Do not do unto others as you would have them do unto you—they might have different tastes.

George Bernard Shaw

This past week began with rain in Phoenix, so much rain that for the first time since I emigrated here, the weather forced me to stay home from work and my daughter to miss school. Even my mother called from her sunny kitchen in rural Derry, where the weather is cooperating and will maybe stay dry for the On Home Ground Festival in honor of our Seamus Heaney this weekend.

Transformed by flash-flood warnings, power outages, cars abandoned on lakes that were freeways the day before, the Valley of the Sun was in a state of emergency, even making it into the record books as the 100 Year Flood. As for the rain, it was bucketing down for most of the day – a solid 10 on The 11 Levels of Irish Rain.

Typically, Phoenicians welcome the rain, as you would if you only get five inches of the wet stuff each year. Myself, I can’t stand it. It reminds me of why I left Northern Ireland and its grey skies that weighed heavily on me at twenty-one – unemployed, restless, and always praying for the sun to shine.

But on Monday, I was grateful for the rain, especially when an e-mail came from work, informing me that I could work from home. Don’t get me wrong. I enjoy my job and my co-workers, many of whom have held me up on the darkest days over the past year and a half – and there have been dark days indeed since the death of my husband last November.  Of course there have. After all, “death of a spouse” is at the top of the Holmes-Rahe Stress Inventory. Still, I find myself making irreverent jokes about it, playing “the widow card” (when I’m not playing “the cancer card”).  Laughter is much more acceptable in the workplace than crying.

But I have felt like crying.

A week before the Monday Monsoon action, a familiar fear moved in again. Since January 2012, I have tried not to worry that the cancer that first showed up in my right breast will reintroduce itself in my bones or my brain or my liver.  I have tried not to think that it will sneakily take up residence in a vital organ, but the truth is that every little headache has been a warning bell, every little twinge in my left hip, a harbinger of disease (Number 6 on the Holmes Rahe Stress Inventory). I know I should know that living in fear is no way to live.  Growing up in Northern Ireland during the Troubles, I learned early on that you can’t not go outside for fear of being blown up by terrorists. If you succumb to that fear, you’ll never go out.

Mostly, I have told myself I’m fine. I have even permitted people to cajole me and tell me – with authority – that the cancer “is cured” or “in remission,” even though I know it has not even been three years since the diagnosis and that my oncologist would not use the word remission. (I am holding out for five years and a pronouncement of NED – No Evidence of Disease). I have allowed people to tell me that God would never give me more than I can handle, and I refrained from biting her head off when a woman I barely know admonished me to put “my big girl pants on.”

But when the blood appeared a week before the storm, I was angry at God for giving me more to handle, because I’m not sure I can.  Surely God knows that stress, by definition, is when “demands exceed the personal and social resources the individual is able to mobilize.”

My personal resources are maxed out.

It didn’t help – and I knew it wouldn’t – that even before calling the doctor, I consulted Google, and after an interminable trek through the Internet, I convinced myself that I must have endometrial cancer. I’m realizing that in spite of the shock in November 2011 when I heard, “You have cancer,” and the shock in November 2013 when I heard my best friend tell me on the phone, as she stood over my husband’s lifeless body, “Ken is gone,” I have reserved a little space inside to be shocked again.

Naturally, the bleeding began on a weekend, Labor Day weekend. Who wants to go the Emergency Room on a holiday weekend?  So I didn’t. I waited until the Tuesday to make an appointment with the best gynecologist in the world, the one who had cared for me 17 years ago, when I was pregnant with Sophie.  Of course I couldn’t remember when I had last been to see her. (Menopausal women are not known for their ability to recall details). As it turns out, I have been a bit negligent, so much so that I had to complete all the paperwork of a new patient.  Still, she saw me as soon as she could and before examining me told me we would be keeping our fingers crossed for a little polyp that she could just pluck off, but no. That would have been too convenient.

Because she knew I would spend the entire weekend Googling, she tried to schedule a hysterosonogram for that afternoon. No such luck.  It would be another week before that happened with another doctor and another three days before she would tell me that yes, the uterine lining is abnormally thick, there are polyps in the uterus, and we need to do a “mega biospy” next week.

. . . followed by more waiting. More bleeding. 

(Meanwhile, what if I bleed to death?)  Oh, and by the way, does this have anything to do with the Tamoxifen I took? Possibly. Possibly.  Was I wrong to have said no to chemo? Plenty of strangers thought I was and – in front of my daughter -scolded me for not partaking of the treatment and its side-effects. So did I bring this on myself? Did I?

Yes. I am stressed. And even though menopause is not explicitly called out on the Holmes Rahe Stress Inventory, I still score over 300 points which has stressed me out even more this morning.  

Come to think of it, why isn’t menopause on the list? It bloody well should be. Looking at items 34 – 40. I could check every one because of menopause, but I don’t want to score even more points thereby increasing my odds of developing a stress-induced health breakdown. It’s not quite a “major personal injury or illness,” but menopause is definitely a major change, and we don’t do a very good job talking about it or supporting women through it. Surely the time has come for us to address this given the numbers of women over fifty who are now in the workplace.

According to an AARP article:

“The rate for workers 55 and older . . . in 2013 was 40.3 percent. Although female workers still trail men in sheer numbers, look how far they’ve come. In 1975, the proportion of women 55 and older in the workforce stood at 23 percent, while the rate for men was more than double, at 49.4 percent. Last year, the labor force participation rate was 35.1 percent for older women.”

Yes. We’ve come a long way, baby. So much so that in its  Job Tips for 50+ Workers article, the nice folks at AARP used a Getty image of a man in a suit with the obligatory briefcase. He’s not quite Don Draper – he looks a tad too nervous. Still, he doesn’t have to worry about bleeding all over that nice white couch, does he? Dealing with the symptoms of menopause while holding down a full-time job makes it difficult to appear poised, professional, confident, and competent all at the same time.  So we who suffer try to conceal it, and those who don’t might dismiss it as a “normal” part of the aging process. Thus the symptoms of menopause are often “under-recognized as a disruptive health condition” (Kleinman et al).  Were these same symptoms associated with male menopause, I think things might be a little different.

So what should we do? For a start, we should talk about it. When we design our workspaces, we should consider them from the perspective of a menopausal woman  – a hot one – drenched in sweat, with boiling hot flashes, unpredictable heavy bleeding, pain, bone-crushing fatigue, memory loss, and mood swings. We should think about temperature and ventilation, and the availability of feminine hygiene products – like a tampon machine in the restroom.

I’m ashamed to admit that until it happened to me, I relegated all the complexities of menopause – blithely unaware of chemical menopause brought on by breast cancer treatment – to a vague category of “female problems.”  It never even occurred to me to consider whether menopause “counted” or was covered by the law that requires employees to protect the health, safety, and welfare of all employees.

Citing research conducted by Amanda Griffiths of Nottingham University (Women’s Experience of Working through the Menopause), Michael Rubinstein offers the following tips for employers:

1. Raising awareness of menopause in an occupational setting through health promotion programs and awareness training for managers.
2. Organizing social support within the work place.  This could include information packs, mentoring schemes and lunch time support.
3. Offer flexible working hours, job sharing, and opportunities to work from home.  Many women experience tiredness.
4. The temperature of the work environment can be an issue, especially in refined spaces. Fans and temperature controls could be implemented.
5. A “rest” room where women can relax, just to have some space.
6. Cold drinking water – many organizations do not provide this.
7. Prioritize work life balance and maintain firm boundaries in working life and non-working life. Adopt buffer zones so that women feel in control more effectively. Many menopausal women experience feelings of ‘not coping’. If work becomes an issue encourage a specific time each day so that worries can be written down and then discarded.
8. Remain hopeful and optimistic – women experiencing the menopause often go through different types of emotions such as anxiety and depression. Remember these feelings do subside. Encourage women to discuss how they feel as these feelings are very normal.
9. Become a supportive manager –  women are more likely to discuss menopausal issues with somebody they feel able to talk to. This also encourages organizational loyalty and less absenteeism which can only be a good thing for all companies.

Until then, this menopausal woman will “stay strong.” And, while I may not remember exactly what you have said or done over the past couple of years, I will never forget how you made me feel – mostly loved.

“For strong women” Marge Piercy

A strong woman is a woman who is straining.
A strong woman is a woman standing
on tiptoe and lifting a barbell
while trying to sing Boris Godunov.
A strong woman is a woman at work
cleaning out the cesspool of the ages,
and while she shovels, she talks about
how she doesn’t mind crying, it opens
the ducts of the eyes, and throwing up
develops the stomach muscles, and
she goes on shoveling with tears
in her nose.

A strong woman is a woman in whose head
a voice is repeating, I told you so,
ugly, bad girl, bitch, nag, shrill, witch,
ballbuster, nobody will ever love you back,
why aren’t you feminine, why aren’t
you soft, why aren’t you quiet, why
aren’t you dead?

A strong woman is a woman determined
to do something others are determined
not be done. She is pushing up on the bottom
of a lead coffin lid. She is trying to raise
a manhole cover with her head, she is trying
to butt her way through a steel wall.
Her head hurts. People waiting for the hole
to be made say, hurry, you’re so strong.

A strong woman is a woman bleeding
inside. A strong woman is a woman making
herself strong every morning while her teeth
loosen and her back throbs. Every baby,
a tooth, midwives used to say, and now
every battle a scar. A strong woman
is a mass of scar tissue that aches
when it rains and wounds that bleed
when you bump them and memories that get up
in the night and pace in boots to and fro.

A strong woman is a woman who craves love
like oxygen or she turns blue choking.
A strong woman is a woman who loves
strongly and weeps strongly and is strongly
terrified and has strong needs. A strong woman is strong
in words, in action, in connection, in feeling;
she is not strong as a stone but as a wolf
suckling her young. Strength is not in her, but she
enacts it as the wind fills a sail.

What comforts her is others loving
her equally for the strength and for the weakness
from which it issues, lightning from a cloud.
Lightning stuns. In rain, the clouds disperse.
Only water of connection remains,
flowing through us. Strong is what we make
each other. Until we are all strong together,
a strong woman is a woman strongly afraid.

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