ILLUSTRATIONS BY VIVIAN SHIH

Second Days by Kaavya Ramesh

On Misdiagnosis & Endometriosis

The women in my family are cursed with pain. Once a month, the pain comes to us, and it comes and will come for decades.

I was thirteen when my first menstrual cycle came. It was a light cramp, the kind that girls complain about, and I was uncomfortable and annoyed, but it wasn’t life-ending pain, and I complained my way through that year. I didn’t like the feeling of it: my stomach cramped, I was constantly dizzy and tired, I wasn’t sure if I was hungry or in pain, and I felt like tearing everybody’s head off, my own included. But I was an athlete, I had stamina, and if there was one thing the women in my life had taught me, it was to power through.

By the time I was sixteen, I couldn’t power through any longer. Something had changed in the last two years. Inch by inch, minute by minute, the pain grew and took control. Periods went from annoying to terrifying. I was in such pain every month, with strange new symptoms that I couldn’t understand. In tenth grade, I started throwing up on the second day of every menstrual cycle. It was a cycle, on a precisely timed clock, and I learned its rules: any food on the second day meant hours of violent vomiting, my body glued to my bathroom floor, crawling to the toilet bowl when the urge overcame me. I found this out the hard way, the way hard ways always teach you — through experience.

“The women in my family are cursed with pain. Once a month, the pain comes to us and it comes and will come for decades.”

Mango ice cream: liquid, a canary yellow. Three hours of retching. I couldn’t eat mango ice cream for years afterward. Punishment for having broken my body’s rule on a hot summer’s day. I should’ve known better, my body told me, even though I didn’t know at all. Lasagna came out still whole and identifiable: two hours. Two bananas: one hour. German chocolate cake: thirty minutes.

After that, I didn’t let myself break the rules. I couldn’t handle the consequences, so for one day a month, I went without food.

My stomach roiled like my innards were being squeezed, wrung out for their blood. I was being stabbed hundreds, thousands of times, all over my abdomen. And the unbelievable part was not the pain but the fact that nobody could see it.

“It hurts,” I told my mother, my aunt, my friends. “It really, really hurts.”

But it’s supposed to hurt, they said. It always hurts, right? So I told myself to get familiar with the pain.

In eleventh grade came the fevers. I would get hot, and sweaty, and sometimes cold and clammy. My body was in a fantastic flux and couldn’t pick how to torment me, so it chose all of the above. On the dreaded second day, I would stay home from school. My mother understood, so I curled up on the couch in the living room, back turned to the kitchen, watching whatever was on daytime TV. Usually, I resigned myself to infomercials and SpongeBob blaring mindlessly in the background.

In twelfth grade, I found out that I could stomach one slice of plain bread on the second day without vomiting. It felt like the biggest and most pathetic victory of my life.

I got so used to vomiting that I would keep a book ready in the bathroom. Vomit, clean my mouth, read.

When my mother asked, I said, “It’s not so bad.” Weirdly enough, it made the stabbing sensation in my stomach quiet a little. The stabbing was the worst. It made me almost thankful for the vomiting.

My first year of college, I had to warn my roommates: “By the way, I kind of… throw up on my period. Just warning you, so you don’t freak out. Sorry.”

They were understanding, even if they didn’t understand.

“Inch by inch, minute by minute, the pain grew and took control. Periods went from annoying to terrifying.”

Thankfully, the few times I did throw up, I was away from the dorm and got a little respite, free of embarrassment. But still, it hovered in the back of my mind. I kept track of the days, and added them and cross-checked them against the dates on my class syllabi. What if the second day falls on a midterm or a final?

I took pills. I had since I was fourteen. Advil first, until my body got so used to it that it didn’t do anything anymore. Excedrin. Extra-strength Tylenol became my college mainstay. They didn’t do anything for the vomiting or the chills or the sweats or the roiling or the stabbing, but they took the edge off. Like I was getting gutted with a rusty blade instead of a sharp one.

Taking pills didn’t make the one-and-a-half-mile hike from the dorms to my classes any more feasible. But on many second days, I managed it, teeth gritted. Power through.

I talked to two doctors. One, an older woman who spent most of the appointment talking about how both her sons were attending Harvard Medical School, didn’t listen to me and prescribed anti-vomiting pills.

I tried them, and they did nothing. When I finally vomited up the anti-vomiting pills, I gave up and threw them away.

“These were doctors, they were smart, and they didn’t really have solutions for me, so maybe there were no solutions.”

The second doctor was gentler but equally off-base. “Have you tried taking ibuprofen before you get your period?”

I wanted to laugh and cry at her. But these were doctors, they were smart, and they didn’t really have solutions for me, so maybe there were no solutions.

I trudged on for two more years, planning, cross-referencing, and praying to all my gods for good luck.

In my third year, the worst happened. My second day came on the morning of my Macroeconomics final, a final I really needed to do well on. My throat was aching with thirst, my stomach a carved-out hole. But I couldn’t risk it. I popped an Excedrin and went to the final.

There, I found out that Excedrin had stopped working for me, too. And as always, I found that out the hard way.

Ten minutes into the exam, the pain hit me, all at once. My stomach was being ripped apart and put back together in the wrong order, in the wrong places.

I looked down at my paper and tried to focus my eyes. Something about the Solow Growth Model. My paper blurred in front of me. I could feel my mind go blank. I remembered reading about that, but I couldn’t remember what it was… The pain came and went in ripples, shifting from horrible to unbearable. Horrible was the best I was going to get. I knew that, so I had to take advantage of it. Whenever the pain lessened to even slightly manageable levels, I perked up, ready to work. I would force myself to read the question — three, four times. I had studied so much for this! I couldn’t let the pain make me fail a test worth 50 percent of my grade.

ILLUSTRATIONS BY VIVIAN SHIH

When the pain shifted back to unbearable levels, I would let go of my pencil and lean back in my chair and feel it wash over me. I waited for it to end, eyes closed. I sometimes sighed, sometimes cringed, and sometimes attracted the attention of the classmates beside me, who gave me sideways glances, curious. I fantasized about walking to the front of the room and announcing to the professor that I had a medical emergency, although I had no idea what that would provoke. I thought about turning in the final and just failing the course, but that seemed so unfair to me, to the three months I had studied and paid attention in class.

The three hours of that final exam were the most strenuous physical exertions of my life. Working to keep my concentration afloat through the pain was a staggering challenge. I clung to the few precious moments of lucidity and reminded myself that this, too, would pass.

And it did. By the end, I trudged up to the front, half dead but desperately relieved. I could not have lasted a minute longer.

Then I went back to my apartment and told my roommates, in a jubilant state of deliriousness, that I had failed my first test, my first final exam, and my first class all in one go.

As it turned out, I didn’t fail that test, and ended that class with a B-. I stared at my grade incredulously and told myself that even through my pain, I was still myself. The worst pain of my life could not destroy me. I told myself it could not ever stop me.

I was wrong.

In the summer before my fourth year, I began taking iron pills for my anemia. It made things worse. Two months in, I had the worst menstrual pain yet. It was mind-numbing, bone-breaking pain. I couldn’t concentrate on anything except the pain. I waited for it to pass, and then I crawled to my bed and bawled.

“When I began talking about my pain, she listed to me, eyes keen and curious. She interrupted me with questions and nodded at all my answers.”

“This can’t be normal,” I babbled to my mother. “I don’t care what the doctors said; there has to be another solution.”

But my mother had no answers for me. She shared her own horror stories, and her sister’s, and the ones from the girls in her school, girls who’d had such painful periods they needed injections. To my mother, extreme pain was normal. But I refused to live like this any longer.

So I went that August to see my third doctor and she listened to me inquisitively. Two minutes in, she interrupted me and said: “You know, this is not really my specialty. Let me take you to the front desk to schedule you another appointment.”

I scheduled an appointment with Women’s Health that same afternoon. I sat in the waiting room restlessly, not particularly hopeful that anything would come of this.

The OB/Gyn who ushered me into her bright, clean office was friendly and bubbly. We chatted about our alma mater — UCLA — and she asked me if it was how she remembered it.

When I began talking about my pain, she listened to me, eyes keen and curious. She interrupted me with questions and nodded at all my answers.

“I think you have endometriosis,” she said. “Have you heard of it?”

“If my pain has taught me anything, it is that I am strong enough.”

I hadn’t, but I learned it was a condition in which uterine tissue grows outside a woman’s uterus and can cause dysmenorrhea, a term that describes painful menstrual cramps. The symptoms include vomiting, abdominal pain, nausea, and pelvic pain. And if not treated, endometriosis can progress, with uterine tissue creeping across the body and causing still more pain.

My doctor prescribed me birth control pills, and I went home feeling triumphant. My problems didn’t disappear entirely — the pills caused problems of their own — but within three months, my pain had been halved. Within six months, the pain was a shadow of what it had been.

These days, my life is still not pain-free. I have other kinds of pain, in other places in my body, and other diagnoses. But when I think back on my old pain, I am reminded of the difficulties of being an adolescent and a young adult who didn’t know any better, who was constantly told that pain was normal, even by people who had experienced that pain and who had meant well. I’m not angry with my mother or my aunts; in my Indian culture, hormones are not commonly used as a form of treatment. Certainly, they had received no help in managing their own pain. They had studied and worked and cooked and cleaned and powered through their pain, and told me to expect the same.

If my pain has taught me anything, it is that I am strong enough. I am strong enough to accomplish, I am strong enough to power through. And I am strong enough to know when to stop.

This story first appeared on ENDPAIN, an online magazine focused on creating valuable content and meaningful experiences, with the goal to dismantle paradigms of shame, fear and guilt associated with pain. Select stories are published on Medium, and more stories are available to read on their website, www.endpain.com.

One clap, two clap, three clap, forty?

By clapping more or less, you can signal to us which stories really stand out.