Mama Needs a Hysterectomy
“What worries you most about the hysterectomy?” Andrea asks.
Andrea (not her real name) is my new, doctor-prescribed psychotherapist. Because I have bipolar disorder and ADHD, I have the pleasure of visiting medical offices with the words “behavioral health” blazoned upon the signage. I had skipped out on psychotherapy for months after my previous therapist left the practice, but when the erratic mood swings, paranoia, and suicidal ideations started happening, my psychiatrist insisted I get back down to business.
This is our third session. During our first meeting, I thought Andrea an automaton. During our second meeting, she guessed some of my childhood dynamics and, catching me off-guard, made me cry. A moment of catharsis: I don’t remember having ever cried in therapy. Today, the jury is out. I will likely continue with her. I’m in no state to be picky.
Andrea’s stylish outfit is late millennial, and her chunky jewelry screams therapist. She’s dressed for the part. My outfit, on the other hand, is frumpy and stained. Nothing unusual for a middle-aged mom with attention problems. I too am dressed for the part.
“The existential crisis?” I shrug. “You know—a woman without her womb.”
Andrea says nothing. I’m not surprised. Pride flags decorate the walls, door, and desk. In this safe space, woman is performative, not embodied. One’s uterus is an afterthought. Her philosophy is as stylish as her clothing.
“But I’m doing this for my health,” I add. “Besides, I’ve clearly hit perimenopause. This change is happening anyway. There are other ways of being a mother.”
This earns me a nod of approval. I am choosing a hysterectomy for my health. In 2007, I was diagnosed with endometriosis, a chronic disease in which endometrial-like tissue grows on the outside of the uterus and surrounding organs. The lesions respond to hormonal changes in the body, growing and bleeding, causing inflammation, scar tissue, and adhesions between affected organs. In response, the immune system goes into high alert, triggering other autoimmune conditions.
Symptoms vary from woman to woman: pelvic pain, irregular bleeding, cramping, hormonal imbalance, chronic fatigue and brain fog, migraines, nausea, food cravings, allergies, weight fluctuation, and (unsurprisingly) infertility. An estimated five to ten percent of women have endometriosis, many unknowingly. The disease has no known cure.
Two surgeries, a restricted diet, and a decade’s worth of pregnancy hormones had kept the symptoms at bay. But this changed following the birth of my sixth. After I miscarried my seventh, the symptoms spiked.
My mental health followed. With every change in my cycle, my moods swung wildly. My active imagination—which, for a novelist, is a gift—turned against me. I dreamed up worst-case scenarios. Past sins rose to the surface as intrusive thoughts. Death and betrayal were around every corner. I was suspicious of everyone, especially my husband. I was sensitive to every minor slight, and we fought often. Some of my grievances were just; most were not. Nineteen years married and we could still count our arguments on our fingers. Not anymore.
Then the ship would right itself and I would come to my senses with a, “What just happened?”
My sane days were spent downing coffee and scurrying to finish work and chores. I had begun picking up freelance work and was anxious to maintain my veneer of competency. Meanwhile, my psychiatrist was throwing drugs at the problem, attempting to stabilize my mood before the suicidal ideations became life threatening.
Endometriosis and bipolar disorder, not to mention age, grief, and stress—we had just purchased a new home—were sinusoidal waves amplifying each other. I was a hot mess.
Andrea sees all this. She has been trained to help people like me. Already she knows my tendency to downplay, intellectualize, and dismiss my misgivings. We’ve even joked about it. She encourages me to enter into my worries about my hysterectomy. But for persons with bipolar disorder, feel your feelings is easier said than done. Strong emotion can be a sign of instability. And we all know feelings are fickle, anyway.
“There’s a divine pedagogy in all of this,” my husband says.
We’re sitting on the loveseat in our bedroom, my laptop open and logged into MyChart for a virtual appointment with my obstetrician/gynecologist. A bright, grating theme song echoes up the stairs. The kids are watching Paw Patrol, the only show guaranteed to keep our two-year-old glued to the screen so that my husband can join me.
My obstetrician knows us well; he delivered five of our six children. After friendly chit-chat, he lays out endometriosis treatment options from least to most aggressive. Do nothing. Lifestyle changes. Natural remedies are not enough—I’ve grown past my crunchy stage. Over-the-counter pain management. Hormone therapy. Various forms of birth control. Orlissa. Lupron. A third laparoscopy. Are we hoping for another baby?
My husband and I look at each other. He’s forty-six. I’m forty-three. His dark hair is silver now, and I’ve developed wrinkles and hip issues. We have six living children, one of whom has high needs and requires constant support. While we would welcome a late-in-life surprise, we’re also not gunning for one.
I shake my head no.
My doctor continues, laying out the case for and against each treatment. I nod as he speaks, though I’ve heard much of this before. Some of these treatments I’ve already dismissed. I don’t need any more drugs in my system. Drugs solve nothing; they only kick the can down the road. Not until he reaches the final option—total hysterectomy with bilateral salpingo-oophorectomy—does he say the hoped-for word.
Healing.
He says it in passing, without any guarantees. But I latch on to it, and in my heart, something shifts. He raises the possibility of improved mental health as a side benefit of going through menopause. Again, no guarantees. Some women handle menopause beautifully. Others, not so much.
Is this the path forward? Dare I hope? This treatment comes at a cost. In a perfect world, my doctor could heal my endometriosis without removing the body parts whose function and fruit have shaped the course of my life.
My husband and I voice our questions. I promise to message my doctor when we have a decision.
“There’s a divine pedagogy at work,” my husband says again. “I really do think God is trying to tell us something.”
We step out in faith, and I begin preparing for this change. I am losing my womb, that sacred place where seven lives had been conceived. Yet regardless its tabernacle-like telos, my uterus is also an organ, subject to disease like the rest of the body. I learn to hold both truths at once.
Meanwhile, my husband and I are discussing the future without the “so long as I don’t get pregnant” asterisk beside my name. We had bought our new home with the understanding that I would be drawing a real income. My career is no longer a potentiality but an unfolding reality.
But one lingering doubt remains. What if we are supposed to have one more?
Just one more.
Is this the expected existential crisis? A crisis of conscience? Scrupulosity? Manic-depressive impulsivity? Or perhaps the last baby-hungry cry of a perimenopausal body?
I do not know the source of my doubt. Yet each time my husband and I discuss the question, we come around to the same conclusion. We love our children. But my body suffers from disease and I’m losing my ever-loving mind. Just one more would not only be imprudent, but potentially dangerous.
“The miscarriage has been on my mind.”
I wince as soon as my impulsive words are out of my mouth. Judging by her lack of a wedding ring, I assume Andrea is unmarried and childless. She can sympathize; she can project and extrapolate. I’m sure she read a textbook on the subject.
Though perhaps I am wrong. Perhaps she does know the grief of miscarriage. One ought never assume, I remind myself.
“How are you processing your grief?” Andrea’s professional tone is calm and inviting. She wants me to know this is a safe space.
I tell her the steps I had taken, of the books I’ve read and the journaling I’ve done, and of the support of friends and family. I’ve meditated on devotional reading. I’ve prayed.
Her pen scratches her legal pad.
“I’m not avoiding my grief. I know better.” After a pause, I blurt, “And I’m Catholic. We’re not adverse to talking to dead people. It helps.”
My little one has joined the great cloud of witnesses. And the great cloud of witnesses knows my struggle. Yes, I believe heaven can hear me—and why not? The saints are in the direct presence of God, filled with his divine life. That they have been subsumed into eternity does not rob them of their awareness of things temporal. And experience has taught me, again and again, that when I ask a saint to pray for me, God responds.
This is not a line of reasoning I can share with Andrea, however. She knows I’m bordering on psychosis, depending on the time of the month. I don’t want the Church’s teachings called into question simply because I’m unstable.
She jots another note and moves the conversation along.
Four days before the surgery, I am inside the college building where my husband teaches, my footfall an uncomfortable echo in the cavernous stairwell as I ascend to the second floor, in search of a different safe space.
Fr. Nick, a Dominican friar, is chaplain to the college’s Catholic students. Though an employee of the parish, not the school, a previous dean had given him an office, grandfathering him in. Here he gives spiritual direction and hears confessions. Foam blocks cover the inside of the door. He takes my phone and puts it inside a box, lest Facebook hears our conversation and starts spitting out the wrong sort of ads in its feed.
“I’d like to take you up on your offer to pray for the healing of memories,” I say.
We settle in, and he explains the prayers he will be praying over me. My job is to surrender to Christ and to let memories bubble up. “You don’t have to do anything with them,” he instructs.
He opens us in prayer. After a moment of resistance, I ask Christ to give me an open heart, and I give him my past. The big sins come to mind as Father prays. Then the medium ones. He repeats the prayers once, twice. Long forgotten sins rise to the surface.
“Other memories may come back,” he says after we finish. “Let me know if you want me to pray again.”
I make my formal confession, and he gives me absolution and offers me anointing of the sick. I leave his office feeling more at peace than I have in months. Talk therapy cannot compete with this triumvirate of mercy.
Two days before the surgery, a card arrives from my friend. On its front is a picture of the Blessed Mother carrying Jesus in her arms. At her feet is a lamb. Inside is the promise of a Holy Hour, prayed in memory of my miscarried baby.
Only then did I realize what I had done. I had unthinkingly scheduled the hysterectomy for the week of what would have been my due date.
Yet peace prevails. I am sad, but I do not panic. I would have much rather have held my baby in my arms. But my baby, and all of heaven, is present in this too.
I thanked my friend for her card, telling her about the surgery. She hadn’t known about it, she replies, and she promises to pray for me. Up until this point, I had been reticent to talk about the hysterectomy. Only my family and a handful of friends know.
“I’m going to post something on social media,” I tell her. Before I can change my mind, I do exactly that. For a few hours, I wonder if I made a mistake. I don’t like pity parties, especially when I am at the center of it. But I do need the prayers.
But I have the best friends and readers. The body of Christ responds, and grace pours in.
“How are you feeling this morning?” my doctor asks.
I’m suited up in my hospital gown and lying on a gurney bed, IV in and flowing. My husband sits on a nearby chair, entertaining me between nurse visits. Our kids are at school except the youngest, who is home with my mom. We are ready.
“Good,” I answer. “It’s the right choice. Though it does rob me of my reason for visiting you so often.”
My doctor chuckles.
“You really ought to think about a frequent flyer program for your repeat customers.”
More pleasantries pass before we turn to business. He hands me a clipboard with papers to sign. The hospital wants to ensure that I know this procedure will, in fact, make me sterile. Oh, lawyers. As I sign on the dotted line, my doctor tells me surgery will last about half an hour—an estimate contradicted five minutes later by the anesthesiologist, who asserts that whatever time a surgeon gives, double it.
It's time. They roll me back to surgery, shuffle me onto the operating table, and in what seems like half a minute later, I’m back in the original room, dispossessed of my reproductive system, answering my husband’s greeting through a drowsy haze.
“Everything went well,” he says.
I fall asleep again.
On day two of recovery, I wake up feeling thoroughly, deeply rested.
A fresh pot of coffee awaits me downstairs. Ah, coffee. Heaven in a cup, to quote my beloved character Molly Chase. I sip my first cup as I say morning prayer. I pour myself my usual second and begin my morning routine, preparing for a busy day of resting on the couch. After drinking half of that cup, I set my coffee aside. I don’t want any more.
Now carrying a glass of water, I comb the shelves in search of a book to read. A spine catches my attention—a scholarly, philosophical book, pitched at a high popular audience, that has been sitting on my shelf for years. Other than my spiritual reading, I hadn’t been reading nonfiction because I couldn’t sustain focus. I carry it to the couch, make myself comfortable, and open the book.
To my growing astonishment, I decode every word and sentence. I understand the main concepts. I’m interested in the author’s argument. When I set the book aside, I’m eager to return to it. The next day is the same. No chronic fatigue. No brain fog. I’m on narcotics—I shouldn’t be this clearheaded, right? But when the narcotics run out, the clarity persists.
God be praised. I have my mind back.
Mama didn’t need more coffee. Mama needed a hysterectomy.
“How are you feeling after the surgery?”
Several weeks have passed since I last saw Andrea. She’s poised on the edge of her seat, hands folded on top of her clipboard. Her expression conveys her professional concern. She’s anticipating my existential crisis, I realize.
“I feel great,” I assure her.
“Oh?”
Everything is healing as it should. My moods are stable. My emotions, happy, sad, and otherwise, are normal. I can think. I’m finishing tasks and am more present to my family. My conscience has sharpened: I am seeing my real faults, as opposed to the effects of illness. Even menopause is going swimmingly. I have had a handful of minor hot flashes, and that’s it. And with my psychiatrist’s approval, I have dropped all medications except my mood stabilizer. Sometimes I wonder if I’m hypomanic—but no. The other warning signs are not present. No, I’m just happy. And thankful.
My husband was right: a divine pedagogy is at work.
Andrea’s eyes widen. “Wow. That’s wonderful.”
She smiles, then jots a note.
