Curettage and Dilation
Wellness and Inequity In Light of George Floyd and the Protests
I’ve tried at times to explain my medical history to Mexican healthcare providers or to share my fertility story in passing conversations, but I haven’t had the right Spanish words for dilation and curettage. ‘Dilitación y legrado’ or ‘dilitación y raspado,’ Google Translate tells me.
Communicating via Google Translate is like using a condom. A film between me and the rest of humanity blocking the fullness of my creation from touching others. Dissatisfying, but my words still do get through. It’s but one price to pay for being here and not yet fully committing to the language; a barrier upon me to remove.
My ‘Barangrill’ Healthcare Options
I’m trying so hard to open myself to full healing, but life itself seems like it’s my condition. Somewhere between my Joni Mitchell “Barangrill” options, I’m wondering about a third way. Neither ‘the thumb and the satchel,’ nor ‘the rented Rolls-Royce,’ are appropriate options for me, as the song describes. ‘Some of the crazy you get from too much choice.’
Even though, from a health equity perspective, my penchant for organic food and functional medicine, indeed represents a first-class ride.
Even within those lifestyle privileges, there are economic layers, and I am on the lowest rung of the highest level. My choices include regional and local organic food, not pre-made Paleo snacks. I go to what seems to be one of only a handful of functional medicine practitioners in the entire country of 126 million people, where laboratory testing is solid but basic, and most supplements still need to be imported from the US. I do these things out of what I consider necessity, not choice.
I try to find ways to make it all stretch, for these kinds of costs are perpetually stretching me. Mine is not the life of Paleo delicacies, biohacks, and guru doctors. It looks the same from the perspective of a food desert or of someone living on the Mexican government’s healthcare alone, but in the weeds, it not only feels but is different. The results are windier, I might end up spending more and taking longer to heal, if ever, than I would with better resourced medical expertise, diagnostics, and treatment.
Knowing I couldn’t have even afforded the low-end of a functional health path had I stayed back home, and of course that many others don’t have this knowledge let alone access to it, keeps me both grateful and wary.
Somewhere Between Economic Immigrant and Expatriate
I could say that I’ve moved to Mexico to improve my health and I wouldn’t be lying. Somewhere between being an economic immigrant and expatriate, I believe that I represent a new US American reality that isn’t fully recognized. Plenty of people move here in retirement, watching their pennies and enjoying a better life, but the number of us who have also moved below retirement age to fulfill the “American dream” by leaving so-called “America” is steadily growing.
Maybe this is what the decline of the middle class looks like, being educated enough to know and want better, but without the economic possibility or firepower to truly pursue it. Maybe we’re just stupid because we followed our fields of service diligently rather than figuring out the slick tricks of investment and venture capitalism. We spent our best earning years paying off student loans rather than investing in any assets to speak of, and we started our family late to boot. But, maybe that’s just how it is.
Why I Moved Here
Of course, plenty of people make healthy lifestyle choices on budgets that are smaller than mine. However, with my variety and consistency of chronic diseases and conditions, I would either be on multiple pharmaceutical medications or in perpetual despair if I couldn’t commit to functional medicine practices.
I moved here both to raise my daughter better than I could and to live the functional health lifestyle I couldn’t back home. But moving here brings risk and awareness that I couldn’t have anticipated. Sometimes it’s hard to parse out what’s even true.
Would my career instability be the same had we stayed in New York? Would our social isolation and feeling like outsiders in upstate New York, our stepping-stone between New York City and Mexico, have eventually mitigated and might we have ultimately felt at home had we stayed close enough to the city we still pine for?
These questions swirl around in my head, and I recurrently have to let them go. Eventually I pan farther out and see there were a million possibilities in a million directions, and it doesn’t really matter because we’re here now.
Dilation and Curettage
To me, dilation and curettage always sounds like it means to expand and cut, but it’s actually French for expand and scrape. Either way, it’s equally brutal. Having undergone the procedure four times due to early pregnancy losses, I can attest that it’s the scraping part which really sucks. You’re anesthetized and semi-conscious, so it’s not so much the physical pain.
Rather, you feel the tugging of your parts and you know what you’re letting go. It’s a forever kind of sadness being split open on a table like that, as the remains of fetal demise are scraped out of you by hands you cannot see.
In my recurrent what-if’s, I have played out whether I should have bled naturally, rather than had those d&c’s. Being a busy professional and in each case feeling already quite sick, it never felt like the right option. Only when I had a difficult delivery that was potentially due to uterine scar tissue, did I realize that perhaps I should have surrendered my body to the natural waiting game rather than asserting surgical control.
Forensics Are the Bane of Middle Age
Of course, hindsight is 20–20, and forensics are the bane of middle age. It takes a creative mind to play out the thousands of what-if’s and synthesize enough to plot forth data points that yield useful reflection for moving ahead. Without your history, you’re doing the same things reflexively; with too much history, you’re stuck in sentimentality.
Life as an immigrant/expat or USer/American is kind of like that, a perpetual sculpting of your own reality, without even clear enough terms to define yourself crisply. It’s been painful to feel small and insignificant while adapting to an entirely new culture and language, watching from the sidelines as my home country implodes.
I’m not so naïve that I don’t know how blessed and privileged I am to be here, yet I am also aware enough to feel displaced by those very same options. Just because you made your best choice, doesn’t mean you love it. Just like you might hate your home country and still miss it because that’s what you know.
Curettage and Dilation
Having been through these experiences, I now imagine the procedure another way. Curettage and dilation, to scrape first and then expand.
For life in perpetual adjustment does that to you, it takes you down until you have no choice but to expand out from that new, bleeding place. It’s ironic that your chance of conceiving spikes right after such a loss.
Personal development does the same. Surrender yourself to healing. The only way out is through. Be vulnerable. Crack yourself open so the light can shine through. The thing those catch phrases leave out is the dull, relentless repetition of it. How many times do you have to surrender yourself to healing until you’re actually healed? How much of yourself do you need to crack open in order to walk in the sun?
Where is my third way, I wonder. What’s my actual destination after all of this work? Where will expansion take me?
Wellness and Inequity in Light of George Floyd and the Protests
In the throes of anti-racism urgency this week, in light of George Floyd’s brutal killing and subsequent civil and state unrest, the call to improve and sustain white alliances with black lives and leadership has been elevated. As I continue co-founding a health coaching organization intended to contribute to health equity by coaching those in need who wouldn’t otherwise access it, I’m acutely aware of the ongoing critique of the health and wellness movement.
Personal development often comes across as victim blaming, a market that targets only those who can afford it, a privilege that elevates individuality on the basis of one’s wallet.
A friend says, “our society only bestows the right to be an individual with all rights and protections to whites. Immigrants, indigenous peoples, and descendants of slavery are still waiting for those protections and visibility as valued individuals. While they wait, they suffer stress that goes unacknowledged which cascades to bad health and living conditions.”
A fellow coach in a Facebook group talks about marketing to new clients by telling them how the coronavirus targets those who are already “fat and out of shape.”
Some question whether providing health coaching for free to those in need might actually devalue the field itself.
I try in each case to assume some leadership and reflection, to use these disparate views to shape some synthesis about who we are as health coaches, and what we can do.
My Spoonie Self
And, yet, I am struck on the weekends with exhaustion. A list of things to do that are a mile long, and I find myself staying in bed, watching way too much tv.
What’s my problem this weekend? The acid reflux that’s risen so high that it’s invaded my nasal passages and blocked my breathing? Chronic fatigue that shot out of nowhere with a thousand hypotheses as to why? Have I slid again into depression or am I having a trauma response that I haven’t yet recognized as such?
I read an article about what it means to be a spoonie (a person with chronic disease and limited energy) and try to remind myself of the meaning of grace, which albeit Christian in sentiment, seems to apply well enough.
I go back to the basics, and I force myself to conduct my personal development routine. I ask myself whether, as a white middle class woman, this represents indulgence or progress, and I come to the same conclusion that both keeps me going and gnaws at me in equal parts.
The Human Condition: It Just Ain’t Pretty
The cure for the human condition is development that’s focused on progress. It just ain’t pretty. It’s not shared equally and it’s something to fight for internally for ourselves and externally for others.
If I don’t do it, if I don’t commit to it, if I don’t believe that there’s hope for me and for others, I simply don’t know what other next step I can take. It’s clearly not enough and it’s also not just, but neither does it let me off the hook.
Curettage and dilation, scrape off what’s lost and expand again beyond it, amidst more fertile ground. It’s a step. At least, it’s my next step, and I can only hope it helps.