Sunday, February 03, 2008

Three Excruciatingly Personal Blog Entries, No.2

The trouble with the grand plan I have now announced twice (viz. writing three posts that push the limits of the personal) is twofold.

First, I find that those limits are mutable. After a few days, Excruciatingly Personal Blog Post No.1 came to seem far too personal, with the potential to involve other people’s emotions and senses of privacy. And so I deleted it. It was an interesting exercise, all the same. Meredith made a beautiful comment, to the effect that poems usually take much longer than blog entries to grow and develop, and by implication, to develop a sense of the readerly exchanges they might invite, and the emotional effects they might set off.

Second, the genre of the blog doesn't naturally lend itself to plans. I've been caught out many times planning a blog entry - even taking the photos for it - and then because I don't write it that day, feeling the moment has passed.

But in this case I do feel that my blog has been working towards this second of three posts, for some time now, and I think I'm ready. So here goes:

The Menopause Post

I have never been a purely cerebral thinker or writer. I'm always deeply conscious of my surroundings: light, temperature, sound, bodily disposition. I've never been good at working in cafes, for example. I notice everything around me; and I think it's both a strength and a weakness in the kind of work I do. But ever since I announced my cancer diagnosis and made the decision to keep on blogging, I have been even more conscious of the fact that I am writing, here, and other places as well, both as a body, and as a mortal being. So in fact, this will probably turn out to be a post about menopause and ageing, not just the former.

It's more than a year since I began the hormone therapy that will last five years in all. I'm being treated as part of a global clinical trial that is testing the side-effects and recurrence rates of cancer under drugs that are normally prescribed according to one's menopausal status, being used in a range of conditions. It will amuse many readers of this blog to know that it is called the "TEXT" trial. So while Tamoxifen is routinely given to pre-menopausal women, I'm being made post-menopausal by an additional regime of ovarian ablation: this takes the form of a monthly injection to suppress ovarian function and the production of estrogen. Tamoxifen works to "lock up" any breast cancer cells that might remain after surgery and radiotherapy, and to stop them feeding on estrogen: the Triptorelin injections suppress the production of estrogen. There are a number of different kinds of breast cancer: mine was of the slow-growing, estrogen-feeding kind.

So, while menopause usually involves the gradual diminution of estrogen, its onset in my case was very sudden. Menopausal symptoms result from changes in estrogen levels as the body adapts to this changing hormonal environment... But I should put a disclaimer in here. Of course, I'm no medical expert. This is just what I have picked up.

The breast cancer booklet available from the National (i.e. Australian) Breast Cancer Centre lists these as the side effects of anti-estrogen drugs like Tamoxifen: menopausal symptoms, blood clots, stroke, cancer of the uterus and changes in vision. And the good news? lowered risk of osteoporosis, lowered cholesterol levels.

Menopausal symptoms are also spelled out: hot flushes, sleep disturbance, vaginal dryness and/or discharge, decrease in libido, no menstrual periods or irregular ones.

This is a shortlist; the leaflet with the Tamoxifen lists many more, though they affect only a tiny proportion of women.

Here's another list I found:
Other symptoms that can occur include anxiety, poor memory, poor concentration, insomnia, fatigue, palpitations, decreased libido, muscle pains, crawling skin and urinary problems.
And to really cheer you up, here's a list of 34 symptoms!

Of all these potential symptoms, the only one that's caused me any significant discomfort, to the point of thinking about any kind of medical or psychological intervention, are the hot flushes. It's like functioning with a broken thermostat. It's a little easier now but for most of last year, I would wake many times in the night, alternately freezing cold (even cold to the touch) and then burning hot. Imagine the most embarrassing deep blush you can; and imagine it spreading over your whole body. Twenty or thirty times a day. Every day. Then imagine being so cold, half an hour later, that you could see the sense of a nose-warmer, just to add to the dignity of proceedings. The flushes are often accompanied by a rush of perspiration, running down the back of your legs, say, when you have just introduced someone at a conference, or yourself at a "research lunch" hosted by the vice-chancellor.

My oncologist says if it gets bad enough, it can be treated with a low-dose anti-depressant, but whenever we have this discussion, we usually say something like "well, let's see how it goes, and we can review in three months".

I've written elsewhere about heightened levels of anxiety, especially when I went back to work last year. Of course it's impossible to say whether anxiety — which I've learned is sometimes regarded as a form of depression — is a direct result of hormonal changes, or compounded by other things like a cancer diagnosis and treatment, or major changes to the work environment, such as we've experienced at Melbourne over the last two years, or the general condition of trying to juggle several writing and research projects with teaching and administrative tasks. (Truly, most of you academic readers in the US: You Have No Idea how many such tasks senior academic staff are expected to take on in Australia.)

Other symptoms come and go a bit, while there seems to be a bit of dispute in the medical profession about what is a symptom or not. Heart palpitations? maybe. Changes to the constitution of one's tears? possibly. Weight gain? disputed.

And then we are quickly in different territory. Because of course it's not just menopause we're dealing with here: it's also the after-effects of serious illness; and it's ageing, too.

About six months ago I looked in the mirror and thought I must have absent-mindedly let my pen draw a vertical line down the side of my mouth. But it was a long crease in my skin, a new wrinkle, or a fold. I'd heard of people's hair going white overnight as a result of shock. This seemed to me to be of the same order. And very shocking it was, too.

Now I've read enough feminist theory to have a sense of the social and cultural climate in which women experience menopause and ageing, but I'll admit I was still unconsciously thinking of both these things as a kind of end, or even as a kind of failure, or flaw. I see myself looking at women younger or older than I am, and see myself making judgements about them. And I've lived enough of my life in the light of The Gaze to anticipate its withdrawal as a loss. But on balance, I thought I would mind much more than I do about starting to look older. OK, seeing that line on the side of my mouth was a bit of a shock, but it certainly hasn't provoked any lasting trauma.

But what I can really see now is that one's mortality is a much bigger deal than one’s ageing, or one’s hormonal status: that really is an end.

I never anticipated what it would really feel like to turn 50, as I will do next month. I think I have quite a strong capacity to empathise, but I could never identify with academic folk who talked about retirement, or with characters in fiction who were concerned about their life's work coming to an end. I can, now. I don’t mean to sound too dramatic: of course I have lots of good and productive years ahead. But I can see, now, that just as the ovaries only have so many eggs, I might have only so many books and essays left to write, that there might be a finite number of years ahead. Unexpectedly, thinking about my own mortality makes me, if anything, less anxious about writing and finishing project after project. It seems to take some of the pressure off, somehow.

And so, really, there's nothing very special about this set of menopausal side-effects, or really, effects. I am just about the perfect age to go through this, and I'm sure this makes it much less traumatic than for younger women, especially those who were planning to have children, or more children. My friends and I now regularly talk about our symptoms; and they all seem to be perfectly calm and cheerful about it, even about the anxiety and moodiness that beset us. There’s no doubt that naming and sharing the process is of immense comfort.

Menopause, then, turns out to be like so many of things we go through: childbirth, marriage, love, death, puberty. The experiences might be universal, or at least common, but the "going through" is not. It still feels, each time, for everyone, like an individual rite of passage. It’s made for blogging.

14 comments:

Pavlov's Cat said...

I just wrote a long comment and then wiped it. Can't think of a single engaging, witty, useful or positive thing to say about menopause.

Oh wait, yes I can. One really does care much less about what people think of one -- particularly about what men think of what one looks like. It's very liberating.

Stephanie Trigg said...

Yes, I detect a "sinking like a stone" quality about this post. Much more exciting to talk about sexual politics and the risky invasion of personal territory!

But my dear, you are always engaging, witty and useful. And often positive, too.

Pavlov's Cat said...

I dunno about sinking like a stone; I think you have many people's breathless attention. Women who haven't been through it yet are apprehensive, women who have are grim, and most of your male readers are either nodding their heads sadly or competely squicked out. I'll never forget the time a woman we both know, ten years older than me, arrived at whatever the gathering was, joined a conversing group of women, and said 'Girls, I have an announcement to make. Menopause sucks.'

But it takes a huge amount of, I don't know, insouciance? to talk openly about one's experiences of these things; one makes oneself very vulnerable putting this kind of stuff online. This may be what people mean by brave. It's one of the qualities I've always loved about Helen Garner.

I'm still having (comparatively mild) flushes, nine years after the blood tests first showed that the process had begun, but I'm glad to say the constant nausea and the head full of cement and/or cotton wool are both things of the past.

I'm interested in the way you see menopause as the marker of being at the end of one's reproductive and under-the-Gaze lives -- it has come upon you abruptly because of the treatment, but mosly it sneaks up on people. And for me it's more complicated than that, for a number of reasons; I gave up on both of those things when I was about 40. For me the defining moment of this stage of my female life was the 2001 hysterectomy that revealed a massive irony about my reproductive life, all of which was spent in elaborate contraceptive mode -- but such was the state of what Zoe would call my ladyparts when revealed to the world that if I'd been domestically settled early in life with hopes of children, my life would almost certainly have been dominated and blighted by difficult and dangerous attemps to reproduce, probably involving failure, heartbreak, obsession, broken relationships, nervous breakdowns etc etc, and never mind the career. It was much better to find this out at 48 than it would have been at 25.

Kathleen said...

I'm with PC, Stephanie - this post hasn't sunk like a stone for me. I'm mulling it over (and I chickened out of leaving the first comment).

* I don't really want to have children - everyone tells me I'll change my mind, but I have felt this way for long enough to be pretty sure, I think.
* And my partner, who already has a small child, DEFINITELY doesn't want any more children.
* And time is a-ticking - not rapidly yet, it's true, but more so if I look at the clock in relation to things like establishing a career, living overseas, and so on.

What I deduce from these things is that the likelihood that I won't have children is very high. So my reproductive possibilities (which, as PC points out, are completely speculative at this point anyway) annoy and inconvenience me, more than anything else.

But how will I feel when they're gone? In Italy I once had to define my status, on my permesso di soggiorno, as "celibe". This sounded bad enough to my ears, but I was informed it could be worse: I could have been defined as "nubile".

Stephanie Trigg said...

Well, I guess I was curious to see what kinds of responses I got to these three Big Posts, especially as they seem to have caused a bit of a spike in my readership. But yeah, one doesn't easily rush in to this kind of territory. And I'll admit to drafting my post in Word first.

It's lovely to have these beautifully written, candid and evocative responses. I can't tell you how honoured Humanities Researcher feels to host them.

genevieve said...

Stephanie, always when I visit here I read something remarkable that is always beautifully expressed.
Thanks for this calm and lucid insight into a more sudden change than most - and PC, I didn't know the cotton wool thing was normal, but I'm sure glad to hear that it goes away.

genevieve said...

Also can I add that I draft everything for the blog in Notepad, even if it's just brief notes with URLs. I have lost things too often to Typepad limbo(by foolishly clicking off to another spot without saving) not to do so.

I'm rereading your final paragraph with its closing statement that life experiences are 'made for blogging'. I don't know about that. I have a box full of communication books from my son's early intervention period which probably took the form of a debriefing kind of writing about disability and its impact on a young family - but I could never have blogged it. Not in a million years.
However the thought of editing all those details down for a book is equally problematic. How much of the experience would be missed? what don't we know when we've read such a life-document? which we would of course find if we checked into a blog on same.
Thanks for getting these undrafted thoughts out of me, Stephanie:-)

Stephanie Trigg said...

Thanks, Genevieve.
Well, that's interesting, you know. I guess I meant that menopause was a common experience but that the individual still needs to struggle to make sense of it somehow, and that blogging was a good medium for such.

Tracing a child's growth and development, however problematic or untroubled, has a similar potential to traverse the universal and chart the unique. I suspect the answer has as much to do with the blogger's desire (and the desire of the blog, once it gathers momentum) as it does about the subject-matter.

And then again, when blogging about someone else, you're blogging about someone else, and so then you're back with a whole other bunch of ethical issues.

Nice thoughts. Thanks.

David Thornby said...

"To traverse the universal and chart the unique" -- I like that! It sums up very nicely both writing about and experiencing menopause (or aging in general, or death, or childbirth and parenthood?) and personal-blogging as a genre.

I've read and reread The Menopause Post several times now, and the responses to it. I was struck by wariness, and by feeling like a foreigner to some degree. Then I thought I might at least offer a male perspective. And then I wondered whether I did actually have a perspective to offer; the issue of whether holding a male perspective on menopause is even valid isn't what I'd consider easily settled. I mean, as a man, I didn't feel I could offer an observation that I could be comfortable defending if it turned out to be disagreeable to anyone on any grounds.

And yet, I suppose, that IS a perspective. Menopause is so different from male aging; I think it holds much living symbolism that we as men don't have any easy way to do more with than observe as outsiders. The fear of making a mistake around that kind of symbolism is intimidating, so taking part in the naming and sharing that you mention is (for a man) I think a loaded process, and difficult. Naturally most of us simply avoid it because it's not easy.

I'm glad that confronting your mortality is taking some achievement-pressure off. This is good!

genevieve said...

Thanks Stephanie. I think you are absolutely right about the desire component - there is a large section of this part of my life that I simply don't want to re-enter. Though I guess the 'journal' writing in the communication book to staff could be seen as a primitive form of offline blogging, providing an avenue for 'naming and sharing' that would not otherwise have been available.

You have definitely got me thinking about that kind of writing, also about what blogging has provided to me at this later stage: there's such a huge gap between what I do online and what I would write on paper, and I am very conscious of that reading your wonderful posts.
Looking forward to no.3...

genevieve said...

whoops, also conscious of all those things when reading the responses too. Especially PC's above. The conversation...

Stephanie Trigg said...

Thanks to Genevieve and David for setting the issues spinning again.

plainsdweller said...

I have been dipping into your blog for a month or so now since at a similar age I had a similar diagnosis six weeks ago and surgery three weeks ago. Instant menopause awaits me when the chemotherapy begins next week so have found your experiences fascinating to read and I feel that I am wandering along the path in your wake - finding the clues you have left which allow me to consider the direction this journey is taking. A journey I had never really considered myself but certainly an all consuming one.
Thank you for your considered and exquisite commentary - a guide to the road ahead for me.

Stephanie Trigg said...

Dear plainsdweller,

I'm sure all who are reading wish you all the best on the road ahead.

Some of the best advice I received was to take my time in going through it all; time just to process it. You're right, that it can take you over. But that's not always a bad thing.

And of course, you'll find - or make - your own road, too.

Courage, mon amie!