My Father, My Doctor

Mary Smith

When I was twenty my father touched my breast. I had told him I’d found a lump, and he was a doctor. He did not ask permission. It did not occur to me that I could say no.

He and my mother distrusted the secular, outside world. They told me that I did not need a doctor of my own. They homeschooled my three sisters and me for our entire lives, carefully controlling the interactions we had with the outside world in our small rural town.

Several years later, after graduating from college and distancing myself from them, I now keep returning to the lump and to the exam, trying to make sense of them. I want to correctly label what my father did and tell the story of it as accurately as possible. I keep failing and keep trying.

Telling 1

My nipples grow hard in the cold. Dad’s hands are warm and damp. I try to make eye contact to show that this is fine. I cannot force a normal rhythm on my heartbeat, cannot remember to breathe, cannot stay in my skin.

He stares at my breast as he presses the lump and rolls it back and forth between his fingers. I can’t look at our reflection in the bathroom mirror, splattered with toothpaste and smudged with fingerprints. I get through it ten seconds at a time, just like when Mom yells. One. Two. Three. Four. Five. He’s a doctor. He’s a doctor. You need him. You need him.

In mid-September, the New Hampshire nights are already near freezing. The cold purifies the air, clears the leaves from the trees. The newly renovated bathroom is full of dark corners, blooms of black mold in the caulk between fresh white tiles.

“Yeah, you’ve got a lump,” he says, as I stand shirtless in front of him. My lungs open, my heart slows—relieved he confirmed it, relieved the touching is over. I couldn’t really know what I’d felt in my dorm room the week before, when my stomach fell in panic as my hand brushed over it.

I never thought to say no. Not outside the bathroom door, when he said, “Strip to the waist.” Not as he lathered his hands with Dove soap for a full twenty seconds. Not while he rolled my flesh back and forth and back and forth. Saying no would have meant leaving the lump unidentified, saying no would have meant not trusting his care, saying no would have meant not loving him.

Mom hovers in the hallway. Neither of them mentions his exam again.

~ 

The first time I read that scene to strangers in a writing workshop in New York, I was surprised when the whole room was silent for a long time, and then everyone said, “I’m so sorry that happened to you.” After sharing a later version, one reader said, “It seems like the speaker is unsure if what her father did was abuse.”

I wanted to say: “Don’t you understand? I was an adult, it was only a few moments, he was a doctor, doing it for a medical reason, even though it’s weird.” But I want to write the memory accurately. To be accurate, I need to clearly classify what my father did and then layer on the meaning of it. Was he just being a doctor? Or was it abuse?

~ 

The American Medical Association’s guidelines on treating family members:

In general, physicians should not treat themselves or members of their own families. However, it may be acceptable to do so in limited circumstances:

(a) In emergency settings or isolated settings where there is no other qualified physician available. In such situations, physicians should not hesitate to treat themselves or family members until another physician becomes available.

(b) For short-term, minor problems

In reply to (a): According to my parents we were in an isolated setting. My parents homeschooled my three sisters and me (I was the second eldest), from kindergarten until college because of the “bad” teachers around us and “toxic mainstream” kids we’d encounter at school. My mom also insisted we keep at least two months’ worth of food on hand “just in case” of a major storm or nuclear attack. We had a fifty-pound bag of kitty litter in the basement (we did not own a cat) in case a terrorist attack affected the sewage system.

They frequently told us, “The doctors around here are all bad, it’s just so rural.” But we lived less than a mile from a hospital with an ER and an on-staff ob-gyn. We lived twenty-nine minutes from a teaching hospital that employed 1,300 physicians. We did sports with public-school kids. My parents invited neighbors over for dinner. We worked with tutors for some of our subjects. Not isolated.

What about emergencies? The Medicaid definition of emergency medical condition is:

medical condition (including emergency labor and delivery) that manifests itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:

Placing the patient's health in serious jeopardy;

Serious impairment to bodily function; or

Serious dysfunction of any bodily organ or part.

Nothing about dime-sized breast lumps in young women is an emergency. I was not in pain; even if it were cancer, a few days would not have resulted in serious impairment or dysfunction. And my dad is an ER doctor. He had nearly thirty years of experience in diagnosing and treating medical emergencies. He ordered an ultrasound for two weeks after his exam. It couldn’t have been an emergency if that kind of delay were okay.

Regarding (b): Could a breast lump be a short-term, minor problem?  Benign lumps are the most likely, but there was a possibility of a long-term, serious problem—cancer. Cysts or benign fibroadenomas (which is what it turned out to be) are the most common. Standard of care is ordering an ultrasound after confirming there is a lump. The comma in the phrase “short term, minor” seems to imply a relationship between the two adjectives, but the lack of a conjunction—and/or—makes it possible only one must be true.

My father did not follow the guidelines, he was unethical. But not following them doesn’t mean it necessarily was abuse, right?

Sexual abuse is defined as:

Unwanted sexual activity, with perpetrators using force, making threats or taking advantage of victims not able to give consent. Most victims and perpetrators know each other. Immediate reactions to sexual abuse include shock, fear or disbelief. Long-term symptoms include anxiety, fear or post-traumatic stress disorder.

Is a breast exam sexual activity? Larry Nassar, the longtime Team USA Gymnastics doctor, abused hundreds of young gymnasts under the guise of medical exams. What made those exams abuse? Most definitions I can find say that the defining aspect of sexual touching is that it is done for the purposes of arousal or gratification of one or both people. Larry Nassar touched young girls in exam rooms for sexual gratification.

But as far as I know, for my dad there was no arousal or gratification. This had never happened before; it didn’t happen after. If it was for gratification, why wouldn’t it have happened when I was even younger and more vulnerable? And I wanted to know if the lump was okay, perhaps this counts as making this touching “wanted” rather than “unwanted.”

I was twenty. Not technically a minor, I could have said no. According to most laws I can find, I was able to give consent.

But then I re-read the AMA guidelines:

Patients may feel uncomfortable receiving care from a family member. A patient may be reluctant to disclose sensitive information or undergo an intimate examination when the physician is an immediate family member. This discomfort may particularly be the case when the patient is a minor child, who may not feel free to refuse care from a parent.

Because he was “my” doctor and could read every medical record, I never told a single nurse, nurse practitioner, physician's assistant, or physician that I had been taking birth control. This meant that no one who cared for me got a complete history and had to treat the lump as if it were actually a potentially much rarer form of growth than the fibroadenoma it was. Fibroadenomas are the most common type of lump in women between the ages of fifteen and thirty-five, often caused by hormonal birth control.

“Taking advantage of victims unable to give consent,” “child, who may not feel free to refuse care from a parent.” Both of those seem to apply, even though I was no longer a minor. He wielded two types of power over me: parent and doctor. Larry Nassar’s victims struggled to make their parents and outsiders believe what he did was abuse because he carefully described it as a medical necessity, complete with PowerPoint slides that explained his fake “treatments” for real medical problems. Reporters and observers asked over and over, “How did he get away with this hundreds of times?” But it did not surprise me because I know the special kind of power doctors wield. My dad couldn’t walk through an airport without being asked for medical advice, shown weird moles, painful joints, and then being thanked with shining eyes and, “please, if you ever need anything, just tell me.” His expertise got him tickets to Beyoncé concerts, trips to Dubai, free fishing trips to luxury Colorado ranches. Medicine seems like magic when you aren’t a doctor. And access to medical care in this country, where it is never guaranteed, is precious.

His power over my physical well-being felt total. He could have acknowledged this, used empathy to imagine why I might not feel comfortable saying no, and told me, “It is okay if you’d prefer another doctor.” He didn’t.

And the symptoms of sexual abuse seem to fit me. I decided, right after the exam, to not believe that it had happened. It was too hard to reconcile his touching with the fact that he was the only person in my life who could have helped me if I had cancer. And I have had anxiety and fear about doctors ever since this. Perhaps getting lightheaded and breathless at every medical appointment is PTSD. And though there were other reasons too, the cancer scare, the exam, and the mess of feelings it left behind were major reasons in choosing to pull away from my family.

It must have been abuse then. He was my parent, there was no consent, no emergency, and no “short-term, minor problem.” He was also my dad, who did not seem to think he was doing anything wrong.

Perhaps I can tell it as truthfully as possible. I’ll try again.

Telling 2

My father says, “I’ll take a look” after I tell him, “I think I have a lump in my breast.” He is so businesslike, his eyes sharp blue-grey, as he says “strip to the waist” as if it is a thing fathers say to their daughters, like “don’t stay out too late,” or “call us when you get there.”

He does not say “is it okay if I take a look?” or “do you want me to take a look?” or “do you want to have another doctor take a look?” As far as he knows, I have never had any kind of sex ed and haven’t gone to a doctor since I have gotten breasts, and this means there’s a reasonable chance I don’t even know what my own body feels like. And I wonder if he wants to show me what he is capable of, that I am his, make me feel that I cannot say no to him.

And immediately I know I was foolish to not expect this. He provides all our medical care, gives my sisters and I stitches on the kitchen table. Mom says often, “You are so lucky to have a doctor in the family.” But this feels different, it is my breast, not a flu vaccine into my shoulder, not a cut on my knee. This is a sexual body part. I did not think my dad would ever see my breasts, ever touch them.

My nipples grow hard in the cold. I worry this makes me look turned on, and that this will make it worse, entice him. Dad’s hands are warm and damp. First he palpates the edges of my left breast, so slowly, as if to memorize the feeling. And then he closes in on the lump. He does not feel it and then stop and let me go; instead he finds it and stares intently, rolling it back and forth. First left to right, then right to left, then left to right. Up and down and down and up. Why does it take so much touching? Perhaps he wants to be extra sure of what he is feeling, not rush through like he might need to rush through another patient during a busy ER shift. His time is precious, he is usually away from home, and now he is giving so many minutes to me.

It is not real that my father is staring at my nipple as he touches my breast. I cannot have that kind of father. My heart races and immediately my mind escapes from my skin.

The closest bus station is five miles by foot. He knows this. I have $136 in a checking account both he and Mom have access to. I cannot leave without their permission, without them helping me pay for a bus ticket and driving me to the station. Perhaps this is why he did not feel he had to ask.

I remember my mother telling me at ten, “You can’t walk around without a shirt anymore, now that you’re developing, not around your father.” And I wonder if this is why she told me. Perhaps this is the consequence of growing up and being his.

My body feels as it does when Mom sits on my legs, one sister holding my arms, another holding my feet, as they all take turns tickling me. I cannot breathe, I kick and squirm and try to squeak, “Stop! Stop!” But I have no air to form words. They laugh and squeal. “Why aren’t you more relaxed? We wouldn’t do it if you didn’t make it so fun!” It feels as if my role is to be touched, for them to assert their ability to touch.

And he is still touching me, still staring, and every cell of me wants to dart away from him, cover myself in layers and layers of clothes, and never be touched again. The back of my tongue tightens and swells with nausea. I want so badly to think this is fine, but if it were fine, why would my body react this way? Maybe this is just what breast exams are like. I have never had one after all. Perhaps for doctor’s appointments they don’t really use the gowns. 

“Yeah, you’ve got a lump,” he says, as I stand in front of him. Why couldn’t he believe me? Why did he have to touch me himself? I put on my T-shirt as fast as possible and resolve never to tell anyone about this. His voice is so kind, so soft, as if he is moved by his own care for me. His own father was a doctor who both beat him and treated him for cuts, bruises, broken bones. In this moment he must think he is the good father he imagines himself to be, saving me as a physician, sparing me the physical abuse he got as the child of a doctor. This is how he knows to love me.

~ 

This telling is too jarring. If this were the way it really happened, then it would mean that my current explanation of my father is wrong. He’s not just a sad, traumatized, narcissistic man; his actions hold the possibility of a more sadistic mentality, the desire to show control over me by showing that I could have no boundaries of my own—a desire shared by my whole family.

I hear my family’s voices inside my head. “Why can’t you just say it plainly? What does the covering-up comment have to do with anything?” I wonder if I am relying too much on the subjunctive, the hypothetical, to be fully truthful. Is it really fair to juxtapose all those “I wonders” and “perhaps” in one scene, taking those comments about my body out of context, creating my own new context for them all? If it really happened this way, shouldn’t I just be able to stay in simple indicative? Not have to imagine any extra meaning into the simple, physical maneuvers of the scene? According to Wikipedia, the subjunctive itself is defined by states of unreality, such as wish, judgment, and possibility. “Unreality” seems to be an answer. If I have to rely on conveying some form of “unreality” then all these hypotheticals must not be true.

And yet the subjunctive seems to contain the truth of it. Creating my own new context allows me to convey the constellation of violations that defined my life in my family. It was a life of many small infringements, each one just small enough to merit the thought: “Other families might do that, it’s fine.”

And the subjunctive version of the scene explains why, after this, I could not see doctors without getting lightheaded and dizzy, barely able to answer their questions. Even though he never touched me this way again, I always expected it from other physicians. I was surprised to be given robes at every breast exam I’ve had since, surprised when they said, “I am about to examine you, alright?”

~

I want to add to the scene the paragraphs and paragraphs of all the things he got right as a dad: long August bike rides together, coming to watch me ride a horse he leased for me, cheering me during countless swim meets, paying for my college. I want to reassure myself and the reader that it wasn’t all bad, but in doing so I would create a less truthful version of the scene, one that didn’t reflect my actual experience of his touching.

Writing it this way, accepting it as accurate, removes some of my ability to say, “I was just a poor fit for my parents, they had their issues they didn’t deal with, but they weren’t really that bad.” Choosing to touch your daughter’s breast is bad. Holding her down and tickling her as an adult is creepy. I don’t want to be the daughter of creepy parents. I want to have the control, to make the distance between us my fault, because that means there is still a possibility I might fix it. This telling makes me worry that there are other moments of violation I’ve decided not to remember, and remembering the exam this way might cause them to well up and flood my current understanding of myself, crack all my newly formed foundations. I almost rewrite, again.

But then I imagine how it would have gone had my father chosen to behave ethically, had my parents been less afraid of the outside world and intent on exerting control:

Telling 3

I tell my mom, “I felt a lump.” She says, “That’s so scary, let’s go to your doctor.”

She comes with me to my appointment; she doesn't want me to feel alone. My doctor says, “This is probably from your birth control, let’s pause that and get an ultrasound.” I don’t lie about my birth control, Mom knows, and though she doesn’t agree with it she still loves me.

I feel awkward during the exam because doctor’s appointments are just awkward. I have had many by this point. My doctor knows my full history and they tell me, “This is extremely common in young women, it might even go away on its own.” I trust them.

We decide to leave it alone and do an ultrasound every six months.

Dad says, “Do you want to talk about it?” And I say, “Not really.” And he does not press. He’s just my dad, who happens to be a doctor, but he is not my doctor. He has never touched my breasts.

~

I imagine it as I write this ideal version of the scene inside my New York City apartment, which I have painted soft yellow and filled with books my mother would classify as mortally sinful. I live hundreds of miles away from my parents. They have never seen my new home, though I have lived here two years. Two bonsai bask in sun on the kitchen windowsill, a Chinese elm and Serissa. I never prune them, I adhere to a strict watering schedule, measure fertilizer by the gram. I do this because I know that choices that may seem little to me—a slightly too aggressive cut, a tablespoon too much fertilizer—might damage them irreparably. I let them be a little wilder than I’d like. They are happy, the elm sprouting many soft green branches, the Serissa blooming continuously.

Mary Smith is a writer who lives in New York.