Misplaced Loyalties


Aisling Walsh

My cervix has been weeping for longer than I know. The pearl-pink nub at the neck of my womb is marked by a lesion which releases a constant trickle of blood. The ulcer was first spotted by my gynaecologist, Linda, when I first visited her clinic on moving from my home country of Ireland to Guatemala in 2014. It is like a grazed knee, but one that refuses to heal. 

There is no apparent cause: no infection, no bacteria nor virus; no growths, no other alterations nor injuries. I’ve had all the necessary swabs and cultures. They came back negative. I’ve waited for it to go away. It didn’t. I’ve treated it with suppositories. They didn’t work. I’ve waited some more. It only got worse. When, earlier this year, Linda urged me to consider a more direct approach, I even began to meditate with it, talk to it, urging it to cease its weeping, trying to visualise smooth, healed flesh in my mind’s eye. Anything to avoid an intervention. Unsurprisingly, this also failed to work. 

Linda remains mystified. I, however, suspect the cause is something that cannot be found in standard medical texts. Intuition tells me my cervix is clinging to something, remaining faithful to the loss of my mother. She died thirteen years ago of cervical cancer. Even as I have done many things to heal and let go of my grief, my body, apparently, still has lessons to teach me. 

My mother was diagnosed in September of 2007. She had been experiencing gynaecological issues for months, including severe pain and daily bleeds. Her GP, a man in his late thirties, insisted it was peri-menopause. He prescribed iron pills and ibuprofen, then instructed my mother to stop worrying. When she finally managed to persuade him to write a referral letter to one of the few gynaecologists available in Cork at the time, she was told there would be a seven month wait. Such a wait was not unusual, but for serious gynecological conditions it can mean the difference between health and long-term morbidity, or life and death. Even now, fourteen years later, the waitlist to see a specialist can be up to eighteen months. 

My mother waited through a summer of trying to act normal, trying to believe her bodily discomfort was nothing more serious than the ‘change of life,’ even though she was only forty-six. She made light of the pain, the fatigue, the dizzy spells, the bloating and the continued bleeding, not wishing to worry her three children. 

I was twenty-two and riding a wave of elation after completing the first year of my undergraduate degree. I had spent my summer in Spain failing to teach English to kindergarteners. My mother and I met for a long weekend in Barcelona, our first holiday together as adults, with a plan to return home together just in time for the new college year. She arrived on a Friday afternoon, and by the time we had dispensed with our check-in, she was already wilting into the starched sheets of the hotel bed. 

While unpacking her sun dresses and strappy sandals, she admitted she had not been feeling well and had nearly cancelled the holiday. I was alarmed. My mother—a single mom who worked full time—never passed on an excuse to take a break from work and Ireland’s dreary weather by visiting one of her children abroad, especially if this came with Mediterranean sun, tapas and Rioja.

Despite her fatigue and occasional breathlessness, we managed to climb the spiral staircases of two of Gaudi’s houses and traverse the trinket and souvenir shops of the Gothic Quarter. We didn’t talk about her need for frequent rest stops, nor the afternoon naps disguised as siestas.

It was our moment of détente after an adolescence of constant warfare, and the only time I have shared a snatch of this other life, the one I lead in Spanish, with anyone from my family. I’m forever grateful she decided to come despite her discomfort; it cemented our reconciliation and was the last time we would share anything resembling normalcy.  

We had only been home two weeks, the new semester just beginning, when my maternal grandfather died. It was certainly his time, and few men were more prepared to go: he left an envelope on his night-stand entitled ‘Important for when I die.’ Even so, he was my mother’s rock, and his passing hit her hard. During the week she spent in Dublin trying to organise his funeral, my mother experienced a haemorrhage and was rushed to the emergency room at one of Ireland’s main maternity hospitals, the Combe. They asked to see her two days later for a biopsy. 

It took another couple of weeks for the results to come back. Positive. She was referred to a consultant oncologist in Cork specialising in gynaecological cancers. By then, however, it was too late for any intervention other than repeated blasts of chemotherapy and radiation. 

She did not survive the year. She left us three days before the first anniversary of my grandfather’s death. 

I have shed many tears over the delays, the failures in health care, the destructiveness of her illness, the loss and the missing of her, but it was only recently that I realised my cervix was weeping too.

‘Cervix’ means ‘neck of the womb’ in Latin and derives from the Proto-Indo-European root ‘ker’ for horn or head. The cervix is a rounded nub of soft, pinkish flesh, a ligament protecting the opening to our womb. Despite sitting more than three inches deep in the vaginal canal, the cervix occasionally comes in contact with objects from the outside world (tampons, condoms, and the like). As a mucous membrane, meaning it offers less protection than skin, the cervix is particularly vulnerable to infection from foreign bodies.

The cervix is so obscure, so hidden—and, apparently, mysterious—that it only merited a name in Western medicine as recently as the sixteenth century. It is tricksy, hiding far from reach during menstruation but popping down so that it is near enough to touch with one finger during ovulation. It responds to orgasms, expanding and suctioning any fluids that may have been deposited at its entrance, proving once more how the human body is driven by the overwhelming impulse to facilitate the persistence of our species. 

The cervix is a portal between our inner and outer worlds, beyond which only the most microscopic beings may enter. There is little that can leave except our cyclical bloodshed, cervical fluids, and the humans we create. For a baby to make this journey, the cervix expands and “ripens” until it reaches a sufficient diameter to let the still malleable skull pass through. 

The cervix stands between our becoming and our undoing. Not just at birth when two or more lives hang in the balance, but in the ability for those nastiest of viruses and infections to sneak in and take hold.

I have never looked at my cervix myself, reserving this view for nurses or gynaecologists at routine screenings. The fact that I’ve never seen my own cervix may not seem strange to most people. But in my doula/midwife, DIY-gynaecology, menstrual education, sex-positive, group masturbation, queer bodily autonomy circles, self-examination—starting with the vulva and ending with the cervix—is a rite of passage. To have skipped over this step is like pretending you know how to drive without ever taking the test. 

The first time I was invited to perform this ritual was during a natural gynaecology workshop run by a midwife friend, Hannah. It was almost six years after my mother’s death. I was already training to be a doula, and it would have been the perfect moment to confront the unknown and deepen my understanding of my own body. But I said no. The other participants—equipped with a plastic speculum, mirror, and torch—hitched their skirts, as it were, and allowed themselves to explore this cavernous inner world. I sat to the side, wrestling with the certainty that I was just not ready to do it, not among all those people, but also with a bizarre sense of missing out. 

My experience with speculums had, until this point, been largely traumatic. Whenever that duck-billed steel or plastic instrument came anywhere near my soft folds of skin, the first thing I thought about was my mother. I went for my first smear test while my mother was in hospice care. On her insistence, I had found a GP specialising in ‘women’s problems.’ I had no idea what to expect. I never imagined it would be pleasant, but I was not prepared to have the steel bill pummelled repeatedly into my cervix, pinching at the tender flesh as the doctor winched it open. I squirmed on the examination table. The doctor told me the pain was normal; there was no need to make such a fuss. It took me years to realise that such discomfort was not, in fact, normal. But the damage was done. Muscle memory is strong, and any time my legs were in stirrups and the speculum approached, I would tense up and prepare for the worst. It felt like a form of punishment, exacted by someone I had assumed I could trust with the most intimate care of my body. 

The history of gynaecological care in Western medicine, and of the speculum in particular, is a history of torture, bathed in the blood of enslaved women. The man who designed the prototypes of the speculum used across the world today was a slave owner, J. Marion Sims, who practiced on the women he enslaved on his plantation in Alabama. Anarcha, Lucy, and Betsy—and many others whose names have long been erased from the archives—were subjected to multiple surgeries, often with an audience of other white ‘medical men,’ while Sims practiced his surgical techniques and tried out his instruments. The surgeries were performed without anaesthetic, contributing to a still widely held medical belief that Black women feel less pain than white people. The procedures left his involuntary patients with debilitating injuries. After moving to the North, Sims continued to practice on the bodies of poor Irish migrant women. The statue in honour of the ‘advancements’ Sims made in modern medicine stood in New York’s Central Park until 2018. 

Why these medical men did not consult the midwives who had a millennia of practice and inherited wisdom is, of course, no mystery. Such knowledge is too often dismissed as nonsense, or even witchcraft, to university-educated white men. Nor has the medical establishment put any real effort into finding an alternative to the speculum, one that might suit the anatomy better and which is not laden with a cruel history of torture. Moreover, the continued disparities in access to quality and humane healthcare between white women and women of colour across the Global North and South mean the sacrifices made by Anarcha, Lucy and Betsy continue to benefit white women disproportionately. 

I am one such woman. The access to a caring professional, such as Linda, is a privilege I can pay for. I can call her clinic on a Monday for an appointment the following Saturday. Going privately means there are no waitlists nor delays in getting the treatment I need when I need it. This should be the norm in public health, but services remain underfunded and short-staffed. Many women have to wait, and in some cases the wait could kill them. 

Legs in the stirrups, my mind strays inevitably to thoughts of my mother, then beyond, through the cervix-as-portal to other entangled histories of bodies, cruelty and injustice. 

Hannah’s workshop could have been the perfect moment to regain some control over my own experience, my own body. I had never dared to probe further than the boundaries of my vulva. Beyond this I remained blocked, afraid of what might be lurking up there, waiting to surprise me. But mostly, I was afraid to confront the fact that parts of me were still grieving.

I was finally forced to confront my weeping cervix three days after the thirteenth anniversary of my mother’s death. I did not plan it like this, but after multiple postponements because of COVID—and the hope that it would somehow just clear up on its own—it was the only day Linda could see me. 

Back on the cushioned examination table, my legs splayed, feet in stirrups, Linda chats about the pandemic and her upcoming pilgrimage to Santiago de Compostela. Anything to distract me from the blasts of nitrogen gas she is directing at my cervix. The idea is to freeze off the flesh where the ulcer has persisted so that new, healthy cells can grow. Linda asks for my phone and takes some photos of the before and the during, so I know exactly what’s going on. For the after, I will have to wait another month. 

My legs are tense and trembling. The ibuprofen the nurse gave me twenty minutes ago is ineffective against the cramping, which starts immediately, soft at first but gaining in ferocity with the second and third blasts. Linda keeps having to press my knees apart and hold them steady. I try to focus on my breathing and her easy chatter, but my thoughts slide towards my mother, the virus that became a tumour, taking root, growing and festering until there was almost nothing left of the woman I had loved. I worry about disease and death and whether this procedure will be enough to avoid succumbing prematurely to both. I’m only ten years away from turning forty-seven, and I realise now how terribly young that actually is. And I wonder, for the millionth time, what it was about this particular position that my mother had feared so much that she had avoided years of regular smear tests.

The cramps grow in intensity and pull me back to the present. I begin to worry I might pass out. Linda delivers a third blast, waits a few minutes, then eases the speculum out of my vagina and lets me close my legs and shuffle back up the table to rest. While cleaning up she tells me what to expect over the next month or so. I hear the words ‘antibiotics’ and ‘no sex’ and wonder what I’ve got myself into. I realise that if I had I fully understood what the procedure entailed, I would probably have put it off for even longer. 

They leave me with an information sheet and a scalding cup of chamomile tea I know will do nothing for the pain. My mother had often pampered me with tea and hot water bottles when I was struck down by period pain as a teenager. Lying alone, on this table at thirty-seven with no one to hold my hand, I’m worried I might cry.

Instead I ask for more pain relief and text my girlfriend. I tell her I’m going to be late for our date. She offers to pick me up, but I say I’ll be okay getting home on my own. We’ve only been seeing each other for a month or so. Her offer stokes a fluttering in my belly that has been growing steadily over the last few weeks. 

The tea cools slightly and, lowering my mask, I take small sips, half-sitting with my weight on my elbow. The trickle of clear liquid between my legs has turned into a flood. It doesn’t matter that I’m in a clinic where bodily fluids are part and parcel of their work; I’m mortified by the puddle spreading across the white sheet. This will continue for the next two weeks at least as my cervix sloughs the dead tissue, Linda tells me. I have eight washable sanitary towels at home, enough for two days but no more. I make a mental note to go to the supermarket—once I can move—and pick up some heavy-flow, night-time pads. 

The clock inches towards five. I begin to worry about crossing the city in rush hour traffic and about my girlfriend’s imminent arrival. I gulp the now tepid tea and force myself to sit, then clamber off the table. I manage to get my underwear back on before my head begins to swim and I know I am going to faint, or vomit, or both. I see only medical waste bins in the suite. I dash across the hall, clutching my robe shut, and I empty my lunch into the toilet. 

In two heaves, the knot in my stomach finally untangles itself. I feel suddenly elated, with enough energy to dress, pay my bill, and order a cab. It might be the adrenaline, but I feel like I have left something behind at the clinic, a weight I did not even know I’d been carrying.

My girlfriend and I make it to the apartment within minutes of each other. I order Chinese food for dinner and we watch The Matrix, cuddling while my cervix sheds one layer of grief after another. 

If my cervix was weeping before, it is gushing now. I go through three bumper packs of pads in the first week. I try to picture what is going on down there, willing myself to let go of whatever it is that has prevented me from healing. I can’t imagine going through this again, nor anything more invasive, if it fails. I follow my doctor’s orders to the letter, taking antibiotics I know will mess up my stomach and possibly give me candida. I avoid alcohol and any and all forms of penetration. If I walk too far, a friction—not quite a burning sensation, but almost—reminds me to rest. 

I gush for what feels like eternity, but in reality it lasts only a few weeks. By week three, the waterfall has become a meandering stream, and by the time my check-up comes round, a trickle. Just enough to remind me I’m still healing. 

As I write this I wonder, not for the first time, if this is just too much information. Do I have to be so graphic? Could I not just brush over the more gritty details? Do I need to mention all those fluids? It’s all so very messy.

As my mother’s cancer progressed, she urged me not to repeat her mistakes, not to succumb to the silence and shame that has led to the premature deaths of so many others like her. And so I started to treat my uterus, and its various appendages and secretions, as if they were just like any other part of the body. As a culture we are too often repulsed by what our bodies expel: sweat, tears, urine, menses, semen, breast milk. They are perhaps too close a reminder of our carnality, our animality. They are evidence of physical and sexual impulses over which we have only minimal control. 

In the nearly fourteen years since my mother died, ‘cervix’ has become part of common parlance in Ireland, first for the mass programme of HPV vaccination and then for an ongoing scandal of fatal errors in the national screening programme ‘Cervical Check,’ both of which came into operation just months after my mother passed away in 2008. The Cervical Check service seemed riddled with flaws from the beginning, not least the outsourcing of tests, the months of waiting for results nor three year intervals between screenings. Hardly a week goes by where the Irish news does not feature an update about the women forced to sue the state for information about their own bodies and redress for medical negligence. Or we hear news of another of these women dying from a disease which might have been treated effectively if it had been caught on time. 

There are so many people I could blame: the years my mother spent avoiding screening; her GP, for not taking the clear warning signs seriously and not referring her to a gynecologist sooner; the public health service, for maintaining a structure which leads to seven month waiting lists for gynaecological care that is routine in other countries. But blame, in this case, cannot change the outcome. My mother did what she could with the information and emotional capacity she had at the time. Though she rarely let on, she knew what was happening and was heartbroken. I cannot hold her responsible for my loss. 

Grief is a circular process. There is no end point, no morning you wake up and think, ‘Okay, I’m done with that.’ I will always miss my mother, but I understand now there are healthy, as well as harmful, ways to honour her memory. My body’s loyalty to my mother’s illness feels poetic, but a weeping cervix does no one, least of all me, any good. And so I write to keep processing. I write to keep healing. And I write in the hope that sharing the messy intimacies of my experience might contribute in some way to furthering dialogue in a space where so much silence, shame, and injustice have lived, where so many like me and my mother have wept. 

Aisling Walsh

(she/her) is a queer, neurodivergent writer and translator based between Ireland and Guatemala. Her stories, essays and features have been published or are forthcoming in Catapult, LitHub, Crow and Cross Keys, Púca, Litro, Barren, Rejection Letters, Cordella Mag, Pank, Entropy Mag and Refinery29, among others. Her personal essay “The Center of the Universe” was selected as runner up in the So To Speak CNF Prize for 2021. She is currently working towards a PhD in sociology at the National University of Ireland Galway, where she is researching decolonial and feminist practices of healing justice in Guatemala. Learn more at www.aislingwrites.net or on Instagram @Aisling_Writes.

Art: "A Strand of Hair" by Zee Zee, Drawing

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