My Journal

October 1998

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Thursday, 1 October 1998

I send out email to a wide variety of gynecologists asking their opinion of UAE and begin getting responses like the following:

"If you had a headache you would not dream of killing the brain by cutting the blood supply to it... Let me tell you that the long term effects of this procedure are not known. I personally have seen a lot of cases with severe pelvic pain after this procedure. I do not support this procedure as treatment for bleeding fibroids." MT, M.D.

The following medical report from my September 28, 1998 visit to Dr. Bruce McLucas was written on October 1, 1998. I received a copy of it shortly before my next appointment in the UAE process with Dr. Goodwin. Items that I found that were inaccurate or questionable contain comments in paren and are tagged in red.

Bruce McLucas, M.D.
UCLA Medical Group
Obstetrics & Gynecology

HISTORY AND PHYSICAL EXAMINATION

PATIENT: DIONNE, CARLA

IDENTIFYING DATA:

AGE: 41 SEX: Female RACE: Caucasian
DRUG & DYE SENSITIVITIES: None to medication (actually, I'm allergic to penicillin and told him so)

CHIEF COMPLAINT:

Acute pelvic hemorrhage, pelvic pain

HISTORY OF PRESENT ILLNESS:

This is a 41-year-old Gravida IV/Para III female complaining of menorrhagia with an enlarged, irregular uterus. It is noted that the patient has been on iron supplementation.(I've never been on iron supplementation.) She is barely able to keep her hematocrit in the low normal range (35.8 according to accompanying lab report) despite ingestion of iron (again, have never taken iron) which she is having difficulty tolerating because of gastritis and constipation.(Never once complained of gastritis or constipation. I'm a vegetarian--constipation simply isn't a problem.) The patient has undergone an ultrasound on September 28, 1998 showing a probably pedunculated leiomyoma in the sub-serosal position on the right side. The endometrial complex is somewhat distorted. The ovaries are normal but questionably observed. The patient's PAP smear was normal with the last six months. The patient has had passage of clots and has had failure of hormone therapy for her condition. (I've never had any hormone therapy in my entire life. Not even birth control pills.)

She desires the least invasive therapy and retention of fertility. (Why does this have to say "fertility"? Why can't it simply state that I want to keep my uterus!!!!!)

PAST MEDICAL HISTORY:

Usual childhood diseases. Denies rheumatic fever, denies tuberculosis, denies sexually transmitted diseases.

Adult Illness: Sinusitis

Past Surgical History: Rhinoplasty and ear surgery. (I messed up my nose in a freak karate accident about 11 years ago and the ear surgery was to skin graft over a hole in the drum that was the result of a rather hard slap to the side of my face when I was 14.)

FAMILY HISTORY:

Negative for tuberculosis, stroke, convulsions, seizures. Positive for breast cancer in grandmother and brain cancer in sister and aunt with uterine cancer. Positive also for adult onset diabetes, heart disease and high blood pressure.

SOCIAL HISTORY:

Patient denies drugs, alcohol abuse and denies cigarette use.

REVIEW OF SYSTEMS

GENERAL: No weight change. (I'm not sure where he got the weight change info from. But I would sure think that a general weight gain of 70+ pounds that gradually occurred over the last 10 years is a weight change.) Generally in good health.

SKIN: No evidence of jaundice, skin disease, eczema, pigmentation changes.

HEENT: No history of eye diseases. Patient wears glasses. She occasionally has double vision (??? I have astigmatism. I guess you could say that is "double vision." But, it certainly isn't "occasional"--it's constant!) and headaches--thought to be related to anemia. (Thought by whom? Not me.) Denies glaucoma. Patient has history of sinusitis. Denies dizziness.

NECK: Denies thyroid changes or enlarged glands. (Now, actually, this was never discussed and Dr. McLucas never examined my neck at all. If it had been discussed, I would have certainly told him that my glands had been swollen to such degrees in the previous year that my thyroid had been tested twice. Complete panel of bloodwork by 2 different physicians who were certain that the swollen glands were related to my thyroid. Nada on the confirmation by the blood screen though.) Denies stiffness.

RESPIRATORY: Denies chronic cough. Denies hemoptysis. Denies asthma. Denies pneumonia. Denies dyspnea.

CARDIOVASCULAR: Denies chest pain, palpitations, shortness of breath, hypertension. Patient admits to history of asymptomatic heart murmur felt to be non-pathologic by internal medicine. (Interesting. He never listened to my heart.)

GASTROINTESTINAL: Denies nausea, vomiting, diarrhea, constipation, melena. (Interesting that this info contradicts the "History of Present Illness" paragraph above. Don't you think?)

GENITOURINARY: Denies dysuria, hematuria, renal calculus. Admits to frequency and nocturia.

GYNECOLOGIC: Menarche at age 10. Prior pregnancies four. Prior miscarriages one. Last PAP smear negative within last 6 months. Periods every 28 days lasting 10-15 days (no, lasting 7 days) with passage of clots. Last menstrual period September 18, 1998. Patient admits to history of dysmenorrhea.

LOCOMOTOR/MUSCULOSKELETAL: Denies varicose veins. Denies joint or muscle pains.

NEUROLOGIC/PSYCHIATRIC: Denies convulsions or seizures.

HEMATOLOGIC: Admits to iron deficiency anemia. (???) Denies coagulopathy. Denies phlebitis.

ENDOCRINE: Denies thyroid problems or diabetes.

PHYSICAL EXAMINATION: (I take exception to this entire section of the report. It implies he actually DID a physical examination when, point in fact, he did not. The nurse did take height, weight, BP, pulse, resp, and temp. though. Dr. McLucas did a cursory vaginal exam and a brief ultrasound with portable equipment. But he was interrupted by the phone after only a minute in the room with me and never really did the full "exam" detailed below.)

HEIGHT: 5'3" WEIGHT: 192# (actually, the scales said 194--this is probably a typo on the report)
BLOOD PRESSURE: 120/70 PULSE: 80 RESPIRATIONS: 20 TEMPERATURE: 97.5

GENERAL: Well-developed, well-nourished (*LOL*) female in no acute distress.

HEENT: Eyes: Pupils equal, round, reactive to light and accommodation. Extraocular movements intact. Vision intact. Sclerae are nonicteric. Ears: Hearing and balance intact. Oropharynx benign. Teeth in good repair.

NECK: Supple without lymphadenopathy. No bruits or masses.

CHEST: Clear to auscultation and palpation. (Hmmm. Really implies he listened to my chest--doesn't it? Well, he didn't.)

BREASTS: Normal female. No masses and no discharge. (Funny, I don't recall even removing my blouse...)

HEART: Regular rate and rhythm without pathologic murmur. (He never once listened to my heart.)

ABDOMEN: Scaphoid and benign. No organomegaly. No rebound. Suprapubic mass appreciated.

PELVIC: External genitalia within normal limits. Bartholin's, urethral and Skene's glands are within normal limits. Introitus normal. Vagina without lesions or discharge. Cervix is parous. Bimanual examination revealed enlarged, irregular uterus, tender adnexa.

RECTAL: Confirms pelvic exam. Stool negative for occult blood. (? No rectal exam was done. No stool sample was taken. I think I would DEFINITELY remember this.)

BACK: CVA and spine non-tender. (Never checked my back. He apparently dismissed my desire to discuss the amount of excruciating lower back pain I was in as it appears nowhere in any medical report from his office. Only reference to "pelvic pain". Not the same thing as far as I'm concerned.)

EXTREMITIES: Nerves, arteries, veins, and tendons intact.

NEUROLOGICAL: Cranial nerves II through XII grossly intact.

IMPRESSION:

Acute menorrhagia, pelvic pain (Is acute pelvic hemorrhage the same as menorrhagia? He wrote menorrhagia here -- which is accurate -- but wrote acute pelvic hemorrhage under "Chief Complaint"--something I never complained about.)

PLAN:

Candidate for least invasive therapy which would be uterine artery embolization, pending negative evaluation by endoscopic procedures.

BRUCE MC LUCAS, M.D.
BM/jk

Friday, 2 October 1998

I have no idea who the anesthesiologist will be. No idea what kind of anesthesiology will be used. McLucas is on vacation today. His staff is too busy to check the records to see that I am at work and call me there before 5. I finally call McLucas' office. The receptionist knows nothing. Even though my consult was only on Monday with McLucas, his office staff never called me to talk to me about the scheduled hysteroscopy/laparoscopy. At least, not until I called the scheduler around 2 p.m. this afternoon. She's clueless and tells me to call the Beverly Hills Center for Special Surgery and talk with them.

I call the Beverly Hills Center for Special Surgery to confirm the hysteroscopy/laparoscopy scheduled for Monday. I attempt to find out who else will be attending and who the anesthesiologist will be. It's a no go. Office staff does not know who is on the schedule for Monday and I spend the rest of the afternoon playing telephone tag with them as I try to find out. In addition, I can't ascertain whether or not the procedures have been approved through my medical insurance or not. It's mind-boggling how little is known about what is going to occur on Monday. At around 5 p.m. I finally get confirmation that my insurance does not require pre-approval for hysteroscopy or laparoscopy. In addition, around 6 p.m. the Well Surgery Center finally speculates who the anesthesiologist will be and offers me a name. I write it down and look it up on the State Medical Board site as always. Some comfort in knowing who the anesthesiologist will be even though I've lost complete confidence that much else is known about what will occur on Monday.

Monday, 5 October 1998

Hysteroscopy/laparoscopy scheduled for first thing this morning at the Beverly Hills Center for Special Surgery. I arrive at 7 a.m.--fifteen minutes early. I'm handed a stack of paperwork to fill out, most of which are insurance forms. I question the consignment of insurance benefits, pre-certification information, and most of all the fact that they are having me sign to agree for all costs above and beyond the insurance payout. This is contrary to the pre-arranged agreement with McLucas and I question the arrangements.

The receptionist tells me that I have to sign and they can't give me any kind of written agreement saying that they won't bill me for anything insurance doesn't cover. I panic. I panic again with a "oh, dear" when she tells me her supervisor doesn't get in until 9. It's only 7:15 a.m. and I wonder, at this point, whether or not this is going to happen.

I begin to have a panic attack in my head and try to calm down by sitting down and focusing on the other paperwork that I have been given to fill out.

A medical history. Some notifications of potential side effects and several insurance dispersal forms.

I'm called to the counter. The supervisor is in early. Legally they are not allowed to sign anything that says they won't bill me for anything insurance won't cover.

"We can only give you our verbal assurances that if Dr. McLucas has said that you won't be billed, then you won't."

It's clear from the looks on both of their faces that this is a stalemate.

"I can't afford thousands of dollars in bills from this procedure."

"We understand."

"Can you give me your complete names and both assure me that I am not going to get billed?"

They both nod yes.

"Whatever Dr. McLucas has okayed. See. Here. Look at your chart. Notes have been made that it's 'okay'."

I look at both of them. Sigh. Okay. I quietly give in and sign all the papers. I have a sinking feeling that I'll be billed anyway. I make a semi-conscious decision to go ahead. I know that if I leave I won't return. It's now or never. I'm carried on through a fog of decision-making that is, somehow, no longer my own. Kind of like being on the log ride at Knott's Berry Farm and just floating along with the water at the start of the ride but all the while knowing there's going to be a big drop at the end but ignoring that possibility anyway.

A lot happens next. I don't remember much of any of it. I do remember the lack of privacy in getting undressed. I remember the anesthesiologist coming in and introducing himself to me. Not the one I was told would be on duty. I don't know this guy from Adam--my blood pressure rises when he tells me his name and who he is. Too late now. I'm already undressed, prepped, sedated, etc. Shit.

The nurse that cares for me is very nice. She tells me that McLucas will talk to my husband after the procedure. I tell her no. McLucas will talk to me. My husband is not the person who makes medical decisions for me, I am perfectly capable of being spoken to post-procedure. She warns me that McLucas won't like that. I tell her to tell him anyway.

McLucas comes in and can't even look me in the eyes. I have a sinking feeling. Maybe it's the drugs, I don't know. He's not thrilled with my request and talks down to me while rolling his eyes at my request as I specifically verbalize it to him. (Note: He never does come in and talk to me post-procedure.) When he leaves, the nurse tells me he is always like that. Most of the nurses at the Surgery Center don't seem to care much for McLucas because of how he talks to and treats them.

After that, I'm asked to walk into the surgery room and lie down on the table there. It's narrow and I don't really fit. I start to panic some again but as soon as I lay down they wrap blankets around my arms, tucking them under my body, to hold me in place on the table. It's uncomfortable. It's claustrophobic. It's impossible to remember anything after that because they immediately put gas over my face and I 'm out instantly.

Sometime around 9 a.m.: I'm foggy and waking up in a small room with not much of anything covering me and I'm cold. I hear a flat, high-pitched sound coming from some medical equipment and nurses come running. It's me I think. Not sure. Not really awake.

They start yelling at me to wake up and breathe. Huh? I thought I was breathing. Something about O2 levels and one nurse telling the other to go get the doctor. I don't know. She's shaking me and yelling at me. I open my eyes and she helps me to sit up. The noise stops.

I see another man laying in the bed across from me with a bandage across his nose. I ask for a blanket to cover me up. I 'm freezing and I just want to go back to sleep.

10:15 a.m.: No Rich. Where is he?

10:30 a.m. It's okay, I reassure myself. He's probably on the freeway on his way. I'm not dressed anyways. It'll take me some time before I'm ready to go. He's on his way. I know it. He just needs to drop the kids off and then he'll be here. Probably traffic on the freeway.

Time moves very slowly. And, I just need to get dressed. Then, he'll be here.

The nurse comes in to check vitals.

"When can I get dressed?"

"Oh. Are you ready to sit up? Do you need to go to the bathroom? Just a minute and I'll help you."

She starts unraveling monitoring equipment attached to me. Heart monitor, finger clips, blood pressure equipment all comes off. The IV stays.

I sit up. Desperately wrapped in paper nighties torn by nurses in the surgery room, torn more by this nurse to help me get it off. I'm standing, mostly naked with lots of paper, cloth, and plastic remnants dangling from my body.

"Carla, I'm going to wrap a blanket around you and then you can go to the bathroom."

I'm completely naked. Clothing, paper or otherwise, is nonexistent. The recovery room is somewhat of an open room to and from a number of surgical suites and numerous people walk back and forth. Non-medical personnel included.

With the blankets wrapped around me, the nurse grabs the IV and we head to the bathroom. She leaves me to go get my clothes. I drop the blanket and then urinate for what seems like an eternity. The nurse knocks, then brings in my clothes. I put as much of my clothes on that I can by myself and when she returns she helps me with the rest.

10:45 a.m.:

"Carla, your husband still isn't here. Would you like to lay down for a little while longer?"

I nod yes.

"Would you like me to try and call him?"

"Well, I'm sure he's on his way. He just had to go to Camarillo and back. With bad traffic that can take 3, maybe even 4 hours roundtrip. Let's see, if he left at 7...he should have been here by now. Hmmm. It's probably just bad traffic."

"Okay. We'll wait a little while longer. You can just stay there and keep resting."

I can't rest. I try. I can't. Let's see...he left at 7 and got back to Camarillo by 8:15 or so...took kids to school. Melissa to Ventura. Maybe left Ventura by 9. Hmmm. He should be here by now.

"What time is it?"

"11:15. Would you like me to call your husband or page him maybe?"

"I don't remember his pager number. Can I call him?"

"Sure. Go ahead."

I dial home first. Certain he won't be there I'm not surprised when he doesn't answer. Okay. I guess I'll try work. He picks up on the first ring.

"Hello?"

"You're at work."

"Oh God. I..."

"You're at work."

"I just had to write a memo. I thought I wasn't supposed to come back until noon."

"No. 11. At the latest. 4 hours."

"I'll..."

Click. I don't give a damn. I hang up on him. It's now 11:30. He couldn't be here by noon if his life depended on it. He went to work instead of coming back for me. He fucked up. Big time. He fucked up. What a prick. More important to write a memo than to come back for me. For chrissakes, he doesn't even work on Mondays. What a prick.

I'm angry and trying not to cry at the same time. Panic attack starts setting in. I have to get out of here. I have to get out of here.

But first I have to go to the bathroom again.

I tell the nurse. She lets me go. Once in the bathroom I start crying and can't stop. Just gotta wash my face. Get angry Carla. Get angry. He's a prick. Don't let it hurt. He's a fucking prick. 20 years together--married to a fucking prick. I cry some more.

I have to leave and I know it. I dry my face and go back to the nurse.

"What would you like to do?" she says.

"Leave."

"You can't."

"I can't stay here."

"Should we call you a cab?"

I look her in the eyes like the total fucking moron I perceive her to be at that moment.

"If I can't afford this procedure, where do you expect me to get the money to pay for a cab from Beverly Hills to Camarillo?"

"I understand Carla. But I can't just let you leave."

I say nothing. I think "wanna bet."

"If you leave, the surgery center will be liable if anything happens to you."

Great. Just great. What do I care? When the nurse steps away, I walk out. I'm chased down and asked to sign a liability waiver. I do. Then, I go downstairs and try to decide what I'm going to do next. I sit down on a window ledge on the front sidewalk to think. Ten minutes later Rich pulls up and I go home.

The Beverly Hills Center for Special Surgery
Operative Report

OPERATIVE REPORT

INDICATIONS AND FINDINGS: Patient with leiomyomata uterus on ultrasound, tender adnexa, rule out other pathology, rule out uterine sarcoma. The patient's uterus extended up to the umbilicus and was grossly enlarged with no subserosal leiomyoma. The left ovary was normal. The right ovary was not visualized. The patient's hysteroscopic findings included an area suggestive of polypoid change which was biopsied. There was no evidence of perforation and no evidence of malignancy.

At the time of laparoscopy there was no evidence of endometriosis, malignancy or salpingitis. The largest myoma was biopsied with a transcutaneous needle biopsy without difficulty. On inspection of the endometrium a single large polyp was removed. The uterus was noted to be distorted although there was no submucous myoma. Several intramural myomas could be felt on curettage protruding into the cavity anteriorly and from the left side and from the right side.

PROCEDURE: Under excellent general endotracheal anesthesia, the patient was prepped and draped and placed in the dorsal lithotomy position. She was given 2 grams of Ancef for prophylaxis. The cervix was grasped with a single-toothed tenaculum and dilated to admit an operating hysteroscope. The hysteroscope was inserted into the uterus and the findings described above were noted. The hysteroscope was then removed and a resectoscope was placed. Using a cutting loop the patient's polypoid area was biopsied. The base was fulgurated without difficulty. Next the patient's uterus was entered with a uterine elevator to aid in manipulation.

A periumbilical stab incision was then made and the abdomen was insufflated through a Voorhees needle with 2 liters of carbon dioxide. Through the inside of this needle a 2 mm telescope was placed under direct vision and a suprapubic right paramedian stab incision was made and the findings described above were noted with blunt dissection and elevation.

A transcutaneous needle biopsy of the largest myoma was performed. The serosal surface was fulgurated and copious irrigation revealed no evidence of bleeding. In addition an incision was made in the left upper quadrant by the 10th rib in the midclavicular line following insertion of a nasogastric tube and then under direct vision a second periumbilical 3 mm stab incision was then made. Following biopsy with the resectoscope the endometrium was then circumferentially curetted sharply. There was no bleeding at the end of the case. The air was allowed to escape from the patient's abdominal cavity. The incisions were injected with 0.5% Marcaine with epinephrine and closed with steri-strips. The patient left the operating room in excellent condition.

BRUCE MC LUCAS, M.D.
BM/jk

Tuesday, 6 October 1998

The day begins with telephone tag and the runaround from Dr. McLucas' staff. The scheduler is in a meeting. I leave voicemail asking her to call me after 1 p.m. at work. She calls my home at 12:45 and tries to leave a message for me to call her. Rich defers her to my work number. She calls my work and leaves a message at 12:50 p.m. I try to call her back at 1:15 but she's on another line. Do I want to leave a message, I'm asked? I say no thank you, I'll hold. I'm plunked into voicemail anyway. I leave a message and hang up. I call again later and am told that test results won't come in until Wednesday. So much for Dr. McLucas' instructions for me to call his office today.

Wednesday, 7 October 1998

Scheduler not in today. Played telephone tag most of the day with McLucas' office. I finally reach him at 3:15 p.m. He tells me that I have a lot of polyps. Hyperplasia that is pre-cancerous. No pre-cancerous cells yet, but I would benefit from progesterone to get the lining of the uterus to a more normal stage. That's all he will tell me over the telephone and insists that I must come in to see him. We schedule an appointment for Monday the 12th.

In the meanwhile, chills and fever plague me from the hysteroscopy/laparoscopy. I'm worried about the hyperplasia because I'm completely unsure of what any of it means and I'm sicker than a dog from the surgical procedure just performed. My husband and I sleep very little during the remaining week until my next appointment.

Monday, 12 October 1998

I go to work at 6 a.m. today as I have scheduled both a dental and doctor appointment. Ugh. It's going to be a long day.

Dr. McLucas prescribes Provera, talks about hyperplasia, and is never really clear about the lab results. I go away completely unsure of what I was just told. He took less than 5 minutes of his time and never communicated to me what he did, exactly, during the hysteroscopy/laparoscopy. He ends the session by telling me to start bugging the scheduling office to schedule the UAE. It's in their hands now.

Tuesday, 13 October 1998

Called the scheduling office per McLucas' instructions and got a "new" person. I told her that McLucas told me to call and bug them about scheduling the UAE. She said she would work with the other scheduler and call me when things were approved for scheduling. While talking to her I told her about the headset girl at the front desk and explained how verbally "mean" and insensitive she is to the women that come into McLucas' office.

I told her that I signed a release to get copies of my medical files because I am seriously considering not returning. I am too tired, anemic, stressed, etc. to "deal" with someone like the headset girl on top of McLucas. Her behavior is rude and snarly and uncalled for.

She told me she "understood" and could tell that I was upset and that she would talk to McLucas about the girl and let him know that she was the reason I requested copies of my records. She asked me not to consider leaving McLucas as this was not a good reason to allow myself to be deprived of a surgeon such as McLucas. Ugh.

Same day. I went to get the Provera prescription filled. McLucas did not put his phone number on the prescription. This is a problem, according to the pharmacist. In addition, the pharmacist indicates that he is not allowed to fill the prescription with 100 tablets per what is written by McLucas. Huh? I don't really understand but the pharmacist works around what's written on the prescription and gives me 30 tablets with 9 refills. What? Yep. Apparently McLucas wrote a prescription for a 30 month supply of Provera. 2 1/2 years. He must be kidding.

At 4:00 I call McLucas' office to try to find out what's up with the prescription. I never get an answer as he never returns my calls. But, his new nurse confirms that he did, in fact, prescribe 30 months of Provera. Huh? I don't get it. He told me he was prescribing for the next 3 months. Not 30. Unless, of course, I'm as dense as mud and deaf to boot.

Today, I decide, that Dr. McLucas is definitely no better than any other doctor that I've encountered. They are all assholes who simply do not "get" how much information and decision-making that a woman's mind is cluttered and disoriented with while trying to understand all of what is going on with themselves physically.

I cry more tears. When will the well run dry?

Of course, subconsciously I did know that progesterone was long-range treatment. But, he didn't state that AND it's always quite a shock to have a pharmacist point out details like that to you as they argue with you over the prescription.

On another note: NO SIDE EFFECTS????? Oh brother. I knew he was lying to me. Why did he bother? Was it a test? A challenge? A "so what if there is?--what are you going to do about it?" kind of mockery of my question? I don't know. I only know that he lied. There are no other options for me and he knows it. Why should he bother to take the time to explain potential side effects?

Respect? He wants my respect? I don't think so. Nope. He won't get it from me. Not with lies.

Obfuscation of information. Again.

I call McLucas' office and get put on hold. After 5 minutes or so the line goes to voicemail and I hang up.

It's gotten to the point where I simply can't manage even the smallest of issues. Petty things that I would fight to correct in the past no longer matter to me. Everything upsets me terribly and I am reduced to crying like a weenie every time. I am definitely suicidal and I know it.

Wednesday, 14 October 1998

At about 8 p.m. I'm working late and decide to place a call to the Employee Assistance Program asking for help. A psychotherapist calls me back and we chat awhile. As it turns out, she's a neighbor of mine that lives around the corner from me in Camarillo. Ugh. Not good. While she was quite excited that she is "friends" with my immediate neighbors and suggested that she could walk over for a cup of tea if I wanted her to--I tried desperately to get off the line. I'm not comfortable with that kind of close proximity to someone whom I would like to spill my guts to. She wants to help but I'm very afraid of the conversation getting back to my husband. In addition, she informs me (as she's legally obliged to do) that our conversations would not be confidential. They are, in fact, available to my employer. I thank her kindly and hang up.

I cry a lot of tears. I don't know what to do now.

Friday, 16 October 1998

I call the scheduling office again. I'm put on hold. When the phone is finally answered it is somebody new and I'm told the previous scheduler is no longer with Dr. McLucas. The new scheduler is "behind because of the release of ..." if I want something to happen perhaps I should call Dr. Goodwin's office, I'm told. But they can't seem to give me the number without McLucas' approval first.

Spoke to Dr. McLucas' new nurse of only two weeks. She's very nice and having a very hard time of it. She told me that my records were approved for release today and would be mailed to me. I asked her to read to me the results of the lab report so that I could get clear on what, exactly, it had said. Hyperplasia without atypia. Follow-up required. I thanked her. I don't think I've ever felt such relief before. What the hell was wrong with McLucas that he didn't tell me this to begin with? Why the foreboding seriousness that made me believe that something was imminent? That he had "caught it just in time" and was my savior because of his requirement to do hysteroscopy and laparoscopy? (Note: I don't learn for many more months that this information could have just as easily been acquired via endometrial biopsy.)

Monday, 19 October 1998

The calls begin again. First to McLucas' new nurse to see if she will give me Dr. Goodwin's phone number. She does.

Next, Blue Cross. I check on submission of referral and pre-authorization documents. Blue Cross has received nothing.

Call Dr. Goodwin's office and am told they will call in the authorization today and then call me for a consultation and procedure appointment.

Tuesday, 20 October 1998

UAE is authorized today. But not before I have to speak to a reviewer and explain to her how desperate I am to have this procedure. I practically beg as my tumors are so large they simply must be stopped. No, I DO beg. The reviewer takes care of the rest and calls me back later in the day to tell me she has received all of the appropriate information and the procedure has been approved. I thank her.

Thursday, 22 October 1998

UCLA Medical Center, Room BL-423, Center for Health Sciences (CHS building). I have an appointment with Dr. Goodwin.

It's a rats maze and I get lost numerous times. I have no clue where I've parked in relationship to where I'm going and doubt that I will ever find my way back. I need a map from Yahoo.

Dr. Goodwin's office is in the basement and quite small. I guess I'm surprised. His office staff is very nice to me. I'm surprised again. After my encounters with McLucas' staff I have very low expectations of Dr. Goodwin. I promise myself that if I am treated as poorly by Dr. Goodwin as I was by Dr. McLucas that I will not proceed with the UAE.

I'm surprised again. Quiet. Caring. Interested. Asks lots of questions. Discusses the procedure in detail and shows me the PVA and catheter he will use. We go over my medical records (which I have received a copy of by now from McLucas' office) and I make it very clear to him that there are things that are just "not right" on the medical records that McLucas has sent over and submitted to the insurance. We go over everything in detail and he makes notes on my chart. I don't want to go into surgery with this man thinking that the information that McLucas has provided him is actually a picture of me. It is not.

• I have never taken Lupron. (McLucas wrote that I couldn't tolerate it.)
• I have a heart murmur. (McLucas wrote that I did not when, in fact, he never even asked or checked.)
• I have never taken iron supplements (McLucas wrote that I had)
• I don't suffer from constipation or gastroenteritis (as McLucas wrote that I did)
• My bleeding is controlled within my normal monthly period (McLucas wrote "acute hemorrhagia")

The list goes on. Page by page I point out the inaccuracies. We discuss McLucas in detail and he shares his thoughts with me.

It's not me after all. It IS McLucas and this man is confirming everything I've thought about him. Unbelievable.

I like Dr. Goodwin and think he is a surgeon I can trust. I decide to go ahead and schedule the UAE.

Monday, 26 October 1998

Date: 10/26/98 6:01 PM
To: Scott Goodwin
From: cdionne@earthlink.net

Dr. Goodwin,

Thank you for taking the time to meet with me and discuss the UAE procedure that I am currently scheduled for at 12 p.m. on Monday, November 2.

I've taken the time to read all of the materials your staff provided me and I have only one question. In the French article published in 1997 and translated by Gisele Jaffre Grabowsky entitled "Application of Particulate Arterial Embolization in the Treatment of Uterine Fibromyomata," under the section entitled "RESULTS" on page 4, there is a reference to 5 catheterization failures as follows:

"-3 times due to a vasoconstriction of the uterine arteries caused by too recent hormonal therapy: progestin (2) or LH-RH analogues (1) . . ."

As a result of the hyperplasia findings per the lab report from the hysteroscopy/laparscopy, Dr. McLucas prescribed Provera during my last visit. I have not begun taking this prescription but will begin on the 28th of October (16-25th days of menstrual cycle). Will this pose any problems to the UAE? I would prefer to NOT postpone the UAE but want to make sure that you are aware of the prescription for progestin.

Carla Dionne

Got home about 6:45 p.m. and everyone was gone. Rich went to take Alex to soccer and pick Melissa up from dance. Rich was upset with me. I didn't call and say I'd be late. He wanted to know where I was and sounded angry at me that I hadn't called. He said he was "worried" about me. I was taken aback.

Rich never expresses concern about me out loud. In 20 years of marriage he has only expressed such concern once...and that was because he had something planned that I caused him to miss. He had to continue watching Melissa (she was only 2 at the time) and he was angry with me. His anger had to do with selfishness and not concern over me.

So, I was taken aback. He was so visibly upset and concerned that it stopped me cold. He isn't talking to me directly about his concerns over my life. Everything is kept quiet unless I bring it up first. He's so bound by his feelings that he doesn't know what to say.

Believe me. His anger knocks me for a loop. I think "oh man, please don't start weirding out on me now." I'm still the same person. But, I guess I'm not. Not really. Not anymore.

Later, after Rich goes to sleep, I lay next to him and caress his head, his hair, his face. And I cry. Things won't ever be the same again.

Wednesday, 28, October 1998

Begin taking Provera for 10 days.

Thursday, 29 October 1998

I lose my voice. Unbelievably sick again. And only a few days before the UAE.

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