Blessed be my brain – that I may conceive my own power
Blessed be my breast–that I may give sustenance to those I love.
Blessed by my womb–that I may choose to create what I choose to create.
Blessed be my knees–that I may bend so as not to break.
Blessed be my feet — that I may walk in the path of my highest will.” -Robin Morgan

I hate that poem mostly because the poet has fallen back on the motherhood standard to define woman. If that’s how she defines herself that’s one thing. A noted composer set this poem to music for the choir in which I sing. I resent it every time we sing.

After a blissful Saturday in New York which held me over for a couple of days, I came crashing back to Earth on Tuesday evening. They were an ordinary couple. He was lightly tanned, immaculately groomed, greying at the temples. She was lightly tanned, immaculately groomed, and pregnant. He looked like he was my age. She looked like she was around the age of my ex-husband’s girlfriend. After that it seemed like I could not escape women talking about how tough their pussies were. The example most of them invariably used was childbirth. A friend of mine bragged about how her pussy could take a pounding going in and coming out. She talked about the size of her son’s head at birth. In “Hit Like a Pussy” the author also uses the birth of her daughter as proof of the strength of her vagina.  To her credit, the author does state that, “I would never equate reproductive status with womanhood, because, just, no. Nor would I ever diminish the ways of becoming a mother that don’t involve pushing a human person through a vagina. So let’s put birth aside for a moment, because pussies are intended to do all kinds of things—primarily whatever their owners choose to do with them.” But it’s already too late. In “putting birth aside for a moment” she has already established the standard by which all other experiences will be judged. The same with the Village Voice review of Ali Wong’s Baby Cobra. Ms. Wong talks about wearing, “a frozen diaper because her pussy needs to heal from the baby’s head shredding it up.” Pregnancy and birth are the standard. Surgical instruments shredded my vagina and uterus. I used pads soaked in witch hazel on my vulva. I found out about that remedy myself. No one told me. I was sent home. Better luck next time.

The first surgery, a myomectomy, happened when I was 29. I don’t like to say I had my first surgery because it makes it sound like I elected to have surgery. I did not “choose to create” the tumours that invaded my uterus. When you read the literature on fibroids, writers can be a little cavalier. They are the most common benign tumour of the pelvis in women (Tintinalli’s Emergency Medicine) . Around 25% or white women and 50% of black women have fibroids during their reproductive years. Somewhere in the first paragraph you will see “Leiomyomas decrease in size during menopause,…” and “Most fibroids/myomas/leiomyomas are asymptomatic.” (Tintinalli’s Emergency Medicine, Williams Obstetrics, Current Medical Diagnosis & Treatment). Given their ubiquity, their general lack of symptoms, and the fact that they all but disappear after menopause it’s no wonder that medicine can be a little nonchalant even when someone who is symptomatic, like I was, comes through the door. I have heard all three of those facts from just about every physician I have seen. And my answer has always been, I am symptomatic. I am 30 years away from menopause. Watchful waiting is not acceptable. I have had my share of the caring and the cavalier over the course of my treatment.  The first surgery removed three small tumours.

After my first surgery, my gyn left her private practice and went into public health. I hunted around for another doctor and eventually found one. Symptoms were back with a vengeance within a couple of years: severe pain, bleeding through tampons/pads and clothes, pressure, bloating. She used real estate as an analogy for my suffering-location, location, location-put me on a progesterone-only mini pill and stopped taking my calls. I was suffering from morning-sickness like symptoms that lasted through lunch and my periods lasted three weeks out of four. Frustrated, I made an appointment with another gynecologist. Several ultrasounds later, I say several because I had at least two transvaginal ultrasounds that I can recall and I don’t know how many other ultrasounds, she found another two tumours and referred me to a surgeon who had an office upstairs. he looked at the ultrasound results and did a couple of his own and determined it would be a quick surgery-removing no more than three tumours, maybe four. When I came to in the recovery room he was there waiting for me. I removed 25, he said. That’s a lot, I slurred. Yes, it is, he replied and left. Later at the follow-up appoinrment I asked how the surgery went. It was tedious, like plucking grapes, he said. Would you rather have tedium or excitement in the OR, I asked? Give me tedium any day, he replied. I was 34 years old.

The symptoms returned when we were living in the intermountain west. Time and again, I got in the car for the two-hour drive to Spokane to see the gynecologist. The latest ultrasounds showed one tumour that was about the size of an orange holding court at the top of my uterus. It needs to come out, he said. The tumour? Of course, I replied. No, the uterus, he sighed. I hope you don’t mind, but I’m going to get a second opinion, I told him. I emailed copies of my films to my surgeon back in New York, who emailed me back the next day and said, if you can get here I will operate. I flew back in the fall. The pre-surgical consultation in his office was unforgettable. Marty the surgeon and his surgical resident hovered over my naked body as he proceeded to explain how they were going to “slice me open, yank the uterus through the muscle tissue, pop the top off, take out the tumour, sew me up, tuck me in, that’s all she wrote.” I’m right here, I said. I know, he said, you’re also one of my favourite patients. You think I have this conversation in front of all of my patients? He removed seven tumours, including the one that was the size of an orange. I My abdomen was distended and sore. I had a six-inch incision in my abdomen and an umbilical incision that changed the depth an shape of my navel permanently. A few weeks later I went back for a post-operative follow up and he found two more tumours on the ultrasound. Please let me take them out, he begged, I don’t want to send you home with more tumours. I agreed and I was wheeled into the operating room the following day. He removed 10 more tumours. I had my third and fourth surgeries when I was 36.

This was about the time when I started to make jokes about have more tumours than children or more instruments in my vagina than lovers. I laughed about it then, I don’t so much now. I knew after the second surgery that my chances of conceiving were virtually nil. I just did not think there was any recovering.  42 tumours covers a lot of real estate when your uterus is small. My ex, however, was not convinced. My periods were still long and very heavy, but he was undeterred. When we moved to Philadelphia and I started being treated at the fertility clinic. My gynecologist and I created a birth plan: three month bedrest, c-section, hysterectomy. Very simple!  When things started to go wrong, I had a hysterosalpingiogram. This is a hysterosalpingiogram:

  • You will be asked to lie on your back with your feet placed as for a pelvic exam. A device called a speculum is inserted into the vagina. It holds the walls of the vagina apart to allow the cervix to be viewed. The cervix is cleaned.
  • The end of the cervix may be injected with local anesthesia (pain relief). You may feel a slight pinch or tug as this is done.
  • One of two methods may be used to insert the dye. In one method, the cervix is grasped with a device to hold it steady. An instrument called a cannula is then inserted into the cervix. In the other method, a thin plastic tube is passed into the cervical opening. The tube has a small balloon at the end that is inflated. The balloon keeps the tube in place in the uterus.
  • The speculum is removed, and you are placed beneath an X-ray machine.
  • The fluid slowly is placed through the cannula or tube into the uterus and fallopian tubes. The fluid may cause cramping. If the tubes are blocked, the fluid will cause them to stretch.
  • X-ray images are made as the contrast medium fills the uterus and tubes. You may be asked to change position. If there is no blockage, the fluid will spill slowly out the far ends of the tubes. After it spills out, the fluid is absorbed by the body.
  • After the images are made, the cannula or tube is removed.

The hysterosalpingiogram was clear as could be. Not long after the hysterosalpingiogram, the doctor finally listened to me and ordered a hysteroscopy. I had been concerned about the condition of my uterus all along. My concerns, sadly, were justified. As the camera slipped through my cervix into my uterus I saw one large and countless small lumps being fed by an intricate network of capillaries. As he pulled around the large tumour what remained looked like the surface of the moon, grey, lumpy, lifeless. It’s not supposed to look like that, is it, I asked. No, he replied. It needs to go, I said. Yes, it does, he replied and he patted my foot. A month or so later I was recovering from a robot-assisted laparoscopic hysterectomy when my ex looked at me and said, I love you very much. No, you don’t, I thought and fell asleep. When I saw my doctor later, away from my ex, I chided him saying he didn’t provide any pictures. He laughed and said your uterus was shot. There was nothing left. I read the pathology report. I had diffuse uterine leiomyomatosis a condition where the myometrium is replaced by countless, benign smooth muscle tumours. It’s a rare condition with only 30 reported cases by 2001. I had also developed adenomyosis a condition where the uterine lining breaks through the muscle wall into the myometrium where it grows and breaks down during the course of the normal menstrual cycle. On top of that I had also developed Asherman’s Syndrome. Asherman’s is rare and preventable and my surgeon followed every prevention protocol, estrogen supplements and an interuterine balloon, but to no avail. Ashmerman’s is also treatable but not in my case. Having had close to 50 tumuors removed in 10 years, there was nothing to salvage.

I do not know what it’s like to give birth, but I know what physical pain is. The difference between you and me, a friend of mine once told me, was that when it was over I had a baby. Your pain kept you from bleeding to death. Your uterus had to work as hard as mine just to stop the flow of blood in your menstrual cycle. I got an epidural, you got Advil. For the last half of my marriage, I was changing a super plus tampon hourly. I kept extra clothes at work and in the car. I slept wrapped in a towel, if I slept at all.

I have secret knowledge. I know things most women (and men) will never know. I am an expert at getting blood out of anything (hydrogen peroxide gets blood out of just about any fabric). When a women talks about the pinch of a cervical injection or suture, I know that pinch. I know how to get out of bed with a six-inch abdominal incision and I even used that knowledge to help a friend get out of bed after an emergency c-section. I know how uterine contractions build to a plateau and drop off; how the pain subsides but doesn’t go away completely until the job is done. I know what it is to have to consciously breathe through pain. It infuriates me when politicians insist that women who need abortions get transvaginal ultrasounds, because it’s being used to induce guilt and shame. I know what it is to clean a pool of your own blood. I know how to scoot down an x-ray table using my arms because my vagina is full of surgical instruments and I can’t bend my knees. I know what it is to live with someone in total denial. I know what it is to be with someone who is so focused on his wants he has no regard for your health and welfare. I know what it is to be tossed aside figuratively for something any 12-year old can do, but not literally because he doesn’t want to be the bad guy. I know what it’s like when it’s “your fault”. I also know it is tender and soft and warm like any lover’s. I have enough scars on my abdomen that I look like I survived a knife fight, and you know what? No one fucks with me at the gym. I know my pussy is strong as hell because it is battlescarred like any mothers’.  I know these things because I am strong as hell and tender and soft and warm. I know what it is to define yourself as a woman using nontraditional avenues. I also know that you pay a heavy price, maybe not immediately, maybe not forever, but you pay.

 

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