It

“I can’t get no one to address my concerns about my lump, so I thought a doctor wouldn’t repair It,” Jada said.

“I promise I and the nurses will address your concerns,” Dr. Smith said.

Jada yelped and tears squeezed between her closed eyes. A white Sharpie oval marked a distention on her pelvis, with a knife half-embedded in the center. A foul smell indicated a perforated intestine.

“Jada, are you pregnant?” Dr. Smith asked.

“Not pregnant,” she said.

Jada refused addictive painkillers, and the IV acetaminophen barely helped. Rolling her onto her side for a nerve block required stabilizing the knife. Jada already immobilized it with bulky bandages, but even when she lay on her back, the knife swayed. A nurse held it still.

Dr. Smith ultrasounded Jada’s spine for the nerve block and, coincidentally, saw the mass. Without changing his expression or tone, he asked, “Jada, how long have you had the lump?”

Answering verbally interrupted Jada’s self-controlled breathing. “At least eight years.”

“You should feel numb within about half an hour. Have you been diagnosed with cancer?”

“No.”

“The lump is very big and serious. I’m more concerned about it than the knife wound, but your knife wound also needs repair. Have you received treatment for the lump?”

“Nobody’s done nothing about it.”

“We will do what we can, and you will need to stay in the hospital for treatment, possibly overnight.”

“Keep examining me.”

“A further exam may cause too much pain, and you are stable.”

“Fine. Examine me.”

Carrying a backpack and document box, Jada entered the Jacksonville Mayo Clinic Department of Emergency Medicine. She immediately went to the women’s restroom, where she stabbed herself. Jada bandaged her wound and walked calmly towards the triage desk. Another woman in the restroom alerted the triage nurse, who met Jada halfway.

The mass shifted under Dr. Smith’s hands, and wincing, Jada held her breath and clenched the blanket.

“You didn’t hurt,” she grunted.

Something jabbed visibly under Jada’s skin.

“It may be an awkward question, and nobody here will judge you. I need to ask. Has anything living or moving gotten stuck in your body?” Dr. Smith asked.

“No,” Jada said.

“You aren’t pregnant. Do you have any idea what might be moving?”

“It grew in me, and It’s mad.”

“What is It mad about?” Dr. Smith asked.

  “At me. Stabbed It, and we’re going through withdrawal, and It’s hungry.”

“Can you describe how It moves?” he asked.

“It moves when It wants to. I can’t make It stop.”

“Can you make it move?”

“By hitting it.”

“When it moves, are you pushing like a bowel movement or something like that?”

Jada shook her head.

Dr. Smith ordered a CT scan, then started reading the green journal titled For the ER Surgeon. Jada had duct-taped the journal and her West Virginia ID to her sweatshirt. The ID stated her age (21), ethnicity, and gender. She wrote in gel pen, and the text resembled a bullet journal. White-outs and corrections dotted the pages.

I’ve had It for at least 8 years, and I lost weight, so you’d see It. I’m tired of asking for tests and doctors not running them. I couldn’t get good medical care. I don’t want to be addicted so I’m not a drug seeker. I’m not suicidal or harming myself, and I can’t kill It because I’d die. I sterilized my hands, abdomen, pelvis, clothes, and knife.

Then Jada listed her medications and the last time she drank alcohol, smoked, and used drugs, all within the past week. To prepare for surgery, she fasted from food for twelve hours and water for eight. Also, she had checked her golden labrador service dog, Ping-Pong, into a local kennel, and gave the address, and her parents’ contact information.

Next, Jada summarized her medical history. We didn’t go back to no doctor that didn’t listen, she wrote.

At age eleven, Jada underwent the removal of a benign ovarian teratoma by a reluctant pediatrician Dr. Ripley. The non-cancerous tumor developed from a germ cell and grew on Jada’s right ovary; it caused no ill effects yet and removal could damage her ovary.

Jada and her mother suspected the teratoma recurred at age thirteen. She wrote, When I was about fifteen, Mamma thought maybe he left it in, but we don’t have no proof. But her doctor expected her to outgrow the symptoms. The second doctor diagnosed her with an ovarian teratoma. Because the surgery would damage the ovary, the doctor refused to remove the teratoma.

She bounced from doctor to doctor and specialty to specialty. Jada cooperated with tests and treatments. Also, she and her parents researched specific conditions and requested specific tests, occasionally about teratomas. Doctors often deemed Jada’s self-researched conditions and tests unlikely and unnecessary. They addressed other health concerns with the same symptoms. Over the years, surgeons considered operating and always found reason not to, despite Jada and her parents asked.

But Jada gradually differentiated between the teratoma and her other health concerns. Managing the others rarely helped the teratoma. Treating symptoms reduced her overall discomfort, but sometimes she doubted she had the conditions or that the treatments addressed the root problem. I tried talking to them, so they’d understand, she wrote. I tried not telling them about the teratoma and letting them find it.

When she was fifteen, an exam showed the teratoma had grown, but the doctor declared it too small to worry about. Jada wrote, I felt It squeeze tight during the appointment and spread out afterwards.

One gynecologist scanned the teratoma. Jada estimated at the time, it was approximately apple-sized, but the gynecologist compared it to a plum. It didn’t show yet, so we didn’t know It was so big, Jada wrote. Dissatisfied with the blurriness, Jada’s mother wanted another scan, but the doctor said the first was sufficient. I said that a teratoma grows 1.8 mm a year, so It should be smaller. She told me not to trust online health advice. The gynecologist diagnosed her with endometriosis and treated it medically.

Lifestyle changes, alternative medicine, and psychiatry somewhat improved her physical and mental health, and they prevented complications and side-effects. I don’t want to get sick from something else, Jada wrote (hence never injecting illegal drugs).

Nobody thoroughly followed-up on the teratoma.

Jada argued that by removing It, the doctor could exclude it from potential causes of her health problems. She specifically told doctors It mentally distressed her—beyond stress or discomfort arising from being sick. The teratoma Itself bothered her.

I feel It like It is an instinct and a lump. Its moving isn’t a hallucination, and I’ve had them. It twists and untwists my ovary and presses on internal organs. Behavior reinforcement didn’t work and trying to hold it like potty training or Pilates didn’t work.

When her physical health improved, It became more active, which worsened her health. Physical stress aggravated Its behavior and slowed Its growth. Also, Its growth accelerated when she reached maturity.

One psychiatrist thought Jada expressed herself through the teratoma, while another recommended surgery. I’d still have issues, but I’d have peace of mind about It, Jada wrote. The second psychiatrist continued to care for her.

Doctors increasingly dismissed Jada’s symptoms and concerns; she admitted that her later drug use and mental health contributed to their decisions. Her inability to pay prompted some doctors to refuse treatment. Emergency rooms provided little care, waving her off as an addict, placing her under psychiatric treatment, or examining her, treating her pain, and referring her to a doctor.

Jada lost weight to make it more palpable and give doctors one less reason to ignore her concerns. It stays in my middle like It hangs on to something, so it doesn’t show much. It gets hungry when I’m not.

Planned Parenthood maybe would’ve found It and done something. My pregnancy test was negative, so they didn’t examine me. She took over-the-counter abortion pills, which had no effect, as expected.

Jada resorted to addictive substances. I keep It calm with drugs, but It gets mad when I’m clean. Since the first dose, she acknowledged it was a terrible, stupid decision.

Finally, she attempted killing It, while recognizing the idea’s extreme wrongness. Jada inflicted life-threatening physical stress on herself to no avail. I kept track because maybe I’d get too sick and couldn’t help myself recover. Someone always found out.

Between her self-stress techniques and the drug use, sometimes, the slightest effort overwrought her. I’m pretty broken down, she wrote. I don’t think I can get through a bus ride home. She considered a service dog early in her drastic measures, and quickly adopted Ping-Pong, a golden Labrador. I really need Ping-Pong. She knows when It is acting up, but she isn't trained for the teratoma. She found It by herself.

When Jada threatened to stab herself in a Level 1 Trauma Center’s emergency room, security restrained her. The doctor briefly examined her, then transferred her to a mental health institution. She explained, It looked like normal fat and I looked mentally ill with a crisis.

Dr. Smith slammed the notebook on the desk and snapped at an intern to find references to the teratoma and also each blood test from her medical history—the document box with dozens of copied medical documents. Then Dr. Smith apologized for snapping.

One biopsy of her teratoma was inconclusive. Some blood tests indicated the teratoma better than others; several results could be attributed to other conditions.

The blood test Dr. Smith ordered easily identified the teratoma. The CT scan showed a perforated intestine beyond the knife’s reach. Altogether, the multiple blurry images showed a fetus-like mass, approximately the size of a pineapple, in Jada’s pelvis and abdomen. Dr. Smith resisted the urge to punch his clipboard.

Jada's notebook and medical documents corresponded to Dr. Smith’s examination and tests and her answers to his questions.

Gently, Dr. Smith told sweating, trembling, goosebumpy Jada there was a mass in her abdomen. “And it shouldn’t be there, and it shouldn’t have been for years,” he said.

“You read my journal?”

“The first few pages and the summarized medical history, and it and the medical records were very useful.”

“Was my mamma right about Dr. Ripley?” she asked.

“I’ll look for signs of previous surgery, but the mass might disguise them.”

“Could he have?”

“I don’t have enough evidence to form an opinion.”

Dr. Smith told her that the mass was probably a fetiform ovarian teratoma, which resembled a fetus. Its movement mystified him, but closer examination or later tests could explain it. Waiting years for surgery had probably unnecessarily increased her risks, and the operation would probably resolve some of her symptoms.

“The mass needs to be examined and treated thoroughly. I can examine the knife wound laparoscopically, repair it, and refer you to a doctor for the mass. Alternatively, I can examine the knife wound and the mass laparoscopically, repair the knife wound, and attempt removing the mass. Do you need some time to think about it?”

“Not switching doctors,” Jada said. “Get rid of It. Get rid of Its ovary. Get rid of whatever It adheres to.”

“I will remove the mass,” Dr. Smith said.

“I need to see It, though.”

“You can. If you are concerned about Dr. Ripley’s treatment, I advise preserving the mass and other tissue as evidence. I can arrange the preservation and storage.”

“Yes,” Jada said, nodding.

Anesthesia stilled It.

Blood partially obscured the underlined word “STOP” written on the blade in black Sharpie. The knife punctured Jada’s abdominal wall and pierced the brown mass, leaving other organs intact. Scars and scrapes, healing or fresh, showed the teeth and bones’ range of motion. The teratoma’s bony protuberance had easily reached the perforated intestine.

It stretched from Jada’s ovary to her back and right side. Held to her abdominal wall by adhesions, It wove between her internal organs. The teratoma adhered to her uterus and a few other nearby spots, but, generally, It grew into her abdominal walls. Among the cysts, a different tissue pulsed; two of many blood vessels led to it. A nerve cluster connected Jada’s ovary and the mass’s brain-like tissue.

Dr. Smith aggressively excised the teratoma, including Its adhesions. He repaired Jada’s perforated intestine and double-checked the ones which the teratoma attacked.

The teratoma’s pulsing ceased by the end of surgery.

Due to sheer disgust, Dr. Smith longed to personally throw It, the ovary, the scraps of internal organs in the incinerator and light it. On principle, however, he wanted the oblivious doctors themselves to require Its surgical removal.

Dr. Smith entered the recovery room for the second time—the first time, anesthesia made Jada loopy—, and like the first time, her vitals monitor beeped steadily, healthily. Jada set her greenish-blue cup of Sprite on the table.

“Is It gone?” Jada winced, easing herself upright, though already propped her up in bed.

“Yes, It was successfully removed,” he said. He thought she babbled the same question the first time.

Her black eyes crinkled as she smiled, her second, almost identical reaction to the outcome. “I knew It was gone. I can’t feel It.”

Dr. Smith explained the surgery.

“I could not determine why It was moving,” he said.

“I want to see It.” Jada held out her hand, with long, green, sparkly nails.

“You can see It. It has an eye, and some people may think that is creepy.”

“Did you?” Jada asked.

“No.” The teratoma revolted Dr. Smith, particularly the eye.

This is where you stabbed it.”

It thunked as she turned the specimen bottle. The moist teratoma had a pupilless eye with a cloudy brown iris and a tuft of black hair.

“Because It scratched your ovary, I couldn’t tell definitively if Dr. Ripley removed the first tumor. If you are concerned, I recommend contacting a forensic medical examiner. I strongly recommend that.”

“Was It alive?” Jada asked.

“In the sense that anything able to make cells is alive, the ovarian teratoma was alive. Your blood flow supplied it with oxygen, and cell death began when the teratoma was removed from your blood supply.”

“I knew the treatments didn’t work. I don’t think mine worked, either. Can a teratoma grow on the other one?”

“Possibly. I checked, but you don’t show any signs of another ovarian teratoma, or a teratoma anywhere in your reproductive organs. If another teratoma grows, a doctor should pay attention to your medical history, and probably catch it early.”

“I didn’t want to stab myself.”

“You were very desperate when you came here. You will need to switch doctors, and I can’t guarantee another doctor in the Mayo Clinic will treat you.”

Jada nodded. “I need drug rehab, too. Will you put me in another psychiatric hold?”

“No, unless you feel you need one. We have a psychiatrist, or we can contact yours. You know your state of mind better than I do and the doctors and nurses here will listen to you."

“No. Are you sure?”

“I was monitoring you for a crisis before the surgery, but I’m not inclined to think you are in a mental health crisis.”

“Why?”

“You took precautions that limited complications. You brought documentation that would have allowed me to treat you whether or not you could speak. You wanted to survive. I have adequate proof the monster in your body was real, not a hallucination. Your psychiatric history concerns me, but I do not have immediate concerns about your mental health.”

“So I can tell you something.”

“You can tell me anything.”

“If you hadn’t gotten It, I would’ve tried to cut It out.”