What Happens When Your Body Image Nightmare Comes True

I'd always been self-conscious about my abdomen. When I got endometriosis, everyone else became conscious of it too.

I was checking out at the grocery store, loading cat litter and toilet paper into my cart when the clerk paused, mid-scan. "Oh my gosh!" she said with the unmistakable — yet very mistaken — joy I now recognize instantly. "When are you due?"

My heart sank the way it does when somebody identifies the one thing about yourself that you're constantly hoping nobody will notice. I bent to put the litter in the cart and stood up, conscious that I was trying to stand up straighter, and even more conscious that no matter how straight I stood, my belly was not going to suddenly melt and flatten underneath my yoga pants. "I'm not pregnant," I said. I sounded apologetic. I'm sorry my body has confused you.

The clerk's face flushed red: "Oh my gosh, I'm so sorry. That's the worst. Don't worry, I'm not perfect either…" And then, somehow, remorse wound its way around to incredulity: "Wait, really? You're not?"

Really. I'm not.

But it was an honest mistake. From the end of my twenties to the start of my thirties, I spent around 10 days of every month looking three to six months pregnant. My not-a-baby bump was caused by endometriosis, a chronic medical condition where the lining of your uterus builds up in places other than your uterus. In my case, the uterine lining has coalesced into lumps that doctors creepily refer to as "chocolate cysts" in both of my ovaries. The cyst on my left ovary, which I named Horace, was almost three inches in diameter. During my period, around ovulation, and really, any time according to his own whims, Horace flared up, which felt like someone shoving a red-hot fire poker repeatedly through my pelvis. The pain lasted for hours, sometimes days, and brought many delightful side effects: migraines, nausea, and watching horrible infomercials at 4 a.m. because I couldn't sleep for the vomiting. My abdomen swelled up to an early-second-trimester-sized bump as a result, and stayed that way for days or sometimes weeks after the pain subsided. Yoga pants, empire waists, and flowy tunic-y things became necessities: I could no longer button my jeans.

Endometriosis has no cure, but many women find relief by staying on the Pill indefinitely or with laparoscopic surgery. I tried both, but Horace was irrepressible — he grew back three months after my surgeon removed him and all his friends (4 pounds total) with lasers in the spring of 2012 — which left me trying to answer a question facing anyone with a chronic illness, a disability, or any other constant body frustration: How do you love your body when it doesn't love you back?

I've always had a complicated relationship with my stomach. I spent years in yoga and Pilates trying to find my possibly nonexistent transverse abdominal muscles. The pair of jeans that doesn't give me a muffin top has yet to be designed. Look, everyone has their own body-shame deal. But J.Lo taught us to embrace the booty; Christina Hendricks brought back hourglass curves. No celebrity — unless she's actually building another human inside of her — ever says, "I love having a Buddha belly." Even before my diagnosis, I spent more hours than I'd like to admit in dressing rooms asking, "Does this make me look pregnant?" So when I first started getting sick at age 28, I assumed I was making too much of my stomach yet again.

Then I started getting mistaken for pregnant in public. A lot.

And I started to privately obsess, documenting my stomach swelling with selfies shot in profile before and after Horace flare-ups — yes, exactly like a pregnant woman charting her belly growth. I hopped on the scale and confirmed my weight could swing 6 to 10 pounds in either direction, depending solely on Horace's mood. Fitted cardigans, sheath dresses — it felt like half my wardrobe was on hiatus. My worst body-image fear had taken up physical residence in my body.

But no matter how fake-pregnant I looked, my family and friends seemed to think I was focusing on the wrong issue. Why get worked up about something as shallow as the shape of my stomach when I was missing work and birthdays and quality time with my loved ones due to mind-numbing chronic pain? "You need to just be nice to yourself," my mom would say. My husband also refused to play ball, sticking to "you're still beautiful." But more than declining to indulge my insecurities, everyone seemed to want me to rise above such petty concerns, as if a chronic illness should make you all profound and Zen-like. But being sick didn't erase my complicated relationship with beauty — it just made it more fraught. Wanting to look pretty isn't a privilege reserved for the healthy; the standard just feels even more out of my reach now.

I knew my stomach size didn't matter as much as the fact that I was in too much pain to leave the house. But my anger at how my body looked was tangled up in my anger over those things. After all, our cultural definition of health is beauty, and we're told all the time that both are possible if we just apply enough discipline, diet, and exercise. We make New Year's resolutions to lose weight "for our health," but we're really thinking of our skinny jeans or how we looked on our wedding day. When people do lose weight, they celebrate their new dress size, not their reduced blood glucose level. In my case, weight didn't cause and couldn't fix my health problems — it was just the most obvious symptom.

Then one brutally honest friend said, "I hate your body so much!" when I told her that Horace was back post-surgery. I laughed, but it felt like being slapped. She was talking about my medical issues, but just hearing those words spoken out loud — after saying them so often inside my own head — changed everything. It was like when my sister and I were kids. I'd kick her out of my bedroom a hundred times per week — but if another kid made fun of her on the playground, I'd want him dead. You can't say you hate my body, I thought. Only I get to hate my body. And only I'm entitled to do that because actually, deep down, I don't hate it at all.

What I actually hate is the beauty culture that has convinced people a woman's stomach should always be pancake flat — with one specific, brief exception — when there are a thousand perfectly valid reasons why someone might "look pregnant" when they aren't. So I began to systematically replace every negative body thought with a more honest assessment of my frustrations. This started while agonizing in my closet over what to wear to a party: As soon as I thought, Everything looks terrible on me, I corrected myself: It's annoying that Anthropologie doesn't make jeans to fit my shape. I also tried pairing my negative thoughts with a more positive take on my body: I hate that my jeans don't fit…but I look great in boots and short skirts. It helped so much, I found myself giving internal pep talks any time I felt like my body was letting me down.

On a weekend hike with friends in Vermont, I came face-to-face with how months of chronic illness had impacted my aerobic capabilities. I lagged, wheezing, 15 minutes behind the next-slowest member of our group as we trekked uphill for two hours. When I ran out of nice things to say about my body (I don't dye my hair and it is a lovely color, My feet are very small), I began listing my other good qualities: I knit an excellent cable stitch, I make amazing pancakes, I can do a headstand. On the way down, some faster friends took pity and walked with me, so I told them about my strategy. They added to the list: "Your hair looks amazing even when it's just air-dried!" said my friend Michelle. Then her husband Kurt chimed in. "You know, I don't consider walking slowly to be a moral failing," he said.

Even if my stomach fears had been realized — and even if the cultural association of health and hotness perpetuated those fears — I was still my own worst critic. My friends weren't judging my hiking speed. They also weren't speculating about the reasons for my weight gain. Those grocery store clerks and gas station attendants weren't delivering a referendum on my character when they mistook me for pregnant. They were just making conversation. I was the one imbuing it with meaning.

I would like to say that insight completely transformed my relationship with my body. But here's what happened instead: I got pregnant for real! It was a relief, both because I'd been worried that it might never happen (endometriosis is a leading cause of infertility) and because as soon as my daughter took up residence, she sent Horace packing. She's 19 months old now and my endometriosis has been in remission ever since.

And for nine glorious months there, whenever someone asked when I was due, I could just…tell them. It was lovely, but also temporary. Fast-forward to five months postpartum and there I was, being whisked to the head of a wedding buffet line because the waitress was so sure I needed to "eat for two." Or straight to last weekend, when I walked into a wine shop with my daughter — wearing jeans that button, even! — and the owner said, "Wow, and another on the way!" Because I have been pregnant, I seem to look a little bit pregnant all the time now. Which makes me a rather grateful to Horace, for giving me all that practice. These moments are still awkward. The other person inevitably stammers. But I don't apologize anymore. "Not pregnant!" I say. "This is just me."

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