too much information? only if you’ve been spared the experience.

While I was opining last night about gender inequity in healthcare and medical research after my third hot flash in as many hours, the twitter sphere was ablaze with remarks about the Fox interview on the subject of the costs of women’s health insurance compared to men.  Obamacare is ruling that women, who have up until now been charged more for health care by insurance providers, can only be charged the same as their male counterparts. On the show, Dr. David Samadi, a professor at Hofstra University and chairman of the Urology Department at New York’s Lenox Hill Hospital, argued that women should pay more because they have more problems, more organs, and more years in their lives. First, for those of you who have never had a hot flash, let me describe it for you. They happen any time of the day or night, but I think I’ll give you the backdrop of, say, 3:18 a.m. You’re sound asleep (actually, there isn’t really anything like normal “sound asleep” when you hit menopause as hormonal changes interrupt your sleep patterns pretty significantly, but let’s just skip that for the sake of the image.) So, you’re sound asleep and suddenly, for no apparent reason, you’re wide awake. About a minute later, you experience a Taser, set to low, sending an electrical current through your solar plexus and realize that you’ve awakened because you’re about to have a hot flash. Heat begins to spread itself throughout your body, up into your head, you (who has never, even under extreme circumstances, done anything but “glow” in the past) sweat profusely, and kick off the bedding.  Sometimes you are forced to get up and change your drenched night clothes. You fall asleep and, in about thirty minutes, awake, shivering because you’re damp and inadequately covered. You pull the blankets up again and fall asleep. In a couple of hours, you’re sound asleep and suddenly, for no apparent reason, you’re wide awake and you go through it all again. During the day, these sudden spikes in heart rate and temperature have to be endured with grace; as trickles of sweat slide down your back and into your underwear, needle-like prickles erupt on your arms, neck and face, and sweat accumulated in your hair which you nonchalantly swipe to keep from running down your cheeks , you continue whatever conversation you are in and pretend all is well. In over fifty years of research, no one has yet figured out what causes hot flashes. My guess is that, because it is a private reality that only women face, few public funds are available to do so. It can get to you after awhile. As noted above, you never get a good night’s sleep unless you take something pharmaceutical to help you do so. Your mood drops. You reduce your interactions with people, other than those you live with, to only the necessary. Your energy levels are undermined and you can’t seem to be able to do what you used to be able to do. You stop drinking coffee, eating chocolate, sugar, carbohydrates – everything you’ve read might have something to do with it, all to no avail. You take supplements, none of which, after months of ingesting them, seem to make any difference. You hear a woman on the radio say she’s had hot flashes for seventeen years and you start looking for tall buildings…. You become moody and easily upset.  No kidding. Here are a few of the things, other than hot flashes, that Dr. Samadi might want to consider – not as reasons to raise insurance premiums but to change his perspective on what women cope with.  Last night I listed these things to my persevering husband, adding that I’d appreciate the courage of men willing to subject themselves to even three months of these issues, conflated as they so often are for women, in pursuit of the knowledge they need to really, finally, get it and understand why women so often resent the dollars and talent that went into developing Viagra. Periods. When my daughter got her first period, I made her a red silk dress and all the women in my family gathered to celebrate, carrying with them objects that brought her great-grandmothers to table as well. It was a portal into womanhood but as I watched her walk through it, I couldn’t have felt more uneasy. For me, getting my period had meant only bad things: pain so intense I passed out on the way to high school, leaning over the hoods of parked cars I as tried to cope; vomiting; learning how to lie with my knees up to ameliorate the pain – something you can’t actually do in the middle of English class, while dissecting a fetal pig in biology, or struggling with a small child in the aisle of a grocery store, or preaching; embarrassment at sailing school, in the classroom, and fear of it any time you visited someone else’s home or public place and had to sit down on furniture, knowing that when you stood up, you wouldn’t be alone in the room and the upholstery might condemn you as unclean. Ultimately, every woman experiences the humiliation; my daughter experienced the same kind of pain I’d had. Fortunately, twenty-five years later, she had better options for controlling her discomfort – not that would eliminate it, but that lessened it.  Also, we were better prepared for the pain because we knew she might have …. Endometriosis. Yeah, that’s why my pain was so bad but the fact that pain is so accepted as “part of the life of a woman” meant that my endometriosis wasn’t diagnosed for thirteen years.  Enough time to have allowed the material that usually lines the inside of the uterus – endometrial tissue – to grow throughout my abdomen, cementing all my organs to my pelvis.  Two major surgeries later, one including a hysterectomy for a variation of endometriosis called adenomyosis, I didn’t have to worry about painful periods anymore. But I was scarred for life – from my navel to my pubic bone.  Many women are.  We keep having pieces taken out or off of us until, bit by bit, we become roadmaps of our experiences. The lack of periods didn’t eliminate my hormonal cycles or my hormonally triggered migraines. when I was eight, my mom took me to the eye doctor to try to find out why I had headaches. My eyesight was fine. End of that story. Not end of the headaches, though. While at university, a doctor prescribed fiorinal codeine for the pain. It helped although it didn’t take them away. When I tried to refill the prescription, my otherwise kindly family doctor aggressively, emphatically, and self-righteously announced that he “didn’t prescribe narcotics.” I felt humiliated and embarrassed. I hadn’t even known that codeine was a narcotic. Looking back, I’m glad he didn’t give me the prescription, but I didn’t seek help for my headaches for another twenty years. I did my entire M. Div. with reflective Serengeti sunglasses on as a way to cope with fluorescently-lit lecture rooms. Finally, in my early forties, I was sent to a neurologist and learned that my headaches were really migraines and, when I started counting the medication I was taking (limited by my insurance company), that I was having twelve to fifteen of them a month – the last three not covered by my medical plan. My migraines didn’t change when my periods stopped.  The pain I had never really connected to my hormonal cycle (because it’s triggered by many different things) was part of that wonder of being a woman. When I finally got a therapeutic medication that stops a migraine within an hour, I wept realizing I had spent a quarter to half of my children’s lives being less than the mother I might have otherwise been. Tired, in massive pain, short-tempered, emotionally inaccessible; it must have been a hard way to grow up. But there’s no doubt that it costs my insurance company more than my male friend who also suffer migraines.  I go through the same amount of medication – $200 worth – in a month that he goes through in a year. Of course there are the breast issues. A stereotactic breast biopsy has left a titanium chip in my breast so that surgeons will know where to look for potential issues.  Don’t let me deprive you of the experience of that.  You lie, naked from the waist up, on an cushionless gurney (usually on your face but I was slightly on my side) with your breast squeezed to the greatest extent possible without exploding. A hollow tube is inserted into your breast and hollow needles are fired through it into the breast to bring out core samples. By fired, I mean fired. I was additionally fortunate enough to be the first patient to be able to enjoy the use of this new technology at that particular hospital so the room was filled with interested staff persons all watching the procedure.  So far, none of the core samples or the many mammograms have yet showed up breast cancer but I can no longer count on two hands and an extra one the number of women I have buried as a result of this disease. Dr. Samadi raises the number of organs we have with which something can go wrong and he is, oh, so right! My left ovary was the size of a grapefruit when it was removed; my uterus, a pound too heavy when it was removed with pathologies too complicated to explain here; my right ovary weighed four pounds when it was taken out – two years after I’d requested that it be – encased in the endometrial cyst that saved my life from the spread of the cancer with which it was filled. Women do have more organs.  And more can go wrong with them.  No doubt about that. Perhaps Dr. Samadi sees a future in the agribusiness of inserting human embryos, grown in a Petri-dish, into herds of bovine incubators who are far less likely to burden the interests of insurance companies. Women, perhaps, and all their physiological problems, can just become extinct or, better yet, have all those pesky organs removed when a female child is born – something like the (barbaric) custom of circumcision done for hygienic reasons so little boys don’t have to learn how to clean themselves.  The human family could evolve beyond the complications of female reproductive organs and so many other ways we mess up the bottom lines of insurance corporations and strain family life. Still, the personal experiences I’ve relayed say nothing about many other realities women face, most the direct result of our reproductive capacities: the challenge to maintain optimal iron levels in our systems; the horror of osteoporosis; the potential complications of pregnancy and childbirth; the frequency of urinary tract infections; the reality that we live longer, often in poverty, with little or no support available to us; that we are, with all these struggles burdening us, still the first responders to the needs of children, our own or others. Last night, when I was recovering from that third hot flash, I thought of golf and sailing. I know little about the first sport excepting that, whenever I play, my score is “handicapped”. As for sailing, though I have more experience there, I can’t, unfortunately, afford any kind of a boat that might have a handicap, good or otherwise.  But I know the concept.  Here’s Wikipedia’s succinct definition: Performance Handicap Racing Fleet (PHRF) is a handicapping system used for yacht racing in North America. It allows dissimilar classes of sailboats to be raced against each other. The aim is to cancel out the inherent advantages and disadvantages of each class of boats, so that results reflect crew skill rather than equipment superiority. Here it is for golf: A handicap is a numerical measure of a golfer’s potential playing ability based on the tees played for a given course. It is used to calculate a net score from the number of strokes actually played during a competition, thus allowing players of different proficiency to play against each other on somewhat equal terms. I thought perhaps we could work with that and give women a handicap (poor word, I agree) that might lay out a level playing field, make their contributions, moods, pay scales, and this morning, their insurance premiums, the funds that go toward medical research on our behalf, a bit more equitable. Perhaps they might even reflect humanity’s dependence upon women for its survival. Women, who are routinely looked down upon for their physical weaknesses, many of which are related to our reproductive cycles and the havoc they wreak upon our bodies, are not given that hand up, never offered compensation, in whatever way it might be offered, in the same way as are golfers and sailboats operating with less efficiency, that might even out the playing field, our honour the accomplishments we’ve achieved despite the physical realities with which we cope and from which men are spared. Since it very likely was not women who figured out those handicap scales for sailors and golfers, one can only assume that, when it comes to the differences between men and women, it is in the interests of men to ignore the hurdles that sap women’s energy and strain their coping skills every single day. Rather than pay us less, making us take sick days or vacation time when we are in so much pain we can’t get ourselves off the bathroom floor or recovering from surgery, or refusing to give us medical insurance because we’ve had a stereotactic biopsy or frequent urinary tract infections, we should reap greater benefits for the suffering we experience in order to bear the organs through which the future is populated. Whether or not a woman chooses to use them in that manner remains her choice, but, given the chance to have all the medical challenges that having those organs present even without having to experience the realities of carrying and birthing a child, can you think of a single man who would take them on?  I can’t although I can think of one I’d like to give the privilege to – Dr. David Samadi; I could only hope he’d be eager to learn something through the experience and find ways to champion rather than denigrate women for the organs they carry and the price we pay – willing or not – to do so.