Tick-tick-pause: Ahead of another surgery, Kim Knight contemplates broken hearts and empty wombs

"You don’t have the heart to say: I no longer love you." Photo / 123rf

It sounds like a mistake. A soft landing or a comic book collision. “Oophorectomy.” It is a word for a surgical procedure that sounds like it should be performed in a cartoon hospital.

Subtotal hysterectomy. Right ovarian cystectomy. My stomach is an angry teenage snarl. Metal staples, like a mouth full of braces, track down from my belly button. The parts of me that can make another person have been taken out and disposed of.

When I wake up, I just want to know where my shoes are. Did I remember my toothbrush? James shows me a thick brown paper bag containing the clothes I wore that morning. He slides open the drawer beside the adjustable hospital bed. Comb. Deodorant. Phone. There are sentences in my head but no energy to say them. There is a button to press for the pain. Am I hungry? Would I like a sandwich?

White bread with cheese, cut on the diagonal. Thick and dry, a wad of food I can’t swallow. I did not do the research. I did not know that when you’re under anaesthesia there is a breathing tube down your throat. These are details you don’t notice on Grey’s Anatomy. Another time, after another procedure, I woke up with sellotape in my hair. I only noticed it after they took me to a room and gave me biscuits that I ate like medicine. Slowly, deliberately.

The hysterectomy nearly didn’t happen. There was a storm and schools were closed, hospital staff stayed home and when they figured out the rescheduling, oncology patients had the highest priority. My blood pressure was very high and they gave me two Panadols and asked me to lie in a cool, quiet room for an hour. What if I don’t wake up again? What if I don’t really go to sleep and they don’t know? The young female surgeon can’t understand why I’m keeping my cervix - don’t I want to absolutely remove all risk of cancer? It’s the patient’s choice, says the older male surgeon. The curtains around the bed where I am sent to get calm are printed with wobbly, watercolour checks in lemon, grey and blue.

Eventually they wheel me into an operating theatre that seems so much bigger than necessary and now I’ve woken up and I’m in another room and it is night time. The curtains are open to a view of the city. Hundreds of office lights are sparkling; hard-edged Auckland against a plush navy sky.

Histology confirms my pelvis was filled with multiple fibroids up to 12cm in length. The cyst on my right ovary was a dermoid. It is the second time I have received information like this. Did this one have teeth? The photographs from the first surgery showed a milky balloon; dark wavy hair pressing against a translucent membrane. I imagined it bursting and the hair taking root, growing up inside me.

A dermoid cyst is normal tissue that your body begins to nurture before you are even born. The medical literature says it is formed when skin layers don’t grow together as they should. I imagine my uterus as a carelessly arranged spanakopita, harbouring pine nuts in all the wrong places. I wonder: are these rogue sacs full of half-formed human-parts why I have never wanted children? Perhaps some switch I was waiting to flick on was actually activated so long ago that I just never felt its absence?

Three weeks after my hysterectomy, Sarah comes over and we drive to a grand mansion that is now an art gallery. We sit on the verandah in the freezing sun and drink coffee. My eyes have been aching for a horizon, for a view beyond the couch and daily walks around the block. The lawn slopes gracefully and green, its edges planted with Moreton Bay fig trees with liquid trunks that flow over the ground like lava. Years later I will read a sign that says the mansion is built on a pā site. I will learn that kūmara used to grow where the stepped grass is, that the figs should be tōtara or kauri and that the man whose art collection filled this gallery is a convicted sex offender, but these are someone else’s stories.

I like thinking about the people who once lived in this place. What they ate and dreamed and hated.

In the driveway, dropping me home, Sarah asks me if I’m okay and I tell her, that even though I knew I never wanted to have children, I hadn’t appreciated that I would also never know what it felt like to be pregnant. That line on a stick, the mundane fulfilment of femaleness, the cinematic movie moment of realisation - I won’t experience that. White, middle class and rarely denied, I am absurdly, ridiculously, mourning the loss of an experience.

According to the post-operative review, my hysterectomy scar has healed well; my gynaecology is reduced to short, useful sentences: “She still has a cervix so will need to continue having cervical smears. Almost all of her right ovary was conserved so that should keep her well oestrogenised.” Everything you read says it takes six to eight weeks to recover from a hysterectomy. Of course, it depends entirely on what you are recovering from.

I think about a photograph, taken when I was around 12 years old. I am wearing a brown floral sundress with a shirred bodice and straps that tie in bows at the shoulder. My left knee is crooked under me, my right leg long and tanned. My hair is messy, my crossover front tooth not at all fashionable, but I look like a model. My face reeks of insouciance. The day the picture was taken I had thumped my sister quite hard and poured salt and pepper into her hair and told her I would never speak to her again. I don’t remember why I said or did that, but I do recall thinking: “I shouldn’t have children because I might not be very nice to children.”

My friend’s pregnancies were a constant surprise. Was I simply not listening on the days they said this would be part of their life plan? I found myself slightly annoyed when they stopped drinking wine and listening to my endless dramas. They were preparing to protect tiny lives. Surely I could take care of myself for a bit?

A near miss. One Friday in Wellington when I drank too much. The man who came back to my hotel room was sweet and funny. I saw him again the next morning on the street outside the pharmacy where I was collecting the morning-after pill. He was en route to meet someone else for coffee.

My mum and dad had broken up when she discovered she was pregnant. They married abruptly. Recently, I texted Mum to say it had been raining in Auckland since last October. My parents lived here, five decades ago, when Dad was in the Air Force and Mum didn’t know a soul except me. Yes, she replied. I remember that well when I was trying to dry your nappies.

When I was 17, I went to Canada to live for a year, got screamingly drunk most weekends and saw David Bowie live in concert. My mum had spent her equivalent year trying not to catch her long hair in the wringer attachment of an agitator washing machine and waiting for the rain to stop.

“Give me a good reason,” I once demanded of a friend, as we drove from Greymouth to Christchurch. She was a geologist and there was not a rock formation she could not scientifically explain. “Give me a good reason why people have children?” We ran through the possibilities and they boiled down to something that sounded suspiciously like legacy or graffiti.

I WAS HERE.

My broken heart was first diagnosed in a posh suburb in Christchurch. I had health insurance, and the cardiologist had corresponding rooms in Merivale. The rooms and the recordings of my heart were later destroyed in an earthquake but what I recall from that time is that my chest would thud-thud-skip. I imagined it separate from my body, lying on its side and fluttering. A bird with a broken wing; a melodramatic damsel lifting a bell-sleeved arm to a forehead she always pronounced as “forrid”.

Cardiac arrhythmia is when the electrical impulses in the heart don’t properly work. Possibly, many of my impulses had been questionable. I could have been married and, instead, I was single. I could have had children and steadfastly refused. I explained my situation to the wealthy cardiologist and he told me it was actually possible to break your heart.

Was this a medical diagnosis?

Takotsubo cardiomyopathy is a real thing, a known phenomenon that can occur in people who experience intense emotional or physical trauma. The left ventricle enlarges and its ability to pump blood lessens. The name of the condition comes from the new shape of that ventricle. It looks, temporarily, like a pot for catching octopus. My heart is a container of tentacles.

When I was 8, we hauled an octopus up on a fishing line and the sun slicked off its sticky skin that blazed and flared like a heartbeat, the same burgundy as blotches of old blood. We cut off its legs and threw them in the bait bucket and then rolled up our sleeves. Those suckers have long memories. They wound around our tanned arms in the manner of headless chooks that take some time to die. Pure mute reflex. We were gruesome medusas.

I didn’t always know that octopus and squid were different. One has a round head and the other triangular. The octopus feeds by first injecting its prey with a toxic venom and then crushing it in its mouth; the squid has a multi-step process that ends with the ribbony, raspy radula - a tongue, covered in tiny teeth, that acts like a grinder. Both species die after mating.

You grow up in the heartland. You spend a lifetime getting to the heart of the matter. You are brave of heart, kind of heart, hard of heart and heartless. You don’t have the heart to say: “I no longer love you.”

In Auckland, everything beat faster. I fell in love with a man who glittered like a wolf and I told him I had an armadillo heart. Hard. Scaly. I knew what I was talking about because my parents went to the Friday auctions like some people went to the pub. They would come home with a brass fire screen embossed with sailing ships (“Can you believe someone painted over this?”), lidded boxes for holding kindling wood and, once, a small, stringed instrument with a curved body made from a really hard, dead armadillo. You could have hit someone over the head with that armadillo ukulele and killed them cold. That wolf clawed his way in anyway.

You think you’re empty and then they take you to hospital and cut some more out anyway. The part of you that makes other people and, perhaps, the part of you that made other people want you.

Thud-thud-skip. In the emergency clinic they worry it was a heart attack. In the ambulance they said no way was that a heart attack. And in the hospital, the arrhythmia is given even more syllables - atrial fibrillation. You can’t mess with it. When the heart’s upper chambers get multiple, mixed signals, they don’t know how to send messages to the lower chambers. The blood that should pump can instead pool and clot and cause a stroke.

I am medicated and it settles. I catch Covid and stop taking blood thinners so I can start taking Paxlovid and the a-fib does not come back. I finally get a date for an umbilical hernia repair, which will turn into surgery for a second, hysterectomy incision-related hernia that will only be confirmed in theatre, and my staccato heart returns with a vengeance.

Now they want to know my cholesterol levels, my blood sugar levels and how many flights of stairs I can walk up while maintaining conversation. I am almost never short of words, but my head feels as tired as my heart. I am reminded, frequently, that my body is a failure and a burden even though I personally know some thin people who have died of aneurysms or cancer; who have required surgery to replace an arthritic joint or remove a dying kidney; who have been hospitalised with pneumonia or blinding headaches. None of those people have lost 23kg in a year or 15kg in another year but, here I am, listening to an anaesthetist explain my surgical risk profile.

He asks me to imagine it is Easter Weekend and it is raining and I am driving to Hamilton for my niece’s wedding. Statistically, he says, six to eight people will die on the roads on this terrible night. “But not you. Because you REALLY want to be at that wedding.”

It is 3.30pm and I have not eaten since 8pm the evening prior. I am wearing disposable hospital knickers and no bra, staring at this old man with a pot belly who I have known for approximately six minutes of my entire 53-year-old life. He tells me he understands that it is hard to lose weight. He is my ally. Today could be the start of my journey to health, a pathway he clearly and delusionally believes he has just inspired. “F*** you,” I do not say out loud.

(I am, of course, worried about my heart. They are stupidly easy to break.)

It is daylight when I go under and dusk when I come to, packed full of Tramadol and surgical mesh. I’m the only person overnighting in the four-bed room in a ward that looks across to a park. The curtains are still open. I can’t work out what the noise is. And then I realise a frenzy of bugs is slamming against the window, attracted to the light. They hurl themselves, full tilt, over and over and over. Tick-tick-tick.