Proximity

Pizza shop in New York City

“I need to do a six month physician supervised weight loss program before I can get the gastric sleeve covered by my insurance.” She wasn’t even that heavy to start off with, her BMI was 32. She wasn’t diabetic and did not have high blood pressure. 

“You are going to be married to a fistful of vitamin supplements for the rest of your life.”

“I don’t care. I am tired of being fat, of having people judge me.” I understood. People can be so cruel. “My friends have all had it done and they look great,” she said hopefully. “But I can’t loose too much weight right now or I won’t qualify anymore…”

We both knew she had no intention of really trying. 

Sure enough she demonstrated a nice weight gain at each visit and steadfastly refused to count her calories or exercise or do anything except to say, “I’m cutting back, Doc. Really I am. I don’t know why I keep gaining this weight!” 

I don’t know why that sort of thing qualifies someone for surgery. A barbaric surgery with lifelong consequences. Sometimes I wonder about the ethics of the surgeons doing these things and why there isn’t better after care for people undergoing the knife. Cut them up and then cut them off seems to be the plan across the board. 

She had her surgery. 

Three years later her weight was back where it started from and then some and she wanted a referral for a surgery revision. 

I wanted to say, “I told you so.” And then I wanted to call her surgeon up and give him a piece of my mind.

But I didn’t….

A few weeks ago I was at one of those giant outdoor malls. There were easily 20-30 restaurants clustered around. Right there in the midst of it all there was a weight loss clinic. 

Having just eaten at the Melting Pot myself I was so stuffed it was hard to breathe. Way too much food to be healthy but then why didn’t I just stop eating? I was too focused on not wasting anything. Getting my money’s worth. I blame my upbringing. I blame past poverty. I blame portion sizes. 

I blame myself.

Where does that come from, anyway?

At first I was offended that this clinic placed itself where it did. Then I realized it was a brilliant marketing strategy. This is what we have become, isn’t it?

Binge. Purge. Binge. Purge.

Binge.

“How’s your daughter?”

He smiled and pulled out his smart phone, flipping through pictures of a grinning, curly haired toddler. They’d had so much trouble having a baby. 

“Oh, she’s beautiful!” 

He nodded, beaming.

“How is your wife?”

His face changed in a instant. He looked stricken. “You knew she had the gastric sleeve done?”

“Yes, I had heard.”

“Well, she developed Korsakoff Syndrome.” Oh. Wow. “She got confused, couldn’t remember things. Couldn’t walk straight.”

Thiamine deficiency.

“When she said she wanted to get the surgery, I didn’t say anything. I just wanted her to be happy. She suffered so much emotional turmoil over her weight. We had no idea something like this could happen, though. If I could go back in time I would tell her she didn’t need to do it. That I loved her just the way she was. Now she is not the same person. She has to carry a book with her to write everything down since she has so much trouble remembering things and she uses a cane to get around.” 

“Mommy, I’m thirsty!”

It was swelteringly hot. I stood in line to get our fifth soda refill of the day in the $15 red amusement park drinking bottle I had purchased earlier that morning.

*Free* refills on Coca-Cola products all day!

I don’t need Coke products. My kids don’t need Coke products. Water would do just fine to keep us hydrated. But STILL…. I paid $15 for that stupid cup since I could not bring anything into the amusement park. I want to get my money’s worth, dang it. A small bottle of water costs $4.50 a pop multiplied by at least five times per person per day… but soda pop in the big red drinking bottle? Yeah. What is anyone going to pick?

So here we are.

Making money by making people fat. Making money to make people skinny again. Making money getting them fat again. Making money to get them skinny again.

And so on.

It does not ever stop.

How do we make it stop?

Worn

Interior, Metropolitan Museum of Art

Every year around this date I especially find myself marveling at love…

Love that is gained and lost, and found again. Love that is unrequited and unrewarded and yet still persists. Love that claws its way through the heart and lodges itself there against all logic and stays regardless of physical presence or absence. Love that endures despite being utterly spent, never quite reaching the point where it simply cannot love anymore. 

Lonely love.

Brilliant love.

Eternal love.

For over twenty years I have loved this love. At times gingerly, even tentatively, and at other times fiercely and with conviction. Is it more valuable for bearing all of the scars and scuff marks, the wear and tear of time and hurt? Is it more precious for simply surviving?

Perhaps….

But then, all love is precious. 

The Artist

Room detail, Metropolitan Museum of Art in NYC

Over twelve years ago I met an artist.

What she had was a gift. I never had to tell her what to do. It was like she just knew. Left to create on her own she did the most amazing work.

Today was my last appointment with her. 

My hair stylist is retiring and I am grieving. She was the first and only person to ever take charge of my hair and make it look GOOD. She made me feel better about my hair, about myself. I cannot put into words how important and life changing that was.

When I ask patients what they do, often I’ll get the, “I’m JUST a…. fill in the blank.” Hair dresser, office worker, mail handler, Mom, etc. I hate, hate, hate that phrasing. 

Never doubt that what you do has an impact. No matter what your job happens to be, it matters to someone. 

It matters to me.

Maybe I will find someone just as good. 

Maybe I won’t. 

I loathe this kind of change so it will be a growing experience regardless but for now, I grieve. She was an artist in the true sense of the word and she will be missed.

The Boobs Have It

Display in museum in New York City
Do you know how many breasts I have touched? 

Thousands of them.

It is staggering when I reflect upon it. 

So many breasts. So very many. All shapes and colors and sizes. Hairy. Not hairy. Moles and rashes and skin tags galore. Droopy. Perky. Somewhere in between.

During breast exams I have for years and years referred to the exam as the “boob check.” Whenever I made reference to my breasts of anyone else’s I nearly always called them boobs or boobies. 

To be honest, I thought it was cute.

Touching another woman’s breasts makes me uncomfortable, maybe even a bit embarrassed. I feel the same when someone else is looking at or touching mine in a nonsexual, clinical sort of way. So I made fun of breasts and joked about the situation. It took some of the sting out of the situation to act goofy.

One of the many beautiful things about blogging  is that from time to time someone says something that makes me reexamine a part of my life and causes me to make some changes. 

Mark at Exile on Pain Street made a comment on one of my blog posts a while back (ok, maybe it was WAY back in July of 2015) that has stuck with me:

“I hate that word. Boobs…. Boobs sounds comical and crude. It lacks decorum. They’re beautiful! Not something to make fun of.”

This. From a MAN. 

At first, I blew it off. What does he know about women’s bodies anyway? What gives him the right to tell me what is disrespectful about the term boobs. I can can dang well call them anything I want, can’t I? I own a pair after all.

But it ate at me. 

And I felt kind of guilty.

I would take that comment out from time to time and chew on it. The word boob is, after all, another way to refer to someone who is a fool. An idiot. My breasts are way better than that, aren’t they? So are every other woman’s breasts for that matter. They give pleasure. They give life. Right or wrong, so much of who we are as women is wrapped up in these exocrine glands. I would never tell a man to show me his “twig and berries” if I were doing a genital exam. Why do I persist in denigrating the female anatomy during office visits? 

Excellent question.

Yesterday I was telling a woman to change into my lovely blue paper gown so we could do a breast exam when it struck me…

When was the last time I called them boobs?

It had been a long, long time, I realized.

And that made me smile…

Uncovered

Mission ruins, San Antonio

“Mommy!” my daughter gasped urgently. “Look, she’s a mermaid…” There was reverence and surprise in her voice. 

Imagine meeting a mermaid here!

“Yes, she is…. now, shhhhhh,” I responded.

I held my breath waiting for my little girl with no filter to say something about the woman’s size. She was probably close to 400 pounds and she was wearing a two piece bright purple and turquoise mermaid swim suit like it was the most natural thing in the world.

Mercifully my daughter said nothing more. Instead she snuggled up against me wrapped in her towels and fell asleep, smiling. I am grateful that she and the towels completely cover up my thighs.

I found myself very jealous of that woman. If I could have even half of that confidence, I could… 

But then, I remembered, what I saw was probably only just the tip of the iceberg so to speak. What kind of ugly things had been uttered by people under their breath as she walked by? Was she really, truly confident or was her swim suit an act of defiance, a f**k you to the world wrapped up in flashy purple and turquoise lame fabric? I would never know the reality of what lies beneath.

In contrast to the mermaid, there was a woman who must have been a size 4 standing in the wave pool with a voluminous hot pink coverup who looked so incredibly self conscious and miserable. I felt and understood her pain. She hid her body but did not succeed in hiding her discomfort. 

“Nothing makes a woman more beautiful than the belief she is beautiful.” —Sophia Loren

I looked around me at the hundreds of other men and women, bodies of all shapes and sizes and the swimsuits of all sorts, each one an act of courage. Bacne, surgical scars, stretch marks, cellulite, fat rolls, belly bulges, love handles, etc. all exposed. 

My body is a blessing.

“You are the best looking woman out here,” he whispers in my ear as I take off my cover up. I’m not. The mermaid is, but I love that he can make me feel like he believes it is the truth. 

So I decide to walk around like I am, like I really do believe I am beautiful in my deep cobalt blue velvet one piece swimsuit. I don’t like my body but that is OK. I am not this body. I am not this swimsuit. 

I am beautiful.

A Down Sizing

Mission San Jose in San Antonio

I see and touch an awful lot of breasts. 

Just about every “uninhanced” woman on the face of this Earth has one breast that is slightly larger than the other. I certainly do. As I age it becomes more and more obvious… the left is fuller than the right. Every time I put on a bra or look in a mirror, I am acutely aware of it and I wonder if other women notice or care about their subtle discrepancies in size. Not that I would ever bring it up in the clinic, mind you. That would be akin to your beautician asking if you want her to wax your upper lip… creates a paranoia if there was not one there to start with. 

Thankfully, I have never had a man look at my chest and run away screaming.

Every once in a while I come across a patient with a more dramatic mismatching, like the woman with one breast a cup size A and the other one a size DD. It created a serious self esteem issue. She had never had a relationship as she was terrified of anyone see her naked. She stuffed her bra with whatever she could find until someone sewed her a pillow to tuck in there instead.

Hey! Sugery can FIX that for you…

You would think this would be a no-brainer, but no…. Invariably the response from insurance companies on the request for augmentation or reduction is, “Not medically necessary.”

I always wonder who the people are making these decisions. Men? Women? If a man, would a woman make a different decision? Or vice versa?

I know the angst I have had over the years over my slightly different sizes. I cannot imagine the psychological burden carried by these women with their really noticeable differences. So what determines medical necessity? We allow breast reconstruction in breast cancer. Is is “medically” necessary? Maybe not. But it is psychologically necessary. 

So then, what determines something being psychologically necessary? What size disparity is traumatic enough to warrant coverage? One size? Two? Four? How do you measure something so subjective?

And then what else causing cosmetic angst should be covered? I had a mole removed from my face while I was still in med school. Right next to my left nostril. It wasn’t huge in real life but in my brain it covered half my face. Best thing I ever did for myself, getting that sucker whacked off. 

So, what are your thoughts? How is your breast size? What do you think about insurance covering breast augmentation or reduction? 

Pecking Order

Flamingos fighting

Just take a nip 
Here and there
So I can be pretty
Fix my hair
Pull and tuck
Gouge at my eyes
Make me look pretty
Slim my thighs
Whiter teeth
A larger bust
I’m still not pretty
Another adjust
Raise those cheeks
Now my nose
Got to look pretty
Paint my toes
Some fuller lips
Sharper jaw
She is so pretty
Fills me with awe
Chisel me down
Tighter skin
I could be pretty
If I were thin
Sew me up
Dress me up
Give me more pain
So I can feel alive
So I can feel loved 
Still not happy
Just a pinch more
Want to be pretty
Want to be adored
Soon I’ll be there 
You wait and see
Soon I’ll be pretty
Soon I won’t be me

Hanging Out

Old Ferris wheel in black and white

I find that I am more and more conscious of my own nose hair. What is interesting about this is that I never, ever notice the nose hair of other people and if I did happen to see some bits poking out of a nostril it would not gross me out. So WHY on Earth do I care about my own nostril hair? 

Is this because my nose hair is getting longer? 

Perhaps I am growing more and more sensitive about the change of appearance that comes with aging and I am finding myself more interested in controlling the things that I can have some influence over? 

And then I wonder if there are people who do care about other people’s nose hair and if so, why do they care? What else do they do in their free time?

These are the thoughts I have on a Sunday morning after yet again having one of those pesky hairs ripped from my poor tender nostril by the stupid nose hair trimmer that is supposed to CUT the stupid things. I swear, next time I may as well just tweeze them out….

Pointing Ahead

img_3944

I thought I would do something a little different for the last post of 2016…

On A Slave to the Face from the other day, DM made a comment that got me thinking about our perception of beauty. What do we think the world wants to see in us and how does that compare to what we actually want to see in others. How does it compare to what they see in us?

What attracted you to your partner? How do you let them know what you find attractive about them? Do you think they believe you? What does your partner say about you? How do you feel about their compliments? What would you change about yourself? What would you change about your partner? Why?

This year I resolve to be freer with my own words of praise and a more gracious recipient of compliments from others.

A Slave to the Face

Victorian tombstone
I am going to let you in on a little secret: I own a Princess Leia slave costume. 

Yes, for those purposes. I am not going to claim that I ever looked good in it but I did purchase it and have worn it more than once. Well. Maybe more like *not worn* it….

You can say all sorts of things about sex and slavery and the subjugation of women and how wearing such a costume betrays feminism at its very core but here’s the thing: Princess Leia choked the ever lovin’ life out of Jabba the Hut while in that costume. She strangled that slimy, disgusting bastard with the chain that bound her to him while wearing a bikini. She wasn’t cowering in a corner, ashamed of how much she hated her exposed thighs. She owned that chain and she used it to her advantage. That is some kind of woman. I long for that kind of confidence.

I am not who you think I am.

You will remember in my post last year that it really bothered me how much criticism Carrie Fisher took for her appearance in The Force Awakens, how I didn’t think it was about her so much as it was about our own aging and mortality. For many of us, she was a tangible way of measuring the passage of time. Her appearance spoke to our own finite existence, our own mortality. It was like holding a mirror up to our souls and for some recognizing that we did not like what was reflected there.

She looks older. 

So do I. 

I am not what others see in me.

There was a time that I would get told by complete strangers that I looked like Nicole Kidman or Jullianne Moore or Bree from Desperate Housewives. No one says that about me now. My face and my body are changing. The days of Star Wars kink fests are over.

I am not who I think I am.

I grappled with the anxiety and panic of that for a few years. I tried laser… once. The pain from that was indescribable. And Botox… once. Let me tell you, there is nothing quite like the contortions and fasciculations from Botox wearing off. Then, I smeared the most godawful smelling stuff derived from baby foreskin on my face twice a day while choking back my own vomit.

My face is NOT all over the big screen and yet I freaked out, doing crazy stuff in a vain attempt to hold onto my youth. There was the dysphoria of not recognizing the face staring back at me from the bathroom mirror and the despair of feeling my sex appeal dwindle away.

Who am I now?

I cannot even imagine what Carrie Fisher went through in her lifetime, the tremendous courage it took for her to play the role of Leia once again decades later. As a little girl I wanted to be like Princess Leia. I wanted to learn to shoot a blaster, sure, but I also wanted to look that good in a bikini slave costume. What I did not realize at the time was that virtually all women, no matter how beautiful, suffer from a distorted image of themselves. Princess Leia suffered. Carrie Fisher suffered. Now I find that Carrie Fisher herself is my hero even more so than her character ever was. 

But then Carrie Fisher died.

So will I.

Suddenly a face seems like such a triviality. I won’t say I am completely over myself or my vanity, but I am working on it.

May we all rest in peace…