‘Excision’ by Elizabeth O’Neill

Try to praise

Instead of counting the minutes until morning, I tried learning a poem, one I’d heard a few weeks before.

There were no amulets for protection, just some books and a framed photo of my dad, a veteran of the operating theatre. This was my armoury, the layer between me and the medical team, giving a paper thin illusion of control.

The room was small, with a sink, and a window facing out into a car park. It was a summer Sunday evening, with the sun still blazing outside. My friends, in a beer garden that may as well have been as far away as the moon, dispatched their good wishes.

It was quiet. My sister, Laura, was on the maternity ward, in a room directly below mine. The cries of the newly born didn’t carry upwards. This corner of the maternity hospital was to console those who’d lost their babies. Or mend those who had to forego their wombs.

With vital statistics measured and noted, and the bleached surgical gown and stockings laid out, there were still hours to wait. To remember.

I’d been inside countless hospital rooms, never as a patient. Border crossings give new perspectives. I’d grown up in close proximity to scars, knew their waxy, pink nature from the outside. Knew they made the viewer wince from a primordial sense of pain.

Mum’s livid hysterectomy scar had never faded. I’d asked what mine would look like. With luck it would be horizontal, would heal better.

Dad’s were the legacy of heart disease. The miracle of open-heart surgery twice saved his life but the scalpel exacted a hefty toll. Skin sewn back together, leaving rivulets running down an arm, a leg. An incongruous, dimpled scar right down the centre of his chest, from his sternum to his belly. A final bypass attempt failed. For so long there was a sense of borrowed time that would and did run out.

In all that time, as he was minded like a china cup, I never considered how he might regard himself afterwards. What the fusion of scar tissue actually feels like. How he would have felt before surgery, only how I felt, terrified at his loss which obliterated empathy towards his pain.

On the quiet top floor of a Victorian maternity hospital, I could think of little else. I was beginning to understand the way ill health of any kind makes you re-evaluate your body and I was afraid.

Laura, in a room one floor below, punctured that fear. She left her tiny newborn girl with the nurses and came up to hold my hand. To talk of the future.

*

Witches eat virgins

In a lush forest in Belize, a river runs right into the heart of a sacred cave. The aqueous light of the entrance marks the threshold of two worlds and the river is your means of traversing it. Years ago I visited the place, and can still remember the glowing green foliage behind, the shock of the cold water and the infinite darkness ahead.

Once inside you continue on foot through Mayan relics, neither sealed off nor protected from tourists’ feet. The flashes of the headlight beam light the way while burning photographic impressions of stalactite altars and shrines until you reach the very centre.

There lies the main attraction, the skeleton of a Mayan girl. The so-called Crystal Maiden. It is said that, when the cave floods, she dances. This is a trick of the rising water and the position she lies in, her pelvis broken.

Her bones, calcified and fused to the floor of her grave, are extraordinary, dense and luminous in this dark place. No human hand could create such beauty. She is made of time, nature and sacrifice.

Her ritual killing was to appease the Goddess Ixchel to indemnify the land against drought. A prayer for fertility.

Actun Tunichil Muknal means cave of the stone sepulchre, recognized by the Mayan priests as intrinsically sacred. It was believed the deities lived below.

Gods now mostly forgotten, the locals say the entrance to the cave resembles the body of a witch. At the very least you can see it’s an hourglass and female. Entering the cave, you enter her body.

This is a story old as time. The witch who swallowed the virgin, hungry for fertility. For youth. For generation. This is a real and bloody iteration of our own western folklore which perhaps reverberates with knowledge of long ago human sacrifice. How many women, real and imagined, have been rendered monstrous or pitiful when their wombs do not yield fruit? As a woman, if you are not a mother, what are you?

Our guide was a direct descendant of the Maya, talking of local customs, chanting and burning sage from the forest. He warned that bad luck could follow us and also those close to us, because we were on holy ground, but were not of this place. With surgery bringing an abrupt end to my own fertility, I remember the witch and the Crystal Maiden and sometimes wish the guide had burned more sage.

*

Witches are never mothers

Barren is a terrible word. The first time I came across it in the context of infertility was reading Shakespeare’s Julius Caesar. It evoked images of deserts, desolation. Cracked earth. No life there. Calpurnia was a woman to be pitied. Aged fourteen, I pitied her. This was not something I should grow up to be.

Before all that, I was well aware of biblical childlessness and child bearing, through osmosis and fidgeting through gospels and homilies. Virgin, barren, ‘righteous before the Lord’ slowly dripped and calcified in my mind. Elizabeth’s son John the Baptist was miraculous, growing in her geriatric womb, because she prayed him into existence. Jesus even more magical, being conceived of the Holy Spirit. Fruitofthywombjesus was uttered several times a day, the chant shrouding all meaning. For a small child there was no knowledge of what a womb was, never mind that it might contain fruit or that I might be the possessor of one. Regardless, its cultural, sexual and historical weight were being drip fed.

All we needed to know was that Mary was very holy, and a virgin, and we should be like her.

It was as much a story as the fairytales I loved. Still love. Witches, ogres or jinn out for the fresh blood of children. The witch in Hansel and Gretel, the Russian Baba Yaga. They are always childless and usually trying to catch and eat children.

Worse, there are the woman driven to satanic acts to trick their wombs into yielding. The magic promise is inevitably cursed. The queen in The Enchanted Doe sacrifices her husband in order to obtain and eat the beating heart of a sea dragon. She ultimately loses the love of the twins that are born.

In our small school library I came across a book, Young Bess, about Elizabeth I, juvenile and outcast long before adorning the monolithic paraphernalia of her virginhood. Here she was vulnerable. It contrasted with the history class version where she was ruler of an empire, head of the church. Something had to give, so she ‘unsexed’ herself, and cast off the burden of motherhood. The pictures were almost all testosterone, and little emotional oestrogen. She was not feminine, she was not what you wanted to be. Even her attire looked weaponized.

Our other literary childless icons included rambling Miss Bates in Emma, a dusty Miss Havisham in Great Expectations, mad Bertha Rochester.

Who would want to grow up to be any of these?

At an age when secret and copious monthly bleeding was beginning, the full weight of being a possessor of a womb and all it conveyed was already in place. Blood flow is shameful, don’t talk about the pain and whatever else you do, keep your legs crossed. The purpose, the end point is childbearing and motherhood. That’s what our mothers were told, and their mothers, and so we were too. In our 1980s convent school, sex education was religious education.

The message that the sanctity of motherhood, the end goal of womanhood, was in stark contrast to the madness, terror, and emptiness of childlessness was sown early on. If you’re not a mother, what are you? A witch?

Is the pain and madness of uteri a priori or is that significance put upon this most central of organs afterwards?

*

We are our choices

The one thing that can be said for certain about this life, nothing in reality feels the way you’d imagined it. Not sex. Not death. Not love. Not loss. The feeling of skin on skin or breath into breath cannot be replicated, nor can you fully understand the unnaturalness of a body with no heartbeat, until it is the remains of someone you’ve loved.

Grief is not tangible until the neverness of the situation is fully acknowledged. This takes time, until you realize your very soul is bent out of shape.

Years after my dad died, it came back to me.

My time in the hospital was routine, morphine was a cotton wool dream, the pain was manageable. Once vitals are maintained and you get up and walk, progress is straightforward. I read, talked with the nurses and thought about the rest of my life. The healing of my body was going so well, it was prosaic. But other wounds were opening.

‘There are other ways of being a mother,’ remarked one of the nurses. This was meant in kindness, words from a woman who’d probably seen it all. A maternity hospital is an exaggeration of all the processes of the world, life and loss crammed into a few thousand square feet. It’s a place of miracles, and intense sadness. I heard about a fellow patient whose full-term baby didn’t make it. The cries from downstairs could not reach this tucked-away place.

Jean-Paul Sartre said, we are the choices that we make. We have the means to define ourselves and give value to our lives if we choose to do so. I’d believed this to the extent of having the sentiment tattooed on my inside forearm. The white-hot fact of excision not only changed by view but flung me right out of orbit as the world kept spinning.

In the months before surgery, fully appraised of my prognosis, I had to make the decision for myself, to have my womb removed.

Afterwards, while the flesh on my pelvis was tightening and knitting inwards, the nerves were not and the visceral and the existential numbness was just beginning. With the shock surgery and the distraction of healing receding, like the tide going out, you don’t know what’s washed up on the shore.

The loss has dragged back the residue of old grief, like two mirrors reflecting each other, it has seemed endless, and I’ve cried. In traffic, in work, in yoga class, the tears have flowed. Loss, I’m sure like childbirth, is not imaginable, because who can have any inkling of the pain to come.

Are we the entirety of those choices that we make, or hostages to chance and circumstance? No matter what we do, certain events are lying in wait. It’s genetically encoded. At what point in the story do you realize, you are the witch and not the mother?

*

The wandering uterus

Once upon a time, in ancient Greece, Hippocrates pinned madness to wombs. It’s an association that stuck. We know the term hysterectomy comes from the Greek for womb, hystera, which in turn gives us the Victorian notion of hysteria. Hysterectomy is the literal cutting out of madness.

Hysteria, according to Hippocrates, is ‘a disease caused by a restless and migratory uterus’. The so-called wandering uterus roved in the body, hungry for semen, causing havoc in the process. If you were mad it was because your uterus had travelled upwards. In his dialogue Timaeus, Plato describes uterine suffocation, the womb ‘when remaining unfruitful long beyond its proper time, gets discontented and angry and wandering in every direction through the body, closes up the passages of the breath’.

Of course, this was at a time when few human eyes had seen any internal organs, male or female. There was a widely held belief in corpse pollution that delayed the practice of medical dissection until the 15th century.

One of the first ancient anatomies, from Galen of Permagon, influenced later medieval texts and drawings, most notably Andreas Vesalius’s On the Fabric of the Human Body.

While the male anatomy was considered The Human Body, the female was relegated to the functionality of the womb, and it was thought female reproductive organs were the same as the male, just inverted and inferior. Drawings were crude at best. Like the barrel of a gun, a womb was considered multi-chambered, the right yielding boys, the left for girls, the middle for hermaphrodites. This was also a time when the poisonous gaze of a menstruating woman was believed to wither crops and blacken mirrors.

A more accurate rendering came from Leonardo da Vinci, his horned uterus, held in place by four cable-like ligaments. This monstrosity wasn’t going to wander anywhere. It, apparently, was based on a cow’s organs, ones he’d seen himself.

In her book Secrets of Woman, Katherine Park outlines how few women were dissected, unless for Caesarean sections or for religious embalming. By the 16th century, understanding these secrets of the uterus became a primary goal of physicians and anatomists in order to better understand all human life and process. Italy was the centre for dissection with the first university medical school in Bologna. It was also a patriarchal society where the only way to guarantee paternity was to try to understand what happened in the site where life begins. To arrest these secrets from the hands of women. The womb was to be understood and possessed. Folkloric remedies and midwifery were also subsumed and formalized into male medicine.

These ancient terms and practices stuck around until the 1950s. It’s fair to say knowledge of female reproductive health was positively medieval.

How far have we come? A noisy, but painless, MRI mapped and charted my womb and its alien contents. While we can have full colour picture, without dissection, of what we look like inside, we still don’t know what the spark of life is and can’t agree on when it begins.

It’s an emotive topic. In Ireland female body autonomy has been overshadowed by clerical and patriarchal domination. Until very recently, Irish women were not allowed govern this mysterious, sacred space. Their own bodies.

*

Bleed for this

I can still remember the childhood metallic taste of fried liver, the sweet meat smell and the slippery texture. It didn’t initially disgust me but as I got older I shrank from the offal. It was prescribed for anaemia, something that came and went throughout my life without much issue.

Until two years ago when the bleeding became chronic. I’d already been to the doctor nine times within a year. Nothing was found, but nothing was really looked at. The tipping point was months of continuous bleeding that culminated in a trip to the ED on Christmas Eve.

‘Roughly, how many cups full have you lost would you say?’

‘Three, or five,’ I said, hoping not to attract bears, or turn dogs mad through the bleeding.

This type of bleeding is called ‘flooding’. I did not know what was to follow.

Double standards exist in plain sight. No matter what we think, women can be the worst perpetrators, fuck the sisterhood in the name of our own machismo. I never wanted to hear complaints of pain or bleeding and was therefore complicit in the notion of its shamefulness. I was becoming all too aware of the desperate need to not bleed publicly.

Periods are so secret and subjective, we’re doing ourselves damage as regards knowledge of our own health. When does it become a red flag?

Heavy menstrual bleeding is referred to as menorrhagia. It can have no known cause. Another case of put up and shut up. It was only through my own insistence on a pelvic ultrasound that I discovered I had a cyst and a fibroid on the lining of my uterus. The knowledge made me high. Relieved. I was not going mad. There was a root cause. I had never heard the term fibroid. I still had no inkling of what was to follow.

*

Excision

The final solution to the problem would be excision. Clear, clean and absolute. The cutting out of something. The ultimate giving up of something, a dream, potential. Excised. Removed. Aborted.

A fibroid is a benign tumour with its own fibrous blood supply, making it hard to operate on. In many cases, small ones can be ablated or removed without damage. Mine turned out to be bigger than my uterus.

This news was delivered inside a consulting room, as the rest of the hospital heaved with pregnant women. Everywhere I looked, pregnant women.

Human nature is such that often we only know our heart’s desire when it is out of reach. I’d been too busy, my head turned in the other direction, to find or settle on someone to have children with. With time and age, while the dream of own child was fading, the door was still open, there was hope. Nothing was impossible, and the articles on fertility I chose to read and believe, reflected this. Fertility did not fall off a cliff in your mid-thirties; revisionism pointed out that those statistics were medieval.

When limbs are cut off city trees, they grow back in parallel lines reaching for the sky, in natural acts of defiance. Some years ago, a heavy snowfall burned the tops off all the cordyline trees in Dublin. Along the canal they grew back in incongruous places, down low, copious, looking monstrous.

In the past eighteen months, I have felt angry, at times like thorns were growing in the space where my womb was. It is not OK to categorize a woman by her reproductive years, it is not OK to joke to a female colleague about freezing her eggs. Women with children are not automatically more empathetic, just as women without children are not inherently selfish or less maternal. More attuned now, I’ve witnessed these jibes, assumptions or discriminations on an almost daily basis. It is not OK to assume children are wanted or a given. Assume nothing, because you know nothing.

I have felt castrated. Wombs are so central, physically, emotionally, and chemically to our essential female selves. There have been changes, along with the numbness there is a loss of libido. Time might reverse this. Perhaps that’s something to be investigated. It was not something that was expected or explained.

What happens when something is taken away from you, something you didn’t even know you really wanted? It’s been a time of grief and questioning, the shock of realizing I would never have use for names secreted away, of seeing too much space on the walls for photographs that will never exist. No rounded belly. No heartbeat bar my own. I will not hold my child and see familiarity or a genetic imprint. My aloneness has been consolidated.

Ultimately, I’ve blamed myself. For not knowing what was happening inside myself and for not prioritizing a family.

*

Margot

She was the smallest thing I’d ever seen and when the midwife offered her to me, my hands didn’t know what do. My sister Laura knew instinctively how to hold her.

Margot arrived into our lives a few weeks early so that our time in the maternity hospital overlapped. Laura asked me to be godmother. As sisters, our opposing circumstances caused us no rift, only served to galvanize our bonds.

Margot’s insistence on being here proved to be the greatest change of all. She brought great joy that was tempered by sorrow. Her arrival forced the full stop of my situation into submission. When I saw her, I knew how much we’d need each other. Margot is loving, beautiful, determined. Her smile is a sun burst. Margot has Down Syndrome. New words. A new world.

The night before surgery, learning the words of a Polish poem about uncertainty there was comfort knowing my family was one floor below. Laura, suspending her own fears, came to hold my hand. We spoke our worries aloud, our words together filled the room and built our fortress.

‘We will get through all this.’

‘We will love her.’

Barren, a terrible word, not only refers to infertility, it also denotes something of little value or purpose. If you’re not a mother, what are you?

I am an aunt. Laura is a mother. Laura says when she holds Margot the world makes sense. When she falls asleep in my arms, I think in this world there is no better feeling. She is teaching us new values and insisting on renewed perspectives as her tiny hands dance together to form signs, as she makes herself fully known to the world.

There is purpose. There is familiarity. Pictures on the wall. There is life.

There is generation.

From issue 7: autumn/winter 2018

About the Author
Elizabeth O’Neill lives in Dublin and works in radio and TV production and as a freelance features writer. She has had two radio plays produced by RTÉ Radio One. The play Ghostbike was shortlisted for a 2016 Zebbie Award.