The Final Score

Cathryn Vogeley

“You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimension.”

–Bessel van der Kolk, The Body Keeps the Score

The house was stone quiet except for our pendulum clock’s slow thunk thunk and my whimpering. Excruciating pain. The smell, copper-like. Two superabsorbent pads and a tampon weren’t enough to last the night. I wanted to cry out loud but kept rocking and moaning. My periods had become a real problem with heavy flow and “stay at home” pain, but I had put off seeing a doctor, trying to wish it away. Deep breaths, slow and deep. I wondered if I had appendicitis.

My husband, Jimmy, lay snoring next to me, and our two young teenage daughters were asleep upstairs. Jimmy woke up blinking, confused at my squeaky whispers that something was very wrong. I scribbled a note on the back of an envelope and left it on the kitchen table. Hi girls, quick trip to the hospital for a belly pain. Nothing to worry about. Be home soon. XOXO

It was 1987 in northeast Ohio, and I was thirty-seven. As a nurse, I kept my emotions distant from the medical emergencies I witnessed, and even in this situation I didn’t feel fear. But my daughters would, and I imagined them wandering downstairs half asleep to an empty, silent house and finding the note. I didn’t want them to stress over their mother going to emergency room and so, until facts said differently, the ER visit—for them—would be no big deal.

While Jimmy parked the car at the hospital, a muscle-bound orderly who smelled of cigarettes whisked my wheelchair through sliding doors under the sign EMERGENCY to a cubicle where a padded gurney with its spotless sheets sat, ready for action. I laid down there and curled into myself. The orderly turned and sped off, catching the corner of a metal cart that sent a blood pressure tower crashing to the floor. I covered my ears. Jimmy arrived and laid a hand on my shoulder—then, without saying a word, sat on the chair next to me and opened the morning newspaper. He was a quiet man who shrank from all things medical.

A young woman stepped between the curtains, apologized for the racket, and wished us a breezy good morning, sounding fresh as a bird song. She pulled the curtain, metal balls raking the ceiling track, surrounding me in a yellow tent with wrinkled walls. Blood tests and scans were performed.

Jimmy waited with me, fidgeting, running his hands through his hair, pulling on his shirt collar. Years ago, I realized this was my lot, to be the wife of a non-talker. Put him in front of a sports competition or at a bar with his hunting buddies and he came to life. My passions were books and music and gardening. We were always out of sync, the stereotypical man from Mars and woman from Venus.

We had our problems, but when it came to our kids, we were united. Every school play, every marching event, we were there together. We bought a used pop-up camper trailer and spent vacations at a lake or historical site, hiking and horseback riding. I made sure holidays were memorable with Easter egg hunts and Christmas traditions. Our children were our glue. I loved Jimmy for standing by me, for being trustworthy, and for being a good father. I knew that if I needed to stay in the hospital, he would be at home, cook fish sticks, make sure the girls got on the school bus in the morning.

My gynecologist, Dr. Drake, called “knock knock” and made his way into my tent. He was about my age, with a face like a choirboy. Even though we knew each other from the hospital where I worked, he greeted me with a serious expression. He said I did not have appendicitis but a bad case of endometriosis.

I knew about the disease from nursing school. Uterine-like cells grow outside the uterus and react to monthly hormones, thickening and bleeding, getting trapped, causing irritation and scarring. It often runs in families. There is no solid answer as to why it develops in some women and not others. The diagnosis made no sense to me. I was an active, healthy woman with children and no family history of endometriosis.

The nurse appeared again, carrying a syringe which she attached to the IV. “This is for your pain,” she said, pushing the plunger in slow motion. The medicine immediately rested my shoulders and dulled the pain.

Dr. Drake said, “Sorry to say, you need surgery. Taking out the ovaries is the only sure way to eliminate the disease.”

“That’s it then? Surgery?” I asked, feeling no emotion. “Any other thoughts?”

He said, “I suppose we could try hormone therapy. But there’s no way to predict how you might respond. You have nothing to lose by waiting if you think that’s what you want.”

I opted for the surgery. I had the notion that my body was a mechanical thing, like a car with parts that went bad, not my flesh and blood that I inhabited. It seemed easy enough to have the tissue I no longer needed snipped out.

At my age, I wasn’t looking to expand my family. “I’ve had my children,” I said, “Go ahead and do the hysterectomy. Take the uterus too.”

Dr. Drake questioned my choice. “You’re sure about that?” He looked to Jimmy who shrugged one shoulder.

I nodded, “What do I need it for? My mother died of thyroid cancer at fifty-six. I’m not saying I think I’ll get cancer. But without these organs, it’s one less worry. Do you have any reason I should keep them?”

Dr. Drake said, “I don’t know. But for lots of women, it’s part of their identity. Part of who they are.”

“It’s okay, just take it all. Jimmy? Any comments?” He looked resigned and with a tight mouth, shook his head. 

“If you’re certain that’s what you want, then that’s what we’ll do,” Dr. Drake said and turned to leave.

Jimmy followed him to find some coffee, and as I watched the curtain flapping behind, I wondered why I’d developed such a disease.

*

Growing up, I spent an unusual number of days in bed. As the middle child of five, I was the one who was most often awake all night puking. If it wasn’t my stomach, it was a sore throat or an ear infection, rheumatic fever or strep throat, a ruptured ear drum or an unexplained rash. If I didn’t feel well but had no fever or florid rash, I had to go to school. “Faker!” my sister would yell, and Mom would say, “There’s nothing wrong with you. You’re fine. Now hurry up before you miss the bus.”  

The minefield we called home likely played a part in my frequent illnesses. My parents managed stress by yelling, using the palm or a fist. Dad would burst into a rage for no apparent reason, and Mom would go into screaming fits over insignificant missteps, like the time I was afraid to board a bus for kindergarten because it was a different color than I was used to. I waited and waited alone for the right bus that never came. When I showed up at home, my mother went nuts, screaming and pulling her hair while I curled in a ball on the floor, thinking a witch had replaced my mommy. After an unexplainable explosion like this, there was no debriefing, explanation, or apology.

My parents went on as if nothing ever happened, quickly switching tracks like sitting down to dinner together, having a picnic on the beach with Nana and Papa, stringing popcorn for the Christmas tree, or riding the roller coasters at Kennywood Park.

We pretended yesterday’s slaps were forgotten. I learned to compartmentalize the bad stuff so that life made sense.

*

When the emergency room nurse checked my blood pressure again, she noticed it had jumped several points. “That’s odd,” she said. “You’ve just had pain medicine. Try a few deep breaths, relax. Let’s have you rest a bit and recheck before you go home.”

I lay alone on the gurney, thinking about how soon the surgery could be done. I wanted it over with as soon as possible. To my mind I was being strong; taking life’s hits and feeling nothing.

The hangers screeched again as the chirpy woman rattled the curtain back and announced, "You can go home now." Someone would call me to schedule the operation.

I counted on hormone replacement to take care of my missing ovaries, and that would be that. This disease won’t get me down, I decided. I’ll have the surgery, begin the estrogen medicine, take a week or so off, and get on with my life.

On the ride home, Jimmy and I talked about how the lawn needed cut and what to do for dinner.

*

By then I’d completely walled off memories of “that time”, when I was eighteen, the year I went away.

My boyfriend and I had sex without a condom in his dad’s car. Afterward, back in the student nurses’ dorm, I rushed to the only bathroom in the place with a tub. The large room had several sinks and showers. While classmates yakked in front of the mirrors, I turned my back, pulled off my clothes, and stepped behind the tub’s curtain. Blasting scalding water, I pressed my feet against the brown ceramic tile next to the faucet and lifted my hips in a panic, trying to douche the semen away, horrified at what I might be facing. In the late sixties, morning-after pills did not exist. Abortion was illegal everywhere in the US. Shotgun weddings were common. Quickie weddings raised eyebrows. Unwed pregnant girls were called tramps. Their babies were bastards. My biggest worry from the beginning was Mom—that she would never love me again.

My boyfriend chose not to marry me; said he couldn’t take care of a family, he had to finish college. When we told my parents, they threw him out of our house. I thought I’d die from heartache and humiliation. My parents were mortified and had no intention of helping me keep my illegitimate baby. I dropped out of nursing school, lied to my friends and siblings, saying that I’d taken a job out of state, when instead I moved twenty minutes from home to a place for wayward girls run by Catholic Charities.

Strangers adopted my newborn, people I hoped would love and protect her. As was the practice at the time, it was a closed adoption, in which new birth records were issued without the names of her first parents. In Pennsylvania, the original documents were sealed and filed away for ninety-nine years.

Back home after the birth, Mom insisted that I forget it ever happened. “Don’t even think about it. Keep your mind forward, really try to get on with your life,” she repeated like a mantra that must have worn grooves in my brain. She never spoke of the baby or what I went through.

After I transferred to a new school, I met Jimmy at a party for nursing students and guys from the vo-tech, a vocational school for electronics. He was a handsome man with high cheekbones and an easy laugh. Plus, he was available and he liked me. I told him about the baby and how she was given up in a closed adoption. He showed no interest; since she wasn’t part of my life, my past didn’t matter to him. We never talked about it after that. 

*

The day of the operation I felt no sadness, had no tears, even knowing my body would be thrown into surgical menopause in a matter of hours. Natural menopause allows the system to adjust as hormones gradually decrease over years. But for me, the change would begin immediately with vaginal dryness and atrophy, hot flashes, sleeplessness, weight gain.

I woke up from anesthesia feeling groggy and cotton mouthed. Dr. Drake stood beside my bed, still in OR scrubs, wearing his paper hat. “I’m glad you’re awake,” he said, “the operation went fine.” He stood there tapping his fingers on the siderail.     

Words stuck in my dry mouth, “Everything alright? Was there a tumor or anything?”

He shook his head, “No, no tumor.” The pager dangling from his waistband sounded an alert and, rather than check the number, he pressed the cancel button. He said, “I gotta tell you, it was a mess in there.” He frowned and lowered his voice, “Normally, ovaries have a fibrous capsule around them, even with endometriosis. But when I lifted yours out, they literally fell apart in my hand. Very unusual. I’ve never seen anything like it.” It puzzled me to think of my ovaries disintegrating, but as perplexing as it was, the news didn’t bother me, numb as I’d been for years, thinking there’s nothing I can do about it, so accept it and move on. 

*

Depression descended in the year after my surgery. Jimmy’s mother suggested it was because of the hysterectomy. I didn’t agree but, like the disconnection I felt with my endometriosis, I didn’t understand why I felt as I did. I truly had no inkling as to what made me cry or why I loathed myself. All I wanted was to disappear, to have never been alive.

At my lowest point, on a day when the girls were at school, I reached into the back of Jimmy’s closet and pulled out his pistol that he used for small game hunting. The weight of it made me cringe. I imagined the devastation I’d cause, then thought of my sweet daughters and knew I could not leave them. I resolved to do better.

I joined Weight Watchers and lost twenty pounds. Then I enrolled in the local university and took classes like anthropology and sociology that opened the world to me. Jimmy and I tried and failed at marriage counseling until we acknowledged the many differences between us and divorced. My professional life flourished but, even with antidepressants, I couldn’t shake the sadness I’d feel when alone.

In my fifties, I fell in love with a man who taught me what real love is by his attention and trustworthiness. He was open to my children—by then including grandchildren—and understood I had lost a daughter to adoption. We shared a love of travel and water-related sports like scuba diving. My life became full again. But within a few years, I developed symptoms of post-traumatic stress disorder, like out-of-control drinking, irritability, and nightmares. I did not know what was wrong with me but knew I needed help and found a specialist in treating PTSD. Over the next two years, she helped to mine the past, beginning with the anxiety of my childhood. Eventually my unwed pregnancy came to the surface. Stuffed emotions poured out of me—all that I hadn’t allowed myself to feel or talk about. My insides began to relax and my sleep improved.

In time, my therapist suggested that I search for my daughter, by then a middle-aged woman. Laws around closed adoption had changed in Pennsylvania, where records could be opened with the assistance of an intermediary for a search. My daughter was located living on the other side of the country from me, and as we connected, I set an intention, deciding that she owed me nothing. I resolved to accept whatever she chose. I wanted her forgiveness but wouldn’t ask for more unless she was willing. I’d given her away when she had no choice, and now it was important to me that she be free to decide on her own whether or not she wanted me in her life. 

Long emails followed for months with her questions and my candid answers. Eventually the notes shifted to text messages, then nothing. She did not want to meet and shared only one fuzzy picture, never her voice.

By that time, my need for her had grown beyond anything I imagined. I reminded myself over and over that I’d met my goal: to let her know her first mother, to ask for forgiveness. (To which she replied, there is nothing to forgive).

Her rejection was devastating, but I was able to work through my grief by talking about it with my sister and husband. I learned the craft of writing and found comfort in putting my story down on paper. Having my memoir published drew many first mothers and adoptees to contact me and enfold me with love and validation. 

*

There was no World Wide Web in 1987 when Dr. Drake couldn’t give a definitive reason for my endometriosis, but while writing a memoir, I began searching the internet for answers. I found an online article proposing that ovaries are the repository for negative emotions. Part of me wanted to believe that my ovaries had been destroyed by grief. In a sense, the idea of my organs disintegrating as if I was dying inside felt like a testament to my suffering. But I needed more than speculation. I kept looking for a scientific explanation.

I’d become familiar with Dr. Bessel Van Der Kolk’s book titled The Body Keeps the Score and was intrigued by evidence that childhood trauma can precipitate physical ailments in adulthood. However, there was nothing specific regarding endometriosis and emotional trauma. Autoimmune disorders like fibromyalgia and asthma may be correlated, but endometriosis was not listed. 

Another source said: “Experts don’t know why your immune system turns on you. It’s like it can no longer tell the difference between what’s healthy and what’s not — between what’s you and what’s an invader. There are some theories about why this happens, but experts aren’t completely sure.”

I’ll never know for certain why the endometriosis developed, but I suspect there were compounding factors. Strep infections triggered an autoimmune response, made worse by the stressors at home. Then, as an eighteen-year-old, the fight or flight chemicals (cortisol and adrenaline) flooded my system as I wore my way through pregnancy alone. Losing my baby, maintaining the secret, and being denied normal mourning impacted my organs and worsened the overactive autoimmune response that had begun in my childhood.

These days, I’m ready and willing to seek help when things go awry. I recognize now that my body is precious and that it holds a past I’ve forgiven myself for. I don’t look away or deny a problem but investigate and then move ahead. When my knee recently had to be replaced, I did so cautiously but deliberately as an informed patient. I’m grateful for good health into my seventies even if it took all my life to get here.

Cathryn Vogeley is the author of I Need to Tell You, a memoir of loss and triumph, by WiDo Publishing. Her work has been published in Grande Dame, Five Minutes, and GirlTalkHQ. She is a retired clinical nurse specialist currently living with her husband and three terriers in the Pacific Northwest. Find her here:

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