After having her first mammogram, Anna Rawhiti-Connell finds efficiency, reassurance and care in a beleaguered public health system.
I have a very Swiss attitude towards my body. In the interests of peace and stability, body neutrality has been my go-to policy since entering a period of detente four years ago when I accepted that being very overweight for most of my adult life wasn’t entirely my fault.
My body is a vessel and a vehicle. It’s useful and deserves a level of care that I still fail at consistently delivering. It gets by with basic maintenance and an annual warrant of fitness from my GP. I neither love it nor loathe it.
After having weight loss surgery in 2020, and until this year, it has not been particularly bothersome. There have been a few bouts of Covid, gallbladder attacks, a need to take three supplements each day and occasional gastronomical protests after eating too much sugar.
This year, however, I have felt more than a little out of alignment. I am still blessed with good health, for which I am very grateful, and to the over-45s reading this, I know I am still relatively young, but a bit of age has dings feeling like dents and dull aches becoming niggling pains.
“It’s almost impossible to age with any dignity.”
It’s the opening line of a gig review written by Duncan Greive in August.
“My elbow had a swollen fluid sac bulging out. A friend finds her fingers numb when she sleeps in the wrong position, while another took his first fall ‘that felt like how an old person would fall’. We’re all in our mid-40s,” he writes.
I imagine it might be frustrating for someone who has written about music their whole life to find out that I cannot recall whose concert he was reviewing. His weird “fluid sac” and “old person” fall lines though? Permanently lodged in my brain.
I am prone to rolling on my ankles, and therefore, I am prone to falls. Instead of bouncing back quickly as I did in my 20s and 30s, these trips and slips have turned into six weeks of physio for a “jarred pelvis”, a puncture wound on my chin and eight weeks in a knee brace after tearing my ACL. My knee and lower back now remind me of the slips and the trips every time I move. I do not sleep well any more and take magnesium and low-dose amitriptyline most nights. I have a long-awaited specialist appointment early next year for something I hadn’t heard of until now but is apparently quite common “at a certain age”. I had sinus problems for three months this winter, and after years of living blissfully free of UTIs, they are back with a stinging vengeance.
This boring list of minor irritations and ailments can probably be linked to the seemingly endless march of the most mercurial of phases, perimenopause. I am so bored with the boring list, but as I tick off each new bodily dysfunction, cautiousness creeps in. I hold stair rails now and pay stupid amounts of money for all kinds of insurance. Instead of just dealing with the consequences of the small risks that come with living any kind of life, I increasingly think about preventative measures.
On the morning of my 45th birthday, I filled in the online form to get my first mammogram. The urgent sense of needing to stay one step ahead of anything going wrong was a powerful motivator. I also like taking tiny jars of jam and shower caps I never use from hotels. This love of “free stuff” also seems to apply to having my breasts squashed and screened.
Afortnight ago, I had that first mammogram.
I arrived at the breast screening centre seven minutes late. I parked outside a nondescript office building in a nondescript suburb in which many topless women have the secret cellular lives of their breasts exposed.
I’d spent too long deciding what bra to wear. I didn’t know what to expect at my first mammogram, and a nervous job interview reflex had kicked in. It’s not a job I was after, but an uncomplicated experience and a clean bill of health. “Best to dress for the outcome I want,” I thought. I settled on a mesh wireless bra I bought during the pandemic when all clothing had to be comfortable, and to online shop was to test whether you were still capable of making good decisions.
After I arrived, the receptionist gently told me she was just about to ring me. Her smile transmitted nothing but calm in the face of a person who’d possibly buggered up the flow of her day.
I expected to be sat down and told to wait, having missed my spot.
“It’s my first time,” I said, hoping to use nerves as a cover story. The receptionist just smiled another smile, serene and affirming. She handed me a form and asked me to check the information. It was all correct. That’s quite rare when you have my surname. Systems hate hyphens and non-English names.
“I will take you through now,” she said. Because I’d been expecting to sit, I was caught unaware. “Sh-OK,” I said, aiming for sure or OK and failing at both.
“You change here.” She pointed to a cubicle with a heavy patterned curtain. “Take off your top and bra and pop on a robe with the opening at the front. “Put your belongings in here,” she said, handing me a red shopping basket, “and carry it with you because you get changed again on the other side.”
It’s like a drive-through, I thought. I made a silly little joke in my head about “fries with that”.
I am as delighted by efficiency as I am by tiny jam jars taken from hotels. I like to imagine the puzzle that got put together when systems came to be designed. As I whipped my T-shirt and bra off, I thought about the people who gamed out this tidy process. The people who decided it should flow like a drive-through and that you be given a little basket. The people who organise the contract for the cleaning of the robes each day. The people who are part of a system that politicians sometimes refer to as “a bloated bureaucracy”. The people pulling this publicly funded safety net taut as colleagues lose their jobs and departments are dismantled. The people who travel to work reading and hearing about how terrible everything in their corner of the world is. The people who keep turning up while being told that their system is broken and in crisis.
I took a photo in the changing room, deciding the robe actually looked quite good on me, despite the droop occurring beneath it, and then moved into the next waiting room, clutching my basket. It was reassuringly familiar. Warm blond wood with high polish. Tidy, not lavish, and perfectly designed for disguising wear and tear. These exact chairs, blinds and carpets must have been ordered countless times across the country.
Surely, I thought, the whole experience won’t be this impressively efficient and careful. I don’t know how you’re meant to feel before getting your boobs out to be squashed and documented, but I was certain the sense of calm would be fleeting.
The other person in the waiting room had someone with her. I quickly realised it was a translator provided by the broken, crisis-ridden system for people whose first language wasn’t English.
I waited for about two minutes in that room and then the medical imaging technologist took me through to another, darker room.
She spoke assuredly, asking my name. She told me how to stand. She pulled and stretched my breasts onto the plate of the X-ray machine that 80-90% of the time, accurately identifies the disease that kills 650 women in this country each year.
She acknowledged that the second position you take during the screening, with your arm raised and your head leaning against the screen, is a bit uncomfortable without suggesting it was awkward to the point of embarrassment.
She told me I was the very model of a perfect first-timer.
Looking down at my squashed left breast, my first thought was, “smash burger”. My second? “How bloody wonderful”.
How wonderful that someone developed this technology. How wonderful that, as a society, we decided that preventative healthcare was important and should be accessible. How wonderful that we instituted a public health system.
My mammogram results arrived via a text from my medical centre seven days after my appointment. No cancer had been detected. A letter from Breast Screen Aotearoa confirming that again arrived last week. This week we all learned that Nikki Kaye died on November 23, aged 44. Kaye was diagnosed with breast cancer in 2016.
Most, if not all, people in New Zealand have colleagues, friends and family who’ve been diagnosed with breast cancer. As I age, the instances of finding that out about people I care for only increase. My boring list of minor irritations and ailments feels like a luxury when I think of those who don’t get the chance to experience them. Holding a neutral position about my body is only possible because I am well. Knowing that I am well is only possible because other people turn up every day to scoop and stretch breast tissue for the sake of other women’s health.
All is not well in the public health system. This wonderful breast screening programme is plagued by the same inequities and barriers to access as the rest of the health system. The pandemic caused delays in screenings in 2020 and 2021. It is estimated that 28,500 breast screens were missed, and Māori and Pasifika women were disproportionately impacted.
I am not wearing rose-tinted glasses. I had a very good experience; many don’t. But if we only talk about crises and things that go wrong, we miss the thousands of things that go right. If we don’t talk about them, we are in danger of taking them for granted, and what we take for granted can more easily be taken away. An anonymous mass of crisis is easier to chip away at than thousands of single, caring interactions with singularly dedicated people.
As I emerged from the nondescript screening room in the nondescript building, clutching my red basket, I felt a little bit cared for by people and a little less like taking my body for granted. As I slip and trip out of youthful health and enter a different stage of my relationship with my body, I am grateful for the safety nets that hang beneath me.