Monday, December 14, 2009

Adventures in gynecology

For the past six weeks I've been on an outpatient rotation, which means seeing patients in the office from 8-5. My weeks consist of family practice, pediatrics, and obstetrics/gynecology all intermingled together. This afternoon was a gynecology afternoon. Incidentally, this is at one of the top hospitals in the country according to U.S. News & World Report.

My second patient of the afternoon was a pretty, prim and proper, professional white 30 year old woman, the kind you'd expect to meet at happy hour at the yuppie bar near the local office park. I saw that she had a hyphenated surname and heard the nurse mention that the patient didn't want us to use the stickers with her name on them because she was changing her name. I walked into the room and introduced myself.

Me: Hi, Miss Hyphenated-Surname?

Pt: Yes.

Me: I'm Dr. Abooboo's medical student for the afternoon. Would you mind if I go over some history with you before Dr. Abooboo comes in?

Pt: Sure.

Me: So, I hear you're changing your name, is that right?

Pt: Yeah, actually the name they have on there is wrong, my last name is Similarsounding-HyphenatedSurname, but I'm getting married next week, so it'll be changing anyway.

Me: Oh, congratulations. So, what can we help you with today, do you have any concerns, are your periods regular, when was your last Pap smear, etc., etc.

Pt: Blah blah blah, yakity scmakity.

Me: OK, let me go find Dr. Abooboo and we'll be back in together to do the exam.

Exit.
[I should say here that the patient was very nice and pleasant, but I don't have the ear for conveying that in dialogue.]
Enter Hermes and Dr. Abooboo.

Dr: So, I hear you have some big plans! Where are you getting married?

Pt: Well, we're having two weddings, actually. The first one's in Turkey. My fiance is Turkish.

Internal dialog of Hermes of 5 years ago: (Oh, isn't that nice, I'm happy for her.)

Internal dialog of present-day Hermes: (Another one bites the dust.)

(Sometime later)
Dr: what do you do for a living?

Pt: I'm a management consultant. My fiance is too; we both work for the same company.

So this nice, pretty, highly educated and accomplished six-figure-earning white girl will marry a six-figure-earning Middle Eastern immigrant, probably have one mixed-race baby and deposit him in day care, then spend the rest of their lives blowing their combined six-figure income on a big house in some white-flight development with a name like "The Hunt at Glen Run," a couple of BMW's in the driveway, and international luxury vacations until they die in a nursing home. If their marriage lasts.

Later in the afternoon I saw an 18-year-old white girl who was there with her mother to discuss the results of a Pap smear and colposcopy. (Colposcopy is the screening test done after a Pap comes back negative, and often involves cervical biopsy.) She was cute, freckle-faced, with slightly eccentric mannerisms, the kind you can tell is a theater chick just by looking at her. She was wearing one of those knit wool caps with the brim that sticks out which theater chicks always wear. I don't know what they're called. Both mother and daughter were quite irate because they had had multiple Paps and colpos done at one of the other big hospitals in town and had never been able to get the results. They were both quite nervous about the fact that she had had an abnormal Pap. I looked in her chart, and saw that she had already had five colposcopies. Five. This girl was a freshman in college, and evidently she had already spread her legs for enough bad boys--or maybe one who was really, really bad--that HPV had already crawled in, put its feet up, made itself right at home, even built a little bungalow and had a party going on.

Call me naive, cultural leftists, but I'm pretty sure my grandmothers wouldn't have had five abnormal Pap smears by age 18.

This girl was not happy about the prospect of future Paps and colpos. "I'm deathly, irrational afraid of needles," or something equally eccentric, she said with typical theater chick melodrama. The doctor suggested she get the HPV vaccine. She immediately blurted out "I don't believe in vaccines." Her mother feebly expressed hope that if she were with one steady partner, maybe her future risk would be minimized. This normal, white bread, suburban mother, who took it in stride that her unmarried 18-year-old daughter was sexually active, was not wearing a wedding ring.

The fall of Western Civilization continues unabated. Gynecology clinic is the front line.

23 comments:

Anonymous said...

I like that "I don't believe in vaccines", but I don't mind my daughter getting analized.

Where are the barbarians when you need them.

Professor Hale said...

At least she didn't use the "only skanks get the HPV vaccine".

Thursday said...

The real divide with the Turks is religion not race. Turks may be Muslims, but they're white Muslims, not unlike the Tatars, the Bosnians, or the Albanians. Here's a picture of the most famous Turk in America right now. I've had some Turkish students and most of them looked pretty white too.

Furthermore, Middle Eastern groups from Northern India to Morocco really form a second branch to the European of the white race, just like Native Americans and Pacific Islanders are different branches of the East Asian race.

Thursday said...

I think it's only in the past few decades that we've started learning just how common (and insidious) some of these STDs are. Before accurate blood testing I don't think people would have realized that 25% of people are infected with herpes and can pass it on to others, even without symptoms. 45% in the black community. Absence of symptoms doesn't mean much in a partner.

Given that, it really is a good idea for all women to get vaccinated for HPV, even the really good girls. Even if they are themselves perfectly chaste, their future husbands may not have been and may not always be faithful. Same with the herpes vaccine they are testing. (Though that appears to be only effective at reducing infection by 75%.) Most strong Christian doctors I know of are in favour of the HPV vaccine for that reason.

Thursday said...

I find it amusing when someone like Roissy claims to be STD free. Someone like him almost certainly has some form of HPV and unless he has had a recent herpes blood test he doesn't really have a clue whether or not he has herpes. Condoms are only somewhat effective at preventing diseases, like HPV and herpes, spread by skin to skin contact and he has said he ditches those after a month.

The Social Pathologist said...

Thursday. The herpes blood test is pretty meaningless, all it shows is exposure to herpes. If you suffer from the common cold-sore it will come back positive, even if you don't have genital herpes. And with the practice of oral sex, the HSV1/HSV2 distinction is pretty meaningless.

As for the HPV vaccine, it provides immunity against the four most common serotypes of HPV, there are are whole lot of other ones out there. Given today's promiscuity rates, the degree of protection of the vaccine is only moderate. Still better than nothing.

@Hermes:
Call me naive, cultural leftists, but I'm pretty sure my grandmothers wouldn't have had five abnormal Pap smears by age 18.

You might like this post I just put up.

If you do decide to enter family practice, the experience of a mother bringing her teenage daughter in to be put on the pill will be an all too common event.

Ferdinand Bardamu said...

So this nice, pretty, highly educated and accomplished six-figure-earning white girl will marry a six-figure-earning Middle Eastern immigrant, probably have one mixed-race baby and deposit him in day care, then spend the rest of their lives blowing their combined six-figure income on a big house in some white-flight development with a name like "The Hunt at Glen Run," a couple of BMW's in the driveway, and international luxury vacations until they die in a nursing home. If their marriage lasts.

Why do I have the feeling that this marriage is going to end with the bride being chopped up and stuffed in a trash bag after she tries to file for divorce?

This girl was a freshman in college, and evidently she had already spread her legs for enough bad boys--or maybe one who was really, really bad--that HPV had already crawled in, put its feet up, made itself right at home, even built a little bungalow and had a party going on.

I've run in the social circles where girls like this congregate. You're barely scratching the surface - a disproportionate number of arty girls are nutty and slutty. Imagining a girl like this five years from now gives me the willies.

The Social Pathologist said...

Ferdinand

a disproportionate number of arty girls are nutty and slutty.

Agreed.

Thursday said...

I happen to have done quite a bit of reading on herpes and herpes testing. When it comes to genital herpes people should mostly be worried about HSV2 infection. Here's why:

1. Most people are immune to genital HSV1 infections because they are already infected orally.
2. Even when infected genitally, outbreaks are rare. (Rarer than genital HSV2, where outbreaks are less than 50%.)
3. Even when there is an initial outbreak, any reoccurances are extremely rare. (Very different from genital HSV2.)
4. Even when you have genital HSV1 infection it is hard to spread to your partner's genitals because:
a. they are likely to already have immunity from an oral HSV1 infection.
b. reoccurant outbreaks are rare.
c. it's just hard to spread HSV1 through genital to genital contact.
Little discomfort when infected and very low chance of transmission to partners = minor concern.

Oral HSV2 infections are rare, because:
1. You almost never get both HSV1 and HSV2 in the same location and most people are already have an oral HSV1 infection.
2. HSV2 tends not to like the mouth anyway.

Therefore, herpes blood tests are actually pretty useful. You have to do some deduction and some probablistic thinking, but they do tell you a fair bit. You either:
1. test negative for everything, in which case you don't have herpes.
2. test positive for HSV1, in which case you either have oral herpes infection which no one worries too much about or a genital herpes infection which will probably not have reoccurring symptoms and is hard to spread.
3. test positive for HSV2, in which case you almost certainly have a genital herpes infection.
4. test positive for both, in which case you almost certainly have an oral HSV1 infection and a genital HSV2 infection.

And that's when you have no or ambiguous symptoms. When there is an outbreak and then a positive blood test you can be pretty sure about the results.

Herpes viruses generally don't like to be in the places they haven't evolved for. The most common crossover is genital HSV1 transmitted from mouth to genital through oral sex and even that is generally not a serious problem.

Thursday said...

it provides immunity against the four most common serotypes of HPV

Not the most common. There are all sorts of HPV strains out there, but most of them are low risk for cancer. The vaccine targets the types that have a high cancer risk and the types that cause genital warts. The kinds that cause warts are low risk for cancer.

Thursday said...

To correct myself, the vaccine covers the most common high risk strains and the most common types that cause warts. But, IIRC, not the most common strains overall.

The Social Pathologist said...

Thursday:

For your reading pleasure:

Link 1.

Link 2.

Over here in Australia, serology is not in practice used as a basis for diagnosis. Blood tests are not considered very useful except for exceptional cases mentioned in the links.

As for the vaccine (Gardasil), it protects against the two strains of HPV that most commonly cause cervical cancer and the two strains of HPV that most commonly cause genital warts. In my brevity I was inaccurate. My bad.

Faust said...
This post has been removed by the author.
Neo-Victorianist said...

1 Corinthians 6:17
But he that is joined unto the Lord is one spirit. Flee fornication. Every sin that a man doeth is without the body; but he that commiteth fornication sinneth against his own body. What? know ye not that your body is the temple of the Holy Ghost which is in you, which ye have of God, and ye are not your own? For ye are bought with a price: therefore glorify God in your body, and in your spirit, which are God’s.

Venereal diseases now the main cause of infertility

Hermes said...

I like that "I don't believe in vaccines", but I don't mind my daughter getting analized.
Just to clarify, it was the daughter who said that she didn't believe in vaccines.

Thursday,

Furthermore, Middle Eastern groups from Northern India to Morocco really form a second branch to the European of the white race, just like Native Americans and Pacific Islanders are different branches of the East Asian race.

Interesting; I didn't know Turks could look so white. I did know that Middle Easterners are considered Caucasians and are much more closely related to Europeans than, say, Africans or Asians are, but I think that even without the interracial aspect, the interethnic/intercultural aspect of such marriages still bothers me.

Of course, what you say about STDs is true. I didn't know Roissy claims to be disease free; that's laughable. If he actually lives the lifestyle he claims to live, then he already has herpes, guaranteed.

Ferdinand,

I've run in the social circles where girls like this congregate. You're barely scratching the surface - a disproportionate number of arty girls are nutty and slutty. Imagining a girl like this five years from now gives me the willies.

I was actually a music major as an undergrad, and while I was way too socially reserved at the time to participate in any of the goings-on, I inevitably heard about them. What surprised me about this girl was that she seemed like such an introvert--though that could just be because she had her mother there, or was frustrated with her situation, or was uncomfortable having an unfamiliar dude in the room with her doctor while discussing a topic that implicitly touched on her sex life.

sestamibi said...

You got the development name wrong. It's actually "Birnam Wood at High Dunsinane Hill".

Anonymous said...

Turks look much more Eastern European than Middle Eastern. I've know Turks with red hair who are more fair skinned than I am, and I'm mostly of Scottish background. A lot of Turks around the Black Sea are Russian looking, very pale, with grey eyes. My wife is Turkish, and one of our daughters has blond hair and green eyes.

Just to confirm Thursday's comments, here is a photo of Tarkan, A Turkish pop singer:

http://www.nettekeyif.net/gir/data/media/157/tarkan.jpg

Anonymous said...

er... Turks are white, you ignorant dumbass.

Got Education? Geography Class Anyone? said...

You people (Thursday and those who did not correct him) don't even know that India is not in the Middle East and Turks are not Arabs!

Thank God I'm Asian and got an education!

And if bitter PUA/MRA rants were not enought to make start disliking men, a "doctor" who writes about his patients publicly online is!!!

Men like you will be the cause of women blowing up buildings. Mark my word. You are creating monsters!

A New Wave said...

And this is precisely why men should not be allowed to hold positions like doctor, nurse, teacher or professor or any position that has to do with the direct care of women or minors!

Stay behind the scenes in laboratories or shoveling coal!

Hermes said...

You people (Thursday and those who did not correct him) don't even know that India is not in the Middle East and Turks are not Arabs!
You're right; we were idiots to say that India is in the Middle East and that Turks are Arabs. Oh, wait. No one said that.

Thank God I'm Asian and got an education!
More evidence that Asians view themselves as a distinct group, different from whites, and look out for their own interests. Thus, they're really not much better as immigrant prospects than third-worlders. Are you listening, HBDers?

And this is precisely why men should not be allowed to hold positions like doctor, nurse, teacher or professor or any position that has to do with the direct care of women or minors!

That is very interesting. Can you explain why what I wrote shows that men should be prohibited from being doctors and nurses (I'm with you on the latter,) but teachers and professors as well? Maybe you could also explain it to the FEMALE attendings I worked under in OB/GYN who consistently praised me for establishing good rapport with the patients and making them feel comfortable.

A New Wave said...

You're right; we were idiots to say that India is in the Middle East and that Turks are Arabs. Oh, wait. No one said that.
................

Scroll up and read the comments, its all there.

(of course Asians are a distinct group! what - you think everyone is the same???)

Hermes said...

No, it's not all there, but I'm not going to waste time arguing about that with you.

And my comment about Asians was not directed at you; it was intended to criticize HBDers who care only about maintaining a first-world standard of living and not about our culture, and therefore call for an end to the immigration of low-IQ groups into America but are silent about or approve of Asian immigration because of Asians' high IQs.

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