Eviction Plus Three Hundred Sixty-Five

One year.

One year since I took my first-ever sincere pregnancy test to be sure the uterus about to be removed contained no life but my own.

One year since a one-hour surgery stretched to three while my family and friends waited, trying not to think something had gone wrong.

One year since one of the most difficult hysterectomies my gynecologist says she's performed.

One year since the last time a stranger's blood kept me alive.

One year since I woke up, confused and disoriented, unable to feel anything between bellybutton and upper thighs, to the news that the difficult surgery had been a success but I'd lost so very much blood that I needed oxygen for a little while more, and to rest while the local they'd used on top of the general wore off.

One year since I tried to explain to the nurse that losing so very much blood was a thing I just did on a regular basis, but probably just hurled garbled syllables at her.

It was a mess in there, I'm told.  Endometrioma, asymptomatic endometriosis, massive fibroids, something called 'spongy uterus' and an ovary so deeply grafted into it that there was no hope of saving it.  My fallopian tubes were nowhere to be found; there's no way to tell if the uterus ate them or they were simply never there.  My reproductive organs, at their end, were a collection of womanhood gone rogue.  One lone half-ovary lingers, spiking my life with cravings and mood swings that no longer act as harbingers of, well, anything.

They couldn't stop the bleeding for a long time during the surgery, the doctor told me frankly when she came to see me.  I told her not to worry, I'd never been able to stop it either.

But it's stopped now, and the change is extraordinary.

A little over three years ago I staggered, crying, towards the top of the Panoramic Trail in Muir Woods, where my then-boyfriend was hoping to propose.  I was defeated long before we reached the top, moving a hundred, two hundred feet at a time before I had to hold a tree to stand.  He chose a more accessible location for his proposal, and I accepted, because (among many other reasons) what better metaphor for married life can there be than kindly and patiently holding your beloved's hand while she tries to overcome her own malfunctions and fight her way to the top of the trail?

Three months later I was in the emergency room, with doctors explaining that my iron level was life-threatening and probably had been for months.  I'd known I was anemic, but not how deep that particular crisis had become.  I fought my way through supplements, infusions, transfusions, hormones, exercises, and every other suggestion made to me, until finally the only thing left was "Stop losing blood, for good."

So what's life like now?

I still wake up tired a lot of days, because my sleep habits have never been great, but it's "Man I stayed up too late again," not "I'm not sure I can move my legs today."  I can actually, if I don't set an alarm, sleep long enough in a single night to wake up refreshed.  I come home from work and sometimes I just...do housework or work on a project because I feel like it, not because I'm racing a deadline and out of time.

I started back to the gym eleven months ago with gentle treadmill walks, and added in light weight training a few weeks later.  I miss sometimes because I'm busy, but I don't skip workouts any more because I'm too exhausted to do them, and I've steadily put on muscle.  I can walk on the treadmill at a three-mile pace, or run on the elliptical, for thirty solid minutes without stopping.

My husband and I just got back from a trip to Ireland, where we walked over fifty miles in two weeks, including a grueling trek through the London Underground with all our luggage, hefting our fully loaded suitcases up and down the steps with one hand at times.  One of the highlights of that trip was the day I took off solo hiking, only to end up slightly lost in a Galway sheep pasture, falling and badly injuring my knee.  I could still walk, but a year before an injury of any severity would have been perfect reason to head back to the B&B and declare myself done for the day, or maybe the week.  Instead, I hiked another three miles that day and more the two days following.

But it's the little things, the small changes most people don't understand, that really stick with me.  Today I'm wearing a pale lacy peach dress and a white sweater.  I never would have dared before; my pre-hysterectomy wardrobe is a cavalcade of long, full, dark skirts chosen because they wouldn't show blood as badly, and dark or patterned tops that I wouldn't stain with bloody hands by accident.  I pack extra tie-dye in the space in my camping gear that used to be reserved for a massive supply of cloth and disposable backup pads.  We planned our recent vacation around when we wanted to travel, not when I hoped to have the best chance not to be navigating airplane bathrooms on a half-hourly basis and trying to explain to flight attendants that their choices were let me up out of my seat or clean up the blood themselves.  An entire complicating factor has simply just been...taken out of my calculations.

My body no longer sets the conditions on me that it once did; gone is the constant awareness of the possibility that a miscalculation or delay will ruin both outfit and afternoon.  Getting distracted while working on a project just means I'm stiff from sitting too long, not a dismayed realisation that I've missed one too many warnings from my body that catastrophic bleeding is imminent.  I no longer have to plan to carve out six to eight days off work each year to receive iron infusions and see doctors, or an extra three to five sick days for pure exhaustion.  I've found new confidence at work, to talk about projects I want to take on and challenges I want to seek out.

What strikes me the most is how the haze has lifted, and continued to lift.  I have no idea how far down I was into chronic exhaustion after years of constant anemia, but about three weeks ago I found a new level of energy:  having done all the things I *needed* to do, and all the things on my dedicated to-do list, I created a new long-term project for myself, and sat down to give several hours of time and intellectual labor to it.

As to that Panorama Trail that kicked my ass three years ago, we revisited Muir Woods last fall, and I'll simply say that a picture speaks a thousand words.

Eviction

This post will discuss female medical issues in explicit detail.  If that's not your thing, please consider this your warning and move on.  I am talking about this because I can't possibly be the only woman experiencing it and it might help others to know they're not either.  Also, I am under the care of several competent medical professionals.  If you feel moved to offer me unsolicited medical advice, and you are not a doctor (preferably my doctor), please rethink that plan.

About a year and a half ago, in the course of the collection of medical catastrophes that was October 2015, I was diagnosed with uterine fibroids.  As they were 'merely annoying' as opposed to the several other issues rated at 'genuinely troubling' and 'potentially life-threatening', I set the matter aside to address when I had the others stable.  Once my iron levels returned to a reasonable norm, and I recovered from surgery and then from food poisoning, and got my foot out of the orthopedic boot, I set about looking for a new gynecologist (I had fired my previous gyno) who accepts my insurance and isn't an hour from home/work.

Meanwhile, my periods were moving from the moderately heavy ones I've had my entire adult life to something else entirely.  Since my 20s, I've had periods that were slightly heavier than most people's, but still didn't seem to cause the kind of anemia my late 30s offered (I could give blood about half the time up until 2010).  It was about 6-8 ounces of fluid loss (including but not exclusively blood), measured using the menstrual cup:  two heavy-heavy days, two moderate days, a day of spotting at the beginning and the end.  I've always had a lot of clotting, ever since my teens, and that hasn't changed.

They gradually got longer over the last year and a half, though only a little heavier.  By last fall, it was two heavy-heavy days, two moderate days, and ten days of intermittent spotting just heavy enough to need some form of protection.  Sometimes there'd be a day or two of nothing, then SURPRISE!  I understand this is common with fibroids, so it makes sense that as they've gotten larger the periods have gotten more annoying.  Additionally, the clotting's gotten much worse, which makes a cup particularly irritating:  Check cup on schedule, cup is empty, wash hands, walk back to desk, feel breakthrough, return to bathroom, cup is full of single clot.  Empty clot, spend rest of day anxiously waiting for another clot while nothing happens.

After consultation with my gyno and another uncomfortable vaginal ultrasound, we acknowledged that the first priority is to get the bleeding under control so that we can consider fibroid removal vs hysterectomy without the crushing pressure of the anemia driving the decision.  I also explained that the recovery from any surgery needed to take into account the festivals at which I camp in April and October.  To that end, she put me on a 14-day rotation of progesterone in February.  She said, "The next period will be as bad as usual, but after that they should start to taper off fairly soon."  I talked to a friend who's got similar issues, and was put on the same rotation; over three months her periods went from 10 days of wanting to die including 2 days of hourly bathroom trips, to four days of "hey, that's not too bad!" I did a lot of research and by and large the treatment I was put on seemed to help a lot of women.  So, I was hopeful.

It's at this point that someone invariably pops up to tell me the wonders of hormonal birth control and express amazement that I haven't been on it all along.  I agree, hormonal birth control is a wonderful thing...if you don't have migraines, especially migraines with visual auras.  I was never willing to take on a daily maintenance medication that increased my level of stroke that much.  It also turns out that it probably wouldn't have worked, if the progesterone was any indicator.

First period:  About normal.  Second period:  early.  I called the gyno and they said that since it was just a couple of days, it could just be my body adjusting to the schedule.  Slightly heavy flow, which was frustrating, but I told myself "Think how wonderful it will be when you taper off!"  Third period:  again a couple days early, arriving the Sunday morning of a camping festival I attended.  OK, annoying, but they should be tapering off now, right?  Also, gyno appt set up for the first time after festival I'm sure I won't be bleeding, because now my summer is open and I've got cleared time for recovery.  Heavy period.  Like, I've only had maybe ten periods in my life this heavy.  Three solid days of heavy bleeding, severe cramps for the first time in years.  I tell myself I'm ready for this 'tapering off' to kick in any time.

My gyno's office uses this electronic scheduler, where you go and pick out an appointment, but the scheduler doesn't allow you to differentiate between the actual doc and her nurse, who handles a lot of stuff very well but cannot have the "I think it's time to make surgery a priority" conversation with me.  The appointment I made for the first reasonable opportunity after festival gets moved because it was a nurse appointment, so I go into my fourth period of the progesterone.  The thing that I should have done was tell them how much worse it was instead of just telling them I was still having kinda heavy periods and some side effects.  They told me it usually kicks in after a month, but sometimes it could take longer, and if the side effects were too much, I could stop.  This is where I should probably have detailed the side effects, and the degree to which I meant 'still heavy' because when I told the doc about it in the appointment, her eyes got big and she said, "No, no, stop taking that, don't take any more of that."  Instead, having heard and read all the women talking about how bleeding less was so worth it, I soldiered on with it, unaware that the worst was still ahead.

So, about those side effects.  It started with headaches, which every site lists as a normal effect.  Fourteen days a month of what felt like low-grade dehydration headaches.  Lemme tell you, I was one hydrated motherfucker, because I kept drinking water to try and make them go away.  It never worked, but the massive water consumption is probably the only thing that saved my skin, when the hormonal widgeting started flinging the oil levels all over the place.  I haven't broken out this much since I was 15.  I also haven't had this much trouble regulating my moods since then either.  I've spent the last four months completely done with people's bullshit.  I've mostly managed to restrain it to 'snippy' but I've also unfriended about ten people because I just wasn't having any more pussyfooting maintenance of their delicate sensibilities and bigoted 'friends of friends'.  Turns out that part's been surprisingly good for my mental health; with 20% less fucks to give, I have heavily prioritized them.

However, the side effect that's affected me most is known as 'breakthrough bleeding'.  Randomly, at any time in my cycle, in amounts that varied from 'a few drops' to 'ruined outfit', I was bleeding.  Because this occurred in conjunction with an ankle injury that sidelined my cardio, I quit working out entirely.  It only took one instance of stopping mid-lift for a panicked rush to the bathroom to find that only the foresight of wearing a pad had kept me from bleeding all over the machine to make me extremely nervous about weights.  I stopped hiking, because a sudden rush of blood three miles from anywhere is a day-ruiner.  I've had to give up a lot of protests/rallies/marches because I couldn't be sure of bathrooms, of somewhere to check my "is that sweat or is it blood?" anxiety.  To say that I've missed these parts of my life is a tremendous understatement.

Uncertainty over whether Today Is A Bleeding Day has colored pretty much every aspect of my life for almost four months.  Yes, I carry pads everywhere, yes I wear them pretty much 100% of the time now, but the other thing about it is that it's demoralizing on a level it's hard for me to explain and the frustration and constant anxiety over whether I'm bleeding again is exhausting.  My body has been my ally, and I have been its, and now part of it is not cooperating with the plan we had by which I surrender a chunk of each month to it and I get my freedom the rest of the time.  I want to be mad at my uterus, but I know that it's not healthy, that it's decided to build itself some little fibroid friends and give away all my iron to them, but it's not really thinking as its best self right now.

Any of this, all of this, would have been on some level worth it, if it stopped the bleeding.  It hasn't.  This last period was something I can only describe as a nightmare.  Two days of showering while standing in my own blood.  A breakthrough while brushing my teeth that I was just too tired to fight so I finished brushing and then mopped up the puddle.  Less than an hour between cup changes (it holds an ounce, for reference).  The bleeding tapers off at night a little, so I can catch an hour, sometimes two, of sleep before the feeling of a breakthrough wakes me up to run to the bathroom.  I slept on a towel, just in case. I've bled on the office floor at work, I've bled on the bathroom floor at work.  Two loads of bloody towels in three days.  Just before I was ready to take myself to the ER and say "Something has gone very wrong," it slowed abruptly (there were no moderate days, just three days of non-stop then just over two WEEKS of very intermittent spotting).

Through all of this, I found the final fuck-you from the progesterone:  cluster migraines that happened to intersect with a round of weather changes to exacerbate them.  I hadn't had a migraine in two years; I got three in one week.  By the second day of excruciating pain, I had made up my mind to tell the doc that if she wouldn't take me off the progesterone I was finding a new doctor because I was absolutely done with that shit and never taking another pill.  Thankfully, her response was much more "No, no, that's not at all what was supposed to happen, clearly this is not the medicine for you."

In a perverse bit of luck, I started this entire progesterone debacle with dangerously high ferritin due to my liver's inability to cope with the last round of iron infusions.  I was lucky enough to escape any liver damage (in part because my ferritin's fallen from 1100 to 450 in the last two months to recover from the bleeding), but also lucky enough to have enough iron to turn into blood, so I am miraculously only my normal level of slightly anemic.  Score one for the Ally Body there, at least.

The only question at the gynecologist's appointment was which surgery and when, no question of whether.  I had essentially made up my own mind that fibroid removal was a losing game.  Last time I was checked, there are three and they are fairly large, so removal *could* have been an option depending on how they were attached, but I'm not even perimenopausal, so there's a strong chance they'd grow right back and I'd just begin a years-long process of regularly carving out chunks of a uterus I have no plans to use.  So, hysterectomy it is, about a month from now.  I managed to get them to move my surgery up from the last week of July, which would have been monumentally inconvenient for so many reasons.  I'll be out of work for at least a week; I plan to be hardcore serious about doing nothing that week but read books and pet cats.

Those who've seen me have been very kind not to remark on the fact that no matter how much I worked out, and especially the more I worked out, my stomach has just gotten...rounder.  The fibroids, per what I hope is the last incredibly and uncomfortable vaginal ultrasound for a very long time, currently approximate a 24-week pregnancy in size, and expand my uterus up to my navel.  When I was really heavy, this was not so noticeable.  But the reality is that the only reason I can still wear half my clothes in the waist (all the pants are long since given up on) is that I lost fat almost as fast as the fibroids grew over the last year and a half.  I don't know what my body looks like without fibroids any more; I've been holding off buying new work clothes for four months because I have no idea what will change.

The size means that I can not do the easier, quicker, vaginal removal.  I'll have a thoroughly badass lower abdomen scar, and a slower recovery.  I only asked about the fibroids on the last scan, and not if I've still got any ovarian cysts, which I've had the previous two scans; the fact that they have been in different places suggests they may just be a function of when in my cycle I was getting the procedure (usually about day 14), or it may mean that she'll be removing a couple of cysts while she's in there.  Aside from that, she won't remove or otherwise interfere with my ovaries unless she has strong reason to suspect ovarian cancer.  I have no interest in abrupt menopause, so I appreciate that.

I've been referring to this as the 'nuclear option' for resolving the anemia, and it really is.  My periods have been a contributing factor, but the absorption problem won't go away, so I'll still need to monitor my iron.  However, I expect this will end the need for infusions, and I might someday be able to give blood again.  My only real regret is that robot surgery is not an option, so I can't use this to threaten the other organs with robots if they get out of line.

Little Things Matter to Big People

Dear Fitness Center:

When we joined your gym a few months ago, my partner mentioned that he'd been a member previously.  He was asked, "Why did you quit last time?"  I understand the purpose of this question, to try and help someone tailor their experience differently in a way that retains customers.  The answer, as it is for many people who join gyms and quit them, was a complex muddle of "It cost more in time and money than I was willing/able to spend to get the benefits I wanted."

But if I ever have to answer that question, here's what I'll say:

It's your towels.

Not specifically the towels themselves, you see, but what they represent in the context of your gym and how you manage it.

The best time for me to work out is at lunch, which means I drive over, hit the elliptical for 20-25 minutes, shower, and drive back to work for the afternoon.  This is, for me, a workout routine I can establish as a habit, meaning that regular activity 3-5 times a week becomes a set part of my life.  All the studies I've read say that, whatever my size, that is an improvement and a positive thing over spending the same lunch hour working, or sitting at my desk and reading.

But here we find...the towels.  I am not particularly body-shy.  I have used communal showers for almost two decades now, so being unclothed around a bunch of other women in the locker room isn't really a thing with me.  But I'd like to wrap a towel around me as I walk from the shower to the locker, in part because it's a bit chilly in there, and in part because that seems to be the standard of behaviour everyone else is engaging in, and I'd like to respect others' comfort levels.

The towel won't wrap, though.  Each time I work out, each time I shower, I attempt to squish my body into one of your towels, unable to even convince it to tuck neatly around my chest, and it simply gapes below.  My hips and stomach are completely exposed, in all their rounded glory, as I scurry to my locker, trying to juggle my workout clothes and shoes and my glasses and my conditioner, and keep the towel from falling off.  I have yet to succeed; every day or two I hold my head up defiantly as that inadequate towel pools around my feet.  I can't go back to work unshowered, and packing a towel for my own use adds a load of laundry each week to an already-full domestic schedule, so I face the towel every day, and it demoralizes me, removing some of that endorphin high from my workout.

I look around at all the pictures you have, of people enjoying their workouts, happily swimming and biking and practicing yoga, and every last one of those people is thin.  Not just an average-weight person, but a deliberately thin one, one who fits in the towel with ease.  There are no pictures of happy fat people working out in your gym, not anywhere.  I have never, in fact, worked out in a gym where there were pictures of happy healthy fat people, despite the fact that I know a lot of happy healthy fat people who enjoy working out.

When I came in for my 'free consultation', I explained "I am trying to rebuild healthy habits, so what I plan to do is get in the habit of coming in, just to hit the elliptical, or the treadmill or the stairmaster, several times a week.  I have about 25 minutes.  Eventually I will want to put together a weights routine that I can switch out with that, even though I know it'll have to be limited."  The trainer explained patiently that 25 minutes of weight lifting just wasn't even worth doing, and if I wasn't willing to commit to more time than that, then probably I should just stick to the elliptical, because that would have to be enough and it was 'better than nothing'.  I was pushed and pushed and pushed to weigh myself and lay out a 'goal weight' and a 'target weight loss rate' no matter how many times I said it wasn't about getting skinny.

All of this, over and together, tells me that the story you're selling is this one:  thin people go to the gym.  Thin, happy people are people who work out.  People who work out are thin, happy people.  There is no space for the fat fit.  They do not exist, they do not belong here, this is a place where inadequate people come and they get thin, because thin is how you win when you commit to fitness as a lifestyle.

I will never be thin.  Even at my 'goal weight', five or ten pounds above where my face starts to look a little uncanny-angular, I am a 36DDD.  As for the bottom half of my body, this train is an express to Callipygia and it is equipped with a full caboose.  There is no changing that, and I do not want there to be.

My 'ideal body' is measured in my functionality.  At my peak of fitness, I can't tell you my waist size, but I can tell you that I can hike 8 desert miles with ease, and manage Hill Country hikes with hundreds of feet of change in elevation.  I can run five back-to-back 20-hour active days without exhaustion.  I can lift, carry, and push almost anything I'm likely to need to.  My long-term goal is a solo overnight 20 or 30 mile hike.  But when I explain to people at your gym these functional goals I have, I hear "Ok, so at what weight do you think you'd be able to do all that?"

So, I get that this is a gym and selling fitness is your job.  I get that your job is easiest when I'm satisfied with easy metrics like weight and body fat percentage, and when I'm willing to simply do what I'm told, make getting to the gym on your terms a priority in my life, and live out a 'success story' for your ads.  Joe Sixpack who lost 60 pounds and umpty inches makes a much better photo op than the woman who hauls her size fourteen fluffy ass up 15 miles of Big Bend trails.

And I get that you're telling the story larger culture taught you:  There is no room in fitness for fat people.  A fat person in the gym can't possibly be working on any goal beyond self-erasure.  I cannot possibly have a workout goal that includes expanding anything about myself, not even my capacity for physical endurance, because expanse should be my enemy.

I also get that you can't change that larger culture.  That asking a business to change its entire philosophy when most of us can't even find pants in our size or doctors who'll consider non-weight-related causes is not so realistic.  You can't change how the world views me, you can't change the American perception of fitness to include the fact that it is a thing personally defined, by each and every one of us, that it is a constantly-changing idea based on the capacity of the body you inhabit, not a cookie-cutter image of fat-free triathletes smiling past their water bottles.

You can't singlehandedly end shaming and misinformation about weight, you can't singlehandedly make people understand that the entire idea of 'extreme diet and workout program to get to the right size' is a path to failure every single time because it can never be sustainable, you cannot completely revolutionize the world so that fat people feel welcome, so that we feel we have a right to exist in this world.

But you know what you can do?

Get bigger towels.

On Being Alone In Your Head

Here's a question:  when's the last time you were alone in your brain?

Here's another one:  was it a comfortable experience?

When I say 'alone in your brain' I mean really, truly alone.  Not only no other people, but no internet or phone.  No book or movie or music to distract you.  No input except looking at what's there, hearing the ambient noise.  No goal-ended project to focus on.  Just you, and your brain.

Since I've been dealing with severe anemia, I have not been able to safely hike alone.  I've noticed that I miss the time with my brain.  This isn't about 'too many people'.  It's that the distractions never go away unless I deliberately leave them.  The phone is there, with its little games.  The internet beckons me with blogs and facebook and chat.  Even offline, I'm surrounded by books, and radio stations playing catchy music.  There's *manufactured content* everywhere for me to consume and I live in a world of active distraction, and unless I make a conscious effort, I'm never fully alone.

A lot of people ask me, "What's wrong with manufactured content?"  They say, "I get inspiration all the time from things I read or hear on the radio or see on TV."  And I agree that there's nothing wrong with it; it's just other people's brains.  And when you're listening to other people's brains, working on other people's deadlines, you don't have much incentive to stop and listen to the voices in your own head.

You get a clarity, left to face those voices.  You come to understand more about what you want and where you're going and who you are.  You also have to face the big life truths out there in the brain-black, ask the big questions:  Am I happy?  Am I a good person?  How can I be a better person?  How can I navigate the experiences of my life without compromising who I need to be and what I want to become?  If you establish a regular relationship with them, you develop a dialogue and an understanding, and you can really work through some serious growth.  Intuition is based in being able to hear and respect those voices.  So is inspiration.  They represent your subconscious collating information you didn't even know you'd taken in and pulling together your *own* conclusions from it.

Meditation helps, but it's hard to meditate long enough to really achieve the flow and stillness of your own mind.  Driving long distances without the radio is good, but not terribly environmentally sound.  Even when I work out, I'm listening to an audiobook or watching the TV above the elliptical.  I get a few minutes in the shower each morning, but I'm usually going over my day in my head and making lists.  Most of the people I know only spend quality time with their brains at one time: when they're trying to fall asleep.  I've been in that position lately, and I'm starting to notice that I'm having a little more trouble dropping off at night.

I suppose it makes a certain sense.  Is it any wonder that your mind, shouted down all day with television and conversation and books and blogs and work, takes that moment when you're not quite tired enough to fall asleep, grabs you by the face, and drags you off to hear all the things it wants to say?  You're a captive audience.  And when I'm trying to fall asleep, I'm still not in a place where I can engage my brain constructively.  I'm still trying to shut it down with my *own* worries and anxieties: If you do not let me go to sleep, brain, I will not wake up in time tomorrow and I will be late and groggy for work and the whole day will go badly.

I'm feeling much stronger now, and should be able to start heading back out for regular solo hikes.  I'm looking forward to finding out what my brain's been doing without me this summer.