How to Go With the Flow Without the Flow
Ah, Aunt Flow. Everyone's least favorite monthly visitor. Once upon a time, she and I had an understanding of sorts. She would send signals of her imminent arrival and I knew to prepare.
I can’t track my moods anymore, as I am in menopause thanks to chemo. But I have hormones, as uneven as they are, still cycling throughout a month. I have internal ebbs and flows and tides I can’t put on a calendar but feel the movement anyway. I have days when tears come on suddenly and stay lodged in the corners of my eyes all day. I had to put down my new book last night in bed, as chapter two started with the main character going in for chemotherapy. Dammit, Ann Patchett!
Often the tears are accompanied by the crock pot of rage, a long slow simmer that doesn’t need tending, it just cooks on the counter all day. I wrestle constantly with how much of what I feel is real; the strange confusion is that hormonal surges want to attach to events and circumstances, but in actuality are often chemically-induced moods looking for a reason. I feel sad, and then Someone says something flip which on another day would make me laugh. Today it reinforces the sad, amplifies it. If I let it, the feeling will attach to what the person said and use it a reason for its existence: I am sad because Someone is thoughtless. I have to be careful. I have to go slow, and truly examine reality.
Which makes me feel a little crazy. I once read a memoir of mental illness where the writer described insanity as being on a train, looking out the window at another train and seeing movement, but not knowing which train is moving. What is real? Is the feeling I am having real, or chemical? Am I really mad at Someone, or is it the hormones? Which train am I?
I got into a very clean rhythm with my cycle. Tracking and acknowledging my days may have saved my marriage, when the anti-depressants meant to even me out hadn’t fully succeeded. I had Days written on the calendar to look out for: Day 8, 11, 18, 24. Days 8 and 24 were extra emotional, Days 11 and 18 were Rage Crock Pot. I had to get very still inside myself, avoid the attempts at attaching feelings to circumstances, and let them pass. I bided my time on those days, walked on my own tiptoes, and tried to just make it to bed without hurting anyone. I recognized it was my chemical train moving. I wasn’t allowed to cook any new dishes for dinner (one particularly pungent and tear-filled evening led to the warning that I might Burn the Fish). My husband and I could exchange knowing nods with the simple words, "Day 18." I never thought I would say I miss the hallmarks of my menstrual cycle.
In the year after chemo ended, I enrolled in a university study I still don’t understand, which claimed to be looking at how text messaging can help young cancer survivors with their fertility and reproductive health. As much as a friend joked I’m not all that young, pre-menopausal women are still considered young in cancer terms. The majority of breast cancer cases are post-menopausal, and in younger women it often presents more advanced and life-threatening. As far as we know, I was still able to reproduce before this second bout, so my fertility — though personally unwelcome — was still at risk of chemo obliteration.
And, the fact that I had children after the Red Devil in 1999 may be of interest to researchers and younger cancer patients who want the promise of bearing children when they are through. So I enrolled in the study to help out, and maybe if I could walk away with some insight into enduring hot flashes, all the better.
If you’re wondering how text messaging can help young cancer survivors with their fertility and reproductive health, I’ll tell you right now: It can’t. For 45 days I had the morning request to report how many hot flashes I had the previous 24 hours, with a follow-up request to rate them from Mild, Moderate, Severe to Very Severe. Why does it have to be two separate texts? Is there some rationale that says the whole system breaks down if the question is How Many Hot Flashes Did You Have Yesterday (please answer with the proper rating, ex: 2mi 3mo 2se 1vs). One text, it’s over. Why pretend that we are having a conversation about it?
For the first three weeks or so, I had a little chart on the whiteboard next to my desk. Once the hot flash concluded and I could rate its severity, I would grab a dry-erase marker and put a hash mark next to the right abbreviation. Most were moderate; I don’t think I classified more than one as very severe. Never had to change my sheets or underwear. Not so bad I guess.
I started to fudge the numbers. I forgot to make hash marks, wasn’t there another one in the kitchen? Eventually, I stopped keeping track and attempted to count them up by recall. It wasn’t too hard to do because they had lessened dramatically. At my peak I was tracking a dozen a day, then it got down to five. The season had moved from Indian summer to fall, and by the time winter arrived, the hot flashes disappeared. I have answered O on a string of days to those inquiring morning texts. At some point they may stop altogether.
In between the hot flash reporting, I received two “helpful” “suggestions” for information and support regarding my reproductive health: “1/2 Sexual function can change in terms of interest, problems with orgasm and/or pain with intercourse. [Line break] Take a look at your survivorship care plan for how to… 2/2 improve these aspects of sexual health!”
Again, why does this have to be broken across two text messages? Is their hired tech expert so Twitter-versed that they are always counting characters, like a tic? Was the break before the Take A Look directive really important enough to warrant the dramatically empty line?
More frustratingly, there is a link at the bottom to connect to the Care Plan. There is no information about how to improve these, or any other, aspects of sexual health. I’ve looked. I genuinely don’t know what they are talking about.
I don’t really need them to tell me, I’ve been grappling with my hormones for years. I know what can and can’t be done to address my issues.
I know that different foods may affect my hormone levels and how my body processes them. I find nutrition and cooking and menu planning and recipes and food restriction deeply abhorrent and overwhelming. So: ugh.
I know that hormone-replacement therapy or mood-stabilizing medication could help me. For the former, I am way too spooked to put additional hormones in my crock pot. My first cancer was hormone-receptor positive. I have spent 19 years believing that HRT would be dangerous. I can’t flip that switch.
I have had some luck with mood stabilizers in the past, I had a run on Lexapro that helped me through a stretch of trouble, kept me stable enough to get out of the trouble, and see my cycles for what they were and disarm them. But it was hard to get off them, and not something I take lightly. But try again I did: my new primary care oncologist, who specializes in “survivorship” and had given me hormone cream and a hormone-ring insertion, prescribed a new SSRI. I can’t remember the name, but compared to ye olde stand-bys that I was expecting, it was new-fangled. I took it for two days before the diarrhea stirred chemotherapy flashbacks. I couldn’t do it.
There is a part of me that thinks I should be doing more medically, that they could be helping me more aggressively. But I don’t want more blood drawn. I don’t want pills. I don’t want self-care to mean more than a long hot shower. I miss having a big bathtub.
I know what I need to do, and the struggle to get it done is my big demon to face. I need to walk. I need to write. It’s not that complicated. It’s the two places where I really pay attention to my own inner workings, where I start to see the difference between this train and that train.
When I walk, I get stillness. I used to walk with music playing or Wait Wait Don’t Tell Me. There was a time when the magic of shuffle allowed for a-ha moments: hearing that song at that moment when you were grappling with that question… AHHHHHH.
But so much of my music these days is on Spotify in very specific playlists. The a-ha shuffle doesn’t work on, say, the soundtrack to Hamilton or ’8Os mixed tape re-creations. No one ever gained deep insight in the middle of a Squeeze song.
I left the headphones at home one day hoping to just listen to the birds, along with the wind in the trees, the rustle of leaves, the methodical clap of my worn gym shoes first hitting pavement then the dirt path. I was momentarily enchanted by the bird calls, thrilled to hear the spring-time rush of water in the usually stagnant creek, delighted by the quiet greetings of the neighbors out walking with similar intentions.
The grapple-worthy questions still come, but the answers won’t be delivered by the God in the iPod. They are internal, even when informed by external sources. I walked the wooded greenbelt path behind my house one day, reflecting on how I was going to proceed in my creative life: Keep looking for web clients? Reposition myself as a production artist, attempt to expand my graphic design work? A line from Hamilton sang itself as loudly as if the track was playing through my beat-up earbuds: Pick up a pen, start writing.
Another epiphany followed months later, after my daughter was chastising me for forgetting again to get her makeup remover wipes. “Write it down!” I chastised right back. “You know I don’t remember anything if I don’t write it down.”
I need to write it down to remember. And I need stillness to understand it.