Speculum

by Skye Ayla Mallac

The realisation comes to me quite suddenly, from no particular direction, as though the noise which has kept me distracted from this possibility has, all at once, been silenced. And I know, with the kind of crystalline certainty, that there in my abdomen, in the depths of the soft tissue which makes up my life force, the virus has returned. Or maybe it has been replaced with another. Either way, it is there. Crawling and proliferating in my depths. Silent and unobtrusive. Familiar even.

Now the cold silk of the gown feels stifling. The hard examination bed beneath me pushes back at my legs, my hips, my heels. A chill streaks up the length of my spine to my cranium, splitting off at my scapula to follow my ribs around to my front. My heart hammers, unsettled by both the realisation and this unprecedented physical response.

A knock on the door now. Unnecessary but cursory - just like her departure from the room. I’ll leave you to take your clothes off before I ask you to spread your legs so I can bear witness to a part of your body even you have never seen. She is brisk and obtrusive by nature, masculine somehow, as so many women in the reproductive health sector seem to be. I find myself thinking of that now, as she wraps a deflated plastic tube around my upper arm and pumps it up.

‘Nice low blood pressure,’ she remarks brightly, too brightly. ‘You must be fit.’

I know she is trying to gloss over our conversation earlier, to soften the rigidity in my shoulders which has been there since my patient intake.

‘New sexual partner since your last test?’

‘Yes.’

‘Birth control?’

‘None.’

She looked up sharply, lips peeling back from her teeth in a strained smile. ‘No birth control?’

No. I shook my head, explaining, suddenly awkward, how I’d learnt to track my cycle, read my body, know, approximately, when an egg has been released with an unceremonious jab of pain, from my ovary. I know when to have sex and when not to. If she’d had less botox, her forehead would have been knitted. Instead her eyes gave her away. They were piercing and unreservedly judging. She leaned back in her chair and released a huff of breath from her nose.

‘Well, you know what they call women who use the rhythm method?’ she said, in a singsong voice. I waited, wondering if this is further judgement. ‘Pregnant!’ she said with a tinkling bark of laughter. I felt myself recoil from her.

‘Well, I’m not,’ I said softly, too softly, while fury, released from some unrestrained corner of my body, burst forth quietly. Beneath the surface.

Now she is explaining how blood pressure readings work and I am listening because it’s easier to smile and nod benignly than to accuse your female GP, the one you just met, of inappropriate commentary. What if I wanted to be pregnant? I want to ask her. What if I’m getting married? She didn’t even ask if I was in a relationship (I wasn’t), or if I had been pregnant before (I hadn’t) - but that wasn’t the point. The point was, that she had looked me up and down, all 27 years of me, and decided that, should it occur, mine would be akin to a teenage pregnancy and there was nothing - nothing, as we all know - so terrible as that.

Having taken my blood pressure she now has the cold palm of her stethoscope on my back, instructing me to breathe deeply and exhale, without giving me the time to do either. And beneath her obtrusive fingertips I can still feel my recent realisation, echoed in my slowing heartbeat, in the hollow pit of my stomach, in the chill of my ribs.

I am here for a routine pap smear, for my third consecutive clear result which will allow me to leave this place and not return for several years. Except now, I realise, I probably will be back. Probably in six months. But I don’t know this for sure yet. First she has to take the test.

The clear plastic speculum is in a clear plastic bag. Single use. Disposable. But so much better than the cold reusable metal ones of yore, she assures me, far less discomfort. She is snapping her plastic gloves on, applying a thick, clear mucilage to the device - and to me. The speculum reminds me of those sectioning hair clips used at the hairdresser. The sort that slide, impossibly smoothly, through your hair and along your scalp, to clamp down crocodile-like, avian, into place.

‘Relax, breathe,’ the GP is saying as she inserts the plastic beak of the thing into me. Cursory, unnecessary guidance after you’ve been here this many times. Besides, it’s not the insertion that’s uncomfortable, it’s when she begins to crank you open, the jaws of the speculum widening millimeter by millimeter, until she - with a head torch strapped to her forehead - can peer up into your depths.

I have departed my body now. Mentally. In a way that feels necessary for a procedure like this - not realising that this dissociation will be the cause of me curling into bed in tears for the next two days. The body keeps score, and all that. I’m thinking of something else while she inserts a long, thin plastic stick down the channel of the speculum and prods at my cervix.

I am not far - I’m only upstairs, two years before, with another GP, the one who’s name is stamped on the doors of the practice - when she was smiling at me mechanically and I had never done this before and she was assuring me that it was simple, easy, nothing to worry about. Three days later she administered the diagnosis through the clinical drip of a telephone line.

‘You have HPV, you’ll have it for the rest of your life.’

It’s common, she assured me, so common, so very common. The problem, however, were the high grade lesions on my cervix. They’re what the doctors called pre-cancerous. They required removal, excision. Ideally by a heated loop of metal. Ideally sooner than later. She gave me a referral, no longer in her hands now, but someone else, who will happily insert that heated loop of metal into me and scrape these cells away.

Crouching in the garden as the line went dead, I cried for a while. Then I called my mother, naturally. Then I began to research in earnest. This is what I found.

The Human Papillomavirus is a ridiculously common infection with over two hundred strains, some of which are responsible for benign warts - including the small, cauliflower-like one that punctuated my index finger (or was it my right?) in my early teens.

The sexually transmitted strains are so common that 90% of sexually active adults will contract one or another at some point in their lives. Most of the time the virus is eliminated by the immune system before it presents symptoms or is picked up by routine tests such as this one I am undergoing, right now.

A handful of strains present a risk to the cervix, where they will penetrate the twisting, laddering helix of a chosen cell’s DNA, find the rung responsible for the P53 gene - which suppresses tumor growth - and will, in turn, suppress it. This can lead, in ascending order, to cell abnormalities, lesions on the cervix, and cancer.

I also learnt that it would take approximately ten to fifteen years for an unchecked infection of high risk HPV to develop into cervical cancer. I learnt that HPV and cervical cancer are inextricably linked. You cannot get the cancer without having contracted the virus.

At the time I had only had sex for the first time five years before. I thought about it for several weeks and then decided to give myself six months grace in which to explore alternative treatments, before allowing a heated loop of metal into my most delicate arena.

I was, unexpectedly, successful. Seven months later I was presented with an entirely clear scan. Six months after that, another. Two weeks after that second clear result I met a man. Our love affair was brief and virile and harrowing and, eventually, sickening.

As I lie on the medical table, with a speculum funneling air into me, we are no longer together, but I know - with chilling certainty - that he has left something behind. Memorabilia, one might say. A souvenir, perhaps. Something microscopic and proliferating. Something, he insists, when I tell him two weeks later, that it is impossible he could have put there.

It is over text. Thank God. I only choose to tell him because, when I run into him in the little supermarket, there is a mouth shaped patch of red on the skin of his neck. Impossible, he tells me, when I tell him. The two women I was with before you didn’t have it. How do you know? I ask. He can’t answer that. Instead, he is furiously explicating that now he will have to go for a damn test. You can’t, I tell him. There’s no test for men.

He rages. He roars. He hurls abuse through the very same digital drip that informed me of my condition. There is no care, no consideration, no concern for my health and the ongoing impact this will have on my life. He wrenches any scrap of friendship we’d maintained since he shunted me to the periphery of his life and smashes it, stamps on it, pours a viscous black tar over it. Then he turns to me - or perhaps himself, since I have not responded to his ceaseless barrage of messages in the last hour - and says, look. Look what you’ve done.

In the aftermath it feels like a door has been slammed but is pressed up against my cheek. His blocked contact feels like a live wire. I barely sleep that night, febrile and furious. I feel battered to a pulp, as though his words were fists and perhaps they were. Every time my body slips into a doze my mind yanks me back to consciousness with harrowing insistence. It’s not safe, it is saying. You can’t rest, it is saying. He’s a danger, it is saying. And still, deep inside me, something is proliferating silently.

In an attempt to make sense of his bizarre behaviour I begin to research narcissism. The results are, to my eye and personal experience, decisively conclusive. He is textbook, I say to my mother as she tucks the spring seedlings into her garden. Everything he did, everything is textbook. It’s called narcissistic rage. It’s called gaslighting. It’s called redirection. Piece after piece slides neatly into place. Like a puzzle, a wooden one, which allows a satisfying thunk each time a piece of information surfaces which validates my experience.

The knowledge calms me, just like the scientific understanding of the virus lurking in my innermost cavity calmed me.

Some months later, as the haze begins to lift and I can navigate life without his looming presence at my heels, I type his ex-girlfriend's name into my Instagram search bar. It is, I tell myself, a final confirmation of his character. I am curious as to whether this woman, too, fell victim to his icy manipulative tendencies.

She’s not hard to find. We have mutual friends. He had told me about her a handful of times. How they had dated for five years, and how he had loved her, and how her father always, baselessly, disliked him. How they had broken up ten years ago now. How she refuses contact of any sort with him. How it’s an overreaction, but he respects it.

Social media is a bizarre thing. That we should put some of our most personal and deeply affecting experiences on a public platform. That anyone with a profile might choose, for their own reasons, to explore those innermost workings of the mind you have chosen to share. Most people keep their personal profiles locked these days, so I am surprised when I find that hers is public.

I scan the checkerboard gallery. Swiftly gathering the minutiae information with the practiced ease of one partial to research. I click on a square at random and pull my thumb up the cool glass screen to read the caption.

It’s a lengthy one. She is in a loving relationship. She hiked a lot in the past months. She was diagnosed with early stage cervical cancer a year before, which required an immediate and total hysterectomy.

I feel a smooth, polished wood piece in my brain slide into place with a thunk.

BIO: Skye is a writer and creative based in South Africa. She has written poetry and prose since childhood and it serves as both a cathartic outlet, as well as a tether to others. She is deeply inspired by the intricacies of her own psyche, the exploration of vulnerability, as well as - on a broader note - the South African landscapes she grew up in. She worked as a music journalist for 9 years and as a freelance writer for over a decade. Her debut poetry anthology Whole, Gold, Crystalline was published in 2022 through One Mountain Press, and her debut novel The Bee People is published on AmazonKindle.