As the cold days now filled with snow, I could see an older woman struggling to get her walker out of her car from my office window. A few minutes later, I overheard her talking to my medical assistant and realized that I knew her from before. She had been a patient in our practice for many years — seeing my senior partners when she was young and years later switching her care to me. Watching her walk, I knew her health had declined since I had seen her. She always struggled with her weight, but despite that, was active and involved in her community. Today, she looked defeated, huffing and puffing with the effort it took her to walk down the hall.
“I had a Pap smear 3 years ago with my primary care. I felt like he pinched something on my skin and ever since then I have bleeding once in awhile when I wipe. I didn’t want to go back to him, it hurt too much. Since I was told I didn’t need Pap smears anymore, I never came back here.”
When I asked her more about how she was doing, every sentence started with a sigh. She went on to describe her medical issues, the struggles getting her medications paid for by Medicare, how she moved into a senior living apartment and hated it. “No one wants to do anything!” She looked tired and worn out from life. Her usual animated and energized demeanor was extinguished. How sad it was for me to see her like this.
In the exam room, it took no time for me to figure out where this spotting was coming from. She had a marble size mass extruding from her vulva near the clitoris. This beefy red, angry looking mass easily bled when I touched it. “I can see what is causing the bleeding and it isn’t because of your last exam. You have something growing here that I need to biopsy.” She didn’t want me to do the biopsy that day. “I have too many things to do today.” I couldn’t convince her otherwise.
A month later, she finally came back for the biopsy. I scheduled a follow up appointment in a week since I was certain the growth was cancerous. When I received the biopsy results my first thought was “this could have been caught so much earlier if she had yearly gyn exams.” But here she was, with multiple health issues, difficulty getting around, and now vulvar cancer with a disfiguring, painful surgery ahead of her.