her face was still so stoic.
Why am I nervous? I thought.

My preceptor greets us in the room. I was taking too long, again.
As she is speaking my mind wanders and I see myself in that chair, I see my friends and my peers.
And I am angry and sad, or is it shock?
Why is she not angry? I thought.
Does she understand? I thought again.
It’s anger.
Why am I angry at her when it is our system that failed her?

Pap smear 2 years ago: HPV +
Colposcopy results 2 years ago: HSIL, cannot rule out invasive disease.
Then nothing.
Pelvic exam from today: too heartbreaking to be included.

There has to be a reason.
I am frantically scrolling through EPIC in search of a reason. Maybe a reason to blame her?
Just any reason. I thought.
Numerous visits with the same complaint over the years: severe diffuse abdominal/pelvic pain.
“Most likely functional;” “anxiety related;” “undiagnosed” appear on the screen.
She should be furious. I thought.
Her face was still, unchanged.
She is a single mom. I remember. What will happen to her kids? I dare to think.

Cervical cancer is supposed to be the cancer you “should never have to get.”
Screening works.
It’s the cancer you don’t get. I repeat, trying to convince myself.
But she got it. And she was alone. And she is alone. And she is my age. My age.

The visit ended. Just like that.
A deep breath and I move in slow motion to the next patient room.
Before I knock we cross paths as she makes her way toward the exit.
And I see the slightest sparkle reflect off of her eyes.
She understands. I thought.

Abby Bossart is a proud member of the University of Utah School of Medicine class of 2021. She has a B.A. in Spanish Literature from Occidental College and took what she describes as the “scenic route” to medical school. The act of creative writing has been a cathartic process for her especially as she navigates the systemic barriers that many underserved patients face in our current healthcare system. She values the intimate and thoughtful science behind caring and being cared for. In her free time you can find her adventuring outside; from backcountry skiing in the winter to scrambling along the ridgelines of the Wasatch Mountains in the summer.

Rubor Participation:
2020 poem, "Fallen Through the Cracks"