My clearest memory of my freshman year of college takes place in the emergency room of Brigham and Women’s Hospital in Boston, where I was studying English Literature at Boston University and living on the eighteenth floor of Warren Towers, in Tower C, in a room with southern exposure. Despite the industrial-strength curtains, the sun cut its way into our concrete block of a room and woke me at ungodly hours. I could rarely get back to sleep because I was usually afflicted with similarly ungodly pain in my abdomen and lower back or a migraine headache.
The summer before I went away to college, my aunt had taken me to the gynecologist for the first time. He prescribed me birth control pills, ostensibly to treat the horrific cramps I was afflicted with each month, but also to control birth. I was, then, in a relationship with a miserable person called Barry, who left me by August for another girl he had met on the beach. When I asked him why—what did she have that I lacked?—he told me her breasts were bigger. And, “She always resets the mileage when she gets gas, so she knows how many miles she gets to the tank. It’s so hot.”
Faced with this crushing logic, I survived the rest of the summer on peach Yoplait and Parliament Lights. Then, at its end, I met an artist getting ready to move to New York City and work as a graphic designer. He was a painter, recently graduated from the local college with a fine arts degree.
“What do you paint?” I asked him.
“Nudes,” he said.
Within the week, I posed for him. That memory is less clear. It’s twilight in a waning summer. The Red House Painters play softly in the background, or maybe it’s Sarah McLaughlin, telling me to hold onto myself, because this is gonna hurt like hell. I remember that during the shoot (“I paint from photographs,” he told me, studiously, seriously), I didn’t know what to do with my body. Later, we broke up, and he painted a large canvas from one of these photographs and hung it in his first gallery show in Lower Manhattan. He called it, Em, Breakup Diet. In the painting, you can’t see the hot light of August falling on my small body. Oil paint, ochre-colored, renders well the blanket he draped artfully around my midsection so that only my arms, breasts, and legs are visible. From the outside in, it looks like the blood covering the gloved hand of the resident who practiced their first pelvic exam on me in the Brigham and Women’s ER, sometime around three o’clock in the morning in the fall of 1998, while I worked hard not to cry from the pain.
“Looks good,” they said to their attending.
“Looks good,” their attending said back, and began the process all over again.
About a third of the way through Emma Bolden’s The Tiger and the Cage: A Memoir of a Body in Crisis, out this past October with Soft Skull Press, there is a moment that becomes an allegory for the book itself. Bolden describes a game she used to play as an adolescent with her friend Mary, which “consisted entirely of saying the word penis, first in a whisper, then moving slowly up in volume until you had to scream penis or forfeit the game.” The Tiger and the Cage is like that game: a book where, simply by being faithful to her history, Bolden continuously raises the stakes.
This is not to say that the book is especially loud, or its tone shrill, or any of the other banal, misogynistic ways we have been trained to describe literature. Bolden gives us the simultaneous horror of what happened to her body and her doctors’ refusal to believe those events, even as they watch or, sometimes, help engineer them. This combination of witness-bearing against a backdrop of continuous, controlled silencing reads like a horror movie in which Bolden is the Final Girl. She survives to tell her story, but the book echoes with the killer’s command: Don’t scream.
Bolden suffers from endometriosis, although suffers, staring back at me from its place on the screen, seems both inadequate and too much. As she ferries the reader from her childhood in Alabama to college dormitories and Manhattan at the millennium’s turn, to the disoriented misery of the tenure-track, to, finally, her courageous choice to have a voluntary total hysterectomy at the age of 33, the physical pain she endures is rendered with terror. Her voice, though, is plainspoken and pitiless.I felt like a balloon a child had let go into the high blue sky. It would be years before I felt grounded again, back inside my body.
The callousness with which Bolden was received by doctors throughout her illness, which began in early adolescence and spans the rest of her life, is enough to make you scream, pound your fist against the wall in frustration, or throw objects across the room. I did, in fact, do all of the preceding at various points while I ripped through this book. By its end, Bolden describes medical trauma so horrific, I closed the book, closed my eyes, tilted my head back, and cried.
Emma Bolden and I were born in the same year, and we have the same name (she decided in high school to begin going by Emma). We’ve had similar educational and professional trajectories—BFA, MFA, tenure-track. So I read many of the scenes in her newest book with a wondrous and terrible recognition, having lived through my own version of big hair and big black smudged eyes like the girl on the cover of Hole’s Live Through This, lived through insomniac repeat playings of “Hey, Jupiter” on my Discman until I fell into a merciful sleep.
Bolden’s retelling of her body’s ongoing crisis is shot through with the signs of the 1990s, when the zeitgeist centered on the glorious mess of women like Courtney Love and Liz Phair. “I focused on their ability not only to admit that they were broken but to articulate how they were broken, and where and when, and who had broken them,” Bolden writes.
In 1998, just before I found myself breaking, I went to see Tori Amos on her From the Choirgirl Hotel tour. I had seen her two years prior at the Tower Theater, where she played alone with her grand piano for three hours. I was mesmerized. As she launched into “Me and a Gun,” her a capella song about how, late one night, a stranger broke into her car and raped her as she left her job as a nightclub singer, some guy yelled, “Play another song!” and laughed from the upper balcony. It echoed through the gilt-edged theater. Then, silence.
Then, dozens of angry young women’s voices bounced around the Tower’s famous acoustics, shouting, “SHUT THE FUCK UP!” and “GO THE FUCK HOME, ASSHOLE!” while Tori sat at her piano, silent and composed. When we quieted, she said, “I can’t believe you would come to my show and think I wouldn’t play that song, I’m so sad for you,” and we erupted, screaming, whistling, stomping our feet. When we were quiet, she finished her broken song about the man who had tried to break her.
The central relationship in The Tiger and the Cage is the one Emma Bolden has with her mother. As her young daughter experiences a series of terrifying symptoms, her mother begins the long process of trying to figure out what’s happening to her. She waits out almost ten surgeries, one that nearly ends in disaster. She holds up her daughter’s head while, unconscious from what is eventually diagnosed as dysautonomia, Emma continues to throw up and her mother must keep her from aspirating on the floor of a bathroom stall at her junior high school.
It’s possibly a function of my own motherhood that these scenes were the hardest to read, but that seems like the easy answer, the cop-out. The harder one, the one I’m trying to avoid by writing about glittering mini-dresses and techno light shows, is the thing I keep coming back to, here, in therapy, in conversations with other women my age.
I remember, at eleven, twelve, thirteen, as I bled and masturbated and orgasmed and tongue-kissed for the very first time, that my own parents seemed both afraid of, and disgusted by, my body and its burgeoning self. Sometime during this, I wrote out a sex scene in my diary. I was so young, I didn’t even know that men got erections or ejaculated, and it was full of misspelled words. Of course, my mother read it, and of course, she shamed me for it, even though anything I had learned about sex had surely come from the pornographic magazines my father kept barely hidden in our house. I tore the pages out of my diary and into tiny shreds, flushing them down the toilet.
When I got my first period, I said nothing to her or anyone. Having read about it, I knew what was happening, and I didn’t want any more shame over things beyond my control. I also felt like I was probably dying—in part because it happened to me so young, and in part because the secret was crushing.
Fathers also play a role in this story, as does sex, love, and marriage. Bolden identifies as asexual, which is another major theme of the The Tiger and the Cage, a thread that points to the unending, complicated tapestry of sexuality. The desire to have sex is not equivalent to the desire to have a child, despite the puritanical way this logical fallacy is driven into the minds of young American women. But in writing this last, I’m taking my cues from Bolden, whose motif about this problem is mathematics, something she calls “the Bolden Offspring Equation”:
I am __ years old. If I date Man __ for __ years before we get married, and if Man __ and I are married for __ years before we produce biological offspring, I will be able to produce a biological offspring before I am age __.
From the moment the first doctor diagnoses Bolden with endometriosis, the conversation becomes about how quickly she has to move—a better word is “strike”—if she wants to have children. Bolden is essentially advised to go hunting for a mate. But the truth—that heterosexual dating for young women is too often a paradoxical nightmare in which the woman is poised as the aggressor, knowing all the time that this is a dangerous game, and victory means giving in—is one that disgusts her, and in which she will not take part.
By the time I finished my first year of college, I was seeing two doctors in my hometown: my gynecologist, who I trusted and liked, and an internist who was my father’s close friend. Because the nature of my problem was clearly gynecological, I was at a loss as to why I was seeing the internist, but I went, dutifully, to the appointments. Because the nature of my problem was clearly gynecological, I also felt that I was to blame for it—I was a slut, fucking her slimy artist boyfriend in his New York loft, so I deserved what I got. By the middle of June, I felt like my body was a broken toy at the bottom of an arcade game, with men battling over the right to send their sharp claw to the bottom and drag me up from the depths. At the last minute, every time, they dropped me.
By the end of June, I landed back in the hospital with what I now know was multiple burst ovarian cysts. When I was released, my mother sat me down on the living room couch to deliver the bad news—she and my father couldn’t take much more of this, waking them screaming in the middle of the night, the trips to the emergency room. This last time, the pain was so bad, my knees buckled on the way to the car, and I had to be carried. Everyone had had enough.
The timer on the arcade game was running out, its red digits dwindling. I went to my gynecologist for a follow-up, where he performed an internal ultrasound, discovering dozens of cysts on both ovaries. He said, I think we may have found the problem. He recommended an exploratory laparoscopy, to check for the presence of endometriosis, to cauterize the cysts and drain any residual fluid. I felt a relief so enormous, I wanted to cry, this time from gratitude. He shook my hand and smiled at me. He was a dad, too.
I drove from his office to the internist, where I had my next follow-up appointment. I told him the good news, expecting similar relief. Or anyway, something benevolent. But he got very quiet. Then, he said, “It seems to me that Dr. Courtney has taken over this case, and you can leave now.” I sat there, confused and unmoving. I knew I had erred, but I had no idea how. He slammed my chart down on the table next to him. He said, “You can go, now.”
In hindsight, it’s possible I should be grateful for that Brigham and Women’s resident and their attending physician; for their bloody, gloved hands feeling around inside of me. At least they asked if they could practice on me—the almost-doctor, then the real one, doing their invisible work in my body. It hadn’t occurred to me, then, that I could say No, to the resident and their attending, No, you may not give me two back-to-back internal exams with your fumbling fingers and discuss me like I’m not in the room, at 3 o’clock in the morning, in a strange city, or that it was cruel to practice pelvic exams on distressed teenagers in acute pain in the middle of the night.
But they did ask. I assume they had to. I don’t know. I do know that by the time I had my second child, in November 2020, in the maternity wing of a local hospital, I assumed I was done with the medical establishment doing things to my body without my consent. Until a nurse put her ungloved hand inside my vagina to pull out the Dinostoprone insert intended to kickstart labor, which was causing my son’s heartbeat to decelerate, and risking his life. Her long, acrylic fingernails clawed at me. It was, once more, almost 3 o’clock in the morning. She said, “I voted for Trump. Did you vote for Trump?”
At least she asked. Which is more than Emma Bolden can say of many of the doctors she encountered in her decades seeking treatment for endometriosis. The most startling example of this comes in the first third of the book, when Bolden, still in high school, is in the recovery room after the first of many exploratory laparoscopic surgeries intended to diagnose and remove the endometrial cells that are causing her so much pain. As she concentrates on chewing ice, the doctor lists all of the spots where the cells are growing, and tells her he broke her hymen:
I kept chewing. He told me not to worry, that he had sewn my hymen up again. Good as new. I stopped chewing. The hand holding the cup of ice fell. My mother grabbed the cup before it fell, too. “Whoopsie,” she said.
Bolden wants to ask the surgeon why—why would you do something like that, why would do something like that and then tell me, “smiling broadly” as you do? But she is stunned into submission by the same desire that has stunned me time and again—she wants to be a good patient. Bolden begins her story in the classroom, where she excels, which becomes a throughline of the book. She is an excellent student and school, mostly, is a positive, nurturing place for her. The hospital functions like the classroom’s bleak underworld where, rather than plunge us into darkness typical of underworlds, Bolden shines an unbearable, clinical light on how our desire to please, to be good, which serves us so well in school, can also lead to disaster.
The day after I scheduled an exploratory laparoscopy with my trusted gynecologist and was quietly ordered to leave my internist’s office, my father woke me early in the morning from a deep sleep. The sun was barely up, and I worried that something was really wrong. As I tried to rouse myself to meet his gaze, I feared my mother was sick, or one of my sisters, that the house was on fire, since his tone was urgent, and he shook me, his hand on the blanket covering my hip. My father never woke us—that was my mother’s job.
Something was wrong, but not in the way I thought. It would take a while for everything to come out, but here is my best reconstruction of what happened that day, after I left my gynecologist’s office and was tossed from my internist.
After I obediently left the internist’s office, he called my gynecologist to ask about the scheduled surgery. Since I had not signed a release form allowing my gynecologist to discuss my case with him, and since I was, then, 19 years old, a legal adult, my gynecologist couldn’t yet have that conversation. The internist became convinced there was some conspiracy between my gynecologist and myself, something we were not telling him about the mendacious cavity of my body: possibly I had a secret disease, an STI, that I left untreated or that, in my continued bad behavior, I kept picking back up. Possibly I was pregnant, and this laparoscopy was a code for an abortion, a secret one. Possibly I had already had a secret abortion, and the pain was from the complications, since god-knows-what could happen to women who make that choice.
Note that all of these possibilities were considered secret, as though, had they occurred, I was obliged to tell these men about them keeping them to myself would be committing a morality crime: these were state secrets.
So the internist called my father, and told him he would take himself off of my case, because there was something I wasn’t telling him.
I stared bleary-eyed at my father that June morning, in 1999, panic rising in me.
“Is something going on you’re not telling me?” he asked. There was no menace in his voice, just panic, genuine enough to meet my own.
I kept my parents abreast of every detail of every appointment I attended. By then, I had been home from school about a month, and had spent almost all of that time at doctors’ appointments, and in and out of the hospital. I was so busy trying to manage my own health that I hadn’t yet started my summer job and was also panicking about missing a month of beach-town cash tips, something I had counted on for my return to Boston in the coming fall.
My father looked meaningfully at me. He said he had talked to the internist. He said the internist thought there was something going on between my gynecologist and me, that we were planning something with this exploratory surgery. He said he had told the internist, that’s not the kind of family we are, which interests me more now than it did then, knowing what I know—that my uterus had become a family affair.
My father asked me again. “Is something going on you’re not telling me?”
I was mystified.
“About what?” I asked.
In the years that followed, I became avoidant of doctors. The only one I trusted was my gynecologist. When he died suddenly and tragically of an aneurysm soon after my surgery, leaving behind his wife and five children, I stopped going to the doctor altogether, in a stark combination of avoidance and grief. I did not have another pelvic exam until I became pregnant with my first son, almost ten years later.
As for sex, I became convinced for a time that it was wrong, possibly deadly, always sure it had “given me something.” I buried my memories of that year so thoroughly that, when I was pregnant with my first child and the ultrasound tech said, “You have fibroids, didn’t you know?” I remembered. I had fibroids. They discovered them during the exploratory laparoscopy.
They also removed my appendix, for no logical reason I can offer. Once my father assured the internist that I had been a good, honest, genuinely suffering girl, my father and the internist agreed that he would perform the surgery, and my gynecologist would “assist.” I imagine my gynecologist there, assisting a surgery he had prescribed for his patient, for a problem in his own medical field—saying little, observing much. My appendix was not infected, and I had no signs of acute appendicitis. But out it went—snip!—to justify the presence of the internist in the room.
I could say I don’t miss it. Except it seems like a little white flag waving back at me, like the not-so-little, not-so-white lies being told about my body, splayed on the operating table, open to see.
It was a very long time before I understood just how badly I had been treated, by which I mean, how poor my medical treatment was, how that treatment included shame and gaslighting in addition to diagnostics and surgery. When I tried to tell trusted women relatives how terrible I had felt, knowing my doctor was talking to my father without my knowledge or consent and telling him lies about my body and my actions, they told me, It comes from a good place. It comes from a place of concern.
Concern for who, I thought. I had no guide, no guidebook, to shepherd me through this place, this good place, this place of concern from which my body and the self it housed seemed absent. I felt like a balloon a child had let go into the high blue sky. It would be years before I felt grounded again, back inside my body. Sometimes, I feel it still—I might float up, out, and away, if the right man decides again—I am not who I say I am, I do not do what I say I do.
My sincerest hope is any woman—every woman—with medical problems no male doctor has yet bothered to really try and understand reads The Tiger and the Cage, a book that feels like the beginning of a new genre. There’s a guidebook, now. And a guide.