Hallway lights rush by, a tracking shot. As does my life. Jump cuts within jump cuts, in no particular order: preschool apple juice, pumpkin patch, red Schwinn, blue eyes: Dad’s. Gone too soon.
“I wish Dad were here,” I say. Out loud? Later, I’ll ask my sister: Did I cry out for Dad?
“No, just your yoga pants.”
My shtetl, halted by a double door. Team Deb is not allowed to go through. “You’re going to be fine,” they say, unconvincingly, growing smaller.
Liars. They have to say that. Where’s the surgeon?
There she is. Masked. Now I’ll never know what she looks like. She’ll be forever entombed in my memory as sandy toes.
An operating room. Frigid air. Overhead lights. Blinding circle above. Legs spread below. I was just here. Three weeks ago. Five incisions, as yet unhealed. Things become disambiguated now, like on my first acid trip, when money became work, and cops became human aggression, and doorknobs stood for the problem of egress. The circle above becomes life. As do my spread legs below, which thrice produced life, but now expose viscera trying to escape into the birth canal and kill me.
I’m watching this all from above, a bleeding body on a slab, arms spread, wrists bound. Jew, Muslim, Buddhist, Hindu, atheist, it doesn’t matter: We are all Christ under the knife. The speculum goes in. L’chaim! Dear Science: I will not die for your sins. That cervix should have been removed years ago, when you took out my uterus. Back then you claimed it played a role in sexual pleasure. In the passive voice: It is believed to play a role in sexual pleasure. You told me to keep it in, when I could have told you—any woman could have—that the clitoris is the only game in that town. That a cervix, unmoored, has no role in a body other than wreaking havoc. This havoc. These masks. This clattering of metal scalpels.
Gas. A voice. “Count backward from ten.” Ten. Nine. Eight…
Fade to black.
Skip Notes
*1 COBRA, I was surprised to learn, stands for the Consolidated Omnibus Budget Reconciliation Act, not Crap Option Bewilderment of Ruinous Assholery. For the non-Americans reading this, COBRA is a limited number of government-mandated months of insurance continuation for American workers who lose or leave a job, and it’s always heart-stoppingly expensive.
*2 A somewhat controversial Zionist organization that funds fifty thousand free educational trips to Israel for young Jewish adults each year. “Enjoy the country. Ignore the dogma,” I’d told her before she left, to which she’d said, “Duh, of course.” We both knew I’d be unable to afford to send her there on my own.
Six years earlier…
TWO
Lunch with Nora, Freds
MAY 2011
“The only thing a uterus is good for after a certain point is causing pain and killing you. Why are we even talking about this?” Nora jams a fork into her chopped chicken salad, the one she insisted I order as well. “If your doctor says it needs to come out, yank it out.” A quarter century my senior, draped in black and bescarved, Nora speaks her mind the way others breathe: an involuntary reflex, not a choice.
“But the uterus…” I say, spearing a slice of egg. “It’s so…”
“Symbolic?”
“Yes. Don’t roll your eyes.”
“I’m not rolling my eyes.” She leans in. “I’m trying to get you to face a, well, it’s not even a hard truth. It’s an easy one. Promise me the minute you leave this lunch you’ll pick up the phone and schedule the hysterectomy today. Not tomorrow. Today.”
“Why the rush?”
“Why the hesitation?” Nora has leukemia. She knows this. I do not. “Wait. Don’t tell me you’re planning on having more babies.”
“Ha!” I laugh. I’m forty-five. “No. Of course not. I couldn’t get pregnant at this point if I tried.”
She cocks her head. Raises an eyebrow.
“What?”
“You get pregnant when you don’t try.”
I’ve been pregnant five times. Two of those pregnancies were planned, three were not, and I’ve had no miscarriages. If my uterus were a math problem, it would look like this: 5 pregnancies—3 live births = 2 abortions. The first was at seventeen. I’d taken all necessary precautions, but the diaphragm Planned Parenthood had given me had not done the one job we’d carefully planned for it to do: keep me from parenthood.
The second was in 2000, after the births of my first two children. The entire staff of the ultrasound office were called in to bear witness to the tiny blastula next to my IUD. “Oh, wow, look at that! So unusual!” they said, as thrilled by the rare sighting inside my womb as I was shook. I was thirty-four years old, in weekly couples therapy that wasn’t working, and I’d been taking an oral medication for a toenail fungus that was contraindicated for pregnancy.
Once again, I went in for a D&C, this time at a hospital instead of an abortion clinic, so I didn’t have to deal with screaming protestors outside or with the hour of patronizing questions inside, asking me if I was sure that I was sure that I was sure. “Yes, I’m sure that I’m sure!” I’d said at seventeen, exasperated, for what felt like the twentieth time. Why would I be sitting there naked under my hospital gown, missing a day of school, with my parents waiting for me in the other room, if I weren’t?
My fifth pregnancy, at thirty-nine, was also unplanned, but I made a deliberate, hopeful choice to keep the child, my younger son, born in 2006, just after I turned forty. The marriage was turning around, or so I thought. His father promised, this time, to help.
To be born with a uterus is to be constantly aware of it. Not just when it’s suddenly colonized by a fertilized egg, or when it’s actively growing a fetus, or every month, when it produces an ovum or bleeds, but every day from the moment you learn what it does, how it does it, and that at some unknowable moment in the future, it will leave the first of many impossible-to-remove stains.
Who am I without my uterus?
“Please,” says Nora. “You don’t need it anymore. It served you well, but that part of your life is over. The sooner you accept this the better. How great is this chicken salad?”
“Delicious.”
We are seated at her preferred table at Freds, a restaurant on the ninth floor of Barneys, between a large column and a wall of windows. The column provides some privacy from her gawkers, as does the one near our usual table at E.A.T., which is the other place we sometimes go to have what have now become, over the course of a decade, our regular lunches. At E.A.T. we get the three-salad plate: cucumber and dill, always, plus two wildcards. At Freds, it’s the chopped chicken salad. I once tried branching off and ordering the daily special, but no. I quickly understood that Nora’s strong opinions derived from nearly always being right: Freds’s chicken salad actually is the best item on the menu. Why order anything else?
To many of these lunches, Nora often arrives bearing gifts, along with careful verbal instructions for their use: Dr. Hauschka’s lemon oil (“Dump at least half a bottle in the bath water. Don’t skimp. If you like it, I’ll get you more…”); a black button-down cardigan from Zara (“I bought five of them, they were so cheap. You can wear it on your book tour. Look, the buttons look just like a Chanel…”); a bracelet with multifaceted stones (“I’m too old to wear this, you’re not…”); a mirrored picture frame (“I’m sure you have a beautiful black-and-white photo that would look nice in this, but make sure it’s black-and-white. Color won’t work”).
“I don’t know,” I say. “Won’t I feel like less of a woman without a uterus?”
“Oh, please.” Nora rolls her eyes again. “Would you rather not have a uterus or be dead? That’s the question you should be asking yourself. You’ll still be every inch a woman after it’s gone, you just won’t bleed anymore, and trust me, if only for that, get it done tomorrow. They go in with robots now. You’ll barely have a scar. So what is this adeno…how do you
pronounce the thing you have?”
“Adenomyosis,” I say, quickly googling it on my phone to make sure I get the definition right. I read from my screen: “A chronic condition of the uterus in which its inner lining breaks through the myometrium, causing extensive bleeding, anemia, heavy cramping, and severe bloating.”
“Sounds delightful. I see now why you’d want to keep it.”
I laugh. Then I sigh. I’d put up with this disease most of my adult life because, like most women who get adenomyosis, I had no idea I had it. “How are your periods?” my gynecologist would ask every year, and every year I would answer, “Heavy,” but with a tone that implied I had everything down there under control. I was bleeding ten to fifteen days out of every month, I couldn’t make it through one of those days without downing at least sixteen ibuprofen, the maximum daily dosage, and I had given up on even super tampons, as they were useless against the flow, but so what? That’s what being a woman entailed, right?
To manage the situation and give less of my income to Procter & Gamble, I’d started using a DivaCup, a breast-shaped silicone vessel you shove up the vagina like a cervical cap, just under the cervix,* to catch the flow. The DivaCup holds one ounce of blood. I was emptying it every thirty minutes to keep it from overflowing. To put this in perspective, the average period lasts between four to six days and produces, in total, approximately one DivaCup full of blood. I was producing one ounce of blood every half hour. For an average of twelve days straight. At night, unable to change the cup while I slept, I soaked through maxi pads the size of airline pillows, ruining hundreds of dollars’ worth of bed sheets until I realized I could just sleep atop those waterproof pads they give you postpartum, the kind they also give to incontinent old people and dogs.
“How heavy?” my doctor would ask, raising her eyebrows.
“Oh, you know, normal heavy. Annoying but no big deal.”
We women are taught, from an early age, to minimize. I don’t mean we’re actually taught this in school. I mean society teaches us to minimize our woes and to internalize its skeptical view of our pain so as not to be labeled crybabies or “hysterical”: a meaningless, sexist diagnosis of unspecified female malaise, which, in the nineteenth and twentieth centuries, could sometimes mean you’d walk out of your doctor’s office minus a clitoris. Why didn’t I tell my doctor I had viselike cramps, slept on a doggy wee-wee pad half the month, and produced over 576 times the normal amount of blood each period? Because what’s an extra 575 ounces of blood every month? A rounding error.
Every woman in a paper robe, facing her doctor, knows she is silently being judged. This is not paranoia or exaggeration. It is proven fact, based on numerous studies. I started collecting these studies, like charms on a bracelet. Women in an emergency room will wait an average of sixty-five minutes to be given pain medication, while men wait only forty-nine. Women who receive coronary bypass surgery are only half as likely to be given pain medication as men who’ve undergone the same surgery. If a woman claims her pain is a 7 on a scale of 10, her doctor will assume 5, while men’s self-reported pain is taken at face value: A 7 is a 7 or maybe even an 8. This is neither the doctor’s fault nor the patient’s. It stems from a history, since the dawn of medicine, of treating women, though we outlive men, as the weaker, more sickly sex, plagued by “hysteria” of the female psyche (hysteria, of course, means “of the womb”).
Dysmenorrhea (period pain), which one British professor of reproductive health described as “almost as bad as a heart attack,” is so severely understudied and underfunded, most doctors have little to offer aside from NSAIDs and a shrug. At the same time, a recent double-blind, randomized, controlled trial of sildenafil citrate—that’s Viagra, to you and me—found “total pain relief [of period cramps] over 4 consecutive hours” with “no observed adverse effects.”
Wait. Hold the fuck up, I thought, when I first read that in a book. Viagra was found to provide total pain relief of period cramps over four consecutive hours with no adverse side effects? You mean the holy frigging grail of monthly ladyparts pain for which every woman I know has been searching her whole life actually…exists? And no one told us?
If you’re a woman reading this, and you hadn’t already heard the news, go ahead and take a minute or two to compose yourself after screaming. Go on. Close your eyes. Breathe deep. Smash a dish.
I’ll wait.
So why isn’t Viagra immediately prescribed these days to women suffering from severe dysmenorrhea? Simple. Lack of follow-up studies. Once researchers had clinically proven Viagra’s lucrative use on flaccid penises, funding for our uteri—which could be equally if not more lucrative, considering 90 percent of them bleed and cramp every month—was cut off before a larger sample size study could be undertaken. In fact, Dr. Richard Legro, the lead scientist, had his grant application for further studies of the effects of Viagra on dysmenorrhea not only rejected—twice—by the NIH, no one ever reviewed it. “The reviewers did not see dysmenorrhea as a priority public health issue,” he said. Why? Because “men don’t care about or understand dysmenorrhea.” And men, of course, still hold the research purse strings.
I’d had dysmenorrhea my entire post-adolescent life, but it grew exponentially worse in 1995, after the birth of my first child. It wasn’t until sixteen years later, however, just after my annual checkup in 2011, that my general practitioner became visibly alarmed. “A seven? This can’t be right,” said Dr. Bertie Bregman, seeing my finger-prick hemoglobin level and asking the nurse to run the test again. The results came back, once again, as 7 grams per deciliter. Anemia, in a woman, begins at any number less than 12 grams per deciliter. “How are you even standing?”
I was sitting. “I’ve been a little tired.” (I’m exhausted! All the time!)
“How are your periods?”
(Have you seen Niagara Falls?) “Heavy.”
“What about your energy level? Are you able to work and take care of the kids?”
“I do my best.” (I mean, who the fuck else is going to do it?)
This time, however, sensing that I was being heard by a caring diagnostician, I elaborated. The fifteen-day periods. The emptying of the one-ounce DivaCup every half hour. The grape-sized clots. The nightly blood bath. Concomitant bowel issues. Intractable pain.
Luckily, Dr. Bregman was unnerved enough by my grocery list of vampire delicacies that he ordered further studies, which came back with the diagnosis of adenomyosis: a disease that had most likely been going on, judging by the size of my uterus, for decades. My uterus had grown so large, in fact, that it was impinging on the abilities of its backdoor neighbor, my rectum, to function properly. No wonder pooping during periods had grown so painful and difficult, I’d have to brace myself and mentally prepare each time.
“Look,” said my doctor at our follow-up, after I got a second opinion from my gynecologist, who confirmed the diagnosis and urged the same uterus-yanking solution. “We can either hospitalize you every month for anemia or you can go ahead and get a hysterectomy. It’s your choice but not really? I don’t think getting transfusions every month is a sustainable life choice.”
“Whatever it’s called,” says Nora, “I want you to promise me you’ll get that hysterectomy this year. Also, I don’t like the new cover they sent you for The Red Book.”
“The one with the woman lying on a park bench, with the book in her hand?”
“Yes. Is it too late to change it?”
“I don’t think so.”
“Good. She looks dead. Like the book was so boring it killed her.”
Ten years earlier, Nora had cold-called my home, annoyed that she’d had to get my number through a mutual friend. Throughout her life, if you dialed 411 and asked for her home number, you’d get it. “Why would you ever not be listed?” she’d said. “What if someone needs to get in touch with you?” But first she said, “Hi, Deb, this is Nora Ephron. I lo
ved your memoir, and I’d like to take you out to lunch.”
“Yeah, right,” I said. “And I’m Joan of Arc. Meg, is this you?” Meg, my friend, is an excellent mimic. Nora had adapted Meg’s novel This Is My Life, and the two had remained close. Meg knew Nora was my hero. Screenwriter, director, novelist, humorist, essayist, journalist: Nora did all the things I’d ever wanted to do but better, faster, stronger, and able if not to leap tall buildings in a single bound then at least to memorialize them on screen in such a way that the Empire State Building in Sleepless in Seattle will always be my Empire State Building. I saw Heartburn three times when it first came out; When Harry Met Sally too many times to count.
Nora’s essays in Esquire, masterworks of the form, set the bar for all of us who came after. In fact, I draw a direct line from reading Nora’s “A Few Words About Breasts” in Esquire to my first fumbling efforts as a teenager in the pages of Seventeen to my first memoir, Shutterbabe, which would eventually conjure Nora, genielike, into my life.
What Nora did in those essays, before and better than anyone else, was to subvert the inward-looking me-me-me of male gonzo journalism and rework it with a self-mocking dash of Dorothy Parker to serve the higher purpose of a collective we: the personal as a poignant and sometimes hilarious path to the universal. She’d choose the most humiliating parts of herself—her frizzy hair, the sag of her neck, the fact of being the only intern in the JFK White House at whom the president did not make a pass—and feature them front and center not as self-abasement but as her superpower. “When you slip on a banana peel, people laugh at you,” she wrote. “But when you tell people you slipped on a banana peel, it’s your laugh.”
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