Ladyparts

by Deborah Copaken

  One study I read said, “Despite being rare, VCDE”—the acronym for vaginal cuff dehiscence and evisceration, meaning the cuff comes undone and viscera falls out—“can carry a lot of morbimortality if not treated on time.” A lot of death? Cool. Define a lot. Another study went so far as to say, “The incidence of this condition is not clear, ranging in the literature between 0% and 7.5%.” Wait, what? Zero percent to 7.5 percent? That’s a huge statistical range for the risk of massive, deadly hemorrhaging following the second most common procedure (the first is cesarean) that women of reproductive age undergo. In the U.S. alone, an estimated 600,000 hysterectomies are performed every year. And 7.5 percent of 600,000 women a year is—I open my calculator app—45,000 women.

  45,000 women? How could the statistical chance of a complication that could potentially affect 45,000 American women a year not be clear and, more important, why are we not told to look out for it when we leave the hospital? Men are told that the incidence of erectile dysfunction after prostate surgery is 60 percent, and that’s not even death. And yet those studies get funded. Men are informed of the risk before they go under the knife. I know the risks of erectile dysfunction after prostate surgery, and I don’t even own a penis.

  Then I read this phrase, so common in women’s health: “missing data.” Ugh! Missing data! Again! To really study the percentage of women who nearly die after hysterectomies and trachelectomies from VCD would require a deliberate gathering of data. Which would mean collecting that data from multiple hospitals. Which would mean investing money and time in the answer. Which would mean actually caring about the answer. Which would mean making sure that at least half of those holding the science purse strings in one hand are not holding their cocks in the other.

  No one is funding these studies. Even though the American Journal of Obstetrics & Gynecology wrote, way back in 2012, the year I had my hysterectomy, that more research into these dangerous outcomes is both needed and necessary if we are to prevent them from happening in the future. In fact, they called for the development of a national reporting system or registries for vaginal cuff dehiscence, while also noting that such a system and study “would be quite costly and time-consuming.”

  Several hours after her partner finished sewing me up, my original surgeon, Dr. Hou, paid a visit to my hospital room with her young daughter. It was July 3, 2017. A Monday during the Fourth of July weekend. Clearly she was not planning on being in the hospital that day, and her daughter looked none too pleased to be dragged along. “I’m so sorry,” she said, on the verge of tears. “How are you feeling?”

  A bright future, this woman has, I thought. Her empathy runs deep. And she showed up with her kid on her day off. So unusual for a surgeon, in my now extensive experience. “I’m fine,” I said. “And please don’t blame yourself. You told me to get a caretaker. But mine flaked.”

  “Your boyfriend, right? Eddie?” I was shocked she’d remembered his name. It’s rare for a medical professional not only to listen to their patients’ stories of illness and woe but to retain the seemingly (but not) superfluous information such as a partner’s name.

  “Narrative medicine”: it’s the new battle cry on the front lines of healthcare. Every illness, like every novel, tells a unique story with its own plot, characters, conflicts, and metaphors. These days, it’s no longer enough to ask, “Where does it hurt?” A good doctor, like Dr. Hou, will conduct both a close reading and a deconstruction of the entire narrative arc of her patients’ lives, including the telling silences between utterances. Why? Because we are not just our illnesses. We are every plot twist leading up to them, whether chosen or imposed.

  “Ex-boyfriend,” I said, after a long pause, telling her how Eddie had left me to fend for myself, three days after surgery. About how in my daughter’s panic the night prior, when I was out cold, she’d group texted him along with a bunch of others she found in my phone—basically the last ten people I’d texted. His first response, when he called me that morning to see how I was doing, was to fret over how my emergency had affected his evening. It had ruined his experience of seeing his friend’s play in Portland, he said. It was quite upsetting.

  “I’m sure it was,” I’d said, and hung up the phone.

  My daughter pushed off the start date of her summer internship with a brain surgeon to take care of me during the first week after the VCD. Dr. Hou gave me her tentative blessing to fly to Nepal where Finn awaited starting the second week, provided I remained in the hospital for the next two days to be monitored and that I returned for a check-up in one week, the day before my flight. It would be good to get out of the four walls of my bedroom, she said. A change of perspective is always useful, a caretaker even more so. “But no sex!” she reminded me. “Until at least the beginning of October, when I’ll check the cuff again.” As if I needed reminding. I couldn’t imagine, in that moment, having sex ever again.

  “Go ahead,” I tell the men in the bowl shop, miming putting the missing bowl back on my stomach, between ribs and scars. “It might not hurt here?” I’m right. A smaller bowl on the part of my torso without the incisions feels fine and also closes the loop so that every surface of my body is now pulsing with vibrations and sound.

  Bong! Bong! Bong! Bong! At some point, I can feel my whole body giving in to vibrations, and then my brain, too, finally shuts down. No more thoughts of blood. No more memories of the smell of bleach. Now I’m only sound. Now I’m only vibration. It’s not that I’ve run out of thoughts to think, it’s that through some alchemy between cacophony, tone, and sound oscillation, my brain has grown quiet. It’s still there in my skull, ready to spring into action, but it feels as if it has been placed, like a laptop, in sleep mode. Without actually being asleep. I’m both aware and not aware. Awoke but not awake. Corporeally on earth and also just a collection of atoms.

  The last conscious thought I have between chimes, before my mind shuts down completely, is simply Here I am. Which are the same words Abraham spoke to God— (hineni)—when he was called upon to prove his surrender to an almighty being. In Judaism, it is an expression of total submission to faith, as God asks Abraham to bind and slay his firstborn. I would never slay my child for anyone, let alone some wrathful godperson I don’t believe in, but somehow—the brain is so weird—that lesson from Hebrew school stuck and popped up at the moment of my own surrender: Hineni. Here I am. A surrender not to an almighty being but to just…being. To breathing. To life. L’chaim.

  When the final chimes finish vibrating, I open my eyes and stand up. Without any help. And with vastly reduced pain in my pelvic area, which, I know, seems crazy, but apparently it’s not. A year earlier, researchers at the University of California San Diego had conducted a study into the effects of Tibetan singing bowl vibrations on anxiety reduction. On a hunch, they also asked participants who were currently feeling pain to rate their pain on a scale of 1 to 5 both before and after sound bowl therapy. To the researchers’ surprise, they discovered that those suffering from pain found a statistically significant relief of that pain after the sounds and their vibrations ceased.

  Ted Kaptchuk, a Harvard Medical School professor who studies the effects of placebos on physical health and well-being, compared conventional Western medicine, acupuncture, and Navajo chantway rituals, the latter of which involves tribe healers leading storytelling ceremonies for the sick. Each modality, he realized, had its own set of rules and rituals, and it was, he posited, perhaps the ritual itself (going to the doctor, getting the needles, telling the stories) that was healing, curative. “Rituals trigger specific neurobiological pathways that specifically modulate bodily sensations, symptoms and emotions,” he wrote. “It seems that if the mind can be persuaded, the body can sometimes act accordingly.”

  In a nutshell, what Kaptchuk discovered, in his many studies using both fMRI brain scans and other surveillance techniques, is that our bodies have a biological response, on a molecular l
evel, to a ritual act of care. Many cancer treatment centers these days, in fact, now provide mindfulness therapies derived from Eastern practices such Reiki, a Japanese form of healing touch; Buddhist meditation; Tibetan singing bowls; and Navajo-style storytelling—the root of today’s narrative medicine and long considered, in nearly every society, as an important path to physical and mental healing.

  “Hey, do you wanna go on a hike tomorrow?” I say to Finn as we walk out of the bowl shop. I haven’t felt this calm, energetic, or pain free in weeks.

  “Do you?” he says, looking baffled.

  I stare up into the giant Buddha’s eyes, squinting at the glint of sun on its gold-flecked face. I get it. Just let go. Be. That’s the path out of suffering: a radical acceptance of it. The body is mortal, a simple container for the soul/essence/whatever you choose to call the nameless I of you. The body will keep getting sick. It will keep breaking down. It will die. The point is to brush it off, after each new knockout, and keep going.

  In other words, the Nora Ephron School of Life.

  I smile. She would find it amusing, my equating her with Buddha. Preposterous that I had to fly halfway around the world for the epiphany. And yet it’s so clear to me now. All those lunches. All those times she allowed me to—no, urged me to—laugh at life’s pain. All of her exhortations to just yank out the damned uterus already and keep living. What was the point of holding on to something painful when you didn’t have to? Cut it out! Chop chop. How’s the chicken salad today, good? Great. We’ll take two.

  I take Finn’s hand. “Yeah, I do. I really do want to go on a hike tomorrow. I mean we can try? And if I get too tired, we’ll stop.” Every morning in the Kathmandu Guest House, a large and ever-changing group of climbers gathers in the lobby with their waterproof duffels on their way to hike the Himalayas. I obviously can’t scale a large mountain in my condition, but I’ve read that some of the nearby foothills are worth a gentle day’s hike.

  “Twist my arm,” says Finn with a wink and a smile, and the next morning, after breakfast, we head out in search of ascension. Though I have not been able to walk more than a few blocks on flat ground without pain since the day they yanked out my cervix, today I put one foot in front of the other at the bottom of the hill, and we start to climb.

  Along the winding path skyward, we find a woman with a cow, a Hindu ghanta bell, a lady with a stick, an arrow pointing up; a woman bagging ash, a field of cannabis, a blue discarded door, a string of faded flags; a Buddha with big ears, another on a roof, a little girl with a goat, a tin roof held with rocks.

  All images of the climb up the Himalayan foothills outside Kathmandu, © Deborah Copaken

  This! I remember this. This finding. This seeking. This looking. This seeing. This turning a blind corner and not knowing what you’ll find. This stopping and noticing. This pausing and saying, “Hey! Hello! Yes, you over there. Please tell me: How do you see the world?” This listening to the answers. Actually listening, not just nodding. This connection of eyes. This melding of minds. This collecting of these small scraps of humanity and chaos and finding a thread onto which to string them so that maybe—just maybe—an organizing pattern will emerge.

  This. This is who I am.

  Hineni.

  This is what I’ve been missing as each organ was removed, as my marriage crumbled, as I struggled to earn a living, as the medical bills piled up, as my will to climb broke.

  At the top of the foothill, which feels more like a small mountain than I would have presumed, I check the altitude on my phone: 6,301 feet. I google the altitude of Kathmandu: 4,593 feet. So we climbed 1,708 feet. Not bad. A good start, 1,708 postsurgical feet into the sky. I check in with my body: It’s winded and tired, but fine. “You doing okay?” says Finn, and I nod. He wants to shoot a photo of me at the top of the hill to mark the end of one climb and the beginning—I’m sure—of many others.

  “Wait,” he says, plucking a pink flower and placing it in my hair, “you need this.”

  And though it seems comical to pose for a tourist photo at the top of a hike with the flower of youth in my middle-aged hair, I give myself over to Finn’s gauzy lens vision. In my mind, I’ll always be that twenty-two-year-old setting out in the world, ready to climb it. It’s only my body that keeps doing what all bodies eventually do—getting sick, breaking down—until it eventually returns to the soil from which it sprang.

  “Come on, smile!” he says, snapping off a couple of shots, being his goofy, game self. I break into a genuine smile.

  “Okay okay!” I say.

  “Will you even remember me, if I’m not in the shot?” He knows how much I hate selfies. How every time I see a couple shooting one I can’t help but offer to take it for them.

  “I’m looking at you,” I say. “How could I forget?”

  Himalayas, Nepal, July 2017, © “Finn”

  THIRTY-FOUR

  #MeToo

  SEPTEMBER 2017–JULY 2018

  Upon my return from Nepal, feeling emboldened by reading about the women speaking out publicly against Harvey Weinstein, I email Sarah, my new Observer editor, once again and ask her to please send me the name, phone number, and email address of a contact at Human Resources, so I can report Ken Kurson’s sexual harassment. She never responds. I forward the “How come you never asked me out?” email to her again with this note: “Resending this in case it got lost in the shuffle. I need this information, please. I’d like to make a formal report. And with both Ken and Lorraine gone, you are my only contact at the paper. I can of course call the operator and try to figure it out from there, but I would hope you could help me with this. Thanks.”

  Again, no response, though I’m able to see, via HubSpot, an extension my son put on my computer, that the emails have been opened by someone dozens of times. Sometimes several times within a single hour.

  I call the Observer switchboard. Ask to speak to Human Resources. I leave multiple messages.

  Again, no response.

  With no other recourse, I do what I’ve always done when faced with solutionless problems: I write it down. But how? An essay in the form of an ironic listicle seems like the right approach, so I do that. Afterward, I send my listicle out to the editors of those magazines and newspapers for which I still have contacts. The New York Times op-ed editor turns it down. A male editor at The New Yorker writes: “First of all, and above all, I am sorry you had to suffer this. No one should, and, maybe, after this moment, fewer will. I dearly hope so. But I am going to pass on this one, Deb; we have a lot of material on this in and coming in from staffers. I am sure you will find a place for it, though, and I hope you do.” A deluge of similar rejection emails follows, from New York magazine, The Washington Post, and others, many of whom will cite the legal ramifications of going public with the story: They don’t have the resources, should they get sued, even though in my original essay, I do not name Kurson. I just call him the “Big Important Male Editor.”

  Before throwing in the towel, I email the essay to Caitlin Flanagan, an Atlantic columnist whom I’ve never met but whose work I admire, and I beg her for a contact. What happens next—thank you, Caitlin—is a lesson in the power of sisterhood. Of women working together with common purpose rather than tearing one another down. This stranger writes back to me, “What a devastating piece. I’m so very sorry you had to endure that. What a loss…I am going to send this to Adrienne LaFrance, who is my Atlantic web editor. I am pretty sure that if they want to publish it—which I really think they should—they would want it to go up very soon.”

  “Very soon” turns into three months of careful vetting by lawyers and editors, who insist I publicly name my perpetrator, though I fight against this. It’s not just about this one male boss, I argue. He’s a stand-in for every male boss who abuses his position of power.

  “You should name him,” says Will. Will spent three decades as a
magazine editor, the last ten as the boss. Bosses, he says, need to be held accountable.

  Several weeks after returning from Nepal, I happened upon a photo of Will laughing in a sunny kitchen on my phone and swiped right. This was on Bumble, the dating app that requires the woman to make the opening salvo within twenty-four hours, or you lose the match. In the career section of his profile, Will had indicated that he worked in magazine publishing, so I texted, “Magazine publishing, huh? How’s that going for you?”: a quick inside joke to let him know I was both in on it and in the same sinking boat.

  “About as well as can be expected,” he wrote back, and we began chatting amiably. His wit was sharp, his mind agile: a file cabinet, I would later learn, overflowing with primary sources, doorstop books, and yellowed newspaper clippings, all as easily retrievable to him as mine are buried under dust and trauma. He was a few years out of his two-decade marriage, separated but not yet divorced. Same, I wrote back. He reminded me that we’d met once before, back in 2001, at a mutual friend’s birthday party for one of their kids.

  Wait, what? From my own brain’s file cabinet, way in the back in a hard-to-reach drawer, I plucked a vague memory of looking up at a tall man with an angular, welcoming face and having a fifteen-minute discussion about…something. Right. Of course. That Will. Got it. Once I’d merged the photo of salt-and-pepper-haired Will in the palm of my hand with the auburn-haired version in my mind, the memory expanded. I could picture us laughing, standing next to a dining room table stacked full with my friend E.B.’s always delectable offerings. Shutterbabe had just been published that week, Will reminded me, on the day we’d met. Remember? He’d been trying to ask me a bunch of questions about my years covering wars, but we kept getting interrupted by screaming toddlers.