I pushed for an hour and a half, my knees pulled as close to my shoulders as possible. There was too much inside that needed out. The intern counted from ten to zero, too slowly, from the top of each contraction to the end of it: 10-9-8-7-6-5-4-3-2-1. Each time, as I released my breath, he poked two of his fingers inside my vagina to probe for the baby’s head, triggering me to puke more than once as he breached that border between a child’s readiness for life and the pain of bringing it.
Later, my obstetrician breezed in, threw one of my legs on her knee and told me to push! My face shuddered and dissolved with the effort. My baby crowned after three pushes. Then she cut me, a smooth slice of the scalpel to open me wider, which I didn’t feel nor question because she should understand my body better than I. In the absence of an epidural, I continued to push with everything I had, so much so that my son Leo shot out of me into the bright light of a hospital room, jostled in the arms of my obstetrician. Then she stitched and stitched the torn tissues and muscles of the fourth-degree tear, an open wound, the stinging of the needle surpassing several rounds of local anesthesia shot into me.
Then I saw him, my baby outside my body, detached from my womb, establishing his ultimate independence and his first displacement. He passed from one set of hands to the next. His head is my husband’s head, long and pointy. This struck me. This wasn’t just my baby. And my body was not just mine because this baby crashed out of it, and that doctor forever changed it, and it would be left bloodied and shivering in the cold delivery room, alone with an orderly who lifted the afterbirth, like a fresh cut of meat, from a table and headed to the garbage.
I got what I wanted. My body felt what it is like for a human to be born from it, to cross the border to the world. I hadn’t thought beyond that yet—what happens after.
Giving birth to Leo made way for snapshots of new life: a soft, small, and newly formed body—and shit, but not just his shit, which I was ready for, but my shit, first streaming through my vagina when my postpartum blood had stopped, and then through a stitched hole near my vagina. When I texted my obstetrician three-weeks-postpartum to tell her that there was brown fluid that smelled foul showing on my pad, she asked, “Does it smell like poop?” And I said, “Well, I thought so, but I couldn’t imagine why.”
I went in to see her soon after. She examined me by sticking two fingers in and smelling them. It was the same projectile-vomit-inducing-two-finger thrust that the intern used when he was checking for Leo’s head as I pushed on the delivery bed. Now, my obstetrician said, her two fingers to her nose, “I don’t smell anything.” I went home, relieved. But the next day, I saw it again. I waited. Two weeks later, when I called to tell her that the stream of foul-smelling brown fluid from my vagina was not gone, she told me, “Please come in right away.” Waiting for me was a colorectal surgeon, who would later perform three surgeries on me, who stuck his fingers inside but didn’t smell them.
I heard him say words that later would prove to be inexact: “She needs a simple surgery.”
Doctors sometimes have a way of infantilizing their patients—by oversimplifying things. This is a way of making patients imagine they are in the hands of a god—perhaps largely to avoid any shame of admitting they may not be able to heal you; or conversely, that they may have made a mistake. The result is, if you are new to the world of surgeries and recurrent medical care, you become blinded to the possible horrors that the hands or body can sew.
In Powers of Horror: An Essay on Abjection, Julia Kristeva describes the abject as being in a liminal state, a border between two positions. Or, between that which is inexpressible through language and that which resists expression. Or, between the internal site of wreckage of a new mother (ie. tattered pelvic muscles) and the simultaneous external site of caretaking of a newborn. The humiliation of my shitting myself when it should have been just this small being shitting himself can perhaps only truly be felt? How much detail do I subconsciously allow myself to express? To what end should I detail the time I was walking in Hamra and my overactive intestines spilled hot and thick, so quickly, into my jeans as I strolled little Leo? How much can I tell of the humiliation of frantically walking into a salon, parking the stroller in its entrance, and running into the bathroom to wipe the wet muddy shit off my jeans, my legs, my underwear, before I could walk home? What about the horrors I left behind in that salon’s bathroom? In the liminal state, there is a hovering demand for decency—triggered by a physical repulsion, or what Kristeva calls our “corporeal reality”—to keep the shitty details to ourselves, out of the public realm.
The sound of that word—surgery—filled the room, echoing throughout my body, knocking at doors in my mind that had not been opened, as I stared at the ceiling. I had never undergone one. Now a scalpel would go into flesh, not just any flesh, but into deep layers of erotic pleasure zones, peeled back, handled, stitched, reconstructed. This is what Kristeva calls the site “where meaning collapses.” Where the surgeon and my gynecologist spoke about “connections between the rectum and vagina.” I had never heard of this happening to a woman before, not a new mother or otherwise. I was just a new mother. Now I had to confront the woman I would become.
The abject begins from the moment we are separated from our mothers. That is, to become an independent human, there must be a repulsion toward our mothers, which also means being repulsed by that which gave us our existence. If this is true, this repulsion may be absorbed by the mother, fomenting her own repulsion—of her existence as a mother. Otherwise, how can she also be independent of her motherhood and be her other selves?
Two years after that first meeting with my fistula surgeon, I was recovering from my third surgery to fix the holes and pathways that were between my vagina and rectum, that border of tissue and muscle that was blown out by giving birth and improperly sewn back together again. But now the diarrhea that would not stop just after my release from the hospital a week earlier was burning right through the suture line (what the doctors call the line of stitches) my surgeon had formed in a surgery that I thought was the final attempt to heal the fistulas that plagued my life since Leo was born. He had been confident that this surgery would do the trick (and as a result, so was I). But when I found a stitch in the bidet a week into my convalescence, I knew it was over. I hadn’t known what desperation was until that moment. I crawled into bed.
I asked Rami to get me some of that hydration liquid that tastes like flavored bathwater from the pharmacy, the kind people take when they have diarrhea and want to prevent dehydration. He took Leo with him. The unbearable fear began settling in: What rebellion was my body fomenting?
I called my surgeon. I told him about the lonely stitch that sat pathetically in the bidet, smaller than my pinky nail, but its omen ruining me. I said, “This probably means that the surgery failed, right?”
He said, “Not really.”
I said, “I think there is stool coming from my vagina again.”
“Wait, are you sure?” he said.
Then there was a gush. I peeked into my pants and saw a red spill, the brightest red, pooling under me, spreading into my mattress, soaking my pants. “Send me an ambulance!” I told him.
“I can’t,” he said, “You have to call it yourself.” I asked him for the number.
The week before, when my friends were visiting me in the hospital, giving me hospital bed facials and keeping me company around the clock, my very organized friend T. pulled out a laminated sheet with numbers of all sorts of ambulances in Beirut. I had taken a picture of it with my phone because although I had lived in Beirut for twelve years, I still did not know what to do in a medical emergency. How was I ever so naive?
Blood. Shit. Tissue. Only my skin is a border between me and the hell breaking loose inside.
I gulped down a bottle of water as I hemorrhaged, my body answering the questions I depended on the doctor to answer. I immediately scrolled to the image of the emergency numbers on my phone and called the first one I saw, a private company. Then I called Rami and told him, please come, hurry. Then he hung up and called the Red Cross, and I didn’t know. I gulped water because I was afraid I would die. But when he walked in with Leo minutes later, I was still alive. He told me he called the Red Cross, so we canceled the private emergency. And shit and tissue and blood pushed out of me with a monstrous force. He pulled off my pajama pants, which were now thick and heavy and red, and they slapped to the floor. He swore, I presumed at the doctors, the blood, the obscenity of it all. But he remained calm. He gave Leo a toy to play with on the other side of the bed. We waited, I have no idea how long, but it seemed too long, and then we decided to call the private ambulance again to see if they could get there sooner. “Do you want us there in twenty or ten?” Because there is a price difference. Rami swore again and hung up.
We waited for the Red Cross who arrived thirty minutes later—there was traffic in Hamra. They scooped me up, a red towel between my legs to catch the tissue, blood, and shit. They too were very calm.
As I was wheeled out, the neighbors peered over their balconies, from their shops, hanging their heads outside of windows—staring at me. Stopping everything so they could watch the spectacle of a young mother wheeled out of the building toward an ambulance. I pulled the blanket over my face, ashamed of what, I didn’t know.
Illness or body horror pull you into ugly places, where you are a few degrees removed from yourself. You keep imagining yourself as you were when you were imagining yourself as a future someone else, which is not what you have become.
I had never heard of a fistula before I had one. Most importantly, between the time I was trying to get pregnant and the time I gave birth, I never had a conversation about the gruesome side of childbirth. Most people, even pregnant women, don’t want to hear it or talk about it. Women still die in childbirth, and many, many women are injured, sometimes beyond repair, destroying relationships and one’s sense of self. What if we talked about these injuries more? What if we left our shame about it next to all the other body shame we are told to shed? Motherhood is always put in a separate category, on a pedestal, cloaked in pastels. But it is streaked in red.
Down in the now familiar white cold of the surgery room, my surgeon was waiting. There was the familiar scene of a cluster of doctors busily prepping things for my emergency arrival. This would be my fourth time in the underground. I told them, “Please don’t let me die. I have a son.” And they all told me that I’d be okay as they placed the gas mask on my face and I drifted into blackness. While under anesthesia, they sucked out the copious blood clots from my vaginal canal, and stuffed it with gauze, which stayed inside of me for the next two days until just before the colostomy surgery when the nurse pulled it out in a long soggy mess of shit and blood.
I woke up blinking from the death of anesthesia and found the surgeon above me.
“I am distraught,” he said. It was not expected that this last surgery would fail as well. His head glowed under the hospital lights as I heard him say, “You will need a colostomy…” I closed my eyes. I heard him say, “quality of life…” He patted me on the shoulder before walking away.
He wasn’t telling me something I didn’t already know. I knew that my third fistula surgery could lead to a diversion of my colon, even if I was in disbelief. I’ve spent the last several years trying to have those rogue holes closed—and trying to explain it all past layers of shame and horror.
Many women from the “Living with Obstetric Fistula” Facebook group, a private candid space of injured women from all over the world, mentioned that they had an elective colostomy to divert their shit so that their shit wouldn’t ravage their suture line. Usually, when you have a suture line anywhere on your body, it needs time to heal, but when it’s inside of you, the healing process is trickier. In other words, the tissue of a fresh suture line in a “high traffic area” such as your rectum is more susceptible to infection by the filthiest secretion from your body, the shit that scrapes along it.
I’d be a person with a bag, I would wear a bag that would catch my shit. I would have a shitbag.
Freud’s anal stage begins around eighteen months, when kids begin potty-training, which is also another stage of separating from the mother, who is also your first “public” audience. Here is also when the first socialized feelings of shame begin to form. Can you control your shit? If not, shame on you. All of us who have known a child who has shit himself, or missed the toilet and soiled himself, embodies a public shame expressed through a burst of screams and cries, sometimes a frozen stare. If the roots of our shame trace back to our first experiences of attempting to shit in a toilet, it makes sense that the subject of shit is most often avoided, or when it is brought up, it is in a fit of giggles, smothering the foulness. But just like any topic that breaks through to the other side of silence, a good poop talk can be cathartic and a tinge liberating.
When I first learned of my situation in my obstetrician’s office one month after Leo was born, when I learned I needed a “simple surgery,” the first thing I told Rami was Please don’t tell anyone. I didn’t want people thinking that I was disgusting or somehow damaged. They would whisper questions about my sex life. They might treat me differently. No one needed to know.
But then I told my close friends. And visitors. And other mothers. And health care professionals. And anyone with whom I sat. Eventually, it became something like an obligation. People needed to know that bringing a person into the world was gruesome. That although we may be in touch with our bodies, we can never completely know them — nor can our doctors. But we do know them in a way our doctors don’t. I wanted conversations about giving birth, and not just about what it meant to have a child or to raise him. But also, I wanted conversations about women all over the world who feel shamed into silence about their condition.
So, I started writing about it. I wrote a daily journal as I convalesced after the first surgery, which failed miserably, the stitches in my perineum breaking free one week later, giving way to shit as my baby looked on, wiggling his arms and legs. I was paralyzed from thinking about anything else. I logged the food I ate, the mania of emotions, the doctor’s office visits, Rami’s care, the baby’s development which was commensurate to my body falling apart. My daily log turned into an essay that I ground and ground over several years about the language the medical community uses to speak about our bodies versus the language we could use that resonates with the intimate knowledge of our bodies. I’ve tried to get it published many places. One editor of a prestigious magazine gave me comments, showed interest, but she left soon before I could revise. I even pitched to a few women’s magazines with no response. I am convinced that people generally care very little about women’s bodies beyond how they can give pleasure or how they die. How often does the damaged postnatal body, that place between giving birth and becoming another woman come into view? When more surgeries came and more failures and the shitbag became a part of me, and I came face to face with the abject on a daily basis, I sought to understand this aspect in relation to shame, poring over Kristeva’s work for months, grasping at an intellectual interpretation of the new features of my body. Her intricate concepts would sink in after a long while of leaving them, somehow proving her point that the abject is that which we resist knowing.
The best fistula doctors are in Ethiopia, where Rami and I went shortly after this last failed surgery, after the colostomy, after feeling like answers to my health were elsewhere. In sub-Saharan Africa, where gynecological care is scarce, many women, especially from rural areas, give birth in their homes, unassisted. Over the course of days in labor, their obstructed deliveries give way to the development of fistulas between their rectum and vagina or their bladder and vagina. Most often, they lose their babies. After the ordeal, they are left so damaged that streams of incontinent stool or urine flow from them. As these women recuperate, but not completely, they are banished to the bed, where they must stay until their legs atrophy, and they will need to learn to walk again. Their families disown them. They are a shame.
The grounds of the famous fistula hospital in Addis Ababa are modest, quiet, an oasis from the hustle and bustle of the city. Bursts of bougainvillea rim the walls, which feels like home. Dr. F walked serenely down the path as I walked up. We immediately knew each other. His voice was smooth as a river. My desperation clung to me now like a leech. I needed someone to heal me, to hear me.
Dr. F showed me around. Here is the building that Oprah sponsored. Here is where the 90-year-old founder lives. Here is where the women do physical therapy and rebuild their muscles after they atrophy. This last place was dark, lights out, save the dull sunlight that shined through the open door. Before and after images of women who came to be rehabilitated were on the wall. These images hit me in the gut with the unjust shame these women are forced to live by. I wept for them.
Dr. F took me to the examination room where the bed had a small pillow and pieces of Ethiopian-print cloths strewn about it. He examined me by gently sliding a long metal probe through the fistula. When he finished, he leaned up against the wall and spoke to me for an hour and a half, behind him a white board with all the surgeries he had scheduled for the day, at least ten. I wanted to know how many of the surgeries he did were successful. He explained that everyone gets better if not fully healed. Many of the women also need bags to live a normal life.
As I spoke to Dr. F, I glimpsed a patient through the window, sitting outside. A sudden gush of urine fell from her and between the wooden slabs of the bench she sat on. She must have had a fistula between her bladder and vaginal wall, meaning incontinent urine passed from her vagina. Dr. F said her baby died in childbirth. She didn’t react as the urine splashed onto the concrete floor underneath her.
I didn’t feel embarrassed for her. Just an affinity with the numbness, the stillness, the passivity she exhibited as her body lost control.
Living with a shitbag can come to be normal. And it can save your life and your health. But it does not cease to be foul as you confront your insides as they splay open on the outside.
One may say “everyone shits.” Everyone shits. When you shit from your rectum, your universe-given mechanism for releasing waste from your body, the colon has already absorbed much of the runny, mucusy waste that flows through it, so you have decent, civilized pieces of shit come out of your body. When it is diverted into a bag that has been attached over a piece of your small intestine that protrudes from a hole in your stomach (aka a stoma), it is the consistency of wet mud. The smell is so intense as you unsnap the full bag dangling from its base that you almost embarrass yourself in the isolation of your own bathroom. A cloud of shit is now penetrating you. You drop the shitbag in a plastic bag, which you close as tight as you can and take it to the bin outside the building, worried that if you leave it outside your door for the natour, he will be assaulted by the smell of it in the closed elevator. He might be repulsed by you. This is a trail of shame.
It is summer, and electricity has become a luxury. The second wave of corona has hit Lebanon, reeling us all back home. I sit and write. I smell like sweat and perfume, and a lingering trace of shit. No one can smell it, or even sense it. But I do. The shame is not about having a bag anymore, but about a disassociation with myself, even if fleeting, that is set off by the ever-present foulness of shit and the separation of myself from the world I once occupied, of what is considered normal. When I am in the bathroom alone and I see that piece of intestine sticking out of my abdomen and all that shit, my bravado and understanding of it are not lost, though I can’t help but hate myself just a little.
Shame is ever-present. It is an emotional state that overcomes us in the most intimate moments, but it is also a concept we return to at major historical junctures. In English, it is present in expressions that relate to a heavy weight, to the chest, to a stifling of air. In Arabic, the expressions derive from shyness and modesty, which deal with the eye and the face as sites of individual and collective shame.
This special issue on “Shame” raises questions about how we receive the disapproving gaze of the other. How does our internalization of shame change our self-perception? How do we live shame individually and collectively in the most intimate and historical moments? In what ways do we flaunt the source of our shame in order to confront it? How do we wield shame as a tool for disciplining the self and others? Ahmed Naji, Zeina G. Halabi, Angela Brussel, Omar Mismar, Rima Rantisi, and the Editorial Team at Megaphone, interpret shame in various prose and multimedia approaches. This issue also features unpublished images from Myriam Boulos’s “Sexual Fantasies” project as well as the first Arabic translation of Silvan Tomkins' seminal text, in which he describes shame as "the sickness of the soul."
This special issue was edited by Zeina G. Halabi for Megaphone News and Rusted Radishes: Beirut Literary and Art Journal, with the support of the Arab Fund for Arts and Culture (AFAC).
Rima Rantisi teaches in the Department of English at the American University of Beirut and is the founding editor of Rusted Radishes: Beirut Literary and Art Journal. Her essays can be found in the New England Review, Literary Hub, Assay: A Journal of Nonfiction Studies, Sweet: A Literary Confection, Past Ten, and Slag Glass City. She holds an MFA in Creative Nonfiction from the Vermont College of Fine Arts.