One day, nine months before Salman and I separated, I was at a studio, shooting the photos for my second cookbook. There’s a photo of me by a window, looking out onto the Bowery. In it, I look contemplative and happy, pretty. In the real world, I was realizing I had started bleeding, and was hoping against hope the blood wouldn’t leak through my underwear and onto my clothing. I hadn’t brought tampons—I was two weeks into my cycle—so that afternoon, I stuffed my underwear with tissue.
My family doctor was already worried. He knew I’d had problems connected with my period and sent me to see a specialist on the Upper East Side. The day of the appointment was a hectic one. I rose at five that October morning to do an early cooking segment on the Today show. The day included, among other things, a work lunch, meetings with my editor and a group of buyers about the release of my new cookbook, and an early dinner at Bergdorf Goodman, where my publisher’s wife was launching her evening dress collection. I squeezed in my appointment just after running home to change and just before the dinner.
When I hailed the cab to the doctor’s office, I had on a shiny, strapless Marchesa cocktail dress embroidered with large cranes and flowers in gold, green, and magenta thread. The birds’ wings and eyes twinkled with little sequins. My TV makeup from the morning had faded nicely, and in the car I touched up my lipstick so I would be ready to dash to the dinner afterward.
In the office, I took a seat across from the doctor at his desk, feeling silly for being so overdressed. The doctor, Tamer Seckin, came in and asked me a series of very thorough questions, almost too personal, even for a medical doctor. “How are your sexual relations with your husband?” “Has your libido dwindled over the years you have been together?” (Doesn’t everyone’s?) “What is your emotional and mental state during the week of your period?” “Do you have gas, or constipation?” “Do you ever argue about sex?” “Do your bra and pant sizes change within a month?” “Do you become irritable inexplicably?” “Have your period and the surrounding symptoms ever been an issue in your professional or home life?” “Do you feel understood?” I was taken aback.
He asked me to don a papery gown and meet him in the exam room. When I stripped down, I noticed deep red grooves imprinted on my torso from the dress’s corset. In my effort to multitask the day, I hadn’t thought things through. I wondered if he would think me so superficial that I was willing to constrict myself in the garment so extremely in order to look good. But surely he had seen a corset or two in his time?
I felt embarrassed in front of this doctor and not solely because of my nakedness, yet I didn’t completely understand why. The nurse held my hand, and Dr. Seckin wielded what I learned later was a pediatric speculum. I squeezed her hand to fight the pain. He performed two exams, one that I had never had before. He did a rectal exam. No one who had ever examined me in all my thirty-six years had ever performed that exam. No gynecologist had ever been so invasive, physically or otherwise. After he had finished, he asked me to get dressed and meet him in his office. The clock above his head read 6:52 p.m. I had a dinner to get to.
“Will it take long, doctor?” I asked.
“Yes, Ms. Lakshmi, it might.”
Sonograms and speculums can see beyond even the most sincere smile, the most glamorous cocktail dress. Sitting across from Dr. Seckin, I heard the word “endometriosis” for the first time. Over the course of the last twenty years, I had dutifully gone for checkups. I had seen doctors and specifically gynecologists of both sexes in various countries around the world. All of them were fine with prescribing pain pills for regular consumption, and reiterated what my mother had said when I first found out about the atrocities my body was capable of in the name of womanhood. Yes, for some women, it’s a lifelong curse, they echoed. No one indicated that what was happening was serious, or damaging long-term, or anything like that. Some doctors thought I was exaggerating. Others became irate, including a woman who insisted that it couldn’t hurt that much while she pushed her cold metal speculum inside me. I flinched, wincing in pain. One doctor actually smoked during the exam in Milan. I minded the smoker much less, especially since he at least put me on birth control, which did help for a time during my twenties.
I had quit using birth control a few months after my husband and I first moved in together, just around my turning thirty. Spending my twenties under the influence of hormones was enough and I could see the side effects taking their toll on my skin. I had also spent most of that time as a smoker and that had preyed on my mind, too. Now at the age of thirty-six, my body, unbeknownst to me, had been going full tilt for six years, producing excess tissue it could not expel at a much more rapid rate than in my twenties, when I was on contraceptive hormones to suppress the disease and its effects.
A healthy female body, Seckin explained, expels uterine lining during menstruation. Not so in the case of a woman who has endometriosis. Instead, the tissue pools in the body’s reproductive cul-de-sac. The body then reabsorbs the lining, which grows. But the lining is no mere plasma or scar tissue; it has glands and responds to hormones—forming layer upon layer in the uterus, a new one each month that spills out into the peritoneum, or lower abdomen. It can pool outside the uterus and attach itself to all the internal organs of a woman with the condition, preventing normal functioning of those organs. It can choke her reproductive system, as weeds in a healthy garden can take down the tallest of shrubs. It can cause gastrointestinal problems and often is misdiagnosed by gastroenterologists, as had happened to me just months before, in April. It can bring your house down with pain, excruciating pain that is ever present during the most normal functions of everyday life. It is very dangerous to the physical, mental, and emotional well-being of a patient as well as the general well-being of her whole family. I had gotten my period twenty-three years earlier, a present from puberty that seemed like a bad joke that September morning. Now, decades later, on this evening, I sat in Dr. Seckin’s office, hearing for the very first time that I had a disease called endometriosis, which could threaten my fertility. I had just turned thirty-six.
For twenty years, this powerful tissue had amassed and twined inside me, growing outward from my uterus, spreading through my body and coiling around my insides. It felt like it had choked and mutilated every part of my being. I wasn’t crazy, or dramatic, and I didn’t have a low threshold for pain. In fact, I probably had a high threshold for pain, and that may have been part of the problem. Dr. Seckin didn’t understand why I wasn’t writhing in pain outside his office. “I believe you when you say you think you have answered my questions honestly and sincerely,” he pronounced very deliberately in his strong Turkish accent. “But what I see of your anatomy and the picture you are painting of your life seem very different.”
So much was suddenly so clear. Just months before, in April, on our second wedding anniversary, I’d had to be rushed to the hospital late at night—the tissue had wrapped itself like a tourniquet around my small intestines, though I hadn’t known then what was really happening. I had been in pain all day but didn’t want to disappoint Salman, who had reserved a table at Bouley weeks before. To his credit, he suggested we stay home, but I wanted to celebrate with him. We both needed a good time together. I knew, too, that he expected to make love, something I wasn’t sure I was capable of. Until recently, we had always been hungry for each other and could never get enough. Lately though, we had been fighting more and more about our lack of intimacy. I figured that after the meal and a bottle of red, he might tire out or, better yet, I might feel better. My plan was not very well thought out. The chef insisted on our having the tasting menu. A third of the way through, I asked the maître d’ for a pillow. My lower back was throbbing and the pain was wrapping around to my abdomen, which was cramping, too. I thought the pillow might give me some support, or that I could find a more comfortable position leaning against it. With each course the waiter brought, my pain increased. I barely made it through the meal.
When we got home, I climbed up th
e stairs to the fourth floor. Halfway up, I began to have trouble breathing and stumbled. I made it to our bedroom, tore off my red jersey dress, and reached for the heating pad, which was always plugged in and waiting under my pillow. I turned on my side and doubled over. My husband came in and I told him that in addition to the back pain, I had begun cramping and that it really hurt. And I didn’t know why. “Of course,” he said. “How convenient for you. It’s not your period and it’s not ovulation. What is it this time?”
This didn’t sound quite as cruel at the time as it seems now on the page. For years I had tried hard to hide my pain from others, even from him, and to dull my symptoms through denial and keeping busy. My mother told me from a very early age what her mother had told her: that this was just our lot in life. She said that the only thing to do was to try very hard not to let it affect any more of my life than it had to. So I compartmentalized the pain, tried to mostly sequester myself in bed until it subsided enough that I could get up. Now I understand that we were both feeling the effects of this vexing disease. To this day, my mother hasn’t been officially diagnosed, but she has suffered the same mysterious pain, the same stab-in-the-dark surgeries. One doctor, ignorant of the cause of her suffering, threw up his hands and removed her appendix.
My husband never truly grasped the extent of my pain, in part because I took it for granted. Now Dr. Seckin was telling me that I probably had pain during sex. I wasn’t sure that this was true. For the first several years together, our intimacy was fully gratifying. I don’t ever remember having pain during sex. But I’d gotten so used to all the other pain that I didn’t even identify it as pain anymore.
Recently I could remember my husband complaining that I rarely wanted to make love, and when I did it was only after we had been drinking. He felt justifiably rejected. I asked Dr. Seckin to call my husband and explain the disease’s particulars, which I was only just beginning to understand. Coming from a doctor, I thought, the information would be less charged, more empirical. Then my husband would have to understand that I wasn’t just making excuses. Yet my need for reinforcements, though I didn’t understand it at the time, reflected a rift in our relationship that grew ever wider.
Now, after just two years of marriage and seven living together, our intimacy was fraught. I began to feel lonely, isolated by my pain. I started to feel happier—or more appropriately, less unhappy—when he wasn’t around. In his presence, I felt as though I was not measuring up and was letting him down if I didn’t do what or go where he wanted. By myself I was free to wonder what was increasingly wrong with my body without being made to feel like I was exaggerating. I was free to wallow in my malaise, and nurse myself without seeing the disappointment in his face. I needed to deal fully with what was happening to me. And I could only do that when I was alone.
That night of our second anniversary in April, he must have thought the pain I reported was in fact equivalent to my saying, “I don’t feel like it and have to get up early.” After a heated exchange of many words and much door slamming, he went to sleep in the room across the hall. Around midnight, I called an ambulance and Salman accompanied me to Mount Sinai hospital, where a gastroenterologist was waiting. Remember, this was before Seckin’s diagnosis. The doctors were still clueless. The doctor who operated that night was like a landscaper, snipping off a small, unsightly root—“just scar tissue, perhaps from your earlier surgery for ovarian cysts, but you should be fine now,” he said—while a massive, gnarled system still lurked beneath my house, threatening to crack the foundation. Sure enough, in the weeks and months after this surgery, the pain resumed. And my husband became increasingly frustrated with me. And I became more and more worried. Not only for my marriage, but also for my own body’s health.
Now, just six months later, Dr. Seckin was telling me I wasn’t crazy for not feeling like being intimate. He said every fiber of my being would be repelled by the idea of intimacy because of what was going on in my reproductive system and with my hormones. In fact, “I’m surprised you walked into my office on two feet,” he said. I started to cry. I remember worrying, for a second, about ruining my makeup.
In the car inching its way down Fifth Avenue, toward Bergdorf Goodman and this glamorous party, I looked back on my past with a new understanding. This sickness, the “endo-whatever,” had stained so much—my sense of self, my womanhood, my marriage, my ability to be present. I had effectively missed one week of each month every year of my life since I was thirteen, because of the chronic pain and hormonal fluctuations I suffered during my period. I had lain in bed, with heating pads and hot-water bottles, using acupuncture, drinking teas, taking various pain medications and suffering the collateral effects of them. I thought of all the many tests I missed in various classes throughout my education, the school dances, the jobs I knew I couldn’t take as a model, because of the bleeding and bloating as well as the pain (especially the bathing suit and lingerie shoots, which paid the most). How many family occasions was I absent from? How many second or third dates did I not go on? How many times had I not been able to be there for others or for myself? How many of my reactions to stress or emotional strife had been colored through the lens of chronic pain? My sense of self was defined by this handicap. The impediment of expected pain would shackle my days and any plans I made.
I did not see my own womanhood as something positive or to be celebrated, but as a curse that I had to constantly make room for and muddle through. Like the scar on my arm, my reproductive system was a liability. The disease, developing part and parcel with my womanhood starting at puberty with my menses, affected my own self-esteem and the way I felt about my body. No one likes to get her period, but when your femininity carries with it such pain and consistent physical and emotional strife, it’s hard not to feel that your body is betraying you. The very relationship you have with yourself and your person is tainted by these ever-present problems. I now finally knew my struggles were due to this condition. I wasn’t high-strung or fickle and I wasn’t overreacting.
All my life, I had had the sense that something was wrong and couldn’t put my finger on it. I had seen college roommates pop two ibuprofen pills and skip off to basketball practice with no problems when they had their periods. I always wondered what was wrong with me: Why did I have such trouble dealing with one of the most basic and common functions Mother Nature handed all women? I heard my mother’s voice echo in my head: “Because I had it, and your grandmother had it. It’s just what happens.”
In my mother’s generation they would just take out all your plumbing if it got really bad. But now, “We can treat it with laparoscopic surgery, excise this problematic tissue and expel it from the body,” said Seckin. “I am surprised you slipped through the cracks without any treatment this long.”
If he was surprised, I was flabbergasted. I had dutifully gone to my gynecological checkups and not one doctor had ever brought up this disease. I even had two ovarian cysts removed at Cedars-Sinai Medical Center, where my Beverly Hills gynecologist had said that one of my cysts was “endometriotic,” or blood-filled. But he never said the words “You have endometriosis. It is a condition that needs to be treated and monitored. It is a serious condition that can and will not only endanger your health and the proper function of your internal organs, but will also affect your fertility.” In fact, endometriosis is one of the three major causes of infertility in women, and 10 percent of all women worldwide suffer from it.
As I reached the dinner, I tried to stuff back down all the emotions that had bubbled up, just as I’d stuffed away from view the pain and discomfort for all these many years. Just like I struggled to fit all my cosmetics back into my small evening bag after I dabbed and patched my face back together. The car door opened; a flashbulb went off. I hopped out of the car and fixed a smile on my face. At dinner, there were toasts and cheers as we looked out over Central Park, the first of the blue night’s stars visible above the bony trees and the fallen autumn leaves.
T
hree weeks later, on the Wednesday before Thanksgiving, Dr. Seckin performed his first surgery. I picked the day in the hope I could recuperate over the long weekend without anyone knowing I’d been out of commission. At first, he guessed the surgery would take an hour and a half, and I’d be home the next morning and back at my desk by Monday.
I awoke to the sound of my own voice. I smelled the faint odor of mustard seeds and ginger. In the darkness of the hospital room, my mother, two aunts, an uncle, and various cousins kept vigil, leaning or sitting on every surface and quietly nibbling food from round tin containers. Top Chef was on the TV. There was a Thanksgiving marathon. Dr. Seckin came to speak to me in the recovery room after the surgery was over. In my anesthetized haze, I heard him say that my right fallopian tube had been rendered functionless from the buildup of endometriosis tissue. He asked if I knew that part of my left ovary had been removed during a previous operation. Incredibly, I didn’t. I learned the surgery had taken four and a half hours, my kidneys were in stents, I had stitches on four major organs, and that of the nineteen biopsies performed, seventeen came back positive as deeply infiltrating endometriosis tissue (also known as DIE). Rather than an overnight stay, I spent five days in the hospital. Twenty-four hours after my discharge, my husband had to leave for a trip. “The show must go on, after all,” he said.
My aunt Neela, who had flown in from India, and my mother, who had come from Los Angeles, cared for me, something they had done at different times throughout my life. Over the next two and a half months, as I lay bedridden on the top floor of our brownstone, they took turns, flying in and out. As they tended to me, my husband toiled in his office below. Over those many weeks, on my back staring at a white ceiling, I had ample time to think. There was nothing to distract me, no work I could do or ways to keep busy. Now, the thoughts that had exploded like little bombs in my head as I drove down Fifth Avenue that inky fall evening could no longer be muffled.
Love, Loss, and What We Ate Page 4