Content warning: Some graphic medical details, cancer, sex, “purity culture”, and religion. However, I feel like it’s important to be upfront about these topics especially in the current restrictions on women’s reproductive rights.
Also, you should check out The Struggling Scientist’s STEM the Flow project about period stigma in STEM.
Leila Chatti is one of my favorite modern poets. Born in 1990, she is a Tunisian-American dual citizen. In in her early 20s, Chatti experienced heavy and unexplained vaginal bleeding. There was a chance that her bleeding was caused by uterine sarcoma a rare form of cancer affecting uterine tissue. According to the Cleveland Clinic, treatment for this tumor includes surgically removing the uterus and cervix. Her experiences inspired the book Deluge (Copper Canyon Press, 2020) which is a frank exploration of her medical journey. The book also explores cross-cultural experiences, as well as sexism in the medical establishment, religion, and social scrutiny of women’s sexual development and motherhood.
Taboo “Female Ailments”
The poetry collection examines how the female body and its bleeding is medicalized, moralized, and culturally surveilled, resulting in various emotional and psychological pressures for the narrator.
In “Mubtadiyah,” the narrator reflects on her first experiences with menstruation, a startling change from childhood into supposed womanhood: “no longer/a girl: the blood my summons, blot like a seal, a scarlet membership/card slid from my innermost pocket. I was newly twelve and wise/enough to be frightened.” (7). The poem entwines menstruation with an increased awareness of the moral and social scrutiny of her actions. Once she had lived “unobserved, my sins not sins” but now feels “God’s reproachful/eye turned my way” (7–8). Menstruation becomes a moment of exposure; the narrator will be facing life choices that can lead to reproach. From a young age, the narrator felt a deep ambivalence toward menstruation and physical development. She confesses in “Mother”,
“If you had asked me, thirteen, what I wanted/to be one day, I wouldn’t have said it./I wanted, for a long time, to be anything/but myself, knew that a soon-to-be/woman was the second worst thing/in the world after a woman” (21)
Similarly, in “Haemorrhoissa’s Menarche” she recalls the physical suffering of adolescence: “I believed finally/one day I would die” (29), realizing the cyclical nature of this pain and the disillusionment of its inevitable return month after month.
One of the most powerful poems in the collection, “Hymen”, explores the cultural and moral weight attached to female virginity. The narrator refers to the bleeding traditionally associated with penetration during sex (stereotypically and falsely linked to virginity) as “second blood” and muses that she is “a box with no prize/inside, a sundae/with no cherry on top” (35) when that “second blood” fails to appear. This shatters a myth the narrator had internalized and calls into question prior religious and cultural teachings. The poem interrogates cultural expectations surrounding purity while also invoking the power of maternal lineage (“I fit inside my mother/when she fit inside her mother”, 35)) However, the poem continues to suggest a moral unease about becoming sexually active outside of marriage; she imagines her blood as something “owed” to a man, presumably her husband. The narrator, however, seems wary of the seemingly inescapable bonds of marriage (“I’ve always been frightened,/little veil, of wedlock’s/lock clicking shut”, 35)
When the narrator describes her sudden, unexplained vaginal bleeding, her fear, shock, embarrassment, and indignation, are clear. She observes the doctors’ subtle disbelief of her symptoms, exemplified in “Intake Form”: “Did it soak a tampon, did you say? How many tampons, would/you say?” (9). The relentless focus on “pain scales” disturbingly attempts to quantify a nightmarish experience.
The cessation of blood can also signal pregnancy. For the narrator, the stoppage of bleeding indicates hope that she could possibly be pregnant (“I am thinking/again of the blood that hasn’t come, the expected/blot and this morning’s bowl clean of water” (“Sainte-Baume”, 83), something she desires, but fears will never be possible given her medical condition. Hence, bleeding is not only associated with pain and perhaps guilt, but disappointment, that she is not pregnant.
Purity Culture
In both religion and society, pregnancy is often portrayed as the ultimate fulfillment of womanhood. Many poems in the collection reference the Virgin Mary, a religious figure whose immaculate conception of Jesus, is an idealized (i.e., sexless) route to motherhood. Yet Chatti’s poems complicate this ideal, juxtaposing teachings of purity with the narrator’s lived experiences of illness, bleeding, potential infertility, and sexual desire.
In “Remission”, the narrator reckons with religious guilt through much of the collection. The narrator lives, unmarried, with her boyfriend, an arrangement that feels shadowed by religious guilt:
“I was convinced his love an affliction, my one/transgression. Wished, having known it, never to have known it. And, knowing this, and without a vow to bind him to me” (62).
Her upbringing instilled a deep sense of moral surveillance, as reflected in “Sundays”:
“Sister teaches us/we are sweet, are sweets/bonbons, good goods/unless we’re unwrapped—[…] who wants a sucker/that’s already been licked?” (72–73).
Such teachings render sex as something that is sanctified only under strict patriarchal conditions, a tension at odds with her physical development.
The narrator’s struggle with illness intensifies this guilt. She wonders whether her suffering is “punishment” from God. This anguish is tied with the historical normalization of women’s pain by the medical establishment, a belief that goes back to the biblical story of Eve, whose “original sin” supposedly condemned women to pain in childbirth. Through these poems, Chatti interrogates the inheritance of that myth: female suffering is idealized as inevitable and divine, but at what cost?
Unfortunately, such notions have not dissipated in the 21st century. Even as late as the 1960s and 1970s, nuns and priests who left the Catholic church were shamed and pregnancy loss was blamed on them deserting their vows. Modern “abstinence-only” education programs often use degrading metaphors to shame sexual activity, comparing sexually active individuals to “chewed gum” or “a cup everyone has spit in.” Such imagery promotes stigma around sex and reinforces harmful notions of female worth.
In “Angel” the narrator receives a dark answer to her prayers: “After a month of asking, suddenly, a voice. It says you deserve that which has happened to you./It says I see what you do with your long, terrene hands” (26). These are devesting lines. Women’s ailments historically have been dismissed as “hysteria”. The prescribed “cures” were often to just get married and have children. The medical establishment has historically led women to expect to endure pain. The hormones involved in the female reproductive system were not fully understood until the 1940s.
Deluge examines both mortality and immorality. The narrator seeks spiritual or religious immortality while confronting her own physical mortality and the possibility that her cure may come at the cost of her fertility. If the tumor were indeed sarcoma, then the “cure” could potentially be to remove the uterus and thus the possibility of birthing a child naturally, often the culturally and religiously decreed ‘purpose’ of a woman.
Dissociation
Because of her symptoms, the narrator was routinely subjected to pelvic exams by unfamiliar health providers—an experience that led her to dissociate repeatedly. These poems reveal how patients’ emotions, especially fear, are rarely acknowledged; instead, symptoms are coldly quantified and measured.
The poems critique the impersonality of the medical establishment, which reduces patients to clinical cases rather than people. The narrator’s voice captures the sense of invasion and loss of privacy inherent in such examinations, rendering the experience both oddly intimate and violating.
The pronoun “you” in “In Portrait of The Illness as a Nightmare” heightens this surreal distance between patient and physician: “everyone looks. You are in your underwear/and the room is cold.” (24). “Awrah” explicitly illustrates this disconnect during a pelvic exam: “A man who does not know my favorite song opens me like a fig./He has the proper credentials./I have a paper sheet” (71).
The poem “Annunciation” renders this dissociation with its words scattered across the page, that indicate the narrator’s surreal experience during a pelvic exam staring at “a white blaze/above” and their empty reassurances “a bit/of pressure a sharp/pinch” and she gazes at the medical screen seeing “black haloes” (14).
Chatti reveals this troubling exposure in an interview:
The experience of ongoing illness involves a great deal of uncomfortable exposure. I spent two years constantly examined and touched. I became quite dissociative to handle the extreme vulnerability it required, and the more it happened, the more surreal the experience became — humbling myself, baring myself before doctor after doctor, doctors who saw more of me than any lover has or could, seeing even inside me, like gods. This was very strange for me to experience, as I was raised in a religion that specifically forbids women from being looked at. There were two powerful forces at play — shame, and a desire to be healed, saved. I hated the looking, and needed the looking, and felt powerless and humiliated and desperate and deeply grateful.
Explorations of Womanhood & Agency
The narrator explores deeply the lack of agency and powerlessness she felt during her medical treatment. Not only was her body suddenly in pain, but she couldn’t get straightforward answers from the medical establishment. Some doctors were overly preoccupied with maintaining the narrator’s appearance, which was drawn from the author’s real-life experiences. For example, Chatti states in an interview that
It felt like every conversation about my health was about my body as something apart from me, my self—what it would look like if I had surgery, or my ability to have children and how that should be put first. And I wasn’t trusted about my knowledge of my body. There was a lot of doubt about if I was really serious about how much I was bleeding, so I had to prove what I was saying was true. And there was also doubt about how much pain I was in—until I would faint. […] At the time they thought the largest one was a sarcoma, and the life expectancy they gave me was less than 10%, so I was obviously taking this very seriously. And when I brought in my stack of research, to say that I didn’t think the procedure they were recommending was safe, the doctor smirked at me and said, “Well, you’re a smart one, aren’t you?”
The first doctor she visits suggestion a procedure called ‘morcellation’ to remove the tumor.
He told me that I would want this procedure [morcellation] because I would look better in a bikini […] —I knew, and knew he knew, that if the tumor was a sarcoma, which is what they were treating it as, and they did this procedure, all the evidence indicated that I would likely die within a year or two—it would disperse the tumor cells everywhere and uterine sarcoma, when spread, is very lethal and hard to treat with chemotherapy and radiation. So, I went to another doctor for a second opinion who basically said, “That’s incredibly dangerous that they would have you do that procedure,” and during that weekend between seeing one doctor and a different doctor, the FDA decided that that procedure—morcellation—should be banned because so many women were dying.
Chatti transformed this experience into the poem “The Handsome Young Doctor, Who is Very Concerned”:
“The handsome young doctor, who is very concerned/with the future possibility of my body/in a bikini, insists/morcellation […] You’ll barely see it/he says, grinning” (51).
In “Mother” the narrator notes that even as a teenaged girl, she knew “to be a mother was the to be the only/permissible form of a woman, the begrudging/exception to the rule of our worth-/lessness” (21) but that the tumor she has threatens this “And I tell you the shame of it:/the feminine failure, its ache/a reminder—at the center the tumor/ballooning, like hope” (22).
Feminism & Medical Activism
Dr. Reed, physician, activist, and patient, whose efforts helped end the widespread use of power morcellation, died at age 44.
After the narrator has surgery to remove her tumor and learns that it is benign, she struggles to accept this new lease on life.
“Two years draped in black trail behind me like a cortege. Suited for a death/that didn’t come. My prolonged, equivocal mourning. It takes time to be/convinced, when I am well, that I am well” (82).
The narrator ruminates over the trauma she experienced, from the medical establishment, her past sexual experiences, the physical pain and danger she experienced, and the difficulties she will face conceiving a child in the future. Her relationships with her family and significant other have been changed by this ordeal. She also realizes that harmful medical procedures have resulted in the deaths of other unsuspecting women.
Chatti herself had to reckon with her definition of “feminism” and how the mistreatment of women personally affected her:
I’ve been a feminist from a very young age. I always knew there was mistreatment of women, but I was surprised to experience it in such a blatant, confusing way, in a context I thought would be professional, safe, and in service of my care. When I was sick, I consistently came up against sexism from my doctors and the general medical field that had really obvious consequences because it had to do with my health and my wellbeing. Even from the first moment—when I first came to the hospital, when I had been bleeding severely (I was hemorrhaging, and that’s where I think of everything starting) and my partner was with me, and he was freaked out, and we were both freaked out—the doctor kept talking to my partner, asking him the questions. “How much has she been bleeding? How much pain is she in?” Very personal questions, and my partner would say, “She’s right here, you can ask her.” That was the first time we were engaging with the medical world on this long journey, and it was very eye-opening—the assumption my partner knew my experience better than I did. That his opinion was more valued than mine.
Chatti was even advised, as a poet, not to write poems about women’s bodies, a warning she discusses in an interview:
“I thought no one would want to publish (or read) a book about uterine illness […] I had been told earlier in my career that no editor would be interested in my poems because they were too “graphic,” too (female) body-focused. Instead of shying away from the realities of my experience or cloaking its specifics in vague language, I decided to lean into making my experience more visible, to linger in image by imagining the experience as an image.”
At the end of the book, Chatti thanks Dr. Amy J. Reed who underwent morcellation and became an activist against the procedure before her death in 2017 at the age of 44.
“Previously, the risk of the dissemination of uterine sarcoma via morcellation was thought to be 1 in 10,000. After Dr. Reed’s activism, the FDA revised the risk to 1 in 350 and banned the use of power morcellation in the vast majority of uterine fibroid surgeries.” (87).
Medical activism is a large portion of feminist science studies. Feminist activists have been successful in combatting the stigma and increasing research funding for such diseases as breast cancer, empowering women with knowledge of their bodies (Our Bodies Ourselves), and fighting for contraception and abortion access. However, many diseases like endometriosis, have not been taken seriously by the medical establishment, and are often ignored in global policy and research funding. Women’s research health is severely underfunded; in 2020, only 5% of global research and development was allotted to women’s health research.
There is still a long way to go.
Conclusion
Overall, this collection is mind-blowing in revealing sexism in medicine into extremely moving poems with elegant, precise language. Her book is a radical form of feminist science scholarship.
I really enjoyed reading a poetry collection from a contemporary of mine. It was an accurate examination of growing up in the 2000s and 2010s as a woman in the Midwestern United States. Like her I come from a line of Catholic women, where discussion of sex was taboo (mention the word ‘condom’ and the equilibrium of the room was disturbed for an hour), and attended Catholic religion classes where we were told not to have sexual thoughts. I can attest, that even in the mid-2000s we were receiving abstinence-only education in public high school. Period cramps were dismissed, and we weren’t allowed to take Tylenol in high school (it was treated as a drug) so I hid pain killers in a foil packets in my purse and would give them to girls who needed them.
Deluge won the 2021 Levis Reading Prize, the 2021 Luschei Prize for African Poetry, and was long-listed for the 2021 PEN Open Book Award.
I would 10/10 recommend this book and am looking forward to reading her new book Wildness Before Something Sublime.
You can follow Chatti on Instagram