A Day in the Life of a Midlife Woman
Upon coming home from nearly a month on the road, I have a laundry list of to-do items. As usual, I bite off the ones that seem simple and straightforward first.
Iris is the nurse practitioner I’ve been going to for years. I need to schedule an appointment to be evaluated for bioidentical hormone replacement therapy. I’ve avoided this for a while. I’ve tried other things. I’m not taking this step lightly or without research and consideration. And...it’s time.
“I’m afraid I can’t schedule you,” she says. She’s been pushing against this decision for a while, giving me various supplements instead. I think this is why and I get a little tight.
“Iris, I’ve tried. I really have. It’s just not working. And you said...”
“No, it’s not that,” she inserts. “It’s your insurance,” and she goes on to explain that she’s basically been removed as an option from my insurance company because she is no longer classified as a “nurse/midwife” but as a “nurse practitioner” and long story short, they seem determined to ruin her over it.
I have been seeing this woman for years. I brought my first daughter to her when the time was right, and I was going to bring my second daughter to her this summer. She has been practicing for several DECADES. She has delivered hundreds of babies, and now, in her later years, has focused less on delivery and more on gynecological care with a holistic approach. She never rushes me through an appointment, she’s interested in my life, she asks genuine questions, and takes time to explain her medical decisions to me, while also listening to and respecting my wishes when I disagree.
In other words, she’s a dinosaur in the industry. And now, they’re trying to take her out.
I’m sick about it. I tell her I’ll write a letter to the insurance company (which I will). But the to-do list beckons. I cross off “Call Iris” and write “Find doctor for bioidenticals” and move on to the next item.
This one is for my mother, who is quickly declining into dementia. I’ve received a call of concern from the doctor at her assisted living facility who sent her for an MRI because of the pace of her decline. He suggests I get her back to the neurologist.
“How’s August 15th at 4pm?” asks the receptionist.
“Far away,” I say. I reiterate the concern, and that time is of the essence. Which inspires a rant in her about how popular this doctor is and how hard it is for them to find someone else to see patients...
“Do you want to schedule an appointment with someone else?” she barks, and before I can answer, she continues, “No, no you don’t. No one does...” and she goes on for about three more minutes in this vein before I can tell her that yes, I’d be happy to schedule with someone else in the practice. To which she responds with surprise, “You would? Well, ok, I’ll write that down and call you when there is someone else. In the meantime, do you want August 15th or not?”
I briefly consider the fact that while bioidentical hormones reduce “mood swings,” I’m pretty sure that only refers to uninstigated mood swings. I take a deep breath and continue to advocate on my mother’s behalf.
You see, my mother was a nurse, which made her a powerful health care advocate – something she passed on to me in spades. It is only the day after Mother’s Day. There is no other gift I can give her that will have any meaning to her at this point.
But this. I can do this.
“Is it possible for me to leave a message for the doctor? Maybe he can address my concern in some way in the interim?” She grudgingly takes my message and tells me she will call me if there is a cancellation.
Meanwhile, I’ve gathered a list of names for my bioidentical hormones – and I quickly learn that I’m now deep in the terrain of “anti-aging medicine,” which happens to also be medicine not covered by insurance. This dramatically changes the interactions with the front desk staff. I am now a “client” not a “patient” and this is a sales call more than anything else. After about three calls, which end in me saying, “let me get back to you,” it’s time for a walk.
Something makes me go left where I would normally go right, and suddenly, I notice a sign that I know I have driven by HUNDREDS of times – Center for Integrated Medicine.
Wait, what? Could this be, literally, a SIGN??
I decide to go in and see what they do. I’m excited at the prospect of this practice being so close to my home, and possible being exactly what I need.
The door is open, but no one is behind the desk or in the waiting room. In a minute or so a short woman carrying almost more charts than she can see over appears, and is surprised to see me standing there. She doesn’t introduce herself, but I eventually discover that she is the doctor.
I tell her what I’m there for – and the minute I say “bioidentical hormones” I can see we have a problem. Namely, that she thinks I’m a complete idiot. She explains that she’s a functional medicine physician. She says it slow, as if talking to a child and asks, “do you know what that is?”
I assure her that I do, and that it's exactly what I'm looking for – I leave out the part that I spent almost four years ghostwriting for functional medicine physicians. I need a urine test not a pissing contest. I drop the name of my nurse practitioner and she knows her. This gives me enough credibility for her to continue speaking to me. But barely.
“Why do you think you need bioidenticals? What are your symptoms?” While it’s beginning to feel more like an interrogation, I answer. When I mention the hardest one – brain fog – she snaps, “that’s not from hormone imbalance!” I ask her what else it could be, and she snaps again, “It could be anything!”
Right, I think, like I could already have signs of my mother’s dementia. Do you think I don’t know that?
At that exact moment, the phone rings and it’s my daughter, calling from Dublin. “Sorry, I have to take this,” I mumble and turn away. She yells after me, “you don’t need bioidenticals...”
I rush out the door, as if I’m running for my life.
I’ve given up on my to-do list for the day. I’ve still got jet lag, so by 4:30 (which feels like 9:30) I pour a glass of wine. The phone rings again and I recognize the number. It’s my mother’s neurologist’s office, and I think, because I’m either an eternal optimist or a glutton for punishment, Oh great! Maybe they’ve had a cancellation. Or better yet, the doctor is calling me back.
“I’ve spoken to the doctor, and he suggests you call a hospice program for further support,” she says, matter-of-fact.
“Excuse me?” My ex-husband is a hospice nurse – so I happen to know that they don’t make that suggestion until the patient has six months to live. “So, this is how you tell me her prognosis? Is that how long he thinks she has? Is that where we are?”
“No, no, no,” she says. “Some of them offer services up to a year.”
I think she meant to be reassuring. But then she looks at the chart and realizes my mother is already in an assisted living facility and says, "Oh wait. That doesn't make sense. Never mind. I'll remind him that she’s not living at home and see what else he says. Sorry.”
I can’t really speak at that point. So she continues, “And I’ll call you if there’s a cancellation,” and hangs up.
Here’s the thing. I don’t think I had a particularly bad day. And I don’t think anything particularly unusual happened. At the end of the day, when a friend asks, “how’s it going?” I don’t even relate all this. Instead, I talk about my existential crisis.
Because it’s so much easier to have an existential crisis than it is to acknowledge that this is what we’ve come to. This is how we speak to one another. This is how we care for one another. This is what we’re up against.
I’m a fighter. I’ve got a sharp tongue. I’m a protector. I’m an advocate. I probably should have been a lawyer. It’s what all the career prediction tests in college told me I should do. And I very specifically didn’t take that advice. Because I knew that profession would eat me alive. I knew I would have to give up my heart to do it. I knew it would be easy for me. And I knew it would kill me.
But in choosing as I did, I don’t have the luxury of giving anger or frustration the final word. I feel all the way into it.
So, today, I am sad. I am hurt. I am afraid. I am defeated. I am quiet. I am daunted. I feel the part of me that would rather just give up. I feel the indecisive one in me. The lost one. So, what now?
I have worn the hard hat before – and rammed into the wall over and over, until it breaks open. I’ve also paid the price for that.
Today, instead, I am going to soften. I am going to listen for what might be next. I’m going to wait, instead of push. I’m going to stay open, instead of close off.
And I am going to post this, because I know I’m not alone. And if there’s anything familiar in this for you, I want you to know that you’re not alone either.
Our circumstances might be wildly different. But underneath – there’s this fight lying at our feet. And we have to choose, in every moment, how to be with it.
Today, I protect myself with love. I wrap myself up in it like a blanket. And I let it heal whatever needs to be healed. Strengthen whatever weakened yesterday. Move on to other items on the list. I eye the ones that might nourish and support me...and vow to come back to the others when I’m ready.
This may be us. This may be where we are, who we have become. But it doesn’t have to be me.
I don’t choose this treatment, these roadblocks, this insensitivity, this system. But I do choose my response. And today, I choose love. And words. And tea. And softness. Let my armor wait in the corner. For a day when I really need it.
And suddenly, it dawns on me: I think this might be the wisdom of age that I keep hearing about.
It’s about time.