Coffee Grounds

This past March I left my gynecologist’s office in tears. The visit occurred a few months after my second pap smear. During that test, I was already familiar with the physical discomfort. I laid on a medical chair with a disposable blanket covering my lap. The only thing between my bare cheeks and the seat was crinkling exam table paper. I was instructed to scoot to the end of this seat, settle my heels into metal stirrups, and butterfly my knees out. The paradox of this procedure was that it would be less painful the more I relaxed, the wider I let my knees fall, opening the butterfly wings and allowing space for the cylindrical speculum. What I hated most about the speculum was the click-click-clicking sound it made as its jaws expanded, like parting duck bills, and locked into place. Once there was a stable enough opening, the doctor inserted a swab to take samples of my cervical cells and screen them for infection.

At the time I was experiencing a weird ache in my pelvic area. It felt like I was constantly leaning my left side into the sharp edge of a kitchen counter. I had a check up, which included an ultrasound. The doctors found nothing out of the ordinary but they encouraged me to schedule a pap smear. A few weeks later I went in and a few days after that I received my results. I couldn’t understand much of the report but I remember bolded red letters: abnormal result.

I felt my stomach sink as I read potential explanations for abnormal cervical cells. I made another appointment just to be sure. I met with a doctor, who quickly and rather clumsily notified me that I definitely had HPV. I was stunned over the next several seconds. I suppose that in her mind, I was young and healthy so this was not a cause for panic. But I couldn’t help but moralize it. I had failed. I was being punished. Things like this weren’t supposed to happen to me. I was too smart. I was in the same boat as literally eighty percent of the sexually active population and I still felt singled out. Ego, perhaps. I am aware that I felt the way I was taught to feel: ashamed.

* * *

I never received formal sex education in my conservative Christian schooling. When I was in fifth grade, a visiting pastor instructed me and dozens of other ten year old girls to kneel before the chapel altar, pledge our bodies to God, and retain our virginity until marriage. The boys in my grade were absent from this pledge. The one time safe sex was mentioned in my high school health class was during a guerilla Q&A session led by a nurse, who was also the mother of one of my classmates. Our substitute teacher kept watch at the door, as if ready to camouflage the scene should someone from the church administration visit our classroom.

I learned about sex from amazing nurses at teen clinics. These were most often black women who spoke to me in motherly and grandmotherly tones, not just about sex and how it worked, but about my worth as a woman. One day I admitted to a nurse that (in addition to regulating the routine nausea and vomiting I experienced during my periods) I only wanted birth control to avoid pregnancy if I were raped. She paused, then said, "Jesus . . . I thought you might want it for when you found your prince charming." I wasn’t sure how to respond.

* * *

The only policy after receiving an abnormal pap smear result is to return for another pap smear in six months. Ideally, my young, healthy body would heal itself sometime between six months and two years, especially since I’d been inoculated against HPV as a preteen. For six months I put myself through an emergency self-care bootcamp. I forced myself to care for a body that felt so estranged from me by laying ground rules. I would dress myself well. I would eat well. I would sleep well. I would exercise. I would openly confide in my mother, my sister, and my therapist. I would rest assured that their love for me would not waiver.

I did everything in my power to earn my health again. I even dug into my teenage vaccination records, discovered that I’d only completed the first two of three HPV shots, and got the third one. Six months passed. I breezed into my pap smear appointment with a book and coffee in hand. I was in and out, onto my workday at home. Surely the worst was behind me. It was time to move on. A few days later the results came back. They were mostly illegible to me except for the words: abnormal result. Whatever the test, lesson, or reason, this was still here.

Soon after this visit I received emails and letters from the gynecologist’s office imploring me to schedule a follow-up appointment. We are concerned for your health, they read. Please make an appointment with us soon. Eventually, I did.

I had a virtual follow-up with a friendly woman. One of her many cats kept crossing her computer screen, its furry tail floating along behind it. The absurdity of the image juxtaposed the weight of her words. She explained that the gynecologist’s office wanted to perform something called a colposcopy on me. It would be a more invasive version of a pap smear, where tissue samples would be taken in order to screen the cervix for cancerous cells, like a biopsy. As she spoke, I took notes. Noticing this, she said “I don’t recommend you look this up.” When I asked why, she provided, “Because the tool that other clinics use looks much scarier than what we use.” I nodded as a chill ran up my spine. Okay then. I scheduled my colposcopy and waited.

* * *

Though I was sexually active, I was single when I had my health scare. The men I’d been entangled with had no idea. When I entered the world of physical intimacy, I felt excited, intentional, and connected to my body. I had consciously shed restricting religious beliefs and allowed my personal relationship with the Divine to determine how I operated my sex life. Then sex became this thing that happened to me, rather than something I was an active participant in. Time after time I failed to advocate for myself. I was too polite and I took too long to distance myself from men who did not care for me. I permitted men access to my body even when they made frequent attempts to sidestep safe sex. I let my guard down. I often allowed their evasions. Several unhealthy situations later I found myself on the brink of tears after, and often during, most sexual encounters. Maybe I was reckoning with the fact that I no longer trusted men. Maybe I mourned the fact that I no longer trusted myself.

As my perspective to sex changes, I recognize the insidious shadow of patriarchy lurking in secular sexual conversations. Too many undeserving men feel entitled to the benefits of sexually liberated women without contributing to safe and consensual sexual experiences with them. I’ve learned to set intentions in my relationships rather than subjecting myself to the whims of young men - devoid of both malice and care - who are pursuing personal pleasure, and who are leaving consideration out of it.

* * *

I will take a quick interlude to express gratitude for the efficient, thorough, and caring healthcare that I received time and time again from this facility and others. That is not always the case for black women, who are routinely disregarded by medical professionals to often deadly ends. So I count my blessings. My mother suggested that I process my colposcopy emotionally so that a routine healthcare procedure would not become a source of trauma. In writing this essay, I am doing just that.

Thankfully, my doctor was a woman. Thankfully the other nurse in the room was a black woman. Thankfully, the gynecologist moved carefully and deliberately and explained nearly everything to me as she did so, even noting the sensations that other patients reported feeling. The paper blanket, the half nudity, the stirrups, and the speculum. Expected. A spritz of cool water. Surprising, but not painful. A swab to disinfect further. If this were a routine pap smear, I’d be done by now. But this was only the beginning. She brought out a slender, bristled tool. My fingers involuntarily went to grip the top of my seat.

“You should feel a slight scratching,” she said. I nodded. I couldn’t see her hands but could feel faint movement on the inside of me. Less pronounced than the cramping brought on by the speculum but . . . unnatural . . . unwelcome . . . uncaring. It was a sensation I could tune out by looking at the overhead fluorescent lighting and softly drumming my fingers against my stomach. More than I could feel it, I could hear it. A scratch-scratch-scratching sound. A queasiness set in as I connected that to the faint feeling of something raking against the flesh, soft as the gums of my mouth, on the inside of me. A part I’d never laid eyes on, but one I knew so intimately now.

The nurse handed swab after swab to the gynecologist, who called out for each by indeterminate names and then discarded each into the trash bin once the appropriate samples were collected. I think this happened four or five or six times. Scratchscratchscratch. No one to hold my hand. Scratchscratchscratch. Fluorescent lights to focus on. Scratchscratchscratch. I could have made better decisions. Scratch scratch scratch. I could have been better. She moved quickly. She would scratch for no longer than five or ten seconds at a time. It was as if she wanted to help me get through this as much as I wanted it to be over.  

When it was over she cleaned with a few additional swabs. Then she sprayed again. I don’t remember completely. I was waiting for her to leave so I could cry and feel bad about myself more openly. I’d had several thoughts flash through my mind over the course of the procedure. If I had a steady partner, I wouldn’t be here. If someone loved me enough, I wouldn’t be here. I would be safe and sexually fulfilled. But some people get loving relationships in their youth and others get clinic visits and cervical scrapings.

She placed one final thing inside of me: a liquid bandage. She told me that I would be bleeding for the next several days. “The liquid bandage is brown. It will dissolve and you’ll start to spot,” she said. She told me that while my wound was healing I was to have nothing in or out of me for three days. No tampons, no penises, no problem. I had already gone a year without sex. One year and nothing inside of my cervix except for swabs and speculums. She handed me a bulky pad. “Wear this to protect your underwear,” she said. “The discharge will come out brown and clumpy like coffee grounds.”

I thanked her. Once I was alone I dressed myself and cried. As I opened the trash bin to throw my tissues away, I could see the bloodied and brown swabs piled on top of each other. I didn’t let myself look for too long. At the front desk I made another appointment for six months in the future. There was nothing left to do.

I walked home from my colposcopy. I made it only a few steps before I called my mom with trembling fingers. She heard one sob from me and in a panicked voice asked where I was, if I was safe, and what happened. Did I get bad results? I told her I didn’t know the results yet. I heard her excuse herself from a meeting, telling her coworkers that she had a family emergency. I explained to her where I was: a short walk from home, what happened: a colposcopy, and what I was feeling: soreness and deep sadness. My mother told me to take the day off. She stayed on the phone with me until I was in my apartment.

“Since I can’t be there right now to take care of you,” my mother told me, “you have to be the one to take care of yourself.” Not an admonishment but a solid truth. I was unpartnered, far away from family, and without friends who knew of my medical procedure that morning. Later I called my sister, who also stepped out of work for my sake. And then I was left with myself. I showered and put on a new panty liner, already bleeding. Each time I opened my legs I was uncomfortably aware of my cervix. I put on soft clothes and ordered breakfast. I took the day off. I wrapped myself in one of my favorite blankets. I cared for myself. I held myself.

For several days after I wore panty liners to protect my underwear from the brown discharge. I threw away a dozen pads stained the color of a waning period or the color of morning coffee. I was staring at a discarded liner when I decided to write this essay.

* * * 

In Come As You Are Dr. Emily Nagoski describes our relationship to sex as a garden. When we are younger, we must rely on others to tend to it for us, planting ideas, watering certain ideologies, and weeding out others. As we get older, we inherit the responsibility of that garden. Like many women, I found myself responsible for the work of weeding out much of what had been planted within me at a vulnerable and impressionable age. Because of these weeds of thinking, I found it difficult to escape the chilling ideology that I was now unlovable because I had an STI. It had a chokehold on me. Like the weeds in a garden, stealing nutrients and blocking all sunlight, it dominated my thinking and marred my self-worth.

There is an unmoored feeling that comes with planting a new garden. I’m still pulling stubborn and destructive weeds from my psyche. I am not immune to life. I cannot be smart enough or good enough to avoid pain because pain is not a moral failure. Sex comes with complex consequences: a mixed bag of life-enriching and life-threatening results. I am rebuilding my worldview devoid of shame and guilt, grounded in freedom, truth, and love. I am only letting in those who love me, care for me, worship my body, and respect my mind. I will not walk in fear. I will not moralize my health. If I had a daughter who was going through this, I would tell her that feeling lost is a part of life.

Women are so polite and private about our pain and our periods. We are demure in our bloating, bleeding, cramping, and childbirth. Our pain is standard, accepted, and ordinary. Patriarchal systems take advantage of this, benefitting from our silences and the silos we form that isolate us from other women. I know that every woman has faced some sort of sexual pressure or shame, be it from pseudoscience, popular culture, or religion. Countless women have moved on from this. I will too. I recognize the coffee color as a sign of healing.

* * *

I left my first pap smear in tears. I’m an emotional person. My mother told me before I scheduled the visit that I didn’t need to ask for a pap smear if I only intended to refill my birth control prescription. But during the check-up, my gynecologist encouraged me to undergo the test. I’d reached the standard age and it was best to start these screenings as early as possible. I remember feeling guilty, as if I had betrayed my mother by agreeing to the screening. It was an intimidating experience.

After the visit I called my mom and told her about it. She shared that the only reason she wanted me to delay my first pap smear was that she wanted to be there with me, holding my hand so I wouldn’t have to go through it alone. The tears fell easily as I thanked her and also assured her that this physician, a black woman, took great care of me. She listened to me. She walked me through every step, announcing each action before she began. When I expressed discomfort she paused, checked in with me, and completely removed the speculum, starting from the beginning.

* * *

My cells are normal again. I’ll continue to monitor them with each pap smear.

The wound closes. The discharge washes away. The body heals itself like the cycles of seasons.  

This is what I know so far.