A few days later, hoping to start a Medium channel for Elli with interesting stories about the brain and Alzheimer’s research, I interview Dr. Lisa Mosconi, a neuroscientist at Weill Cornell who studies the link between estrogen depletion and Alzheimer’s in women. Why, she wondered, early in her career, do twice as many women fall prey to Alzheimer’s as men? Her grandmother and two great aunts had all died of the disease, while her great uncle was spared. Longevity alone cannot account for this. Alzheimer’s plaques and tangles can start building up decades before symptoms arise.
The key, Mosconi became convinced, is the loss of estrogen associated with menopause. But no one was really looking at the difference between men and women when it came to brains.
During our interview, I happen to mention offhandedly that: A) I don’t have a uterus; and B) I’ve been having word recall issues: names of friends; an artichoke held in my hand as my brain draws a blank; a windshield, which I described as “that piece of glass between me and the world;” even just the word wind itself, gone with it. The thing that blows?
“We have known for a good ten years,” says Dr. Mosconi, “that taking out the ovaries or the uterus increases the risk of dementia in women.”
At this point I turn off my tape recorder. “Are you fucking kidding me?” I ask for a moment to catch my thing that lungs do.
“It’s true,” she says. “There’s a strong association between induced menopause and a higher risk of Alzheimer’s in women. And some studies indicate that oophorectomy before menopause, which is the surgical removal of the ovaries, may increase the risk up to seventy percent relative to not having your ovaries removed.”
“Seventy percent????!!!!!” Why the hell didn’t I know this? Why don’t any of us know this?
Later, I type up our interview and publish it on Medium not just for Elli, but as a public service announcement to the millions of women like me—600,000 of us in the U.S. every year—who were told nothing about the risks of cognitive impairment before having their ladyparts removed, even though that information has apparently been available to scientists for more than a decade.
That interview, published in the spring of 2019 with no paid promotion, goes viral, well over a half a million views as of this writing and counting. And at least once a week from henceforth, an apologetic stranger will reach out to me over Twitter or Facebook to ask if I could help her join Dr. Mosconi’s study, which I also eventually join as a subject, because while I’d like to say I’m surprised we’ve been ignoring half our society when it comes to the study of the human body, decades of experience and multiple excisions have taught me otherwise. If I can be one tiny ladyspeck on a data graph, I tell the doc, count me in. Even if it means spending two days every year or so for the next decade, or however long I have left in this corporeal form, being poked and prodded, questioned and challenged, filled with radioactive isotopes and shoved in PET scans and MRI tubes. “Any metal in the body?” the MRI attendant asks.
“Yes,” I say. “A couple of breast clips in my right breast and a tiny shard of shrapnel in my right hand.”
“So two wars?” the attendant jokes, and I want to hug her.
“Yes.” I laugh. “The others didn’t leave any metal.” What they did leave were neurological scars in the folds of my hippocampus, which I’ve been painstakingly wresting onto the page ever since. This is how my brain has always extracted and processed life’s buckshot: shard by shard.
“Today was a good day because I got you,” I wrote on March 11, 1972, the day I turned six and was given my first diary. This was followed seven months later by “Connie is dead and her mommy killed her.” Adolescence produced “God, girls can be so, so, so MEAN!” and “Everyone already has boobs and their periods except for me,” and “I wish I could ask David to go sledding with me, but apparently that’s not allowed, because for some reason boys have to ask the girls, and that’s just stupid.” Yes, sixth grade boyfriend David who would decades later offer to cover four months of my health insurance while I recovered from vaginal cuff dehiscence. I eventually did ask him out to the movies, and he said yes, and the world did not end.
After my brain scans with Dr. Mosconi, Maria Shriver, founder of the Women’s Alzheimer’s Movement, who read my Medium post, interviews me for the Today show. “Have you looked at your brain scan?” she asks. “Are you scared?”
“Yes and no,” I say. “Yes, because one is always scared—I don’t want to find something in there—but no because I’m going to get this information, and it’s going to give me more knowledge about how to treat my body, how to treat my brain.”
Information. Knowledge. Data. Studies. Yes, please. When, please? Now, please. Use us. Probe us. Study us. Know us. Let’s figure this shit out, once and for all, Dear Science, because we’ve had it up to here—up to our brains, yes, but deep into our vaginas as well—with being ignored. Knowledge is power, or so we’ve heard, and we want both so we can make measured decisions about what goes into our bodies and what comes out of them without turning our brains into…what’s that word? Mush.
To wit: Did you know that if you’re a middle-aged woman, you have only a small window of opportunity between the beginning of perimenopause and the start of menopause to start estrogen replacement therapy to protect not only your brain but also your bones and cardiovascular system? I did not, until I dug into the science, because as a woman who was diagnosed with a stage 0 breast lump, I was scared off like so many of us from the results of the Women’s Health Initiative, which got blasted out all over the news and initially showed a link between estrogen replacement therapy and breast cancer, but guess what? That study had so many flaws, its findings are little more than useless and possibly harmful. Worse, women like me without uteri show a decrease in breast cancer with estrogen replacement therapy. But this information never made it either into the headlines or into our gynecologists’ offices. I had to find it in scientific publications such as The Lancet online.
In fact, get this: Our medical system barely trains gynecologists in menopausal medicine. A recent study found that only 20 percent of ob-gyn residency programs in the U.S. provide any menopause training. Yes, any. Which means that 80 percent of all gynecological residents in school today are getting no training whatsoever in post-reproductive women’s health. These are people whose job it is to know everything going on in our ladyparts, but they have not been taught the basic tenets of how to care for either us or our plumbing after we stop menstruating. And by “us” I mean 30 percent of all women alive on earth at any given moment.
Half of my middle-aged female friends deal with chronic urinary tract infections. Oh, well, we think, throwing up our hands in defeat and consuming far too many antibiotics than are rational or safe or even good for the future safety of humanity. It took Dr. Rachel Rubin, a urologist in Washington, D.C., reaching out to me over Twitter to explain that UTIs in menopausal women do not have to be recurrent. They can be mitigated with, yes, vaginal estrogen. Not once was I ever told this by my own doctors. Not because they’re not good doctors or they don’t care, but because no one ever bothered to do the studies or to teach this to them.
Skip Notes
* I paid $210 for an index number. The final filing of the papers cost an extra $125, plus $57 to have the papers served, then another $57 to have another set of papers served. If you want to change your name, as I did, a new driver’s license costs $12.50, and a new passport costs $145. Retrieving the final judgment costs $20 for three copies. When all was said and done, the grand total was $626.50.
THIRTY-SIX
Fuck Your Dumb Fire
JULY 2018–OCTOBER 2019
One year to the day after my return from Nepal—July 24, 2018—I get an email with a subject header that reads, “exciting news for you.” I almost delete it. Exciting news in my headers these days means my old friend Old Navy is trying to get me to buy pants, or a PR rep is urgi
ng me to write a story about a new brand of personal lube so natural, you can spread it on toast. Then I note that the email is from Dan Jones, the editor of Modern Love. Amazon, he writes, has decided to make a TV series out of the column. “They love ‘When Cupid Is a Prying Journalist,’ ” he writes, “and intend to make it the opening episode of the series.”
I gasp. My blood vessels immediately fill with the kind of warm ecstasy that normally leads to rehab, but this high doesn’t come with rotted teeth or a hangover. It’s real. It feels miraculous, except it isn’t. It came about because one morning three years earlier, on a packed subway to work, I opened up my computer and entrusted my brain with the task of counteracting the shame of using my words to help opioid addicts poop by jotting down a few truths I’ve learned about love—a natural opioid derived from endorphins, which doesn’t cause constipation—instead.
“Shooting will begin in NYC in late September,” Dan writes, “so we are on the fast track; they are casting it now. Maybe this fall we can visit the set together and you can see yourself being performed!” Later that summer, I’ll learn Catherine Keener, the actress I would have chosen to play me in my fantasy version of who-would-you-want-to-play-you, will actually play me.
I want to scream this exciting news from the rooftops, but I’m allowed to tell no one. I’m not even allowed to tell Will yet, but come on. I tell him.
Will I get rich over this adaptation of my essay? Hell no. I’ll earn $4,990.47, minus my agent’s commission, on top of the $250 I was paid for the original essay back in 2015. But validation-wise, the enrichment feels boundless. John Carney, the writer and director of both the show and my episode, is the writer and director of what is arguably one of my favorite films, Once, a love story about a love that is never allowed expression, except through the heartrending music it spawns. The film was subsequently turned into a Broadway musical, which—get this—I happened to catch with the long-lost lover I described in the essay, the one who lost the piece of paper with my address and phone number on it and wound up sleeping in a youth hostel and wandering the streets of Paris all weekend by himself, making me believe I’d been stood up. For twenty-one years. He’d traveled to New York the year of the Broadway premiere of Once, which he had to see for his work.
The missed connection and loss of this man—with whom I watched that show two decades later, while crying in sad recognition over its unlived love—sparked not only my Modern Love essay itself but also the wedding of my essay’s main characters: Justin, the dating app CEO, to his own long-lost love, Kate, at which I was the sole witness after they decided to call off their big wedding and elope.
In fact, let’s dive a league deeper: The theme of my essay was that when it comes to affairs of the heart, a love that cannot last in the traditional sense because of circumstance, nevertheless can live on in the brain as a memory whose generative powers are infinite. “Because real love, once blossomed,” I wrote, “never disappears. It may get lost with a piece of paper, or transform into art, books, or children, or trigger another couple’s union while failing to cement your own. But it’s always there, lying in wait for a ray of sun, pushing through thawing soil, insisting upon its rightful existence in our hearts and on earth.”
And now here was that same love once again, spawning an episode on Amazon Prime.
Later that fall, five years after leaning my head out the window of my Harlem writing studio, wanting to end it all because I could no longer write books, my agent sells the proposal for this book to Random House, where I began my writing career, on the same day another email lands in my inbox. This one’s from Catherine Keener, who’s about to play a slightly altered version of me named Julie, so Amazon can avoid paying my life rights. Which is apparently why no one wants Catherine and me to meet in person, even though we’ve both expressed interest in so doing: Meeting would imply that she is, in fact, playing me. Which she technically isn’t. But really she is. And just because everyone else has bought into the delusion that she isn’t, so that all of the Modern Love essayists can be denied payment for our life rights, doesn’t mean Catherine and I have to. “I know, it’s so dumb,” she writes, of whoever’s edict it is to keep us apart. “I just laughed cause I was going to find you anyway.”
I love her already. So often those of us with ladyparts are told to follow the rules and stay in our lanes, to play the part society dictates instead of being our genuine selves. Or we’re fed corporate pablum telling us to stand tall and lean in. But you don’t get to become Catherine Keener by simply tilting your body toward the burning wreckage. You say fuck your dumb fire and use the shoulder to drive around it.
In The Ladies’ Book of Etiquette, and Manual of Politeness, published in Boston in 1860, Chapter XVI, “Polite Deportment, and Good Habits,” reads thus:
Many ladies, moving, too, in good society, will affect a forward, bold manner, very disagreeable to persons of sense. They will tell of their wondrous feats, when engaged in pursuits only suited for men; they will converse in a loud, boisterous tone; laugh loudly; sing comic songs, or dashing bravuras in a style only fit for the stage or a gentleman’s after-dinner party; they will lay wagers, give broad hints and then brag of their success in forcing invitations or presents; interlard their conversation with slang words or phrases suited only to the stable or bar-room, and this they think is a dashing, fascinating manner. It may be encouraged, admired, in their presence, by gentlemen, and imitated by younger ladies, but, be sure, it is looked upon with contempt, and disapproval by every one of good sense, and that to persons of real refinement it is absolutely disgusting.
Yes, it was considered “absolutely disgusting” for a woman to be bold, tell stories, pursue traditionally male activities, speak loudly, sing funny songs, be funny in general, laugh loudly, gamble, brag, use slang, and curse. I wish I could say we’ve had progress since 1860, but really? I have scrapbooks full of anti-woman tear sheet vitriol levied against me proving otherwise.
Catherine and I meet for lunch downtown at the Odeon, where we split a giant chocolate sundae for dessert and proceed to engage in every single one of the “disgusting” activities listed in the ladies etiquette book except gambling and singing. I’m no gambler, but had there been a karaoke machine nearby, I can guarantee we would have belted one out without shame or compunction. My daughter and her son, it turns out, are a year apart at the same college. Her laughter is unapologetic and contagious. She curses freely and with great gusto. Shots of tequila are downed, stories of surviving single motherhood and a career in the arts exchanged. No, I explain, I do not—cannot—live solely off the fruits of my personal writing: I have a corporate day job writing for a Silicon Valley tech company to make ends meet and procure health insurance. She tells me about the ways in which Hollywood treats women of a certain age, just when you’re at the peak of your acting powers. We shake our heads and roll our eyes at the absurdity of it all.
By the end of that three-hour meal, she already has my mannerisms down pat: The way I gesture wildly when I get excited; my nasal, unbeautiful voice; the line of my lips when I’m trying not to smile or show emotion, which only highlights the unhidden emotion even more; the precise angle at which I extend my torso when I want to make a point. It feels like looking into a mirror, watching her transformation. Her hands are big, beautiful, like a man’s. I can’t stop looking at them. Admiring them. Afterward, we’ll walk up to Washington Square Park, where in a couple of days she will speak words I wrote in a last-ditch effort to be heard.
I tell her about two days prior, when I’d written more words seeking an audience, only this time it was an audience of one: a letter written to the fellow student who raped me on the eve of my graduation from college, sparked by going hoarse from screaming at the TV during the Kavanaugh hearings. It begins thus:
September 18, 2018
Dear [redacted],
You may not remember me from college. We d
idn’t even meet until the night before graduation. But I have never been able to forget that night or you. The memory, over these past 30 years, comes and goes, but it always pays a visit whenever I hear or read stories of sexual assault between acquaintances. As you can imagine, that’s pretty much all the time these days, and this latest Kavanaugh hearing is no exception. In fact, it’s been the straw that finally broke this aging camel’s back. I realized I could not go on with my life until I finally wrote this letter. I’m shaking, even as I type it….
I read the letter in its entirety to Catherine, after she asks to hear it, off the screen of my phone as we walk: “Let me state it as simply as possible, for clarity’s sake,” I read. “You forced yourself on me and pushed yourself into me as I kept saying no.”
“Whoa,” she says, when I finish reading. “That’s intense. Did he write back?”
“Better,” I say. Within half an hour of my sending him the email, he picked up the phone and called to apologize. We spoke for a long time, maybe twenty minutes. He had no recollection of raping me, just of the party where we’d met. He’d blacked out that night from excessive drinking and soon thereafter entered Alcoholics Anonymous. But that, he said, was no excuse. The fact that he’d done this to me and that I’d been living with the resulting trauma for thirty years was horrifying to him. He was so sorry, he said. He just kept repeating those words, “I’m so sorry,” over and over. Then he promised to pay it forward in some way, this horrible thing he’d just learned about himself for which he was never punished.
Suddenly, I tell Catherine, thirty years of pain and grief fell out of me. I cried. And I cried. And I kept crying for the next several hours, as I prepared for Yom Kippur, the Jewish holiday of forgiveness. And then, after all those tears, I was cleansed. Reborn. The trauma was gone. All because of a belated apology.
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