All language subtitles for Notre Corps

This film was born of an encounter.

The producer, Kristina Larsen,

told me how she fought
against a rare disease for two years.

While in the hospital,
she discovered a mostly female world

gathered in a single unit:

maternity, cancer, ART,

endometriosis,
gender transitioning, etc.

She suggested
that I film this huge department

treating the gynaecological pathologies
that weigh down on our lives,

on our loves, on our hopes,
on our desires...

All these stages on life's journey,

from youth to old age,

from the beginning to the end.

Between home and the hospital
lies the cemetery.

Crossing it always makes me uneasy.

My father was cremated here
after spending

28 years in a hospital room.

And so I was more than familiar
with the hospital world.

When I first arrive
at the hospital entrance,

I say to myself,

"I hope I'm not going
to catch cancer here."

Then the happy prospect
of encounters gets the upper hand.

OUR BODY

Termination
My choice

What brings you here?

What's wrong?

In September,

around the 20th to be precise,

the 20th of September,
I had intercourse with my boyfriend...

Yes?

I didn't use protection.

I made a mistake and didn't use any.

And I didn't feel the sperm enter...

I didn't feel...

that the sperm had entered my vagina.

You mean you didn't feel it
enter your vagina?

- Yes.
- Ok.

Did the boy penetrate you?

- Yes.
- Ok.

And...

For two months now,

I've been pregnant.

And...

- You haven't had your period?
- No.

Not since early September, I think.

Your period was in early September
and you had intercourse

on September 20th?

Yes.

Was the sex consensual?

Yes.

- Was it the first time with this boy?
- Yes.

All right.

And he didn't think...

He didn't think to wear a condom
to protect you both?

He didn't have one on him,
but he remembered and said

he took it off
before ejaculating, but...

He took it off and I wiped myself,

but I didn't know it was inside.

That he had already ejaculated?

- What year are you in?
- Eleven.

Eleven? Ok.

It was tough keeping it from my parents.

I couldn't, even if I knew
it wouldn't be easy.

I couldn't keep it from my parents.

Without thinking,
I told them right out I was pregnant.

After that, my mother...

She was really shocked

and had tears in her eyes.

- She was moved?
- Yes.

But not moved with joy.

With anger.

Normally,
I'm supposed to confide in my mother,

but I don't.

But, perhaps,
before having intercourse,

I could have talked to my mother
before doing it.

She even told me...

I could...

maybe ask her for...

ask her for...

a condom or...

A means of contraception
to protect yourself?

- Your mum would have agreed, she said?
- Yes.

She'd have agreed.

And my father reacted really badly.

He was angrier than my mother.

He said he'd send me to a home

where I'd have to look after my child.

I know my father

and I don't think he'd do it.

He only said it to make me understand
that what I did is really bad at my age.

- Any brothers and sisters?
- Yes.

Are you the oldest?

I'm the oldest, with two half-sisters.

So, in fact, she's my stepmother,
but she's like my mother.

She's your stepmother, then?

I live with my real father,
my stepmother...

my two little half-sisters
and my little half-brother.

That's a lot of people
running around the house.

What about your mother?
Where is she?

I don't know.

Ever since I was five or six,
I don't know where she is.

It's been ten years now.

I'm 15. It's ten years since I saw her,
but I don't know where she is.

You've come to see us
to terminate the pregnancy?

Yes, even if I was against abortion.

I have to do it so I can focus
on my education

and stop messing up like this.

You call it messing up?

Well, messing up...

First, I used no protection,

and also my parents thought
I was at school when I was...

I didn't skip school,

but it was just before my classes.

Did you go to your boyfriend's?

No, it was in a garage.

- Ok.
- It's weird...

No...

That's what you did, ok.

Does your boyfriend know?

Yes, I told him.

He said right off to get an abortion,
but I told him it wasn't easy.

The thing is,

he told me...

he wouldn't take responsibility.

How old is he?

Sixteen.

- Do you think he'd lie?
- Yes.

- Is that it?
- Yes.

What you need is a bit more perception
to size everything up properly.

To say what really happened.

That's what you did.

How do you feel about it now?

The fact you told
your mum and your dad?

Even if there was anger,

even if there was a lot of emotion,
as you say.

How do you feel now?

I feel freer after telling my parents.

If I'd kept it secret,
I'd have felt bad all my life.

I think I'm going to get an abortion,
but I'll feel bad anyway.

It has also made me realize...

that I have to be careful.

And...

It's your story, it's your experience.

The little girl grows up
and becomes a woman.

And, for parents, that can be a bit...

It can be hard
seeing our children grow up.

So...

I find you speak about it
calmly and thoughtfully,

even if it isn't easy.

So this decision
to terminate the pregnancy

is all your own?

Yes.

But I'm a bit scared too.

My mother explained

that if ever I abort the baby,

I can end up with a malformation
or something,

and never be able
to have children again.

Hold on, a malformation?

What malformation?

Well, you never know,
but if I abort the baby and...

A malformation caused by that
could be a disease or something.

Well, no.

- How old are you?
- 24.

Any health problems
or ongoing medical treatment?

Nothing at all.

So, you're here to terminate
a pregnancy?

- Is this your first appointment?
- Yes, the first.

Were you given
a second appointment?

- You confirm you want to go ahead?
- Yes.

The pregnancy

is recent. I saw the ER scan.

At this stage,
we can use the medicinal method.

The idea is, I give you a first pill

that will halt
the development of the pregnancy.

Normally, nothing much happens,
but there can be a little bleeding.

Then, 48 hours later,

you take the other pills at home
to cause a miscarriage.

- Do you live far away?
- No, about ten minutes from here.

- Can someone be with you in 48 hours?
- My boyfriend.

You mustn't be alone then.

What you'll feel
will be like period pains

or contractions of the uterus.

There'll be bleeding, with clots,
but that's normal,

so don't worry. However, there can be
three kinds of complications.

They're rare, but I have to inform you
so that you know.

Sometimes, the bleeding
can become heavier,

more than for a miscarriage.

There are two ways to decide
if the bleeding is too important.

If it flows non-stop like a tap,
come to the ER for a consultation.

The second thing
is if the pills don't work.

We'll need to schedule
a surgical intervention.

The third thing is,
the pregnancy can be expelled,

but leave some tiny clots in the uterus

that occasionally cause infections.

If you have bleeding or a discharge
with an odd smell,

stomach pains or fever,
go straight to the ER, ok?

- Do you have any questions?
- No, it's ok.

Nothing special then?

Take this first pill here.

Then I'll give you the others
to take at home.

Is the child's father
supporting and accompanying you?

He's a bit uncooperative.

And "uncooperative"
is putting it lightly.

He said he supported me,
but he isn't here.

For starters.

That's all he said, nothing more.
He couldn't care less.

- What year are you in?
- The final one.

Going well?

- Yes.
- Good grades?

I guess...

Cool. Ok...

Are you in a relationship?

- With a boy, a girl, both?
- With a girl.

Is everyone in your class...
Do all the students in your class know?

Yes, I came out two years ago.

The high school knows,

but they refuse to use
my new first name.

It hasn't legally changed?

Exactly. The school agrees

to enrol Aslan under the name Aslan

if the ID papers show it,
but that requires both parents' consent.

So we're stuck.

It's a real problem and it's a pain,
but does it hold you back?

I have to relate my life
to each new teacher.

The problem with the father
is a problem for me too.

We'll play for time and move ahead
until you turn 18,

but I need both parents' consent
for a lot of things.

And I can't avoid that.

But we can do stuff for now
to advance your transition.

- That's good news.
- Yes, it is.

For starters, stop your periods.

Then we can arrange
oocyte cryopreservation.

- If you want...
- No.

Let me finish.

You're 17 and one month.

You're almost an adult, but still young,
with years of life ahead of you.

You'll meet others,
you have a girlfriend.

I don't know how you feel
about having children. You don't know.

Maybe, maybe not,
but things can change.

As you'll be taking treatment
that'll reduce your fertility,

it's good to consider
preservation options

if ever one day,
if the law ends up totally allowing it,

you want a child with someone you love
and who has a uterus.

So what are the options?

A baby with someone with a uterus,
using one of your oocytes,

fertilized by a donor's sperm

and carried by your friend.

That's surrogacy.
It's not legal in France for now.

The other option is to carry the baby
in your uterus as a guy.

- No way.
- Ok.

That said,

we don't know how oocytes react,

exposed to testosterone in trans guys
who have babies.

It seems logical
to preserve the oocytes

before they're exposed to testosterone,
in their "natural" state

so they can be used for a baby
if you decide so.

As a guy, I can't be
a child's biological father.

He's saying you can be.

No, I mean a father with my sperm.

I mean that way.

You don't have sperm, you have oocytes.

That's just one of the elements
required to make a baby.

You need an oocyte and a spermatozoon.
Alone, they don't work.

If you want a baby
with your genetic heritage...

That's what's at stake here,
a baby that comes from you.

You need to think.

Talk it over with your mum,
with your girlfriend,

with your best friends and pals,
trans or not...

It's a complex issue.

But, at 17,

as I can't begin hormone therapy
before you turn 18,

I feel it's best to think it over.

That won't stop us halting your periods
before then, ok?

What isn't possible
is using your gametes

with a cis woman's gametes.

That would be two oocytes
and it wouldn't work.

- Was that your question?
- Yes, it was.

- I understood.
- It's not possible.

Yes, that's true.

If we were to use your gametes,
it would necessarily require

a sperm donation.

Donated anonymously.

May I see your face, Aslan?

You too, madam.
Let's get acquainted without masks.

With masks, I don't know
what people look like anymore.

Yes, that's true.

After, it'll be a "mastec" and the rest?

- What?
- Chest reconstruction.

Yes.

And other stuff after?

- Yes.
- The lot.

- The lot? A phalloplasty?
- Yes.

- When did you start testosterone?
- 2016.

2016, ok.

You're 28 now.

It was five years ago
when you were 23.

What do you do for a living?

I work in a brewery

where I help to make beer.

- Really?
- Yes.

- Where?
- In Sancerre.

That's great. I've been to Sancerre.
It's beautiful.

Yes, it's very pretty.

I work at the Sancerre brewery

and the work there is very physical.

So it's tough
at the end of a dose...

A little.

Above all, it's the menstrual pains
that can be...

- Sometimes, at the end of the...
- The dose.

Yes, there can be pains then.

And that's with Nebido?

No, it's with Nebido.

At the end of Nebido,
your period returns?

The pains start a week or two before.

And, sometimes, there's bleeding too.

But if I take my dose right away,
everything's fine.

Do you have sex with cis men?
There's no risk of pregnancy?

I don't understand.

Have you had a hysterectomy?

Not yet.

Do you have sex
with a risk of pregnancy?

I mean, could there be a baby?

No, I don't want children.

What I'm saying is,

at the end of the dose of Nebido,
you get period pains.

Things start stirring a bit.

And testosterone
isn't a great contraceptive.

So I need to know

if you have intercourse
with a possible risk of pregnancy.

No...

I'm married to my wife and...

We need the right dose of testosterone,

so it isn't too low
at the end of your cycle.

Low testosterone
brings the period back.

Maybe you need the Nebido
two weeks earlier to prevent that,

but not as a contraceptive.

No, it's ok.

The pains are there,
but I can live with them.

Testosterone can turn into oestrogen,
so an excess of testosterone

can create oestrogen
that triggers the endometrium.

And, in that case, it explains why
guys with excess testosterone can bleed.

Otherwise,
you have no health problems?

Have you already had an operation?

- Chest reconstruction?
- Here? No.

It...

- Vanished.
- Shrank away.

Do you want a mastectomy
or are you good?

A hysterectomy?

- The upper body needs no work?
- No.

And do you want a hysterectomy?

I don't know. I'm not sure.

I'm really scared of all the knives
and then, afterwards,

all the post-op care.

May I see your face?

Hello.

Five years of testosterone?

Yes, five years.
And I'd like a thicker beard.

It's a good beard.

Yes, you're right...

It's ok.

We ask patients
to talk to a psychologist.

Someone on our team.

It's so you can speak to someone
who isn't too technical or medical.

Someone used to talking to women
on the same path as you.

It lets you talk and ask questions
that maybe you wouldn't ask

of a doctor.

Over the different stages,

I've already seen a few,
like when I was told I had the gene.

I see you've met the professor

to prepare your ovary operation.

It's been scheduled for September 27th.

Ok, that's great.

So, for now,

we can offer treatment to replace
the ovary hormones if you want.

When we remove
a younger woman's ovaries,

without treatment, there's a risk
of fragile bones later.

20 years from now,
but it's wiser to see to that now.

It's ok, I have good bone density.

Ok, but you have to stay that way.

Your arteries can also deteriorate
prematurely without that treatment.

But, if you take it,
it can protect the arteries.

We can pursue the treatment
until your menopause at 50 or so.

We'll stop it then, depending on
what you decide about your breasts.

We don't really continue after 50
because of the breasts,

as there's a risk
of breast cancer in older women.

My mind's made up.

- You'll keep them?
- No, remove them.

In that case, we may be able
to continue after you turn 50.

I can suggest one last thing
so you have no period

or you have your period.

It's up to you.

No period how?

I can give you a daily pill
so there's no bleeding or...

They'll remove it.

They're leaving your uterus
unless I'm mistaken.

The uterus is a box.
If it's told to bleed, it bleeds.

No, then.

So no bleeding. We'll carry on.
Perfect.

How long after the tubes and ovaries
are removed can the breasts be done?

The breasts?
Whenever you feel you're ready.

The sooner it's all over,
the better I'll feel.

Have you already met plastic surgeons
to talk it over?

No, for now I've only seen
the professor for the September op.

So, the surgeons remove
the inner gland.

Then they reconstruct the breast.

They can use either implants,

or fatty tissue from this area.

It's called a DIEP flap.
Maybe you've heard of it.

- My mother had that.
- A DIEP flap? Is she pleased?

- Yes, rather.
- It went well?

It's a major operation...

I think there's a second op
for the finishing touches, so to speak.

Even with implants,
there can often be a second op

to improve the aesthetics.
It's fairly frequent.

The difference between the two is
if we use your body tissue,

it will follow
your weight gains and losses.

It lives with you in a way,

whereas the implant stays as it is.

It doesn't alter.

It's less natural than the DIEP flap.

So, support is better with...

An implant? Yes, it's steadier.

It doesn't move.

But, over time,
a shell can calcify around it.

Your body tries to protect itself
from the implant

and forms a sort of shell around it
to contain it.

It can end up looking a bit odd
or feel bulky.

When you raise your arm now,
you feel your breast rise too.

The immobility can feel awkward.

Our plastic surgeons
will see about it with you,

because what they suggest
depends on each woman's morphology.

I don't feel any pain or aching
in my breasts.

With the post-op treatment,
the nipples can be a bit sensitive.

They can get a bit stiff,

like when they grew
when you were a girl.

It mustn't hurt.

I've forgotten all that.

It mustn't hurt, ok?

If it hurts, lower the dosage,
and, if it's really bad, stop.

Your armpits now, before you lie down.

Put your feet here and lie down
so I can palpate under your breasts.

Perfect.

The nasty part to finish.
I'll pinch slightly. Is that ok?

All right?

It's all good for me.

Sit up now without falling.

Careful, the step isn't straight.

You can get dressed.
It's all good.

Last December,

after intercourse, I felt a pain...

I'd never felt such pain,
even when I had salpingitis.

I had to use the toilet,
then couldn't get back up.

It lasted three days.

A clearly posterior pain?

Yes, actually, it was really...

How can I put it?

It wasn't like the salpingitis pain,
which was located to the side.

This time, it was really in the middle,
fairly high up, so to speak...

Not this high, but...

Yes, it was right in the middle,
I guess.

- Between the anus and the vulva?
- Yes.

It lasted a long while

and I realized that,
for a long time now,

I feel different kinds of pain,
more or less regularly,

all located in the same area.

It's not necessarily

always the same, but it comes and goes.

But something that's fairly recurrent
in the last two years,

just over two years,

is that I systematically hurt after sex.

It wasn't like that before.

- May I interrupt you?
- Of course.

I'd like to focus on your period.
When did you have your first one?

- More or less.
- At 14.

Was it painful right away?

No, my period was fine
until I got my second coil.

A new coil then. A copper one?

So now you have a monthly cycle.

- Yes.
- Regularly?

How many days' bleeding?

- Seven at least.
- Seven.

And how many days of pain?

From the day before to the fourth day.

So five tough days each month.

May I ask what you do?

- I'm a bookseller.
- Cool.

So, as a bookseller,

does a painful period
stop you from working?

No. Since I removed the coil,
the period pains have vanished.

But?

In fact, the pain wasn't

during my period,

but it was...

At no specific moment?

This posterior pain

occurs after intense intercourse?

- In certain positions?
- Yes.

And you're saying those pains
last for a while afterwards, right?

Actually, it depends.
There's a stabbing pain

and that pain can be deep
or to the sides.

If I hold back defecating or urinating,
it can last for days.

Even if I only hold back 15 minutes.

And...

during sex, it can be a stabbing pain
or a lingering one.

Ok, it seems clear to me.

The most intense pain is on the left?

No... Well...

Don't you feel a sort of pain or ache
around here?

Yes, like a ball.

It surrounds the left side of the pelvis
and spreads back?

I wouldn't say it spreads back,
but it reaches as far as the rectum.

For me, things are clear.

What you're telling me all adds up.

The question is, where to begin?

Let's try to be pragmatic here.

It's clear you feel neuropathic pain,

but you also suffer from real pain
due to the location of something.

This thing, which I hesitate to name,
is endometriosis, ok?

Using your MRI scan,
I'll do a drawing to explain.

This is the bladder, this is the uterus
and this is the rectum, ok?

You feel pain during intercourse

because, between the uterus
and the rectum,

you have a fairly large endometriosis
near the rectovaginal fascia,

between the uterus, rectum and vagina.

It's impossible to have
pain-free intercourse in this area

without it resulting

in the posterior pain
spreading to the buttocks,

that you describe.

Are you single or partnered?

- I'm married.
- Cool.

Any babies planned?

- Sorry.
- It's ok.

I've been married three months
and sex with the guy I love hurts me.

We're going to work on that.

Three months married, that's cool.

If you got married, you have plans.

- Yes.
- Cool.

Plans for a baby?

Not right away.

We'll work problem by problem,
brick by brick and, that way,

move ahead.

You can see that the pain
is multiple, with different sources.

It's of a chronic nature
and has left a big mark on your body.

Treating it in a flash with a pill
isn't going to work.

We have to try various options.

In order to do that,
we'll keep it simple.

Here's my thinking.

We halt your cycle in an attempt
to block inflammation.

Once we've done that,
we can try to build on it.

We're going to try
a progestogen-only pill...

Yes, but...
Well, I'm willing to try.

There are two issues.

Can I...

mentally...

There's the pain, but also
a total lack of libido for two years.

It began overnight, for no reason.

It's not my relationship,
as that's going well.

And it doesn't just concern
my relationship, but me personally.

I understand this pill may worry you
because of your lower libido,

but if it allows us
to reduce the inflammation,

maybe it can improve
your sexual relations.

That's why I stopped the other
after four months.

Because there was
no physical improvement.

I understand.

Mentally, however,

things were worse, for my libido
and for my anxiety too.

So that's something I've learned
to deal with now.

More or less successfully
depending on the moment.

But I know myself well enough at 30
to observe

how things develop
and I told my doctor, "Sorry, I...

I'm saying this in all conscience,

but I prefer pain to a lack of desire."

I suggest starting from what we know
and have found

to see what we can set up
to move ahead.

To sum up, we have a diagnosis
of acute endometriosis.

We mentioned that last time.

There's a digestive problem
that we also talked about.

We know there's no stenosis.

So that means
there's no surgical urgency.

And that's a key point, ok?

No surgical urgency as, for now,

we don't need to prioritize surgery
in your treatment.

Is that clear? It's fundamental,
as it's a huge weight off our shoulders.

What?

- There's no stenosis.
- No.

That's important.

That was worrying me
because the doctor I saw before you

said I'd probably need an operation
to fit a bag.

That was like a sword of Damocles
over my head, so I'm reassured.

That was the issue
of our conversation last time.

The sword of Damocles you mention
is really stressful.

With stenosis,
we'd have had to operate.

Maybe we'll need to,

but that's not the case,
so no worries or urgency there, ok?

Everything's cool for you.

So now, we can take a step back
and organize things.

My priority now is the preservation
of your fertility.

We mentioned it last time
when we said

that we'd assessed your ovaries

and that, rather worryingly,
their functioning was reduced.

Remember?

That's an important issue
because you're only 28

and have no plans to get pregnant yet.

- Not at all, no.
- No plans...

My idea is to offer you an alternative

between waiting and monitoring
the deterioration of your ovaries,

and freezing your oocytes.

Freezing your oocytes seems to me
to be an excellent solution,

so that in a few years' time

the day you want to conceive
either you manage it naturally, fine,

or you can't but, a few years earlier,
you decided to freeze

a sufficient quantity of good oocytes.

Ok? That's the philosophical approach.
What do you think?

I listened to you
and I got an appointment.

Good.

I got it at Clamart,
but they kept me waiting.

It was due to be next week,

but now they've postponed it
until November 12th.

So I'm going to do tests, I think,
new blood tests and all that.

But...

I know I have to do it
and I agree with that,

but I'm a bit scared

because I haven't had my period
since August 2020.

I'm scared of having it again,
the pain, the effect, etc.

Like I said, I'm undertaking
a career change this year.

In relation to that, I have to take
a half-afternoon off work.

It doesn't matter,
but I'm afraid if I do that now,

the pains may prevent me from working
or confine me to the toilet.

I'm afraid of going through all that,
so to speak.

I want to do it, but I'm scared.

All I can do is prepare you
by saying what you may encounter.

And a major factor in all this

is time.

You have your work.

And you see it can be incompatible
at times.

That's why I asked if it was possible
to wait until the summer or...

I don't really know how to answer that.

All I can say is
your stock of ovaries is low

and I think we should do it now.

At first, I thought I could do it
during the Christmas break.

Being in teaching
that would really suit me.

But I can't foresee
exactly when my period will begin,

so it's not easy.

It's up to them to synchronize
your cycle, so don't worry.

- They can do that?
- Yes.

It's not the first day of my period?

They synchronize.

There's something else
I have to tell you.

The priority here is you.

- Understand?
- Yes.

It's hard telling yourself that,
but the notion of time is fundamental.

It's a good job, helping people, etc.,
but your health comes first.

And we mustn't lose sight of that.

We can solve a lot of problems,

but it's impossible to make
everything compatible.

I insist on that point
and I'll support you

by making sure you're the priority here.

The sole priority.

Where's the endometriosis lesion?

- You see that fibrous area?
- Ok.

Move the laser lines

to the endoscope intervention point.

Install endoscope for targeting.

Direct endoscope to target organ,

then press the targeting button
and hold it down.

Targeting complete.

Lock the other arms.

Is it recording?

Hold on a minute
for me to get into place.

Very nice!

But it's a big job.

Can you give me the pliers?

Go on.

That's it.

Help me lift the intestine.

A bit more.

There, that's good.

There's an endometriosis lesion
near the rectouterine pouch.

There's this lesion here.
Check if you can see it.

Move in a bit, please, with the pliers.

Pull that tight.

You see? Bring it under your blade.

That's it, pull back.

Nice and gently.

Take your time.

Cut it.

That's it.

Perfect.

And here, get a bit closer.

Great.

Do the haemostasis of this bit here.

That's it, there. Great.

I like that.

You see?
Wait for them to light the rectum.

You need to be very close
to the rectum.

A bit more...
Get closer to the rectum.

Really, really close.

Even closer.
You have to remove that.

Tackle it from the side,
from the fatty part.

That's it.

That'll let you find the right angle.

That's it.

Cut it now.

A bit more on the outer side.

That's it. Great.

That's it.

Mind that blood vessel there.

Careful, you're right above it.

Don't stay on the surface.
Cut it.

Don't dissect, cut.

Gently. Hold on.

A bit lower.

Remove that ugly bit on the right.

Stay on the surface now.
That's it. Gently.

Nice and slowly. Take your time.

That's it. That's good.

A bit more there.

That's what you need to take.

That's beautiful.

Very pretty.

That's what you need to free.
Nearly done.

You can see the fat.

That's it. Great!

That's that sorted.

It's supple.

Leave that now
and move up to the vesico-uterine pouch.

It's just behind that.
You can cut that bit in front of you.

I'd cut there
where you have your pliers.

Free it laterally.

Use that.

That's good.

Move back up.

There, up you go.

Pull back.

Just a minute while I help you.

That's it. Great.

Put the lesion in the pouch.

Free that and take the pouch.

Take it.

Thank you.

Put that to one side now.

There, that's great.

One last quick wash
and we're done.

How long have you been trying
for a baby?

- Ten months now.
- Yes, ten months.

Since January 2021 more or less?

Have you been pregnant together before?

No.

You were pregnant separately, ma'am,
is that right?

- Do you have children, sir?
- A daughter.

Is your period regular every month?

Yes, it is again now.
It took a while after the op, but...

- All right. Do you drugs?
- No.

Your weight and height?

My height is 162 centimetres
and my weight 93 kilos.

93 kilos?

There's one important thing
about weight.

You're fine as you are,

but it's important
to control your weight.

Being overweight or obese

can reduce the chances
of getting pregnant naturally or by IVF.

The good news is that you have
a fine stock of ovaries,

but you're 39

and the chances of pregnancy
are a bit lower at 39,

due to oocyte quality.

Every extra likelihood of success
increases your chance of pregnancy.

That's to make it clear statistically.

At 39,
as some statistician worked out,

you need around 18 oocytes
to obtain a good quality embryo,

with a 40% chance of pregnancy,
ending in miscarriage in 50% of cases.

So we're a long way
from being 100% effective.

So it's really important

to try to improve your chances
of pregnancy, spontaneously or by IVF.

You really mustn't put on weight,

and even try to lose a kilo or two
if you can.

We're already working on that.

So, you're 39.
What's your profession?

I'm a computing engineer.

You're 36, sir.
What's your profession?

I'm a university lecturer
and I'm doing a PhD in geography.

No testicular pain during sex,
no problem with erections

or ejaculations?

There can be when I'm overworked.

I can feel a little tired then,
but nothing otherwise.

It's only when you feel stressed?

Yes, when I have students' work
to correct.

Do you manage
to have intercourse regularly?

Yes.

How many times a week?

- Once or twice a week.
- That's good.

This is your semen analysis, sir.

I have the first to compare.

Yes, please.

So, the sperm concentration

is 2.4 million per millilitre.

So that makes 10.1 million.

That's a bit less than the norm,
which is around 30 million.

But there are enough spermatozoa,
so don't worry,

but that may contribute
to the difficulty

of a spontaneous conception.

As long as there are sperm, it's fine,
we can manage via ART.

It's always wiser to freeze the sperm

so we don't end up in a situation
where we do an ovarian puncture

and, on the day's semen analysis,
we have

sperm that is useless
or a count that is too low.

Given the past fluctuations,

from 48 to 10 million,

I don't know how it'll go.

There's no sense in making you
do more semen analyses,

but, when we puncture, we mustn't get
a semen analysis we can't use.

Of course.

And...

you say the committee is going to meet
to decide if IVF is recommended.

Actually,
we've carried on trying naturally.

But I'm still not pregnant.

Anyhow, we really want
to follow through on this,

and I wanted to know...

I have questions as we'd like to get
real information, away from the Net.

There seem to be several methods.
How do you know which one suits us?

There are several stimulation protocols.

You have a fine stock of ovaries,
with your AMH at six.

Really!

Often with young women like you
who have such a good stock,

there can be a risk of hyperstimulation.

That's when the ovaries
overreact with a lot of follicles

and that can lead

to kidney or liver failure,

and venous blood clotting
with pulmonary embolism.

Those are serious issues.

But with this protocol we're sure
things won't come to that.

Do I have to have injections too?

No, no treatment for you.
You're lucky there.

- No shots for you.
- Ok.

Your sole contribution is a sample
on puncture day.

Ok, I have it easy, then.

Is your tummy hurting right now?

- No.
- No, you're ok?

When was your last injection?
When and at what time?

It was on Saturday at 11 pm.

Do you remember which drug?

Not Ovitrelle, the other.

- Decapaptyl?
- Yes.

How many vials?

Two of them.

- Two vials?
- Yes.

Check this is you.

You agree she's the same one, sir?

- Yes.
- Good.

Your right wrist, madam.

Will you be fetching her, sir?

At 1:30 pm, you can join her in the room
and stay until she's ready to leave.

Come with me
to see which room she'll be in

and then you'll go down...
Let me check.

You'll go down to the lab.
Remember where it is?

It's the one where...

Take the waiting room lift,

go down to level -1,
walk a bit after the lift,

first left,
and show your ID at reception.

The hard part is
we've already lost a baby.

We often talk about it...

with my partner.

It's a real journey.

We've done two steps now.

In any case, we know it works for me,
that I react well.

That said, I don't know
if the puncture will go well.

After, they have to fertilize them,

and see how they react
before putting them back

to see if it works out.

If it does, pregnancy will be
a whole other journey.

They're just little steps.

But it's for...

It's because we're in love,

so it's good.

I met my partner fairly late,
as I'm no youngster now.

And already we're...

we're happy we met

and so...

that's why we're here,

because we're trying for a baby,

but when you're 40...

it's not as easy

as when you're younger.

It can happen though.

Yes.

Just relax.

Can you edge down
towards me, please?

Move your behind down a bit
on the table.

That's perfect.

Are you ok?

Yes, fine.

I'm going to put the sheets around you.

Yes, you can set your behind down.

I'll explain things as we go.
but if something feels wrong,

be sure to tell me right away, ok?

What do you do for a living?

I'm a primary school teacher.

I'll begin

the anaesthetic.

You shouldn't feel any pain.

It's just unpleasant,
with a prick at one point.

If you feel your heart racing,
any dizziness or nausea, tell us.

I'll inject it now.

It shouldn't be painful.

You'll see the needle appear
along this line.

It'll look like a white line
on the screen.

I'm going to start now.

The probe is a bit bigger
than the ultrasound above it.

Can you focus it for me? Thank you.

Tell me if need be.

Everything all right?

So, there's a first ovary right here.
See the follicles?

Those black circles...

I'll do the follicular puncture now.
Say if you're not comfy.

You can see the white line
moving down...

and entering the follicle.

Now you'll see the follicle vanish
bit by bit.

We'll take that one.

Ok? Let me know if it hurts.
I have the needle in your ovary

and it can feel a bit sore.

I can reposition if you're not comfy.

I'm in the perfect position
and it's really easy for me.

I'll stay there as long as I can,

but if it's unbearable for you,
I can reposition.

The left ovary is done.

I'll do the right one now.

This one's further away
so I have to press down a bit more.

Is the pain bearable for you
for now?

It hurts, but it's ok.

Can I start?

- How do you feel?
- Hold on.

Just say when, no worries.

It's the last one.
I'm going to bother you again

because it's hidden behind your uterus.

I'll reposition
so I won't hurt you too much.

Can I try again?

I'm going to press down on your tummy,
or you can do it yourself.

Press down here.

With your hand.
My colleague will help you.

I'll press down to bring it closer.

You're doing great, just great.

I'm not going to let this one go.

It's the last one and it's lovely.

There, we're done.

It's all over. Bravo.

Thank you.

Are you aspirating what's good
or what isn't?

I'm looking. I think there's one here,
but as I'm not sure, I...

I'm tilting the dish
to remove some blood.

Actually, we take all the oocytes

and put them in IVF pools like this

to clean them first of all

and to stock them.

Given the viral risk,
we clean them twice.

There it is.

That's it there.

You can see in the light that it's...

You can see it just there.

You can go here.

Come in, it's nice and clean.

Here you go.

The container for the sample.

I'll put your name on it.

I'll let your check your identity
and your wife's.

- Perfect.
- All right.

Wash your hands before opening it.

It's sterile inside,
so wash your hands first.

For your personal hygiene,

take the compress and the disinfectant.

Wet it with the disinfectant,

the whole compress.

Then clean and disinfect the glans...

Your willy I call it,
as some patients don't understand.

Then put everything in the bin.

Then open it, put the sample in it
and close it when you're done.

This is just a small stand,
but make sure it's in place.

Close it and then put the container
in here.

Leave the door open to air the room.

Keep your phone on. If it's no good,
someone will call you

for a second sample.

- Ok, fine.
- All right.

I'll leave you to it.

All right, thank you.

DO NOT DISTURB

Do you see any sperm?

Yes, I'm counting them
and checking their motility.

Normally, there are plenty everywhere,
but there aren't many here.

Each time I add a figure,
that's a sperm.

In the first sample,
I saw only nine sperm.

One was moving,

two were at a standstill
and six weren't moving.

In the second, two, one, three, nine.
So twelve.

This one's freezing his sperm
as his count is so low.

The average is 15 million per millilitre
and he's at 0.01 million.

So it's really not a lot.

It only takes one.

It only takes one,
but in ICSI she has to find it.

It's tough when there are so few.

I used dye on the slide

to assess the vitality of the sperm.

It dyes all the dead sperm violet.

We count them and get
the percentage of live ones.

Because, sometimes,

live ones don't move,
but can be used,

while others don't move
as they're dead, making it trickier.

We can't use those.

I'm waiting for the slide to dry.

Are some dead?

Yes, but it's normal to have dead ones.
Generally...

I can't remember what the norms are,
but I think

with 55% of live ones,
we usually have 45% of dead sperm.

In this case, he has a bit more.

He has 24% live and 76% dead.

And?

Is that better?

He's below the average.
He doesn't have 15 million, but 1.6.

But compared to the other guy,
he has 100 times more.

Even if I'm "blasé" about it,

we're all stressed each morning.
We want them to fertilize.

We want to see our results
and get fertilization for our patients.

That's normal.

Yes, we're not that blasé, see.

Wait till you inject.

I don't have time.

You can start.
Begin training on the afternoon shift.

I was trained in ICSI before IVF.

I already have a big head.
It'll be worse if I do ICSI.

ICSI is what I prefer.

We'll make some baby Cléments.

Baby Cléments.

There's transfers too. You feel like
the patient is pregnant thanks to you.

What's the semen analysis count, please?

- Five million.
- Five million?

What's the rule?

There's no rule,
but with a high count I use very little.

Five million isn't a lot of sperm, so...

I'm using a little.

Here, at goal four,

I put some on the PVP line.

The sperm are arriving.

You see them move.

This one looks good.

It doesn't show any anomalies.

So...

Personally, to break the sperm,
I like to be near the line.

Position yourself just above it

and block it.
I've stopped it, see?

You can't see it,
but I'll try to show you.

Then move the needle like this.

There, you see, I broke the flagellum.

Then lift it with the tail,
sorry the head, facing down.

Move towards the exit.

Try to block the flow
so it doesn't go too high.

There it is.

I've lowered it to four
so you can see it arrive.

The position when you insert it
creates a flow.

Now, I insert my needle.

You test it a little.

I can see I'm on the same level

because the cytoplasm...

the cytoplasm and area P
form a small dent.

Now, I bring the sperm
as close as possible to the needle.

And I go in.

Once I'm in, I aspirate.

I aspirate the cytoplasm
and you'll see it move faster.

That's the oocyte bursting.

Once the oocyte has burst,
inject it back in,

with the sperm, of course,

and you're done.

Next one now.

And so on.

These embryos are five days old.

We'll see which ones have reached
the blastocyst stage,

the stage just before implantation.

It's the stage that interests us
to do the transfer.

You can see the two nuclei.

We'll do the transfer with ultrasound,

so I'll put you down here.

After the transfer,
do I take Spasfon or not?

Yes, you can take Spasfon.

Get comfortable here.

I'll keep your ID
until we do the transfer.

The doctor will be along to set up.

You have a hook for your things.

I'll call her right now.

- Good luck.
- Thank you.

You can move closer
to your wife's head.

We'll turn the screen so you can see.

Or you can stay by her side if you want.
It's up to you.

Ok, here we go.

I'll insert the speculum, madam.

May I?

Sorry, it makes you want to pee.

- Is that ok?
- Yes.

Edge down a bit towards me.

Is it bearable?

I have to press a little, sorry.

On the scan, we can see your uterus
and the endometrium membrane

where we'll place the embryo,
using ultrasound to guide us.

This is the little catheter
containing the embryo.

Here we go.

- See it?
- Yes, a tiny dot.

Can you expose the endometrium
a bit more?

What you're doing inside, I can feel it.

Really?

Breathe deeply.

The sphincter inside the uterus
is a bit tense.

Let's wait for it to relax.

Breathe deeply.
That will allow it to open.

Let's see. That's perfect.

We're now in position
to inject the fluid with the embryo.

You'll see a small patch
appear on the screen.

There it is.

I'll remove the catheter now.

My colleague will check
that the embryo

isn't stuck inside it, ok?

I'll leave the speculum there for now
as inserting it was so unpleasant.

Your instructions...
You can go shopping if you want.

Live normally.

If you want to do sport, do it
If you want sex, do it.

If you don't, don't force yourself.

Try to be as relaxed as possible,

if you're able to manage your stress,
of course.

That's all.
We'll keep all our fingers crossed,

pray and hope to have good news
after this transfer.

- It's perfect.
- Thank you.

Okay, it's... quite quiet.

I think you need a bit more...
do you know, uh...

long-acting insulin?

You need a little bit more.

So you was...

you had diabetes before the pregnancy?

Okay, since... how many times?

- How many years?
- Yes.

- 19... 19, 20, 21. Three years.
- Three years? Okay.

- Do you have some drugs?
- Tablets.

- Metformin?
- Yes, Metformin.

Perfect.

I will examine you.

One problem.

My hotel.
There's not cooking, at my hotel.

I need a house.

- Why?
- Because no cooking at the hotel.

- No cook?
- Yes, I am diabetic.

Eating food... outside... problem.
Highly diabetic.

But, I need a house, yeah.

That's a very big problem, for a woman
like you, with the diabetes.

I will make a medical certificate.

Okay, and you have
to give it to the...

social worker.

So they will try to help you.

The 115 social service got it?

The hotel? You have it with the 115?

Yes.

Okay, so I will give you
the medical certification.

And she will give it to the 115, okay?

Perfect. It's not too big.

Perfect.

- Do you need help?
- No, thank you.

Did the scan go well?

- Very well.
- Was it nice?

Did you ask the gender?

No, actually.

- So you want it to be a surprise?
- Yes.

Are you able to say why?

I didn't really want to know.

We're already caught up every day
in gender issues, boy versus girl,

so I felt it was good
to be out of all that for a while.

Obviously, it'll be one or the other,
but it's a nice break.

Apparently, the gender was obvious,
but we didn't want to know.

Because you have
no particular preference?

It's simple, you just want
a healthy baby and that's all.

That said, I don't think I...

I want both, but have fears about both,
so it's good not to know.

- Your date of birth is June 2nd, 1985?
- Yes.

Is it a spontaneous pregnancy?

Yes.

Your height.

174 cm.

- Your weight before pregnancy?
- 69 kg.

Do you have health cover?

Top-up insurance?

- You're married, partnered?
- Married.

- Where are you from originally?
- Senegal.

How long have you been in France?

Almost 11 years.

- Do you work?
- Yes.

What do you do?

I work in a central kitchen.

For schools?

I'm a production agent
in a central kitchen.

- Do you drink?
- No.

How old is your husband?

He's nearly 66.

- Is he from Senegal too?
- Yes.

- Does he work?
- Yes.

- What does he do?
- He's a chartered accountant.

Are you circumcised?

Yes.

How many pregnancies?

Four.

Fourth child?

- No terminations or miscarriages?
- No.

- It's not too uncomfortable?
- No.

There's a contraction coming.
Can you feel it?

No? Everything's ok?

When there's a contraction,
I can feel the baby's head.

Your cervix is dilated
to a good four centimetres.

It should progress nicely.

Keep me posted about what you feel, ok?

Go on, lift your behind.
Perfect.

Do you feel drier now?

Perfect.

Something's running.

It's running a lot?

Is that what you felt?

The liquid running all of a sudden?

You know that's normal?

There was a lot because you lifted
and lowered your behind.

Everything's fine.

It was a lot. Let's clean up.

It was a real flood.

We'll do it all in one go.

Will someone be here with you?

No.

- No one to accompany you?
- No.

Not even a friend or a relative?

Your husband's minding the children?

He's at home with our two children.

Does it seem long?

A little.

A little, but not too long.

Do you feel it'll happen soon?

Yes.

Insh'alla h. By God's grace.

I'm impatient.

I'm impatient to meet her.

I'm impatient.

There's one starting. Can you feel it?

Yes, here it comes.
Can you try to help her descend?

That's very good.

If you feel her pressing,
you can press with her a bit.

Go on, accompany her
where you can feel her.

That's very good, you're doing great.

Take your time.
What do you feel when you do that?

- Is it painful or a relief?
- A relief.

It's a relief, right?
Let's try again.

Take a deep breath, feel her pressing
and push her towards me.

That's very good.

- It's over. Are you ok?
- Yes.

Stay like that. I'll clean you up.

You'll feel her like that from now on
and things will move faster.

Don't hesitate
to press the epidural button.

Do you feel that strong one?
Go on, you can accompany her.

Nice and slowly. I added more epidural.
I'll add more in a minute.

Let's get ready for the birth.

- I'm going to poo!
- Ok, let it out, she's on her way down.

- No.
- Stay calm.

Don't hold your breath.

Give lots of air to your baby too.
Great.

I'll get everything ready
for the birth, ok?

Are you ready? At the next contraction,

give it all you've got.

Ready?

I'm examining you.

Make your tummy nice and hard
and try to feel her head descending.

- There...
- Another one?

I can feel her descending too.
Let's go.

Take in lots of air.

Hold it.

Push your little girl. Go on.
Keep going.

Nice and hard.

Go on. Lovely!

Go on, her head's almost turned,
that's great.

Keep on like that.
Go on, keep pushing.

Very good.

Breathe out, relax a bit
and then get right back to it. Let's go.

Take in lots of air
and push her really hard.

Go on, don't stop, don't stop.

Rest now.
I think the contraction is over.

Let's wait now.

How was the pain when you pushed?

It didn't hurt?

- It's bearable.
- You feel her descending and pressing.

That's great.

Another one?

All right, let's go.

Fill yourself with energy.

Push down nice and hard.

Come on, don't stop.
Harder than that.

Try to feel her pressing.
That's great.

Come on, don't stop.
Nice and hard.

That's perfect.
You're doing a really great job.

A great job.

I can see her coming.

It's so beautiful. Bravo.

Relax now. Relax.

There.

Ready for her shoulder?
Her head's here.

Let's go. Take a deep breath

and push her hard. Bravo.

Go on, don't stop.

Very good. Relax now.
Rest your head on the pillow.

Let her come on her own.

Here she is. Listen.

Want to take her?
Here you are.

Take your little girl.

There...

Bravo.

Are you holding her?

Yes, little sweetheart.

It's all right now.

Who's this then?

Mummy's little princess.

She's so beautiful.

Take your mask off.
We forgot to take it off.

Look how beautiful she is.
Let her see you properly.

Yes, my little baby.

Yes, my love.

Here you go.

Hold her against you.

On her side, like that,
so she can breathe properly.

I'll put a sheet over you.

I'm going to take your voice.

Lift her up slightly.

There.

She has nothing more to say.

That's the placenta.

You can feel me looking,
just to check there's no tearing.

- Am I hurting you?
- No, it's ok.

I'm so happy.

I can see that.

- How was it for you? Are you happy?
- Very happy.

Good, wasn't it?

- I'm happy too.
- You were great.

Really, really good.

It was wonderful,
a really beautiful birth.

You did a great job.

You're so kind. Thank you.

You too, above all.

You helped me a lot.

Let me help you move up the bed a bit.

Until the baby came out,
I didn't really realize.

You wondered if it'd be ok?

I wondered
if it was the baby coming out or...

It was as if I was having fun.

I was giving birth as if...

As if we were having tea.

Exactly!

We'll have tea together tomorrow,
if you want.

We'll really have tea.
I'll come to see you.

I'll fetch it.

I won't have time to deal with 103
before I move to 106.

She's asking for a bottle.

After nine months of complicity,

we've met each other at last.

We've met each other, right?

My little sweetheart.

Yes...

Yes...

This is real life.

May God bless you.

Health.

Long life.

Peace.

Intelligence.

A lot of love.

Respect.

All that, my love, insh'allah.

Hello, I'm the duty gynaecologist.
I'll be doing your C-section.

Everything ok?

Does this hurt?

Do you feel that? Does it hurt?

That hurts a little, but that's normal.

The anaesthetic will kick in soon.

You can feel us touching you.

Feel us touching you?

Does it hurt?

Does it?

Hear that?

A blue sheet.

33 minutes past.

2:33 pm.

- 31?
- No, 31 and 33.

Hello, you little darling.

You got a second one ready?

Look, they're here.

There are two of them.

Beautiful, huh?

Yes, we're going.

Maybe we won't give you both at once.

Not right away.

You can do that later.

Turn the heat up.

Set it at 39 degrees.

You're so cute...

- This one's Sarah?
- Yes, Sarah.

Let's weigh her.

A little diaper.

Did you weigh her?

No, not yet.
I didn't measure her either.

Just her weight.

We didn't weigh her yet.

We're going to talk

with Mummy about what happened
to you both and you'll be here with us.

Concerning that question
you just asked...

Something that could possibly

have a "harmful" effect on your baby
is what you keep inside.

From the moment you...

I have to admit I'm someone who...

I express myself a great deal
and I manage...

to let everything out.
So I talked a lot about the birth

and I admit...

It's a good job I saw the midwife
on Tuesday.

Because otherwise, right now...

I don't know what I'd do.

Actually, last Tuesday,

the appointment with the midwife
did me a lot of good.

Actually, it's funny because...

The midwife was Margot, right?

She went back over the birth

and explained precisely how it went.

That allowed you to understand
what had happened

and to be reassured about the fact

that it wasn't
an ordinary, normal birth,

and that the pain you felt

wasn't the pain...

you had imagined it would be.

I didn't realize
they couldn't hear the baby's heart,

that her heart had a problem,

that that the priority was saving her.

I wasn't aware of all that.

And also why...

The doctor seemed at little harsh
at one point,

but I didn't know
if it was because of me

as I was in pain and screaming.

And so I was thinking

that it was normal for him to be harsh
in order to set me straight.

But Margot reassured me

that he had been like that because
they had to move fast to save the baby.

They're minor things,
but I see I sensed them right.

He was harsh,

but only because he had to do that.

I finally understood
what had happened to me.

Why it had gone that way.

That you don't let a woman
suffer like that.

It was the level of pain, above all.

When I spoke to others about it,

people would say
that birth without epidural is painful.

It wasn't just painful,
it was horrible.

The contractions were so close
and so intense,

I couldn't listen to what they said,
even if it'd have helped me suffer less.

So I was there, thinking to myself
that I couldn't listen to them,

plus I hadn't done pre-natal classes,
so I didn't know how to breathe.

I was thinking all that

and wondering about his attitude
while I was giving birth.

On top of that,
I didn't understand the pain.

I was thinking
I should be breathing properly

instead of screaming
and thrashing about.

I was wondering about all that
and thinking

maybe he was talking that way
because I was behaving...

- The wrong way.
- Like an animal.

What came as a relief to me
was that in various blogs,

luckily I had read

that, when some women give birth,

there's a sort of animal-like regression

with the use of harsh words at times.

For example, my husband,

who could hear the doctor,
tried to say something to boost me,

but it was like an order
and I didn't want orders.

I reacted violently and yelled,
"Shut the fuck up!"

I think the whole unit found that

really hilarious.

The odd thing is
I don't have any memory of this...

They put her on me

and I said,

"I want my baby."

And they told me, "She's there."

Why does this upset me?

I don't know.

They said, "She's there,"

and I kept on saying, "I want my baby."

I couldn't see her.

I don't know.

I don't know why it upsets me.

There must be something.

- How are you?
- Fine.

You saw Lise?

I saw Lise and the baby too.
She did a scan.

- Is the baby well?
- Very well.

- And you?
- I'm ok. A bit tired now.

See I have hair now?

Yes.

I recognize you with or without.

Is it good to have hair?

I don't know.
Uber drivers come on to me.

That's a message for you, sir.

Let's look at the blood test.

The results are good.

How's the treatment going?

Any problems after the last session?

No. My blood pressure's down,
but Lise says it's normal.

During pregnancy, yes.

Today is the fourth session.

Yes.

Nausea? Vomiting?

Your appetite?

I can't stop eating.

It's not the end of the world.

I have to keep eating.

No, it's ok, I really should eat more.

Depending on the term, we'll organize

a few tests with Lise
that we may need for the birth.

And, before we complete chemotherapy,

we'll assess what remains

and schedule the surgical intervention
best adapted to your case.

- All right?
- Ok.

It's my fourth injection
of the first drug.

After this, it changes.

The second one should be better.

Let's go.

Everything ok?

I can't feel anything.

That's the idea, in theory.

You're dozing off.

I'm beat.

You've eaten too much.

- When's the birth?
- Early January.

I have to last till then.

You're strong and supported.

You're right.

The gentleman is working too.

Yes, he's supposed to.

Finding your inspiration?

This is just to relax.

I saw you looking out...

It's because I'm drawing
the building opposite.

There's some left.

Yes, it goes slowly.

The last 5 CCs now.

Four...

Three...

Two...

One...

Zero.

It's over.

It'll be another hour now.

Say if you want the helmet changed.

Thank you.

I hope they find a better treatment
as it's a bit gross.

It's war-time treatment.
They were invented after the war,

all these drugs.

It's mustard gas or something.

When I say it destroys the feminine,
it destroys your period too.

It destroys the cycle, everything.

It's dreadful.

Dreadful...

People ask a lot of questions,
so you have to tell them about it.

You reassure them. They're scared.

It's a genetic cancer,
and I have two sisters,

so it's a threat for them, of course.

That said...

I was the only one in my family
with a case like this so young.

Atypical.

For 10 years, you'd had...

- Pain in my breasts?
- Yes.

I thought it was normal
for a woman to suffer, as they say.

- You know that line?
- Yes.

I've heard it before.

My breast began to swell.

I've been closely monitored.

I had a palpation
three months before I got a nodule.

They said I had nothing.

They can't always feel it.

Or they don't know, maybe.

Who knows?
It's my story anyhow.

Please, have a seat.

I'll give you this. Like I said,
it concerns the four samples we took.

We've found breast cancer.

There are three points in the breast

found after the MRI that you did.

That's why it was best to do the MRI
before taking samples, to save time.

The ganglion
that you felt under your arm

contains tumorous cells.

Cancerous?

Exactly.

What do we do in such cases?

You have to do a further test,

which is called a PET scan.

What's a PET scan?
It's an examination of the whole body

to tell us if there's anything
somewhere else or not.

I had a prescription
to do a scan of my pelvis

and my liver. It was clear.
I have it here.

I'll take that and scan it.
That's good news.

The PET scan is even more precise.

So it's important to know
if we have

a disease of the breast
and of the underarm lymph nodes,

or something more generalized.

We need to answer that question

as treatment will depend
on the PET scan results.

Either we do localized treatment,
surgery, if everything else is clear,

or we opt for general treatment,
chemotherapy.

Do you have any questions?

What do you mean
when you talk about surgery?

Given that all three biopsies
have turned out to be positive,

it's unlikely we'll save the breast,
so we'll need to do a mastectomy.

Are you sure?

Not until we do the PET scan.

- I hope not.
- I hear you.

I hear you.

What I'd like to do...

Is it possible to do reconstruction
straight after?

No.

Why not?

We can do reconstruction straight after

when we're sure
there'll be no further treatment.

We have enough data in your case
to do chemotherapy.

- Will I get that?
- Yes.

Is that true?

Will it be long?

I need more data to say.

You're sure?

Is the chemo after surgery?

It depends on the PET scan.

It depends on that.

So I'll lose all my hair?

There's a risk of that.

Well...

All right.

Ok.

It's not as if I'm the first.

It's intense treatment, but it cures.

Yeah...

If you could avoid taking off my breast,
that would suit me.

Obviously, like I said,
and that goes for every patient.

I'll do my very best to fit

the treatment in with your work
as far as possible,

without losing any opportunities
for treatment...

That's ok.

You see to the film, I'll see to you.

It just happened to appear now.

It's strange.

- That's why I wanted to film us.
- And why I agreed.

Right.

I think if this had happened
before I began filming the hospital,

I'd have been much more upset.

You no doubt see things differently now.

It's important for everyone
to understand.

When you understand and see others...

Of course.

All of a sudden, it's different.

Carcinoma here.

Vagina...

Uterus...

Uterus, ok?

Lymph nodes here.

Radiotherapy.

Radiotherapy here.

To...

reduce the cancer, ok?

For radiotherapy, we need to find out
if here...

carcinoma or no carcinoma, ok?

If...

carcinoma,

radiotherapy necessary

here.

What's also?

Here also.

Radiotherapy

here and...

here too if...

Only if the lymph nodes swell.

Yes, if they get bigger.

Bravo.

To find out...

if it's sick here,

we need a PET scan.

A scan.

Plus surgery.

Removal of...

Lymph nodes, ok?

Yes.

After treatment...

very, very little...

After treatment...

After treat... irradiation,

very little chance of getting pregnant.

Virtually no chance.

Because irradiation...

Uterus not work after.

She asks me about

fertility after this treatment.

I explain to her

that there's virtually no chance
of fertility after this treatment...

because...

the cancer is too advanced

to ensure preservation of fertility

that would be risky
where the prognosis is concerned.

I also explain to her...

the considerable possibility

of menopause after this treatment

for the ovaries must stay
in the irradiation field

because of the advanced stage.

Probably menopause after treatment.

After irradiation,

because I cannot...

preserve

ovaries.

Ovaries.

Because tumour...

Too big

to be able to preserve ovaries.

Ovaries irradiation too.

Also irradiation ovaries.

After, not work.

Under ORAN criteria,
I have no internal swelling.

I have fat,
so it's not the usual aspect,

but I can't confirm an immature teratoma
or something like that.

For me,
it's probably a benign teratoma.

I don't want to do a coelioscopy
with a risk of contamination.

So...

What if I put it in bag
and puncture

with a V-shape rather than...

If you do the adnexectomy
and put it in a bag, that suits me.

That's good. It suits me.

Validated.

What does the review say?

I confirm it was re-interpreted
in the unit.

The MRI confirms it.

You can cut and paste the MRI review.

Adnexectomy recommended.
Remove by laparotomy.

With protected extraction.

Let's move on.

Ok, we remove that.

I'd like to see

if there's any infiltration
of the abdominal wall.

See what I was saying.

That was to answer Sandrine.

We'll have to excise the muscles
with the aponeurosis,

meaning the wall will be
very difficult to close.

It closed in chemotherapy,

but opened up again
with your coelioscopy.

I'm telling you.

I couldn't believe it
when I saw it.

The abdominal wall in chemo,
but sensitivity may alter if I go on.

I think the window of opportunity
is right now.

You're not pressuring us.

I never do.

Her general condition is better,
she reacted well to chemo...

I'm very pleased with how it's evolving,
when I expected it to be catastrophic.

Yes, she's doing very well.
I saw her with...

She isn't obese.

But there's definitely carcinosis.

True, the result won't be spectacular.

So, given the patient's
generally favourable condition,

we confirm surgery is recommended.

The patient must be informed

of the risk of digestive,
urinary diversion

that could be permanent,

as well as

of the parietal risk.

We have the young patient
with a borderline tumour

that I took for cancer,
given its coelioscopic aspect,

but the Tenon radiologists were right,

for once, exceptionally.

So you say!

And so...

As they were right, I did a laparotomy
as there was a tiny carcinosis.

It was very thin, insidious,
dome-shaped.

So I did a laparotomy
to remove the nodules.

I preserved part of the left ovary,
no right ovary.

She only has a bit of her left ovary.
And the results...

A major micropapillary borderline tumour
in the left ovary

and the peritoneal nodules
are non-invasive implants.

- Good.
- Good for her sake.

So, preservation of fertility.

It's only a tiny bit of ovary.
If you could find her...

If you could find her
a few oocytes before...

a recurrence, that would be good.

Next...

There'll be a debate about this one
with Laurie.

- You got the documents?
- Yes, and I replied.

Really?

Hurry up!

She had a 42 mm tumour,
at the age of 37,

centred on the urinary meatus.

If Isabelle can show it,
it'll be interesting.

I gave her a radical vulvectomy.

I went from the clitoris at the top

into the rear of the vagina
with a posterior resection,

and I took the whole urethra,
all the way to the urethral sphincter.

There's lymph node metastasis,
but without capsular rupture,

and the area is healthy everywhere

after the vulvectomy,
with at least 6 mm of urethra.

5 mm, plus the resection.

The healthy urethral cut.

Continent or not?

She's continent, so I have to say

the whole business was very precise.

So I put that: ESGO 2020.

No lymph node radiotherapy as there's
one lymph node and no capsular rupture.

Very precise work by Loubna too.

As for vulvar radiotherapy,

I'd say no, but we can discuss it
as there's ensheathing and so on...

It's a pity, as she's continent
with radiotherapy.

Exactly. At 37, I'd prefer...

Agreed.

For a victim, it's always hard
and painful to relive such moments

and denounce such practices.

We thank all victims
who have the courage to fight

an attacker with power,

firstly for themselves,
and also for all women.

I see a professor-like man appear
with five or six students.

No one asks my opinion.

He doesn't look at me.

Using arcane medical terms,
he addresses his team

and, before I realize,
he gives me a violent examination

that leaves me shocked and in pain.

Despite my refusal and my tears,
I have three rectal digital examinations

by three of the students present.

All he said was, "You have no choice."

I left, shocked by this appointment

with the man who could save me from
a disease plaguing me since I was 14.

My words:

abuse of power and rape.

When one side is more powerful,
like a doctor opposite a patient,

someone on whom your health depends,
you have no choice.

Plus, it's someone
with knowledge you don't have.

With a doctor, we are all
in a position of subjugation,

even more so a woman
in a gynaecological position

opposite a male doctor

who mistreats her and who,
as was said, leaves her stunned.

As a nurse, I see that youngsters,

the young interns,
are more aware of all this.

That's good. I'm optimistic about that.

But there's still

an older generation
in the medical world

that requires training.

I'm furious because, for years now,

management has known all that.

We just found out and we're in shock,

but complaints were filed years ago.

It seems obvious to me that we need

care-givers to install a protocol
prior to any gynaecological examination.

We must be informed
of what will be done to our body.

It's our body, it belongs to us.
We must be informed.

Secondly,

we must give our consent.
It's our body and our decision.

No procedure should be carried out
without our prior consent.

Demanding that protocol
could change things considerably.

Next, there need to be units

to counsel and defend
patients who file complaints.

But not old-style counselling units
confined to the hospital.

No, a unit bringing in exterior groups
like those that have spoken today.

It'd change things.

If a patient and victim could go
to a unit

where she knows she has allies
and a sorority of women

who are afraid of nothing as there is
no relationship of domination

or of subordination as in a hospital,
that would change a lot.

For the breast, as we said,
we'll do a mastectomy,

the removal of the whole gland
because of those three nodules.

Unfortunately, as we said,

it isn't possible to keep the breast.

But we can reconstruct right away.

Concerning the lymph nodes,

you remember one was a bit enlarged
and they did a biopsy

at La Croix.

That revealed some diseased cells
in the lymph node.

And when you redid
the ultrasound scan,

she said she thought
there might be three or four.

That's what I saw on the scan.

So, in that case,
there's a clear recommendation

without any option
for axillary dissection.

Axillary dissection means removing
all lymph nodes?

We remove the nodes from a space.
What does that mean?

In the axillary cavity,
we have markers

like the axillary vein
and nerves on the side.

We remove the nodes from that space,
not the others,

the subclavicular
and supraclavicular lymph nodes.

That said, they play a key role
in the draining of the breast,

and also partly in that of the arm.

I understand, after talking about it,
that for your job...

Good job it's on the left.

With the arm,

the goal is to recover
full mobility of the arm.

We don't sever any nerves
that control the arm's mobility.

All right.

Anything to add about reconstruction?

Any questions about what we said?
There'll be a scar under the breast.

There'll be one scar here
from the axillary dissection,

and a second scar...

Under the breast, in the fold.

Seven or eight centimetres long.

We said we'd keep the areola.

As I said, the areola could be painful.

Your areola is vascularized
by the gland.

We're removing the gland.

It could end up less vascularized
as the vessels that supply it

arrive via the skin or via the gland.

As we're removing the gland,
there's a risk it may not survive.

Shit.

If it doesn't survive,

the areola in the middle,

you'll need another op.
It'll turn blue and then black.

- Cool.
- There's a slight risk.

You'll need an op to remove it,
with a scar in the middle of the breast

We can do it right away
to avoid that risk.

No, I'd rather try.

- Who'll reassure me as I go under?
- Both of us.

- Everything ok?
- Yes.

It's good there's a cinema cameraman.

I love the cinema.

It's great that you're filming this,
Claire Simon.

I love the idea.

Thanks for your generosity.

It's good because it allows people
to see what happens.

I think it's wonderful.

Do you want some music?

That's a good idea.
Music's great, I love it.

What do you like?
Classical, jazz...

I like classical music, jazz...

Piano music would be perfect.

There we go. This is it.

- Relax.
- I am relaxed with this great team.

Clench your fists.

I need to tap a bit.

How long till I'm out?

We'll let you know as we go.

There's nothing anaesthesia-wise yet

as we're placing the monitoring devices.

- The electrodes might prickle a bit.
- No, they're fine.

Try to move your fist like this.

Watch me.

- What's going on?
- I want to see the veins.

- All right.
- Clench it.

The camera makes me laugh.

Clench it tighter.

It changes the whole mood.

It eases the stress.

There, the IV is set up.

- Hello, madam.
- Hello.

- I'm Raphaël, another anaesthetist.
- Hello, Raphaël.

I'll put the mask on you.
It's oxygen.

You just need to breathe calmly.

Is that ok?

Lower the mask a bit.

Can you lower it a bit?

Hold it yourself if that helps.

You can hold it if you prefer that.

Yes, it helps.

That suits me too.

Everything's ok, it's just oxygen.

He's Raphaël, so what's your name?

I'm Majid.

I like that, it's more personal.
Raphaël and Majid.

Everything's fine.

There's only oxygen in the mask.

Focus on your breathing.

Breathe in deeply.

There's only oxygen in the mask for now.

Nothing to put you out.

Stay focused on your breathing.

Make yourself comfortable.
You can move on the mattress.

You should be
as comfortable as possible.

Starting to feel a bit woozy?

You're nice and comfortable.

You're relaxed.

You're feeling sleepy.

Keep breathing slowly and calmly.

You're going to get a warm feeling

in your left arm

that will spread to the shoulder.

Everything's fine.

The warm feeling is pleasant.

As it spreads,
you feel more and more like sleeping.

Everything good?

Majid is faultless.

Yes, he's so gentle.

Incredibly gentle.

Gastric probe before the thermal probe.

Is this the right lady?

Yes, it is.

Surgery for cervical cancer
with lumbo-aortic dissection?

Yes.

Gastric probe in position.

Let me open your file...

- How are you feeling?
- Fine.

You're fine?

It went ok after your discharge?

- Your arm?
- It's ok.

It's not very supple.
Have you had physiotherapy?

Yes, I've started.

- You've started.
- Two sessions.

How long ago did you start?

- This week.
- This week. Ok.

- You can't lift your arm high yet?
- No.

We'll look at that after.

I get the impression
that arm is still a bit lazy.

Do you do the exercises at home?
Does your arm ache?

A bit.

A bit, yes.

I'll take a look.

Is it sensitive to the touch?

Does it feel odd?

The swelling will go down.
It's still a bit swollen for now.

It'll slim down too.

Then we'll see about reconstruction.

No.

Ok, we'll see.
You don't need to decide now.

Put your arm on my shoulder
to see how you lift it.

It's a bit stiff under the arm.

Does that hurt?

A little, yes.

That means you need a lot of physio.

The prescription says twice a week.

- How many sessions? 20?
- 15.

I think you'll need more.
We'll extend it.

And, at home, do this.

I raise my arm until it hurts
and then stop.

I touch my shoulder like in the notebook
and raise my shoulder,

no, the elbow...

I lift my elbow
as if I was brushing my hair.

Even when you don't have physio,
do that at home.

Try to raise it to the side.

Higher.

A bit more.

That's tough, isn't it?

It's still a bit stiff.
Does it hurt there?

It was hurting here...

But it's less painful now.

Are you applying cream to it?

You can use shea butter.

Or a cream like Dexeryl.

A hydrating cream.

This lady had bilateral breast cancer

with a tumorectomy
and sentinel lymph node procedure.

That was a year ago.

Radiotherapy after.
How's it going on Letrozole?

No, we switched to Aromasin.

- Well?
- It's ok, but I'm putting on weight.

I don't know why.

I'm not a big eater.

Sometimes, I don't have dinner
and I forget I haven't eaten.

- That's good.
- I've never been a big eater.

Last time,
you'd put on six kilos, right?

And I've put on more.

What was your pre-cancer weight?

62 kilos. 60...

Never more than 64 kilos.

And now?

74.

So 10 kilos since...

There's something too.

You have a lot to confess!

You still hear?

I now and then, eating with friends, I drink too.

But if ever I drink a little too much,

I get cholesterol.
Not cholesterol, triglyce...

Yes, triglycerides.

- Do you drink every day?
- No...

Once or twice a week?

Twice a week.

- Two glasses or more?
- No.

It's...

more.

- I think it's the drink.
- Triglycerides...

The drink.

Drink can make you put on weight.
Are you drinking more?

Yes. We chat together.

A lot.

How many a day?

Can't remember

But I gave you the number for the addiction unit.

Yes, but I said no.

I'm not going to tell you I'll go.

But it's important.

I know, I'm aware of that.

I know it's for my own good,
but it's the only pleasure I have left.

Have you tried to cut down?

You talk about pleasure, but that's 25 or 30 a day.

- They're not all...
- I see lights.

No difference.

Have you tried to cut down to ten, say?

- Sometimes.
- Not sometimes, every day.

No.

Of those 30, not each one is a source of pleasure.

The more you drink, the more you want to sleep.

It's a kind of vicious circle.

I'll give you the addiction unit number again.

They can give you...
Have you tried vaping?

No, I don't like it.

- But you've tried it?
- Yes.

But I quit once for four years.

Now it's time to...

I never really know before.
On an evening out.

Try to know only on an evening out.

- And in the morning?
- I sleep a lot then.

With my coffee.
I never eat breakfast.

Coffee and bread,
one after another.

Then I'm done.

I can go all day until the evening.

We need to decide how much longer
we give you hormones.

Why? Because you're...

you're nearing the age
of physiological menopause for women.

Even if things are less clear
for trans women,

we know we need
to ease off the oestrogen eventually.

Why?
Because after a certain age, say,

the benefit-risk balance
of oestrogen treatment can alter.

That means there's a greater risk
caused by oestrogen

of vascular problems like strokes,
coronaries, phlebitis or embolism.

That risk increases,
along with the risk of breast cancer.

For cis women, there are recommendations

based on major group studies
that show

a grace period of five years
after the menopause

under certain conditions
for cis women.

For trans women,
we follow the same pattern.

But we lack the data to say...

to proceed differently
than with cis women.

So what I'm saying is
we'll start to think about lowering

your oestrogen hormone therapy.

You're approaching 60, not just yet,
but it's best to prepare for it.

Did anyone else mention this?

No, not really.

We can't permanently maintain
oestrogen therapy for women

beyond the age of the menopause.

Luckily, you're in great shape,
in good vascular condition.

Your cholesterol is perfect, you're slim.

We can imagine your vasculature is healthy

and so the risk of causing

vascular problems with oestrogen
is much lower,

but not non-existent.

So I'd suggest
taking four doses from now on.

Start to lower the oestrogen level,

as what you've gained in femininity...

Well, there's no turning back.

Your body as a woman

is yours until the menopause
and beyond.

- Body hair won't be a problem?
- No.

Because it has diminished
a great deal.

Of course, I've had a lot of treatment,
by electrolysis and laser.

These tests don't show testosterone,

but you have a female testosterone rate,
so a very low one, ok?

There's no reason for it to return.

Well, that's not quite true.

In post-menopausal women,

because there's no more oestrogen,

the low testosterone in the body,

notably from the adrenal glands,

can express itself at times.

So, post-menopausal women,
cis women I mean,

often have more body hair
than before their menopause.

That's normal.

It's because the testosterone
can express itself

as the oestrogen is lower
and a cis woman's ovaries stop working.

This kind of inconvenience is normal.

It's something to deal with
for post-menopausal women.

If it's a problem, we'll discuss it.
But I'd prefer...

From a medical angle,

it's best to lower the oestrogen doses

progressively from now on
and say

that, at 62, 63 or 64,

you'll take no more oestrogen hormones.

May I see your face?
I'll show you mine.

We're still...

- No worries.
- Thank you.

That way, when we meet again
without masks, I'll recognize you.

Let's hope it happens soon.

There are tough moments,
but my sister is here now,

and it's much better
as she spends all day with me.

Frankly, I feel good.

But...

I get the blues now and then,
and I'm a bit scared.

Scared of what?
Returning to Quimper?

No, not at all, it's not that.

The post-treatment care?

Yes, and that same old fear of dying.

I understand.
Have you tried walking with your sister?

We go to the garden
and it does me good.

A power of good.

I'm not surprised. How's the pain
when you're in the garden?

The fact of moving and walking?

I'm happy because I realize
I've made progress.

I can walk all the way round it,
holding onto my wheelchair.

I walk all the way round, then sit
and she pushes me until I try again.

Do you feel the pain is under control
when you walk or is it still painful?

It's under control.

Ok, that's a good thing.

- Really under control.
- Ok.

I could never have done that
back in Metz.

I couldn't even walk.
Even at home, I couldn't go

from one room to another.

I feel much stronger now.

Even though I've deteriorated,

the treatment seems to be working well.

Why say you've deteriorated?

Do you feel that,
between your arrival and now,

you have deteriorated?

Oh, yes.

On what level?
The pain isn't as bad.

Of course.

On what level then?

I haven't deteriorated here,
it was already happening at home.

You can say if you think it was here.
I won't take it personally.

I just want to know
what makes you think that.

Do you find yourself
more dependent on others?

I was more dependent at home
with my sisters.

I'm not used to being assisted
all the time.

For 15 years, I looked after a gentleman
with Parkinson's until the end.

But now I need help,
and that...

- That's what's hard.
- Very hard.

Ok, I understand.

You feel you've deteriorated
because you have lost

your autonomy,
partially perhaps,

and are more dependent on others.

Before, others depended on you.

Ok, I see.

And I was very...

And that's hard.

Does that play a part in your anxiety?

Oh, yes.

But you can see your progress

since you say you couldn't walk as well
when you arrived here

as you can now.

Yes, that's obvious, really obvious.

So that means you've recovered
a level of autonomy,

even if you still need help
for some things. That's normal.

But I feel you've recovered a lot
as you can go out to the garden

and walk all the way round it

without having to stop
because of the pain.

Yes, that's really quite something.

I'm very happy on that level.

- So that's a positive point?
- Yes.

Ok, but you're still dependent
on your sisters.

And you find that hard.

I'm glad I have them,
but I realize I need help.

It's the fact I need help that...

Ok.

That need for help.

Does the idea of returning to Quimper
increase your anxiety?

- No, not at all.
- Ok.

I have a lovely house there,
with lots of flowers.

They'll put my bed
where I can see the garden.

I'll spend my time in the garden.

I'm very happy to be going there.

We're going to wait a few days
to see if the obstruction clears.

All right?

If the obstruction doesn't clear,

I'll have reached a dead end.

I'll have reached a dead end
where cancer treatment is concerned.

- Do you understand?
- Yes.

We've done two different kinds
of chemo.

For now, I don't get the impression
that the second one, after two months,

is having the effect
I'd like it to have.

In other words,
that you'd be eating better,

that you'd be walking more easily,

with more strength, an appetite
and regular bowel movements.

All those signs would show
the disease was in regression.

For now,
that doesn't seem to be the case.

So we'll give the medication
time to work

and see where we are
five days from now.

- All right?
- Yes.

If there's no improvement,
I'm afraid I'll have to halt treatment.

Yes.

- That means I'll enter palliative care?
- Yes.

I didn't call your sister yet,
as I wanted to talk to you first.

Yes.

All right.

- It's hard.
- Yes.

You're very brave but, unfortunately,
sometimes the disease

can defeat bravery
and defeat medicine.

Yes.

And, even if you never complain,
I know you're getting tired.

I can see it.

Yes.

Do you ever feel afraid?

- Yes.
- Ok.

But I could tell it was coming,

so I contacted

the funeral directors.

When did you do that?

Yesterday.

Why do you say
you could tell it was coming?

Because I could see
that even you were discouraged.

Above all, I think...

that many patients,

male or female, in your place,
would have already given up.

With you, despite everything

that I did in chemo,
prodding and bothering you,

you were always...

In any case,

you accepted it without complaint.

"Let's go, all right, Dr Richard,
we'll try that."

But I can see, that between
your last hospitalization and now,

you're a lot more tired.

- Yes.
- Am I wrong?

No, you're right.

And, even you,

I'm not saying you've given up,
but I sense a new kind of weariness.

Ok, that's what we'll do.

Besides, I'm here this weekend,
so we'll see how the next five days go.

We'll see if the obstruction clears,
then talk about it again.

- All right?
- Yes.

You'll tell me what you want.

- Shall I call your sister?
- Yes.

To tell her what we've just said.

Ok, I'll call her this afternoon.

All right?

I remember what I wrote
before I began filming.

Each person comes to the hospital
with their own story,

continually questioned,
cared for and operated on.

Cases are discussed in meetings
and in the corridors,

like a sort of myriad of stories

that everyone here knows are lives,
new lives and perhaps deaths.

It's a sort of crazed waltz
of destinies.

But the big difference between
the hospital staff and the patient

is of course that the patient
has only one story,

her own.

After shooting ended,

I kept coming to the hospital
for treatment.

It's over now,

and my hair is starting to grow back.

Get up, I've decided now
I'm replacing you

I'm gonna take your pain