by Kaitlyn Kretsinger-Dunham

The fourth gynecologist tells me “Everyone gets cramps.” Her dyed-blonde hair looks like straw under the bright fluorescent lights. She admonishes me, “You’ll just need to tough it out like everyone else does.”

“Dysmenorrhea,” opine numbers five through seven: it’s the kinder, more clinical way to say, “everyone gets cramps.”

The pale skin of my stomach is angry and red. The places where blisters have burst are peeled-back pink, taut and shiny from weeping. These surface burns hurt less than the cramps, so I boil the kettle again, refill the rubber hot-water bottle once more, sigh as I feel the heat and weight laid over my scarred skin, the knot of my muscles beginning to ease.

Sometimes I vomit from pain. Once, I passed out on the bathroom floor. Occasionally I miss work or class. More often than not I attend: my job only grants me three paid sick days per year, and the way I see it—since I’ll be in the same amount of pain no matter where I locate myself—at least the night classes are productive. I show up in stretchy, forgiving leggings because I haven’t been able to fit into normal jeans or slacks for years. I sit in dingy classrooms, shifting in the one-piece wooden desks connected to stiff plastic chairs by metal bars, always soaked in cold sweat and reeking of Icy Hot. Driving home, I pull off of the road and onto the shoulder sometimes so I can double over in pain until the worst of it passes.

I have two wardrobes: one for off-period, one for on. When I’m on, I go up two pant sizes and four cup sizes. My periods increase in length, so I use the off- wardrobe less and less often. The sides of my breasts are marred with translucent, webbing stretch marks. My nipples are always painful to the touch.

Everyone I encounter seems to have a friendly suggestion ranging from essential oils to illegal drugs. I’ve tried them all and nothing helps. I power through, because everyone gets cramps. Sometimes they consume me. It feels like a hand is inside of my body, squeezing as hard as it can, then slowly releasing so it can squeeze again. It feels like the hand is made of barbed wire. Maybe I’m just weak.

Lucky number eight: I walk into his office, my cell phone loaded with graphic photos of the blood clots I regularly pass. Their long, spindly arms, thick dark bodies and mucousy tails recall something out of a horror film. I read online that if clots are larger than a quarter, something is wrong. Mine are closer to a dollar bill than a quarter. Sometimes they won’t pass easily, and I have to pull them out of me with my hands, and they just keep coming and coming, stretching between my thighs like nightmare scarves from a magician’s sleeve. My eyes involuntarily well up as I tell him this happens four to six times a day for the first week of my period, which now lasts between fifteen and eighteen days of the month. Please believe me. I’ve tracked my periods for three years and you can see in this tracking app that they are getting longer and longer. I’ve come armed with the statistics.

“Possible endometriosis,” he scrawls on a printout of common symptoms; he orders a blood test before he feels comfortable prescribing me the NuvaRing. I find out from the blood test that I have two dangerous clotting factors: Protein C deficiency and Protein S deficiency. I undergo a second, more rigorous battery of tests at a hematologist’s office, because it is rare to have both; confirmed. Hormonal birth control, the usual solution, is now out of the question. I ask the hematologist if there’s anything I can do. He wisecracks: don’t break a leg and don’t ever get pregnant. The hormones the body usually produces during pregnancy can cause a fatal pulmonary embolism, but so can the ones birth control would artificially introduce into my system. The non-hormonal copper IUD can aggravate endometriosis or even cause a uterine tear.

I keep toughing it out, because everybody gets cramps. Almost a year later, though, I start to think that maybe I can’t tough it out anymore. I’ve tracked my sleep patterns for a year and I average four hours per night. The rest of the hours are spent hugging my knees to my chest, trying to relieve the pressure. I am crumpling. I am spent.

At last, number ten. When I make the appointment, I don’t say I want an exam, I say I want a consult for surgery. In the waiting room, I am the only non-pregnant woman in a sea of swollen bellies.

Number ten is friendly, and kind, and he believes me. He orders a transvaginal ultrasound, although he warns me that the only way to really diagnose endometriosis with certainty is through laparoscopic surgery. I sit, legs spread, the plastic wand shifting inside of me as the ultrasound tech searches. I feel a slight tickle as surgical lubricant trickles out of me. I look at the images on the screen, indecipherable to my inexpert eyes, and a student technician observes the procedure, which takes under half an hour. The doctor tells me my uterine lining looks thick.

I’m lucky because, as coincidence would have it, he is also a surgeon whose specialty is laparoscopy. He asks me when I would like to schedule the procedure. I tell him the spring semester ends May 17—a Thursday—and he tells me he has May 18th open. All he needs is for me to sign a series of wavers and to bring in a letter from my psychologist that I am of sound mind requesting this procedure and that I, a twenty-seven-year-old unmarried woman with no children, understand that it will permanently sterilize me. He notices the shadow that flits across my face and clarifies that it’s merely a formality and that if my regular psychologist won’t sign

off, he will “help me find one who will,” because he knows I am in pain. He says, laughing, “Of course, we’ll leave your ovaries. What kind of Catholic would I be if I took those?”

It’s weird to hope again. I feel crazy and giddy as I get into my car and set the paperwork on the passenger seat next to me.

***

The day of, I’m up at 4am, having a cold shower because the water heater is sluggish. I’m taking a white cloth glove from a plastic zip-seal bag and pulling it over my right hand. I’m supposed to clean my whole body with a special disinfectant. It smells fine but it makes my skin feel taut and dry.

Anxiety churns in my stomach, and I have diarrhea three times before I can leave the apartment. The idea of anesthesia triggers my anxiety: my face suddenly feels like pins and needles. My mom has flown in from Louisiana, and her presence is comforting. She takes me across town to the hospital and I watch the sun rise through the window as we drive.

In the hospital, my mom, fiancé, and in-laws-to-be lounge in chairs around my bed. A nurse hands me a gown and I go to the bathroom to undress and redress and to relieve myself one last time. I re-enter the room, holding the flaps of the gown together behind me. The thin layer of fabric brushes against my bare skin. Something about chronic pain seems to vaporize any vestiges of embarrassment. The nurse installs an IV in my left hand.

Another nurse comes in, holding my chart, and interrogates me about my psychologist’s letter. “What does this mean?” It feels accusatory. I explain that because I’m under thirty and unmarried, and haven’t given birth, I was made to prove I’m making a sound decision. Her accusatory tone turns instantly sympathetic. “I’m so sorry. You’re so young! Well, I’m sure you’ll adopt someday.” Resentment flashes through me. I nod and smile acquiescently.

Eventually I’m wheeled to a prep room. Random supplies litter the tables and counters, and spare beds fill up most of the floor space. “This place is a mess,” is the last thing I think, and then the anesthesia kicks in and I lapse out of consciousness.

“Sweetie, I’m going to need you to take deeper breaths,” a nurse gently remonstrates as I open my eyes. Her colleague is on the other side of me, looking concerned. I feel like I am taking deeper breaths. I make a conscientious effort, but something is sitting on my chest. It takes a few minutes of their worried cajoling, but I begin to breathe normally. I feel pressure on my lower abdomen. “I have to pee,” I mumble to the nurse. She says, “That’s the catheter. They’ll take it out in just a few minutes!”

My mom and MIL-to-be come in to see me, and the surgeon approaches to explain how the procedure went. I am awake but groggy, unable to remember what he says. My mom fills me in later: a subtotal laparoscopic hysterectomy. He took my uterus but left my ovaries and crossed the bands that hold up my cervix and sewed those to the back of the vaginal wall—that way everything stays up where it should be. He said I had the most painful stage of the disease. He said the daily pain would have been equitable to having second- or third-degree burns. He gave me this folder of pictures! Look at these little brown spots—they look small but they run deep and that’s what was causing me so much agony.

I’m back in a hospital room, and a nurse removes the catheter. I still feel intense pressure. I’ve never had to pee so badly in my life. My MIL-to-be, a hospice nurse, recognizes that discomfort as pain. She fetches a different nurse and insists that she set up an IV of pain meds. The pain I’ve mistaken for an urge to pee disappears instantly. I’m given a pair of mesh panties, like people who’ve just given birth have to wear, with a giant fluffy pad in them to absorb any errant bleeding. Now, the nurse tells us, I can go as soon as I’ve actually urinated. It takes two full bags of IV fluid, but I do it, and I’m wheeled out to the curb. The ninety-degree desert air feels sublime compared to the chill of the hospital. I shuffle gingerly into the back of the car.

At home, I suspect I’ll have trouble getting up the stairs, but padded by a soft cloud of Dilaudid I get up them just fine and lower myself into my own bed. My fiancé brings a bouquet of Gerber daisies with a hilarious condolence card peeking out from between the cheerful pink, orange, and yellow blooms: “In Loving Memory of your terrible uterus.”

In just under three days I’m completely off of pain medication. The glassy-eyed fog that the Norco causes unnerves me—I feel sluggish and heavy, like I’m sinking into my bed. I have a recurring intrusive thought that if I continue taking it I won’t wake up, so I just stop. The pain from the surgery is far less than my daily level of pain prior to the procedure.

***

I’m getting used to a whole new body with all new rules. My fiancé peels the metal lid back from a cup of yogurt and I salivate and gag. I experience intense cravings for raw carrots and raw broccoli for weeks. I have five raised, pink scars on my abdomen now: four from surgical entry points, one preexisting from a hot-water-bottle burn. I didn’t lose any weight, but I lost three pant sizes in less than a month thanks to lack of bloating. My nipples have changed in size, lightened in color and softened in texture. My breasts have grown a little, and sometimes they feel heavy. Hormones wrecked my skin for a good six months: I have the acne of a teenager but thankfully the makeup-application skills of an adult. I have several gray hairs, but if I’m being honest the cause of those is enigmatic. My ability to concentrate is returning—I didn’t realize how much the constant background hum of pain had occupied my focus.

Some weeks after the surgery, I can feel something sharp poking inside me. At my follow-up appointment, legs-akimbo, feet in stirrups and plastic speculum inserted, the surgeon investigates with a bright light and tells me it’s just a wayward stitch. He snips the stitch and chemically cauterizes my cervix with silver nitrate. A few weeks later we repeat the process, but this time many of the stitches are mostly-dissolved so he deftly removes them with long tweezers. I feel a painful tickling sensation as they slide out. He places the mangled stitches on a bloodstained towel and cauterizes me one more time. It stings and I try not to flinch. I stare at the ceiling, patient. When I get home there are drops of blood mixed with surgical lubricant in my underwear, and I ponder the fact that it’s probably the last pair I’ll ever ruin. No more frustrated hydrogen peroxide soaks.

***

People tend to first react with pity, then either command or prophesy that I will “eventually adopt.” I have complicated feelings about this. Foremost is antipathy. I begrudge being treated like a vessel for childbearing: I insist am as valuable with or without that particular experience. I have never wanted children, although I have always liked them. But there is a small part of me that also mourns the inability to change my mind. It’s one thing to choose not to have children, and another to know you will never experience something that society has deemed a quintessential initiation into womanhood, even despite knowing that particular rite of passage had a high statistical likelihood of killing you. Sometimes it makes me feel lesser-than, even though I hate to admit it; like some deep, ancient and earthy maternal magic disappeared into a biohazard bag or an incinerator and left me depleted, stripped of my sacredness.

I resent mothers who tell me that women who have never had children “will always be selfish” or “don’t know what it’s like to be tired,” especially when I’ve experienced the demoralizing utter exhaustion of ten years’ excruciating chronic pain—the most recent few while working two jobs, taking full-time Masters courses in the evenings, and planning my wedding. I resent people whose immediate reaction is pity. I resent people who comment on my age or my body, as if the real tragedy here were that my hips are ideal for childbearing and it’s a shame valuable real estate has gone to waste.

I don’t think I am a tragedy. Every morning when I wake up again without pain, I feel light, liberated.