K Klingensmith’s post “Pictures of You,” on medical images of the body, asks the question, “For the person who sees a copy of their X-ray, MRI, or sonogram, how can it seem like their body?” I’m fascinated with this complicated sense of dissonance between the body that we experience and the image that we see — between the body that we experience and the mystery of its inner workings, proceeding without our knowledge or control. What stories do we tell about our own bodies — about what goes on inside them, about what we know of them, and about the extent to which we can control them — and what role science and technology play in those stories?
Because I’ve been lucky and healthy (no broken bones, no serious ailments), ultrasounds are the only images I’ve had done of my own body, but more than that, ultrasounds are a common type of routine images taken by women of my age (I am 33). But the commonness of ultrasounds makes them an interesting case. Ultrasounds have, in addition to their medical function, become part of the ritual of pregnancy in the U.S. First you pee on a stick, then you crave ice cream and pickles, then you have the ultrasound. In anticipating my first ultrasound, I thought I should tear up, as they do in commercials.
So, on one hand, my expectation of the ultrasound was foregrounded by this kind of common story (absorbed from bulletin boards, chick flicks, and car commercials) about how it would affect me. I thought that seeing that image of the fetus would emotionally bond me to that baby. But a darker suspicion was also at work. I feared that all was not right, that my body could not possibly be growing a human being. I had never learned to do such a thing and could not understand it, and was distrustful of the idea that everything would go like clockwork. The ultrasound was a normalizer on both the cultural and personal levels, then. I expected it to move me along the typical emotional path of preparation for parenthood and I looked to the ultrasound to verify that my body was functioning the way it was supposed to. As my friend Cat said, “I remember getting through each ultrasound during my pregnancy as if I had just passed a test.”
But my first ultrasound, when it occurred, only created a further dissonance between the conventional wisdom about pregnancy and my discomfort with the mysteries of the inside of my body. I was alone in the ER in a new city thinking I had miscarried, but the ultrasound showed, miraculously, a little peanut with flapping buds for arms and legs. “Everything is normal,” they told me. I felt relief, yes, but rather than a warm and fuzzy trust for or appreciation of my body the reality of the peanut seemed displaced into the machine, not part of me at all.
Me-as-observer tried to reconcile that image with what I felt — exhaustion, dizziness, loss of balance, odd dreams, sore breasts, and a wild hunger that made me seriously consider inflicting capital punishment on those arriving late to dinner. I understood, intellectually but not viscerally, that the baby growing inside of me had caused all these changes. But trying to intuitively grasp this was like trying to intuitively grasp that light is both a particle and a wave or that someday I will die. My mind pushed back at me and refused to believe. The same ultrasound photograph that gave me proof of my working body only highlighted the discord between the mystical unknowability of the inside of my body and the black-and-white certainty the ultrasound seemed to promise.
Throughout that pregnancy, I was filled with the anxiety that it was already dead inside me or that I was nurturing some sort of genetic or moral nightmare, the stuff of all those horror movies involving reproduction gone wrong.
It was not me but my friends C and J who found out during routine checkups that the babies had died inside them. C said, “I showed up for my appointment and found out that I had been walking around with a dead baby inside me for two weeks. How could I not have known?” I understood acutely C’s desperation, frustration, and feeling of powerlessness. Especially during pregnancy, when all you can think about is what is silent and invisible within you, the inside of your own body feels as distant as the nearest star. Is it any wonder people invest in machines to hear the baby’s heartbeat or that TomKat wanted their own ultrasound machine? The ultrasound bridges that distance to the inside of the body, but it also magnifies that distance, highlighting the difference between what you hope/expect and the reality. (My friend Sandra says, “Those pictures do look like moonscapes don’t they?”)
The ultrasound is not the only method of reaching across the expanse to one’s inner spaces. Every person resorts to different methods to try to cross this expanse. Some resort to fate (“what will be will be”), faith, or hope, or controlling and managing the body from the outside. The latter was my method: no medicine, no second-hand smoke, no sushi, no alcohol, not even my beloved caffeine. I would conquer the unknown interior through a sense of control, through a management program for the body, a program highly conscious of inputs, outputs, and exposures, a management program invested subconsciously in the belief that I could minimize and perhaps do away with risk.
But in pregnancy (and, I imagine, in diseases like cancer) what is at stake is not just your relationship with your body but also all your plans for the future, lost through some betrayal of the body. My friend N miscarried earlier this year shortly before her father died. Her father had been slowly declining, and I think that some part of her had hoped to have that child before he died, a way of countering death with life, a way of giving him one last gift before he passed. Her doctor told her that she may not have even really been pregnant, that it was probably a molar pregnancy, an empty sac. Her experience (it had been her second pregnancy) and her hope told her she was pregnant, but the tests said she was not.
As I prepared a care package for N, I thought about how I often feel, as a mom, that I hold the world together by keeping track of the check-ups, the number, and consistency of poops, and the location of every treasured object. I tell my child bedtime stories of heroes, battles, and challenges overcome, intending to prepare him for the bright future I create with all my might. I thought of N, welcoming that child into her heart and life before it was conceived, weaving it into a story about death and life, generations passing, and her relationship with her father. And suddenly, rage boiled through the sadness. We do everything right: we make charts, watch what we eat, and take our vitamins. We tell ourselves that we control our own bodies. We think that we can hold the world together through the force of our will. Yet we still don’t know what goes on inside our bodies, and we can’t prevent pregnancies from going awry, turning that future we dreamed of into “it wasn’t meant to be.” How I hate that phrase; it turns failure and loss into fate and predetermination.
The rage as I wrote her a sympathy card was as much for myself as it had been for her — I realized, finally, that the way in which I’ve taught myself to live and raise my own children believes in the power of imaginary as well as logistical management — if I believe something will happen, if I take every step I can think of, if I write my hopes into some coherent picture of the future, my dreams will come true. We don’t just manage our bodies and our fears through technological means; the ultrasound, I think, has to be read as part of a larger program of control and management, in which we link discipline of the body with success in our lives. So fat becomes laziness and dissolution, exhaustion is a barrier to overcome, and disease is a mark of weakness, imprudence, or immorality.
A failure of the body can cause a failure of one’s envisioned future in a real sense, of course. Not being able to control one’s body at this moment when it is so important, so crucial to one’s vision of the future, can be devastating to the way one understands the world. Everything can seem right, like a storybook, like a car commercial, or everything can seem unfair, out of control, unpredictable, and random.
Four years ago, my fetus, my second pregnancy, was alive. We were on the verge of embarking on a new stage of our lives by moving to Seoul, and my vision of the new life there included that baby. I saw its heart beating on the ultrasound machine, lodged in the fallopian tube just next to my left ovary, before they sent me down to the ER to have it removed. The doctor (fascinated, I suspect) pointed it out on the screen: “It is rare to see a live ectopic.” In the ER they told me, “It could rupture at any time. We need to take it out as soon as possible to minimize the damage to you.” Written in my chart, “Patient is teary and upset.” There were no symptoms, and I felt fine; how could I not have known? But I didn’t. I expected, by the power of my own positive thinking and the yearning of my imagination, that everything would work out fine the way it had that first time. Having proven myself normal with a previous pregnancy that had gone, after that initial scare, like clockwork, I was no longer so suspicious. I expected that my own vigilance, my attention to diet and fitness, and my strict compliance with all the latest studies and regulations (no more than twice a week for tuna) would usher in a happy ending. I only had the ultrasound so early, at the urging of an OB nurse and friend, because I wasn’t sure how long it would take to find a doctor in Korea. Later that earlier detection would turn into a story of “luck” and “the best-case scenario” and “think about what could have happened if you had ruptured during the flight?”
But at that time, that child had been so real to me, so expected, so much a done deal in my own consciousness and vision of the future. As I sat in the hospital throwing up from the anesthesia was I mourning the loss of that bundle of cells, the future I had imagined, or my faith that I could control my body and my reproduction?
This year, as I listened to N talk about her miscarriage, all those memories came back to me, and I thought bitterly that we were fooling ourselves. We think, with all these tools, that we are in control, have minimized the risks, and can know and regulate our bodies, that we can make those futures we imagine come true through effort and good behavior. As Joan Didion writes, “...I realize how open we are to the persistent message that we can avert death.... And to its punitive correlative, the message that if death catches us, we have only ourselves to blame” (The Year of Magical Thinking, 206).
As I sit here and struggle to articulate my feelings about ultrasounds and miscarriages and bodies, as I sit here and try to write yet another condolence note to a devastated friend, I think that I am open to this message that I can avert death, avert the undesired, and that if I can’t perhaps I have done something wrong. Those who write about miscarriage often feel an overwhelming sense of guilt and responsibility. Four years ago, before my miscarriage, I wouldn’t have recognized that I felt this way or admitted it even had I known. But, whether I knew it or not, I was seeking to cover my ass, trying to gain the desired outcome in any way I could imagine. I believed in the power of my imagination bolstered by those black-and-white images. I told myself these contradictory but hopeful stories about what is possible, some relying on science and technology, some relying on willpower and faith.
When the next pregnancy came it was completely unlike the others, but it didn’t matter; I could not rely on my own symptoms to reliably indicate success or failure. Over the years lived in this body, I have taught myself to distinguish normal and abnormal states of being, but pregnancy throws that all out of whack. I didn’t raise my expectations. I felt grateful for the medical system here, which relies more on ultrasounds than other forms of testing (such as measuring fundal height), but even after a string of five images showed the baby growing well, I didn’t dare to plan or hope or attach.
I read K’s post about a year ago and have not been able to let go of it, to really figure out how I feel about ultrasounds and what they mean to me. One reason for this ambivalence is because ultrasounds, to me, hold the promise of connection to the mysterious spaces within, but in doing so heighten that sense of discord between the body-as-I-feel-it and the mechanical reality of its functions and productions. Another reason is because I cannot see the ultrasound image as separate from the larger management and surveillance of the wayward and undisciplined forces within my own body. But the ultrasound also allows the pregnant patient to be managed by the medical profession, opening her to inspection and judgment. The doctor is my audience; I want to perform well for him or her, to receive the validation of my efforts and energies, and earn the label “deserving” or “not at fault.”
But part of the difficulty also arises from the instability of my understanding of my body. The way I feel about my body at any point in time depends on what I am demanding from it, what my expectations are, the extent to which I feel control over my bodily capabilities, my comfort/discomfort, my past experiences, and the extent to which the shape of my body affects my identity.
In the cultural story of ultrasounds, the ultrasound marks an emotional milestone — you see the image and you’re supposed to fall in love, as if in some sort of bizarre imprinting process. Although I had strong feelings and expectations for my first pregnancy, I can’t say that I loved that child until sometime after he was born, when he became a separate entity unto himself, and I no longer had to deal with the strangeness of him being a part of my body. The first image of him was taken at a moment when my sense of the body had been discombobulated and I really looked to the cultural narrative to tell me how I should feel. In subsequent pregnancies, my experiences guided my expectations, molding the kinds of stories I told about what I could control and what was possible.
I also read my struggle with ultrasound images into a larger struggle with uncertainty and risk writ large. Sometimes, I rage at my body because even in its small betrayals (I write this fighting the functional depletion that comes with lack of sleep) it reflects back to me my powerlessness in the universe, my susceptibility to forces I am unaware of and unable to influence.
Last, in a sense, my difficulty seeking to understand and control my body while knowing that neither process will ever be complete reflects the larger dilemma of parenting. Although the peanut was invisible inside me during pregnancy, that may have been the time I had the most control over its fate. Once he was born, I had to begin the slow process of letting go, of knowing I can’t always monitor and influence what happens to him. I tell him not to climb on his desk a hundred times, but he still does until it collapses under him, leaving him with a swollen forehead but no permanent damage. The frustration of not always being able to conjure up a healthy baby tails me through each bump and hurt of childhood, reminding me, though I refuse to believe, that it is not always my fault, that at some point I need to let go.