DEXA

by Devon Houtz

He takes a step closer to the table I lie on. “We measure the hips and lower spine,” he says, framing his hands over my pubic bone. “That’s really all we need.”

This is standard, but he doesn’t mention it. There is, must be, a clean and logical explanation, developed through debate and evidence-based studies, detailing why the dual energy X-ray beams will be pointing at my pelvis in order to measure the bone density loss. But right now, I’m not thinking about any of that. I’m wondering how many bones actually make up the hip and lower spine. I’m back in high school biology. No—earlier. I’m in seventh grade, positioning paper bone cut-outs to form a human skeleton. Femur, tibia, fibula.

Earlier than that, I’m tracing my fingertip along the smooth, shiny scar that spreads up my mother’s right shin, starting just above her ankle, ending below her knee. An inch wide in diameter, a marbled groove of light pink and white, it clings to the bone beneath.
All along the surface of the table I lie on, plush vinyl cushions my vertebrae. It took me a few moments to notice the fabric on the table. A cold, hard surface, I would have noticed right away. But the vinyl is comfortable and my feet are secure, so I can think of anything or nothing at all. I think of my mom. Hips and lower spine. I think of her eyes, staring straight ahead at nothing in particular, jaw clenched except for when she lets out a groan because walking, sitting, breathing hurts.

When I call her a few days later, tell her the results of the bone density scan, she will be worried, then optimistic. Towards the end of our conversation she’ll add, as an afterthought, that she has had an X-ray recently, too. Just one day before my exam, she went over results with an orthopedic surgeon.

“Barbara,” he had said, pointing to the black-and-white image that detailed the torque of her twisted pelvic bone, “you are one bump, one wrong step away from a dislocated, maybe broken, hip.”

Over the phone, she will laugh and repeat to me the words that she told him: It’s a mess in there!

The man beside me says to get comfortable, to relax. He walks away, toward the computer at the far edge of this room, and his figure is blocked by the arm of the X-ray machine that curves over me. I do feel comfortable. I do relax. It is warm and quiet in this room, so quiet that it might just be me and this table and this machine. I look down at my legs stretched out in front of me.

***

When she was 22, my mom took a road trip from her parents’ home in Michigan to the Bay Area in California. She had graduated a semester early from Western Michigan University and accepted a job offer from an accounting firm near San Francisco. Her sister, Laura—one year younger, still earning her bachelor’s degree while swimming competitively—helped my mom pack all of her belongings into her car, then joined her for the cross-country drive.

The two sisters had been on the road for hours when, somewhere near the town of Kearney, Nebraska, my mom exited the freeway. She pulled over on a small country lane and moved to the backseat so Laura could take the wheel. My mom stretched her legs out then.

I picture her leaning against the rear passenger door, her head tilting back against the glass window, both feet hanging slightly over the edge of the bench seat. Her toes point out in front of her, her eyes fall closed, and the polyester belt is limp and unbuckled at her side.

***

But back to the day at the University of Washington Medical Center. Further back, before waiting for the machine to position itself above my hips, before resting flat on the X-ray table. I check in and sit down in the waiting room, avoiding eye contact with the other patients waiting for their scans, all in their seventies or even eighties, my grandparents’ age. I take out a binder and look at papers, read and reread the same sentence.

My mom has been going to different doctors every week to address the roots of her pain. She’s had consultations, diagnostics, biopsies. She’s gone through rounds of steroid shots, acupuncture, physical therapy. I hear about it all over the phone and, with each treatment, she tells me this one seems to be working. When we meet in Boston to visit my sister and she tries once, twice, to get out of the cab, I reach for her. She shakes her head, gently pushes my arm away, and says, “It’s better for me to do it by myself.”

It took more than six months of not having a period for me to make it to this waiting room. It took eight years to be diagnosed with any form of eating disorder by a medical professional. I thought it was better to do it by myself, too.

A man in dark blue scrubs leads me to the exam room. This man is probably a technician or a technologist, but I am sure he will bristle at my assumption that he is not a physician so I remind myself to call him ‘doctor.’ No chance to call him anything, though. After he closes the door, he says that this exam will be quick and easy and to take off my pants.

“They’re jeans, right? With zippers and metal buttons? Yeah, you’ll have to take them off.” He opens one of the cupboards, digs around, then emerges with a folded pair of light blue scrubs. “We have these nifty pajama bottoms for you to wear.”

After placing the scrubs on the white exam table, he says, “Keep your shoes on. That helps with the positioning.” I look down at my suede boots.
 “Yeah, so keep them on—or, you know, put them back on.” He pats the pair of folded pants, then says, “Just knock on the door when you’re ready.”

Shoes off, pants off. I don’t take off my underwear but I do glance down to double-check for any zippers or buttons that may interfere with the machine, forgetting that I have never owned a single pair of underwear with metal in the fabric.

What is it about taking off your clothes in a doctor’s office that makes you want to hide them? Consider: if he were to see the black jeans, splayed inside out and thrown over the chair’s arm, underwear nowhere to be seen, would he note that? Would he picture them on me, just beneath that thin layer of blue fabric? I drape my black jacket over the seat of the chair, covering my black jeans.

From the corner of my eye I see my naked body in the long mirror against the wall and I rush to slip on the blue scrub bottoms, to cover myself from stolen glances.

The material isn’t as thin as I predicted. The pants are starched, puffed out around me, maintaining their own shape, giving my skin the space it needs. When I pull the drawstring and it closes around my hips, I am all gratitude. Thank you to the technician-doctor. Thank you to whoever is in charge. Thank you to the whole radiology department for not using the hospital gowns, with their cheap shoestring ties in the back that never fully anchor one side of the cotton to the other.

With those gowns, there is always a fluttering from behind. Cool air-conditioned breezes reach in like unfurling tendrils. With those, how does one walk or move at all? With those, why not just give up and hold it shut, one arm reaching behind to bunch up the fabric while you stand on the scale, waiting for the nurse to read from the remote display in her hands. You suck in your stomach, tense every muscle, harden your body because the nurse can really see you now. She is a witness to your flesh and bone. You look away, force your gaze anywhere else, because you can’t be trusted by them or by yourself. Because it’s called a “blind weigh” but you can still see the number that she records on the computer if you squint your eyes.

For distraction, you read and reread the titles of informational brochures on the wall like Contraception: Choosing A Method and Your Pelvic Exam and Be a HERO, Give Blood. The words only serve as a reminder that the greater the surface area, the greater the chances of being injected and penetrated and siphoned off—by others, that is. I’ve been chipping away at myself for years.

In my pajama-scrub bottoms with my boots back on, I knock twice on the door and the technician returns. He tells me to lie down on the table but I sit down, in the center between that little triangle and the gray plastic arm of the imaging device, curved up and over. Which end is head and which is foot? If the triangle is a pillow, I could lean back in a perfect 45-degree angle, but that’s only if it is turned the right way, which it is not.

***

A semitruck on a small country road near Kearney, Nebraska sped through a stop sign and crushed a car, shattering the glass windows, twisting the metal frame. It took months for the surgeons to reconstruct my mom’s spine, pelvis, leg—setting and grafting and fusing. It took years for her to heal, with one foot positioned 45 degrees outwards.

My dad pinpoints the moment he fell in love with my mom by the sight of her footprints in the snow. On one of their first trips together, he looked out from the window of their hotel room in the early winter morning. There had been a storm while they slept and the world was now blanketed in white. The sun had not fully risen, the fluorescent hotel sign gleamed blue against the snow, and there she was: right step forward, left step turned out, her tracks leading to the diner at the end of the street. The tracks could have been from a ballet dancer making pliés and pas de bourrées, jumping in third position all the way down the sidewalk.

I’ve never asked him, but now I wonder: was it her weakness or her strength? Do you love somebody for how they continue on? Or only if they can overcome?

***

The technician places a hand on top of the triangle and says, “This is for your feet.” I rest my head under the machine and spread my legs so that each foot is positioned on either side of the plastic structure.

“Tilt the arch of each foot so they both lean against the sides. Yes, like that.”

Like pigeon-toed, he could have said, like clubfoot, like my stepfather, Mark, who doesn’t walk with his legs turned in but does walk with two feet that turn in, the bones collapsing on themselves. After correctly leaning the arches of my feet against the pyramid, the technician Velcros a band around, strapping me to it. He gestures to the gray arm extended over my head and tells me this will only take a few minutes.

With his shoes on, you can’t tell about the feet, but Mark doesn’t like to wear shoes. They hurt him, so he is often barefoot, always in the house.

We have our jokes, he and I. We have an understanding. He has been married to my mom for seventeen years now, almost twice as long as my parents’ marriage. He wasn’t, isn’t my dad, but has always been there, unconditionally. Mark made my bagged lunch every morning, cleaned the house, took care of the dogs, drove me to and from school, cooked dinner, helped me with homework. No matter my mom’s mood, he wanted to hold her. You’ll never scare me off, he would tell her,  especially when she was trying to. I felt sure that, no matter what, he would always pick up his phone.

On Halloween when I was ten, a boy from down the street rang our doorbell. Instead of saying trick-or-treat, the boy lifted his shirt all the way up over his head to reveal large letters painted in blue on his bare chest and stomach. I shut the door on him. From the living room, Mark asked why I didn’t hand out any candy.

“That boy Billy,” I said. “He just flashed me.”

Judging by how my stepdad sprung off the couch, barreling towards the front door, he had a different definition of the term ‘flashing’ than I did. It was the fastest I have ever seen Mark’s legs move, rapid shuffles back and forth on his bare, curved feet down the sidewalk after Billy. He caught up to the kid, grabbed him by the neck of his t-shirt.

I was less afraid of his fury than I was surprised by his sheer speed, which seemed impossible at the time. But then, unconditional has always seemed impossible.

***

As the technician types at his computer, he tells me I can breathe easily and I should try not to move. Two things I am already doing, but now they seem difficult. That curved limb above begins to hum in anticipation of scanning my hips and lower spine and I am suddenly hot with panic, on the verge of asking him: What about my legs? And my arms? I want to see them, too.

I know my insurance company won’t approve coverage for a total body scan simply because I am curious. In fact, I will find out just two days after this exam that they reject the claim for one of my blood tests because I am young and young people are not, should not be at risk for these deficiencies. But this machine is about to look through the scrub bottoms, the underwear, the skin, the tissue, the muscles, all the way to my structure, the hard frame beneath.

I can meet, once again, the skeleton that I used to hold tightly in my bed, wrapping my arms around my rib cage, pressing my knobby knees together, and curling my chin into the sharp clavicle. In the quiet darkness, hidden beneath the blanket, it was just me and the body. There, beneath my fingers, my bones would say: you are solid, you are here, where else can you go?

The man has stopped typing and starts clicking at the mouse and I am seconds away from the machine ignoring the rest of my limbs to get to the damage. They will miss it all—the mended fractures, the places where my body once knew how to recover. I close my eyes.

***

Were my mother’s eyes closed during the impact? The truck driver who sped through that stop sign and hit her car had been popping caffeine pills to try to stay awake. Were his eyes closed, too?

She doesn’t remember anything about the after, but she was apparently conscious and told the EMTs her name, her parents’ names, their phone number.

She remembers pain and countless surgeries. A nun—maybe an angel—who would arrive outside of visiting hours to sit beside her hospital bed in the ICU. Doctors telling her she might never walk without a cane, would possibly need a wheelchair. Pieces of glass coming out of her face for years. She remembers getting on her bike a year after the accident against medical advice and pedaling for over 20 miles, crossing cities.

***

Imagine this: my primary care physician who ordered the DEXA scan—the first doctor to diagnose me after nearly a decade of disorder—pulls up the X-rays on her computer screen and motions for me to move closer, an invitation to see what she sees. Before she gets into it, tells me what I’ve done to myself, she could point to the wrist and say, “That seems to be an old fracture. What happened?”

I would have the chance to tell her about being tagged It in fourth grade, running after a boy, his shirt just out of my grasp; I was inches away from reaching him, then flying towards the ground, landing on my wrist. I could tell her that when I stumbled, I didn’t know why, didn’t know that his shoe had fallen off and tripped me. I could tell her that, if I had known before the fall, if I had seen it coming, I would have slowed down, or changed course, or hopped clear over. What brought me down to my knees and cut into the ease of barreling forward was long gone once I was on the ground. By then, the damage was determined by how the body would respond. Some people get up, dust off their clothes, start running again. But others hit the ground too hard, too fast, too close to something worse. Instinct tells us: brace yourself, protect the head, offer up some other part of yourself to the impact.

I think about what I could have done differently at 19 so that I wouldn’t end up here at 27. But this body is a mosaic of broken glass, and isolating each piece doesn’t change its color. I’ve pinpointed the moment I decided on denial, on finally saying “No.” I’ve looked back and watched that girl-woman finally take ownership of her flesh, start to scrub clean the body she had offered up, given away, lost. I’ve whispered to her, through the tunnel of these past eight years, that it doesn’t matter how little or how much she eats, how hard she runs or how long she stays shut away. She’s known purification is impossible since the day Mom started covering her head with a handkerchief and a hat before walking to school because little girls can be stolen, anytime, anywhere.

The more I consider telling that girl anything, the less I want to. She was trying to be strong and ended up with only weakness, with who I am now, someone who has memorized denial of self and clings to it.

I try to stop thinking about it. Then I think about it some more.

With my broken arm, I tried to prove nothing was wrong by cartwheeling. I lifted my arms up in the air, stepped forward on one foot, and launched myself towards the earth. Crumpling on my broken wrist was one of my earliest experiences of the body’s limit, it’s refusal to bend to my will.

Years later, after I had broken my biology in other ways, it again protected itself against me. When the urges for sweet, salty, crunchy, fatty hit me in waves and my restriction was feeble against the power of protective instinct, I was angry, defiant, began a battle with my body that could end in no possible victory.

Because my wrist had not been set after the break, my bones began healing in the wrong alignment, growing in the wrong direction. My mom set up appointments, took me to exams, and soon I was in a surgical bed with a breathing tube snaking down my throat and a doctor telling me to count backwards from 100. Everything went dark before I could hear the crack of the re-break, feel the pop of the bones as the surgeon straightened me out.

Now I’m here, lying on this table, and I want to know how the body bonded the break. But the machine’s arm above begins to move, passes over my skull and collarbone, my ribs, my arms, doesn’t even bother with my shins, my ankles, my toes.

After it’s all over, I change out of the scrubs and back into my clothes. I leave the exam room and walk past the gray- and white-haired patients sitting in the waiting room. Once outside the Medical Center, I take the bus home, put this from my mind, tell myself that I will wait, not think about it for a few days. All I do is think about it.

***

When they assess the monochrome images from my DEXA scan, they will not see deformities, the ones my stepfather can somehow disregard in a moment of instinct. They will not see the bulges of new bone filling in and over the cracked spot like putty, the places where my child-body took in what it needed and recovered. They will not see my mother’s pieced-together anatomy, which makes her leg angle to one side but has never stopped her from moving forward.

They will see spots of gray that should be white. They will note, as predicted by bone mineral density, significant osteopenia at the spine, increased risk of fracture.

They will gently suggest that malnutrition results in decreased estrogen levels, spiked adrenal hormones, calcium and vitamin D deficiencies, all sorts of other deficiencies because, really, what else could be expected after years of living at a deficit and shouldn’t it feel good to have a clear diagnosis, a visual aid, that I have finally started to fade away?

They will suggest all of this gently because I am, have made myself, fragile.

***

I’ll take the different vitamins. I’ll eat leafy greens and dairy. I’ll buy canned salmon, the bone-in kind.

When I peel open the lid and flip over the can, plopping the light pink flesh onto the plate, the salmon holds the tin’s shape, not its own.

I’ll use the fork prongs to carefully excavate the tiny ribs, the vertebrae, the spinal column, and I’ll take my time letting it all dissolve on my tongue.

Devon Houtz was born and raised in Sunnyvale, California. She earned her undergraduate degree in English from UC Davis, where she was selected as a finalist for the Ina Coolbrith Memorial Poetry Prize. Devon has worked in journalism and technical writing, and she is now a pre-doctoral instructor and MFA candidate at the University of Washington. She lives in Seattle with her husband, Ben, and their golden retriever, Huey.