By Robyn Correll Carlyle
My first year of public health grad school, I went into the student health center for my general checkup. My blood pressure was well within range. I was a healthy weight. I exercised three times a week and ate vegetables – Not to brag or anything, but I felt like I was pretty much going to ace the checkup.
Everything was going well (and I was feeling pretty good about myself) until the nurse Betty* came into the exam room, looked over my chart and said, “I see you haven’t gotten the HPV vaccine yet, and you’re about to age out. Do you want to go ahead and get it today?”
Prior to grad school, I had been in the Peace Corps, where they poked me with what I thought was every vaccine conceivable. I didn’t relish the thought of yet another. Besides, I had heard about the HPV vaccine. It was the STD vaccine.
I was engaged, thank you very much. To a guy I had been seeing for four years. I didn’t sleep around. I was pretty sure I didn’t have – nor would I ever get – genital warts. It seemed totally unnecessary. And didn’t the vaccine just come out only a few years prior? That’s a little too new for me. I didn’t want to be a guinea pig.
“Umm, is it something I have to get?” I ask. “For school, I mean?”
“No,” Betty said. “It’s not required. But it is really important. It’s to protect you from cancer.”
I didn’t really hear that last part. I just heard “not required.”
“Then no,” I said confidently. “I’d rather not.”
Betty put down my medical chart and sat across from me, giving me her full attention. “What’s got you nervous about it?” She asked gently.
And then she listened. For every concern I had, she had a response.
The vaccine wasn’t “totally unnecessary.” HPV is very common – most adults in the U.S. will get it at least once. And it doesn’t just affect those with risky sexual behaviors. Most new infections are in young people, just shortly after their first sexual experience. Because it can be transmitted skin-to-skin, condoms don’t fully protect against it either. It didn’t matter that I was about to get married, I was still at risk.
It’s not that new of a vaccine. Prior to licensing, the vaccine had been tested for several years in thousands of people. And what’s more the vaccine technology used to make the vaccine is even older. The HPV vaccine is made using the same technology as the Hepatitis B vaccine – a vaccine that not only has been around since the 80s, but also is so safe that it’s recommended for infants on the day they’re born.
It won’t give me HPV. The vaccine doesn’t contain the whole virus, just a slice of virus DNA. So it’s biologically impossible for the vaccine to give me HPV.
One by one, she patiently shot down each and every one of my concerns until I was fresh out of excuses. She gave me the first of three doses then and there, and then made sure I knew when I needed to come back to finish the series.
I didn’t really appreciate it at the time (in fact, I thought she was bit of a bully), but now I’m grateful to Betty for taking the time to talk to me. It wasn’t until a few years later that I truly understood how grateful I should be.
One day a good friend of mine called me in tears. She had just been into her doctor for her annual checkup when she got the news: she had what is known as high-grade cervical dysplasia. The step right before full-blown, rock-your-life cervical cancer.
She wasn’t even 30.
The thing is she had requested the HPV vaccine from her OB/GYN years before, when she was still eligible to receive it (the vaccine’s approved up to age 26). But her doctor actively discouraged her. There were potentially serious side effects, her doctor said (not adding that these side effects are very rare). She should really think about it and then come back if she still wanted it.
My friend didn’t push it. After all, she was just the patient. Of course, time slipped by, and it was annoying to make an appointment. So my friend never got the vaccine. And her doctor (as well as every other medical professional she encountered thereafter) never mentioned it to her again.
Now, she was facing the reality that she could be developing cancer – cancer that probably could have been avoided had she been vaccinated. Her doctor told her they would wait six months and check again. “These things can clear up on their own sometimes.” Otherwise, they would need to remove the pre-cancerous cells, an often painful and uncomfortable process.
Much to everyone’s relief, her body did clear the precancerous cells. But it was a terrifying six months. And throughout that time (and in the time since), she wondered what would have happened had she been vaccinated.
Hearing about her experience made me want to chase Betty down and hug her. My friend wanted the vaccine and was discouraged from getting it. But I actively rejected the vaccine, and Betty didn’t give up on me. She pushed me to really understand what made me so nervous and responded to my concerns in a way that I understood. She took the time to talk it through with me. Even though she was busy. Even though she had other patients to see, other things to do. She didn’t have to do that. But she knew how important the vaccine was, and she didn’t want me to miss the opportunity to protect myself simply because I was ill-informed.
I might have felt (slightly) bullied at the time, but it wasn’t because Betty was rude or dismissive. She was simply being assertive. Standing up for what her education and training assured her was the right thing to do for me and my health. I was taken aback by her confidence, and uncomfortable because she challenged my (I now realize, totally unfounded) beliefs. I thought I was fairly well-educated on the topic — after all, I was in graduate school studying public health — but I didn’t realize how limited my understanding of the vaccine truly was. Betty wasn’t afraid to share — and assert — her expertise as a medical professional. And she did it in a way that was patient and kind to my misunderstanding of the topic.
To Betty – and to all those nurses and doctors like her – thank you for standing up for (and to) me. It might have saved my life.
*Not her real name.
Robyn Correll Carlyle, MPH, is a project manager for educational programming at The Immunization Partnership.