I confess that I’m drawn to any writer who bears resemblance to the love child of Jane Austen and Dave Eggers. Said love child tells a story of poop and vaginas and unhappy guts in an effort to untangle the knot of distressed bodily systems that lead to a certain flavor of chronic illness; not just any chronic illness, but the kind that makes doctors shudder and pass you, the patient, off to another specialist. And Sarah’s story is one of being passed from one doctor to another, ad infinitum.
While these topics may not have been previously mined for their comedic gold, Ramey does a good job with the material. To wit: when considering chapter titles, two contenders were Yeast of Burden and The Red Vag of Courage.
The Lady’s Handbook is addressed to numerous audiences, but if I had to preference one audience in particular, its to WOMIs–or, women with a myserious illness. This illness lives on an sliding scale. It includes low level WOMIs with autoimmune issues and some other subsidiary issues (that’s me!), up to high level WOMIs whose issues create a medical file that weighs as much as they do (e.g., see Ms. Ramey) and dramatically reduces the bearers ability to function in any semblance of a normal life.
Ms. Ramey takes us on a journey of self discovery, in which, over nearly a decade of her own research, she manages to diagnose the plethora of broken things that have taken up residence in her system, wreaking havoc with her gut, her adrenals, her bowl and vagina–ultimately her life. Why, you might ask, would a writer (and musician) have to diagnose herself? Good question. The short answer is because her case, like that of many WOMIs, was misdiagnosed, dismissed, condenscended to, avoided, and inappropriately treated by the legions of doctors to whom she entrusted herself for YEARS.
Why did this happen? Why was her case seemingly impenetrable by the medical establishment? Her analysis suggests a number of factors. First, extreme complexity doesn’t mix well with the standard 15 minute doctor’s appointment. It’s impossible to decipher the sources of such far ranging dysfuntion in a 15 minute window. Viewing medicine from 50,000 feet, this complexity doesn’t lend itself to discernment by a medical system that dissects the body and treats each organ or system independently.
Another prominent factor is an unconscious bias against women that lives not only in the many male doctors who failed to provide competent care, but on account of a mysogeny baked into the culture, one that resides in all of us. The bias subtly encourages doctors to be dismissive of female patients and female patients to accept the condescension and dismissal. Finally, these types of illnesses, while not new, rely on relatively recent scientific understandings of the body. (Practitioners of functional or integrative medicine really search under the rug of a person’s experience to try to unearth the source of complex conditions and may offer more promise for WOMIs).
Her research traces out the connections between the gut microbiome, the central nervous system, the endocrine system, the liver and the brain (but not the kitchen sink). She can paint a picture of WHY more women than men end up with these fantastically complicated chronic conditions and what the science currently says about how we can undo (or partially mitigate) previous damage done. Her answer is to put the silver bullet down and and instead consider making changes to a host of behaviors–nutrition, exercise, sleep, etc. to slowly (but nearly surely) lead the WOMI to better health.
Her ultimate battle cry: “Listen to Women. Shortened form the original, “Listen to Women, You Fucking Motherfuckers.”
Although this was not a hard sell for me, I’m totally on board.