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FACING THE ENEMY WITHIN:
This was the first paper I wrote for Vermont College's Adult Degree Program. The assignment was to write something about myself and discuss why I chose my study. My study that first semester was titled "In Search of a Lost Menopause: Have women of surgical menopause been deprived of an important rite of passage?" The last paper that semester directly addressed the topic.
To paraphrase Pogo, I came face to face with the enemy, and it was me.
In retrospect, I know that I knew very little about my body. My husband and my doctor seemed to take very good care of it as far as I could tell. Neither of them felt compelled to discuss it with me to any extent, and I had an amazing lack of curiosity. Things had been going wrong for a long time before I realized how really wrong they were. The process of taking responsibility for my own body has been a 20-year journey—and it’s not yet ended.
When I quit work in 1969, I was the master of the 20-minute dinner. I had just about worn out my copy of the Campbell’s Soup Cookbook, and I had an extensive repertoire of hot dog delights, rounded out with a selection of canned tuna creations. What does a person do all day at home? I set about learning the art of housewifery the same way I set about organizing an office. I made exhaustive lists of things to do and created absurdly detailed schedules for getting them done. I haunted the library cookbook shelves and filled stacks of 3x5 cards with carefully copied recipes. I began to cook Meals with a capital M.
One cookbook drew my attention with its promise that every recipe would contribute significantly to the health of my family. The author repeatedly referenced Adelle Davis. So I read Adelle Davis. I read all of Adelle Davis.1 That was the beginning of my fascination with nutrition and the end of the reign of white bread, white sugar and canned food. I bought a subscription to Prevention magazine and began stocking my bookshelves with Roger Williams, Frances Moore Lappé, Beatrice Trum Hunter, D. C. Jarvis, Jethro Kloss, Jonathan Wright and anything from the Rodale Press, even as I stocked my pantry with whole-wheat flour, soy meal, honey, nutritional yeast and all the other health-food basics.2
I had taken birth-control pills for seven years, and my reading revealed a number of reports on B-vitamin deficiencies caused by their use. I decided to ask my doctor for an IUD. It seemed the perfect alternative—no more bombarding my metabolism with The Pill. Dr. Bancroft, my Ob-Gyn, told me he had only installed two, and he didn’t recommend them because he didn’t feel that he knew enough about them. I insisted.
It was grand for two years. My menstrual cycles were characterized by heavy flow that ended as abruptly as it began after only three days—an improvement, I thought, over the seven-to-ten-day periods I had experienced on a very regular basis since my first at age 14.
I did not completely ignore the early symptoms that were the harbinger of troubles to come. During my annual checkup with an internist, I asked about the periodic pain I had noticed in my lower left abdomen. He poked around to verify the location, asked a few questions, then told me that I was having pain with ovulation, explaining that I would experience it every other month when the left ovary took its turn in the cyclic release of eggs.
“It’s normal,” he said.
“I’ve never had anything like it before,” I responded.
I went home feeling foolish that I hadn’t known where my ovaries were and that I didn’t know pain at ovulation was normal. That wasn’t in any of the books I had read.
It may have been as much as a year later—certainly no more—when I began my period in the usual way. The flow was always so heavy that I wore a tampon and a “super pad” together. Three days passed, and the flow continued. After more than a week, I went to Dr. Bancroft, feeling incredibly weak and drained.
“I think we’ll just take this thing out,” he said as he plucked out the IUD.
“Is that what caused it?” I asked.
“This sometimes happens,” he replied simply.
I went home anticipating that, with the busy little doohickey removed, I could look forward to a cessation of the flow that left me feeling that there couldn’t possibly be any blood left in my body.
A week or so later there was no change, and I found myself again draped in white with feet mounted in the stainless steel stirrups of the examining table. Dr. Bancroft examined me, asked me to get dressed and meet him in his office. It was the kind of office that gave me a sense of security. All the right diplomas were hanging on the wall, and there was a family picture on his credenza—he and his wife with their four daughters, all smiling pleasantly into the camera.
He gave me a prescription for Enovid, the most popular version of the birth-control pill, in a 10 mg. dose—more than six times the strength prescribed for birth control. It was to help bring the bleeding under control.
We were five or six weeks away from a vacation that we had been planning for over a year, and I was too weak for normal activity. Still, I was determined that nothing was going to spoil our trip. I set up a schedule, alternating two hours in bed and 30 minutes of housework. At the end of each 30-minute housework period, I would thankfully drop into the bed wondering where I would find the strength to get up again.
I kept in touch with the doctor by telephone. He increased the medication to twice a day. Despite the continued bleeding, he blessed our trip, saying as long as I felt strong enough he couldn’t see any reason why I shouldn’t go.
I had to buy new clothes. The Enovid had reshaped my body. I had changed from slightly too thin to a thick-waisted matronly figure, with large breasts and a triple chin. And that wasn’t all. It was only later, when my body returned to a version of normal, that I saw the strange, deep grooves in the skin between my breasts. My chest became photosensitive, breaking out in rash with sun exposure, and the weight of my suddenly engorged breasts pressing together when I slept on my side had created permanent vertical creases down the center of my chest. I didn’t notice that for a long time, though. What I did notice was that I was a swollen, bleeding mess determined to have our family vacation—the first real vacation trip we had ever taken with the children.
The bleeding, which would continue unabated for a total of four months, was with me throughout our trip. We were nearly home, spending the last night of our vacation in an Austin hotel, and it was the day before Easter.
Blake was 11, old enough to know about the Easter Bunny, but too young to give it up. Trevor was four and insisted on believing in all the magical characters of childhood despite my well-meaning attempts to be honest and save him from later disappointment as the “truth” emerged.3
I woke about 2:00 in the morning with a sickening pain in that part of my body that the doctor had identified as my left ovary. We were sharing a large room with the boys, who were asleep in the double bed next to us. When Jack rose at 4:00 to hide the toy-filled plastic eggs that I had brought for the occasion, I was too frozen with pain to help. He returned to bed, tried to sleep, then rose again to pace the room, sometimes looking down at me, asking over and over, “Are you all right?”
“It’ll go away,” I insisted. It didn’t.
By the time I reached the emergency room several hours later, I had become one giant pain. They hurried me to x-ray, and a doctor soon appeared. Exhausted from lack of sleep and drained from the pain, I sank into a deep sleep the moment the pain killer took effect. I woke hours later to the news that I was scheduled for surgery the next morning. Jack had already put the boys on a plane back to Houston, where they would stay with his business partner until he could get back.
The next morning I woke to a pain-free body, weak but rested. The doctor was impressed with my recovery. It didn’t mean that I didn’t need the surgery; it just meant that I could postpone it until I got back to Houston. What is amazing to me now is that I can’t remember even asking at that point what the surgery would involve.
In Houston, I finally learned what was happening in my body. My left ovary was infected and swollen to the size of a grapefruit—a large Texas Ruby Red. The infection made surgery risky, Dr. Bancroft explained. I would have to take antibiotics until the infection subsided, and then we would proceed with the surgery. My uterus would be removed, too, he said, adding that, since I had two healthy children, I really wouldn’t be needing it anymore anyway. There was no mention of my needing my organs for anything other than childbearing.
I hadn’t planned to have more children. Jack had behaved so badly during my second pregnancy that I had vowed there would never be another. Still—the idea that I would never again have that choice . . .
I continued to spend most of my time in bed, getting up when the children came home from school and trying to get a few things done. The bleeding continued; the infection persisted. After two months with no improvement, Dr. Bancroft announced that nothing could be gained by postponing surgery any further.
I remember very little from the time I was anesthetized for the surgery until I finally gained full consciousness more than 24 hours later. The surgery had taken much longer than anticipated, and I had been heavily sedated. I remember seeing Jack through a haze and then drifting off into the deep, drug-induced sleep. He was drawn and haggard, holding my hand and crying. “I can’t lose you. I can’t lose you,” he was saying.
When I finally awoke to full consciousness, I was touched by what I thought to be his overblown anxiety. It was just a hysterectomy—women had them all the time.
They had taken both ovaries. “There was a little scarring on the right ovary,” Dr. Bancroft informed me, “so we removed it too. We didn’t want to take the chance that we’d have to go back in again.”4
I remember so clearly the doctor sitting on the edge of my bed and explaining that they had given me an injection of estrogen immediately after surgery that would last for a number of weeks. “You’re still sort of young,” he began to explain further. I interrupted him with a laugh.
“I’m only 31,” I said.
“Yes, that is young,” he corrected himself with the slightest hint of embarrassment. He was trying to introduce the subject of estrogen replacement therapy. He explained that I would have to take estrogen for a number of years to prevent premature aging and hot flashes.
Jack visited each evening during the two weeks of my hospitalization. He was kind and tender—attentive in a way that I had seldom seen. I felt loved. The day I was to be discharged, he called. “I’m busy,” he said. “Do you mind if I send Bill to pick you up?”
I hesitated, then decided for honesty. “Yes, I do,” I said.
“All right, god dammit. I’ll be there in an hour.” I heard the click of the disconnect as he abruptly ended the conversation.
That set the tone for my convalescence. For two weeks I was to get out of bed twice a day, walk across the room and sit in a comfortable chair for ten minutes and then return to bed.
Jack came home each evening and prepared a meal, eating at the table with the boys and bringing mine to me in bed. Then he would return to his office. The boys would climb up on our big king-size bed, and we would watch television together until their bedtime. The first Saturday morning after my return from the hospital came, and Jack rose early and went to his office.
The boys were not yet awake. They were both self-taught cooks, able to produce eggs and toast when I lingered in bed on a weekend morning. Sometimes they settled for cold cereal and the luxury of eating in front of the TV to watch Saturday-morning cartoons.
That Saturday morning, they fixed breakfast for me and brought it to me in bed. They lingered only long enough to hear my praise, then hurried off to find their neighborhood playmates. It was a long day, with the boys occasionally coming in and out, sometimes with friends. I felt helpless, isolated in the back of the house, unable to look out and see that everything was all right. By the time Jack came home around 6:00, I was nearly frantic. The boys had been gone for hours, and I didn’t know where they were.
Sunday was a repeat of Saturday. It was noon and the boys had been gone for two hours. I took a deep breath and called Jack’s office. “You’ve got to come home,” I said. “I don’t know where the boys are, and I need to eat.”
He muttered something unpleasant, but nonetheless appeared less than an hour later. He brought me a bowl of cottage cheese and peaches, nearly tossing it in my lap. “Here’s your god-damned lunch,” he said as he turned heel and left the room.5 A few minutes later he returned, set up a drawing table in the large sitting area in our bedroom, rolled out his floor plans and schematics and began to draw.
“Where are the boys?” I asked. He glared at me, threw down his pencil and slammed out the back door.
“They’re at the Williams’,” he said curtly as he reentered the room 15 minutes later. He sat silently at his work for the next several hours while I lay in the bed reading.6
Medically, my convalescence went well. The weight and body fat shrank back to normal. Doctor Bancroft had called my incision a “bikini cut.” It extended from hip bone to hip bone, low enough that the scar would not show if I wore a bikini. The size of my infected ovary had precluded the less traumatic surgical alternative of drawing the uterus and ovaries through the birth canal, thus avoiding an incision.
As soon as I was able to spend more than ten minutes away from my bed, I began to sun bathe. I thought the sun would be good for the incision, so I rolled my bathing suit bottom down to a point just below the long, red gash.7
I returned to the doctor six weeks after surgery. I assumed my position on the examining table, and Dr. Bancroft assumed his, with his white head hidden from view behind the white sheeting draped over my bent legs.
“Mrs. Philpot!” he exclaimed. His head came sharply up into view. There was a look of total incredulity on his face. “If I cut any lower, I’d have to make the incision in your knee caps!” It took me a moment to understand what he meant. Just below my incision, there was a very dark, very noticeable tan line. I explained my theory of the healing power of the sun and that my bathing suit was not that tiny. He silently and dubiously returned to his examination.
The examination complete, I was pronounced fit to return to my floor-gymnastics class and was given my prescription for Premarin (the promised estrogen) and a prescription for an iron supplement to correct my blood-loss-induced anemia.
Despite Dr. Bancroft’s insistence that I could do anything, I could do almost nothing. I did not have the physical strength for many of the exercises, and I was very short on stamina.8 I dropped out of the class and enrolled in yoga, where I gradually rebuilt my strength and energy. As I assumed my household chores, Jack’s strange moodiness subsided. He occasionally struck out with unexplained anger, and I conveniently (for him and and for me) attributed it to the pressures of his work.
I was quiet and contemplative for the next two years. Some call it moody, but to me that implies a capricious variation in temperament. I was constant in my silent look inward. I was looking for something I couldn’t quite find, because I didn’t quite know what it was. I began reading self-help psychology books.
I took a course in Transactional Analysis taught by a clinical psychologist, and at the end of the course, I joined the instructor’s therapy group. I was aware of a deep undercurrent of unhappiness, and I couldn’t name it. I had a beautiful husband, two beautiful children, a beautiful home, and with the recent addition of a full-time maid, the leisure to pursue courses, volunteer work, physical fitness—all the things I had always wanted to do and hadn’t been able to, either because I was working or there just wasn’t enough money. It was a good life. Why was I so forlorn?
The group therapy was a good experience. The therapist was gifted at guiding me to insight, and I found out a lot of things about myself and my marriage. My days of silent suffering were over. I made application for college entrance, with a long-term goal of law school.
My sudden interest in life terrified Jack. His subtle manipulation that had kept me out of college and firmly under his thumb for 15 years became an overt, heavy-handed, thuggish behavior. My plans for school again fell by the wayside as the unnamed struggle for power played itself out in my marriage.
I remember telling my therapist of my decision to separate from Jack. I told him about Jack’s capricious moods and his seeming inability to see me as a human being.9 I told him about the nightmare of his behavior when Trevor was born. I told him about the time I stood and listened as Jack explained to a friend that he would never buy a diamond for a woman because there wasn’t a woman alive worth the price of a diamond. And I told him about the way Jack behaved during my convalescence from my hysterectomy.
“Hysterectomy?” his eyebrows arched and he leaned forward in his chair. “When was that?”
“Two years ago,” I replied.
“Oh,” he said, his voice rising at the end of the “Oh” in that now-I-understand-everything tone of voice. I have just poured my heart out telling this man how I have finally come to admit to myself that I am married to an emotionally abusive man who cares not a whit for me as a developing human being. I have just told him stories of events that make insensitive an absurdly inadequate word, and he has diagnosed my entire problem in one word: hysterectomy!10
It was October. With the holiday season looming ahead, we had agreed to a moratorium on discussions of our future till after Christmas. We had been separated barely a month when Jack began pushing for an immediate divorce. Mystified, I conceded to his wishes. When the ball was rolling inexorably in the direction of the courthouse, he told me he had pushed only because he was certain I would become alarmed and beg to come back home.11 Our divorce was the usual pit of anger, emotions, accusations, and struggles.12
Trevor and I moved to South Carolina the day I was certain the divorce was final.13 Our new home was deep in the woods where roads had no names and directions were given by counting the number of dirt roads and “hard” roads you had to pass to get where you were going. Blake was away at private school when we moved. He joined us at the end of the school year.
When we needed a doctor, I found a family practice in a tiny village near our home. (Near meant anything within 20 miles.) I don’t think any among the three doctors were board certified specialists in anything, but they were family—mother, father and son. Mother was known in the city as a shrewd diagnostician; son was known as a competent, up-and-coming young doctor, and father was known as a drunk. Dr. Son became our family doctor, and he continued to prescribe Premarin for me. He told me that I shouldn’t have been taking it on a daily basis; the accepted practice was to cease for five days each month.14 He also threatened to cut off my supply if I didn’t quit smoking. He alluded to some kind of problem with the combination without being specific.15
Five years later, Trevor and I were living on top of a mountain in Greenville, South Carolina. Blake had since moved back to Houston. He had been 14 at the time of the divorce, and he never adjusted to being separated from his friends in Texas.
It was 1980. I had just celebrated my 40th birthday when I looked in the mirror one morning and noticed that my top front teeth were shorter on one side of my mouth. I must have ground them down in my sleep. I rushed to a dentist, who offered to file the rest of the teeth down to match. I left his office in disgust and made an appointment with another dentist. By the time my appointment time arrived, I had continued my nocturnal gnashing to such an extent that my entire mouth full of teeth were quite evenly ground down by more than an eighth of an inch. It was a strange form of permanent self-mutilation.
The second dentist wanted to “watch” me for a while, warning that I would have to wear an appliance at night if I continued to grind my teeth. It seemed that if I or anyone in my family had had a history of tooth grinding, an appliance would have been immediately prescribed. I was not yet recovered from the strange mouth I saw in the mirror each morning when I began to have deep, aching pains in my shin bones.
I had used my last refill authorization for Premarin, so I sought out a gynecologist. He seemed thorough enough in his examination, seemed to ask the right questions, and had all the right diplomas hanging on his office walls. I asked him about the aching in my bones.
“You probably pulled a muscle,” he replied.
“Oh no,” I explained, “It’s in the bones. I can feel it.”
“It’s just a pulled muscle,” he gently insisted. “It’ll go away in a few weeks.”
It was again my turn to insist. The pain had been present for too long to be a pulled muscle, and I assured him that I could tell the difference between muscle pain and bone pain. Again he assured me that my pulled muscle would shortly return to normal.
He wrote out a prescription for Premarin, and his nurse brought me a form to sign. It was a legal release, releasing him from all liability should I have any side effects from the Premarin.
“Why do I have to sign this?” I asked.
“It’s just something new we have to do,” he replied in a matter-of-fact tone.
I hesitated, read it through again and signed it. I did not feel at all assured. He had blown me off about my bone pain, and he had made light of the release form. I left the doctor’s office with a deep, uneasy feeling.
This time, when I had my prescription filled, the pharmacist handed me a printed sheet of information on Premarin.16 I read every word. I lingered long over the possible side effects—among them: “hirsutism.” That was the first time that I realized that a doctor would withhold information about a drug if he had chosen not to believe it—or if he had made the decision for the patient that the benefits outweighed the risks. In 1972, when I had only been taking Premarin for a few months and I had returned for a post-surgical checkup, I had asked Dr. Bancroft about the hair that was growing on my upper lip.
“That has nothing to do with your medication,” he pronounced in a clear tone of patronizing disgust. It had never occurred to me that the medication could be the cause, and his tone stunned me into temporary silence.
“Well, what do you think it is?” I finally asked.
“It just happens when women get older,” he said. Here it was again. I had just passed my thirty-second birthday, and I was “older.”
I went back to that word again and again in the Premarin information: hirsutism. How many women had to complain about that before it showed up in the literature? Apparently enough that Dr. Bancroft had been disgusted to hear it again from me.
The occasional bone pain continued, and I began to notice a popping sound in my ankles when I walked, the kind of sound associated with calcium deposits. There were calcium deposits in my neck that had been with me since my teen years. This was something I understood. I had read about calcium deposits as a calcium-deficiency symptom. It was then that I remembered having also read that tooth grinding could be a symptom of calcium deficiency. Why hadn’t the dentists mentioned that? I immediately began taking more calcium, increasing the dose to 3 grams a day. Within a week I sounded like a walking popcorn machine. There were calcium deposits forming in every joint in my body. I felt certain I was taking enough calcium, so I surmised the problem was absorption. I began taking capsules of vitamins A and D, the kind naturally derived from fish liver oils. Nothing. There was only one more thing to try—a whole-food source of vitamins A and D. I bought a big bottle of cod liver oil and began taking one tablespoon twice a day. In ten days the calcium deposits were gone—including the ones that had so long resided in my neck. Shortly after that, the pain in my shin bones subsided and gradually disappeared.
Trevor and I both had not really acclimated to our new home. We missed our friends in Chapin, and as soon as our year’s lease was up on our beautiful mountaintop house, we moved back.
I forgot about the strange visit with the Greenville gynecologist and continued to take my Premarin for 25 days each month. It was late spring or early summer in 1981, nine years after my surgery, when very peculiar things began to happen. One night I woke up in the wee hours, icy cold and shivering. As I became fully conscious, I realized I was wet—not just wet, but soaking. My long hair was dripping with water; water ran off my bare skin, and my bed linens were drenched. I sat up, confused, not knowing what to do, where to start. I stripped the bed, dumping the dripping linens in the bathtub. Even the mattress pad was soaked through. I put dry sheets on the bed, first carefully smoothing towels over the mattress to shield the dry linens from the dampness in the mattress. I wrung out the sheets that I had tossed in the bathtub, systematically twisting from one end to the next until they were dry enough to carry through the house to the washing machine. I took a quick, hot shower, washed my hair and tumbled exhausted into bed.
At first I thought I had contracted some strange virus, but as the incident repeated itself every few days, I began to make the connection. These must be night sweats. I had read about them. But I was taking estrogen—and that was supposed to be a guarantee that this would never happen to me! I called my doctor and described my experience.
“What color is your Premarin?” he asked. “Are you taking the brown one?”
“No”I replied, “it’s yellow.” That was my introduction to the fact that it came in various dosages. He decided that I should come in and get a prescription for a purple one.
“Is that a smaller dose?” I asked.
“No,” he responded, “it’s a little bit stronger.”
It was actually the strongest, I learned as I questioned him further. I told him I’d call back later for an appointment.
This wasn’t right. If there were different doses, it stood to reason that I should be taking a progressively smaller dose as I aged. This was supposed to be taking the place of the natural hormone my body could no longer produce on its own. It just didn’t make sense to be increasing the dose when my body would have been decreasing the dose, had it been capable of its natural season.
While I was still contemplating a solution, I saw a book in the health-food store: Women and the Crisis in Sex Hormones.17 Every spare minute was spent reading until I had turned the last page. I was angry. I was outraged. I was pissed!
On one page I found a clear description of the pain in my shin bones. It was called osteomalacia, a thinning of the bones caused by calcium deficiency. On another page I read about women who had taken estrogen for nine or ten years and the symptoms they began to suffer. On yet another page there was a description of my hellish four months of bleeding and my surgery. I had never been told that my chances of survival had been 50-50, much less that there were “wholistic” alternatives to surgery.18 There it was. Everything I had been experiencing, in black and white. How much did the doctors know? How much did they refuse to accept? How much were they covering up?
I threw my nearly full bottle of Premarin into the trash and never looked back. I never had another night sweat, but in less than a week I began to experience hot flashes. For the next two years I lived with them. From the way I had heard them described, I was having a pretty easy time of it. I would suddenly get hot all over, feel a bit queasy, and then it was gone—all inside the period of a minute or two. Nothing I couldn’t live with.19
In 1982 I was working at a sporting goods wholesaler as the only secretary among the nearly 300 employees, 250 of whom were women. The company was located in a small village of 200 souls, and employees rarely left the building before the end of the work day. We took our twice-a-day breaks together and ate lunch together in the large company lunch room. In other words, we got to know a lot about each other. I remember the day we were eating lunch when Betty announced that her doctor told her that they had been draining the persistent cysts in her breasts for over 15 years, and it was time to do something about it. “Something” meant to remove her breasts as a preventive measure against breast cancer. I was horrified.
Over the next few weeks, she met the surgeon that her doctor had specified and met with a “buddy”—a woman who had lost her breasts to cancer and was willing to talk to Betty about the surgery and show her what her breasts looked like after reconstruction.20 Betty thought the surgeon seemed less than approving of the surgery, but nevertheless willing to follow the dictates of her physician.
At about the same time, another fellow employee was also scheduled for surgery for the same reason. They both had the same doctor. It was Doctor Mom from the family practice at the bend in the road 15 miles north of Chapin. Doctor Mom had replaced her own breasts with well-shaped, permanently firm facsimiles, and she just couldn’t say enough nice things about them. It seems she was responsible for a fair number of the good country women in those parts traveling up the road to Columbia to have their lumpy breasts lopped off and replaced with a nice pair of silicone jobs.
Betty began to have second thoughts, and then third thoughts. As the word got out that she was hesitating over her surgery, she was pulled aside for a serious talk by a number of her fellow employees. “It’s your life,” they would tell her with stern sincerity. “You’ve got to do it.”
I have to admit that I hadn’t kept my mouth shut. I had a book about alternatives to surgery, and I brought it to work for Betty and Rita to read.21 Rita wouldn’t look at it (and soon wouldn’t speak to me), but Betty read it with interest. It talked about vitamin E and herb teas as a treatment for the cysts. Pressure was on her from every direction, and she couldn’t decide what to do. The scheduled surgery was hovering on the horizon.
One day at lunch, Betty burst into tears when someone asked her when she was going for surgery. “I don’t want to give up my breasts,” she blubbered. “I’ve always been so proud of how pretty they are, and they told me I’d lose all sensation in my nipples. And, Janice, that’s the best part.”
I had been very low key up to that point, but now I couldn’t stand it anymore. I returned to my desk and pulled out the book that I had stored in a drawer. I found the name of the doctor in Baltimore who had done the research on vitamin E and cysts, and I called Baltimore information. I dialed the number in Baltimore and explained to the woman who answered the telephone that I was calling because a friend was going to have her breasts removed to prevent breast cancer.
“That’s horrible!” she exclaimed. “Let me put you on hold for a minute.”
I hadn’t been waiting long, when a man’s voice came across the line. “This is Dr. London.22 Now why is this woman having surgery?”
I repeated the story, explaining about the long history of cystitis and the doctor’s warning that removal of the breasts was the only alternative to preventing breast cancer.
“Well, you tell that doctor that there are alternatives, and if he would read the current issue of the Journal of Obstetrics and Gynecology, he would see that I have six pages of alternatives.” His voice dripped with outrage. He told me that mastectomy as a preventive measure hadn’t been done for ten years, that the only exception was when the patient had a mother or sister who had lost both breasts to cancer. In the course of the conversation, I learned that there was a world-famous specialist located in Augusta, Georgia, just a 90-minute drive from where we worked.
I dialed Betty’s extension, and we arranged to take our afternoon break at the same time. I told her about the conversation and gave her the name and telephone number of the doctor in Georgia. (I wasn’t leaving anything to chance. I had called Augusta information to get the telephone number.)
Dr. Greenblatt agreed to see Betty immediately when she told him the circumstances. He prescribed a short course of male hormone therapy and instructions to take vitamin E and avoid caffeine. Before her scheduled surgery date, the cysts were gone, never to again return. Many people in the office were angry with me for a long time after that, certain that my interference had sent Betty to her death.23
Rita had her surgery as scheduled. She had one of those one-in-a-thousand bad results. Her nipples rotted and her body was riddled with infection. It was whispered that she tried to commit suicide. She returned to work months later—thin, drawn, silent. Neither Betty nor I ever mentioned to her Betty’s great triumph—nor did anyone else. Rita sat through lunch and breaks silent, occasionally exchanging a half-hearted pleasantry; nodding in recognition when someone spoke. Sometimes one of the women would ask her with genuine concern, “How are you doing?”
“I’m fine,” she’d say in that quiet, flat tone so characteristic of grief.
It was Betty’s doctor, Dr. Robert Greenblatt in Augusta, Georgia, whom I turned to two years after I had tossed my Premarin in the trash and a year after Betty had gone to see him. My energy level was at an all-time low. I had to drag myself out of bed in the morning and then drag myself through the day at the office. I quit looking for the reason in my life circumstances; my life just wasn’t that bad. The local chiropractor did a saliva test and sent it off to a lab; Dr. Son wanted to schedule cancer tests. I was ready to make out my will.
Before the saliva test was back, and without succumbing to Dr. Son’s tests, I made an appointment with Dr. Greenblatt. My reason was because of this very fancy piece of equipment he had used on Betty. Because her doctor had insisted on surgery, Dr. Greenblatt was covering all his bases.24 At that time, only a few big research facilities had that kind of equipment. Now there’s an MRI lab on every street corner. I had never heard of the equipment at the time, but Betty explained to me that Dr. Greenblatt had put her through a big tube that scanned her body for cancer. Dr. Greenblatt had guaranteed her that, if his machine didn’t detect cancer, she didn’t have it.
I arrived in Augusta prepared to make out my will.
Dr. Greenblatt was an intriguing individual. He was board certified in endocrinology and in obstetrics and gynecology. He was 76 years old and had the appearance of a very fit and gray-haired 55-year-old. There were certificates on every wall, many of them in foreign languages. Unceremoniously hung midst a myriad of others in a nook outside an examining room was his medical degree, conferred nearly 50 years before. He was a tall man with large expressive hands, commanding but not intimidating. A good part of his practice was in hormonal therapy, helping infertile couples have children, helping children to grow bigger and taller,25 helping middle-aged women avoid the signs of menopause.
Every patient was a research patient to Dr. Greenblatt. In addition to the usual vital signs and weigh-in, I had an x-ray of my hand, a mammogram, several tubes of blood drawn for testing, and my height was measured in a reclining position. I learned later that all of this was so that he could chart my change over time, watching for the progress of osteoporosis.
He conferred with me in the examining room as I sat on the side of the examining table, my nakedness covered only by a blue paper gown.
“Your tests show you are castrate,” he said bluntly. “No sign of estrogen anywhere in your body.”
Castrate! What a nasty word. I was roundly scolded for having discontinued my estrogen. He would hear nothing negative about it, quoting his own studies. My x-rays and tests showed that osteoporosis had begun its insidious encroachment in my bones.
I refused to take Premarin, explaining my experience, which he politely accepted and stubbornly refused to connect to my long-term use of estrogen. There was an alternative—a pellet of time-release estrogen implanted in my hip. He explained that the procedure was considered experimental by the FDA, though he had been performing it for 22 years.
“I’m on the FDA drug-review committee,” he said, “and I still can’t get it passed. I don’t know what’s wrong with those people.”
As an experimental drug, the procedure was available at only five locations in the United States—clinics that had gone through the expensive procedure of having a research protocol approved, allowing them to conduct research on the implant procedure.
He found nothing else wrong with me. I left with a great sense of relief and with no handbag full of prescription medicines, just a band-aid on my hip where the tiny incision had been made to implant the estrogen and instructions to return for a fresh implant every six months.
By the next morning, my breasts had begun to swell, and my nipples were tender. During the following week, my nipples were so sensitive that cloth brushing against them produced a tooth-grinding pain. At the end of ten days, the pain subsided, and my body returned to normal, a much more comfortable normal. I felt more energetic, happier. My brown hair took on a healthy shine, and my skin took on a healthier tone. I attributed my energy to the estrogen and the remainder to being rid of the cancer fear.26
I regained my interest in dating, and before long I had established a relationship with a man whose primary attraction for me was that he was sexually available, sufficient and altogether satisfying. That’s what I had been missing, I told myself—a good sex life, absolutely essential to good health.
On my third visit, the doctor was routinely informing me of my test results and concluded with “and no signs of osteoporosis.”
“You mean I’ve had a complete remission?” I asked.
He was puzzled, and leafed through the chart. None of the notes from my first visit were in the file, He called a nurse in and asked for my complete record.
“We couldn’t find it,” she said, “so we made a new one.” The records never were found.
On subsequent visits, Dr. Greenblatt beamed over my record—normal blood pressure, healthy cholesterol levels. I was a model of what he believed was the benefit for every woman who took estrogen.
When I read something adverse about estrogen, I would bring it up during my examination review. “I’ve been giving it to my wife for over 20 years,” he would tell me. “Do you think I would give it to my wife if it could be harmful?” Then he would have a nurse give me a handful of copies of research reports singing the praises of estrogen.
In January of 1985, two years after becoming Dr. Greenblatt’s patient, I moved back to Houston. Trevor had gone into the Navy just 20 days before my move. Blake was to be married in Houston the following April. I made my first trip from Houston to Augusta on schedule. It was nearly two years before I could afford the trip again. In the meantime, Dr. Greenblatt had died, the clinic walls had been stripped of his diplomas and the hundreds of photographs of happy parents beaming over their miracle babies, and the laboratories had all been converted to new examining rooms. It was a new and foreign environment.
There were no measurements, x-rays or detailed notes made of my condition. The mammogram, which was now an additional $125, was optional. Two vials of blood were drawn, the pellet implanted, and I was on my way. The cost of the visit had increased from under $200 to over $300. A month after returning home, I received the lab results. My cholesterol was 320, some 120 points above high normal. Enclosed was a prescription for Lopid, a cholesterol lowering drug, and a form letter advising I had high cholesterol and should fill the enclosed prescription and watch my diet. I tucked the lab results away with other medical records and threw the prescription in the garbage.27
It was several years before I was to read confirmation of what I pieced together myself, making bits of connections here and there until I had formed my own theory of what was going on in my body. I was watching a panel discussion on television one day when an endocrinologist mentioned a link between calcium and cholesterol. That was it! That was why my cholesterol was so high. I knew estrogen was related to calcium levels. I had let my estrogen levels get too low to maintain calcium levels, and when the calcium levels dipped, my cholesterol went sky high.
I needed to find a less expensive way to maintain my health. I returned to Dr. Bancroft for my next checkup. He gave me a prescription for Estraderm, a patch that was to be worn below the waist. It was good for several days of time-release estrogen. I found that when I sat down, the wrinkles that formed on my birth-scarred abdomen caused the edges of the patch to wrinkle and pull loose. I wondered how much was being lost in the shower. I tried to solve the problem by wearing the patch on my back. Each place I wore the patch would become bright red and a little sore. I had to place it in a different place each time, and it took a week or more for the redness to disappear. It was inexpensive, but it wasn’t going to work for me.
Discouraged by my experience with Estraderm, I returned to Augusta one last time. Again I received my lab results in the mail, but this time with only a form-letter warning that my cholesterol was a little too high. It had dropped to just over 200. I vowed that I would never risk being without estrogen again.
When it was near time for another implant, I heard a television news report that the FDA had approved the implant for general use. I was elated. No more expensive trips cross country. I called the medical schools first, thinking they were most likely to know who might be performing the procedure.
I called Baylor College of Medicine first, leaving a long detailed message and receiving a promise for a return call. The secretary called me back after a week. They didn’t know of any doctor using the procedure. The University of Texas Health Science Center was a little more promising. The secretary took my name and number, and in a few days the Chairman of the Department of Obstetrics and Gynecology gave me a personal telephone call. He was very opposed to the procedure.
“Why?” I asked.
“Nobody’s doing it,” he replied.
I patiently explained to him my experience with oral estrogen and my positive experience with the use of the implant procedure.
“I’ll have Dr. Smith 28 call you,” he finally said. “He has experience with the procedure.”
Dr. Smith called me back the same day. He was unaware the procedure had been “legalized” and was very excited.
“I was in private practice in Colorado for 15 years,” he explained, “and I used that procedure extensively for seven years before the FDA took it off the market. My patients loved it.”
“It was approved for use at one time?” I asked.
“Yes. It was strange. They just suddenly took it off the market claiming there hadn’t been enough research done.”
This interested me. Dr. Greenblatt had been doing the procedure in a research setting for over 20 years, and it was in use as an approved procedure for at least seven years before the FDA took it off the approved list. What did the FDA know that I didn’t know, that Dr. Greenblatt didn’t know, that Dr. Smith didn’t know?
“What kind of problems did you have with it?” I asked.
“None, really,” he replied. “Some patients didn’t like it, so I removed it. I really didn’t have any problems with it.”
He told me he was willing to work with me. He had to check the availability of the pellets and place an order. He would call me when he was ready to arrange an appointment time.
“I’m so glad I found you,” I said. “Your department chairman was very discouraging. He doesn’t seem to like the procedure.”
“Oh, really? What did he say?” he asked with interest.
“Just that no one was doing it.”
“Well, I guess I’d better talk with him. I’ll give you a call when I find out about the availability of the drug.”
We said our goodbyes, and I filed it away in my mind under “do nothing until you hear.” After two weeks with no call, I called the medical school and left my name and number for Dr. Smith. When I still didn’t hear from him, I called again three days later, again leaving a message. After several weeks of silence, it became clear that I was never going to hear from him. What was going on? Whatever it was, Dr. Smith didn’t want to talk about it and neither did his department head.
I had really expected that the approval of the procedure by the FDA would create quite a stir in the Ob-Gyn community. I was not yet defeated. I took out the yellow pages and began to call gynecologists. I targeted the large clinics and group practices first, beginning with the Women’s Hospital.
“Oh, you mean the birth-control implant,” the voice on the other end of the line said.
“No, it’s estrogen replacement therapy.”
“I’ve never heard of it. Just a minute, I’ll ask the doctor.”
A few minutes later the voice returned to the line. “No, we don’t do that.”
It was the same throughout the city. None of the nursing staff had heard of the procedure, and what’s more they reported that the doctors hadn’t heard of it. This was becoming an interesting puzzle. I went to Plan Z. I would call every gynecologist in the book, starting with A.
The first two As didn’t know what I was talking about. The third, Dr. Atkins, was the office partner of Dr. Bancroft. I had him on the line before I realized it. Dr. Atkins had performed the procedure back in that other era when it was first approved by the FDA, and he, too, was unaware that it had again been approved.29
“I quit doing it,” he said. “It was too much trouble.”
“What were the problems?” I asked.
“When a patient didn’t like it, I had to surgically remove it. It was just too much trouble.”
I explained how satisfactory it had been for me and asked if he would be willing to work with me. He agreed and an appointment was set. A few days later, the nurse called me to reschedule.
“Since you’re Dr. Bancroft’s patient, Dr. Atkins thought it would be better if you continued with Dr. Bancroft. Dr. Bancroft is semi-retired now and he only takes appointments on Wednesdays and Thursdays. Would next Wednesday at 10 be okay?”
When I arrived, it was explained that, since I hadn’t been in for a while, it would be necessary to do a complete physical. Having been the victim of a number of careless practitioners of the medical craft, I respected this decision. I just wasn’t certain I was economically prepared.
After a thorough examination, Dr. Bancroft seated himself in the examining room as I sat on the edge of the examining table, my legs dangling over the side.
“I’m not going to do an implant,” he declared flatly. “I’m going to give you a prescription for Premarin.”
Again, despite the fact that I had discussed this with him before, I patiently reported my experience with Premarin and told him of the research reports I’d read.
“Some women don’t seem to do well on it,” he calmly pronounced. “What was wrong with the patch?”
I explained my experience with the patch, the skin irritation and the tendency for the edges of the patch to come loose. I pressed for his reasons for refusing to do the implant. It was clear that he wasn’t going to share his reasoning with me.30
“You can take injections once a month. We can teach you to give them to yourself,” Dr. Bancroft said.
I gave in. After paying for the physical, it would be months before I could consider a trip to Georgia.
“Well, if it’s just once a month, I’d rather come in to get a shot,” I responded.
“We can do that, but it’s expensive—$25 in the office or just a few dollars if you do it yourself,” he countered.
I was convinced. I would learn to give myself the shots. I received my first injection in the office (for the promised fee of $25) and received a prescription. At the end of the month, I filled my prescription and bought syringes. After duly considering my ability and willingness to plunge sharp objects into my body, I called my friend, Joanna. She had spent years as an office nurse.
“Sure, I’ll do it for you,” she said.
Each month for about six months I went to Joanna’s for my shot. It seemed to work well enough, but after each injection, I had the breast tenderness that I had experienced with the first few days after an implant. That’s okay twice a year—not so hot once a month. When the supply was gone, I didn’t refill my prescription. I made plans to make the trip to Georgia. That was several years ago. I never made the trip.
For the first two years, I postponed one month at a time, waiting for the funds to appear in my budget. Then I began to wonder if I really wanted to do it. I finally decided to risk going without the magic juice to see what would happen. There were other things I could try on my own. Hell, I’d let dozens of doctors practice on me, and they didn’t have the experience with my body that I did.
For the past year, I have had some symptoms that I thought would be helped by the estrogen, and I have worried about osteoporosis and my cholesterol level. But something else has begun to happen that has caused me to hesitate to resume estrogen replacement therapy. It began while I was still using estrogen.
July 29, 1990 was my 50th birthday. I told Joanna that I wanted a birthday party, one with all women. Fifty felt like a great passage to me, a passage of womanhood, and I wanted to share it with women. She invited a dozen friends, not telling me that she had given special instructions to each guest.
As we seated ourselves in a comfortable circle of chairs and sofas, Joanna announced “a roast.” Each guest would deliver a short speech about me as she presented her gift to me. It was Joanna’s intention that it would be an evening of hilarity, complete with over-the-hill jokes. What transpired will live forever in memory.
It was nothing like Joanna had planned, but I have no doubt that it was exactly as it should have been. Each gift was a special memento of my rite of passage—a book, a tiny statue, a piece of jewelry—each accompanied by a poem or short message that congratulated and celebrated my passage into the world of the wise woman. The last gift was breathtaking: Joanna, an accomplished artist, presented me with a watercolor portrait of myself. It was me. It looked like me. The face was mine and more than mine. She had captured the look of the wise woman. It hangs in my study, and I still wonder at what she accomplished.
I’ve had four years now to become accustomed to having crossed the threshold. My spiritual inquiry permeates my every activity. It is with me when I eat, when I sleep, when I wash dishes, when I meet with a client. Everything I undertake is a part of that search.
Three years ago I read . . . and Ladies of the Club31 It is the story of two friends, from the time of their school graduation in the 1840s until the death of the last one at over 90 years of age. The entire book is an important historical document for many reasons, one of them for its detailed account of the lives of educated, middle-class women during the years its characters lived their fictional lives. One passage made a great impression on me. The character is said to be going through a period of deep withdrawal after the last of her grown children leaves home. She retires to her second-story bedroom, living there lost in her despair. When she descends the stairs two years later, to the relief and delight of her family, she goes about her life with her old care and vitality. But they sense that she is very different from the woman who ascended the stairs two years before and sank into a place where they could not reach her. Her time alone had been spent in deep contemplation, in reading her Bible and in examining her life and all its events.
“It’s the menopause,” I said to myself. “She is spiritually transformed in her menopause.”
One thing I firmly believe after 54 years of contemplating my belly button is that body, mind and soul are one and inseparable. Examining the parts may be helpful and instructional, but getting one’s shit together is what it’s about. It’s chaos theory on a personal level—bring it together, it spreads itself out, bring it together, it spreads itself out, bring it together . . .
I have no regrets for the decisions I’ve made in the process of learning my body. I may not have always made the wisest choices in ignoring medical advice, but in the final analysis, my guess was as good as theirs.
If I take hormones, am I tampering with precisely that which I long for—my spiritual progress? Has my right to menopause—my spiritual passage—been altered by the surgeon’s knife? Is my experience different from that of women whose bodies have been allowed their natural cycles? If menopause is indeed a spiritual passage, does a surgical menopause mean an early passage? Is it a premature birth of the soul?
These are my questions.