The Menopause Inflection

Posted on February 7, 2022 by Catherine Cheng, MD

From overlook on Ptarmigan Trail, Silverthorne, Colorado. Left to right: Buffalo Mountain, Red Mountain, Silverthorne Peak

What does the graph of your life look like?

I imagine we’d all put something related to time or age on the horizontal axis, but what goes on the vertical? What is meaningful to you, that is worth measuring, over a lifetime? Joy? Financial success/accumulation? Education? Learning? Status? Growth? Contribution?

For a long time I conceptually contrasted puberty and menopause, seeing the former as an exponential acceleration in growth and the latter a rapid decline, like the two stems of a broad arch, an upside down parabola. This past week during a patient interview, however, a wholly different perspective dawned on me. Menopause may signal the end of child-bearing years, of youth. Some may perceive it only as a global decline—the unmistakable physical sign that we are now closer to the end of our life than the beginning. But what if it’s also a new beginning, life expectancy not withstanding?

My patient and I discussed the trade-offs we are called to make throughout life—career, relationships, geography, etc. What do we get in return for trading away our reproductive years? For me the greatest payoffs are wisdom and confidence. After about 5 decades of living, learning, and being in relationship with self and others, I welcome this phase of life with keenness and joy. What a relief to have my personality and values established, to know what I stand for. How rewarding to feel that I can walk into any room and talk to anyone, knowing fully and without question who I am, without having to compare myself to anyone around me. How fun to find opportunities for continued learning around every corner, in domains I never thought I’d encounter, or even knew existed! Everything I have experienced, learned, and struggled through until now comprises a thread in the tapestry of my life, and the picture gets more dense and colorful with each passing day, year, and decade.

The life graph of learning and personal growth is most interesting to me. Superimposed on the graph of challenge and pain, I might see the lines travel in parallel trajectories—no surprise. As the years pass, though, I see a net positive slope, a steady climb of the most meaningful curves, and menopause perhaps as a milestone inflection point, beyond which the ascent may well progress with fewer stutters and regressions, as wisdom and confidence accrue, and mission/cause come into greater focus and clarity.

I choose to see and draw my life graph this way.

Why not keep climbing until the end and go out at a peak?

Gotta go now, I’ got work to do.

Mantras for 2022

Posted on January 31, 2022 by Catherine Cheng, MD

What words encircle your consciousness this year?

Maybe you don’t roll with words? What ideas, feelings, sounds, or other sensations, then?

When you get still, where does your energy settle, and what aspirations arise?

I share some of mine here; I’d love to read some of yours in the comments!

“Stop Shoulding All Over Yourself”

As I get older, I reach for larger, stronger mental shovels to evict certain voices from my mind. “New Year’s resolutions are useless, don’t bother” (see evidence to the contrary). “Get up early and write in the morning, it’s the only way.” Do this, do that, think this, feel that. I’ve internalized enough societal standards and constraints, some helpful, many not. Every year of adulthood also solidifies my own core values and goals, which themselves drive me forcefully—not enough, never enough, must be better, always more. In the end all the ‘Shoulds’, both external and internal, can feel heavy. I know who I am, I know what’s important to me. I’m a lifelong learner. I progress because it’s my nature. I do what I need to do and I’m good at it; I am enough.

Competence and Confidence

So many recurring challenges—this past year especially, but just generally in life, right? When I look back only at the past weeks or months, it’s too easy to judge myself harshly and wonder, am I really enough? Look at all the mistakes I keep making, over and again! But when I breathe slowly and deeply, looking back farther on the long arc of learning, I see unequivocal progress. “If it’s important, it will be repeated,” they always told us in medical school. Life lessons always seem to come around again just when I need them. With every iteration, when I can be fully present, tame my feral emotions, and call forth skills already learned, my ability deepens, even shines. Every such instance prepares me for the next trial. This is the benefit of mid-life: seeing clear evidence of advancing competence, and feeling the confidence to own it.

Transform the Story

The first and most important lesson I learned from coaching was to recognize the stories I tell. All of our perceptions are, in very large proportion, formed in advance by our past experiences, biases, and expectations. “Reality”, how we make meaning, is far more subjective than we realize (ha!) or admit, and I’m convinced that most human conflict arises when we deny awareness and acceptance of this. I’ve gotten pretty good at noticing and moderating the stories I tell in new and low stakes encounters. But in longstanding, intimate relationships and high stakes situations, I am often still chained to my deep, often negative, and ultimately self-defeating stories. Ironically they are stories about others which, when I’m honest, are actually projections of my own concealed wounds. How fascinating…and worthy of the work to disassemble, to free myself and my loved ones from these abstract cages of invented being.

Lightly, Lightly, Ever Lightly

*deep breath*

It’s all so much, this work, this drive, this constant striving in potential and possibility. There is a role and a place for the Shoulds; the challenges all make me stronger; and the old stories all served a purpose once. To grow is to shed, break, and deconstruct, and also to synthesize, integrate, and reform, ad infinitum. It can and does often feel pretty heavy. But now, this year, I choose lightness instead. I have only this one life, yes, and it is finite. There is only so much I can do… And that’s still a lot, and I’m still young yet! I’ got time, I’ got this; and even if I don’t, damn, I’ve done a fair bit already. If it all ended today, of course I would have serious regrets. And I’ve done my best; I’ve never stopped trying. What more could I ask of myself?

Any and every moment can carry all hope, could make or break everything (really?), and could have nothing to do with anything–who knows in that moment? I’m learning and doing every day anyway; why apply unnecessary pressure? No, I’d rather have more fun in this time that I have. So I’ll keep doing what needs doing. I just don’t have to take it all (or myself) so damn seriously.

Oh and ODOMOBaaT, of course. That just goes without saying.

The Optimistic Nihilist

Posted on January 17, 2022 by Catherine Cheng, MD

“The death rate from life is 100%,” my very wise patient once said.

No matter what, you and I will eventually die.

Humans, as a species, will also die, I’m convinced. I’ve said it before: We are the pathogen.

I believe the current vector of collective human action points squarely toward self-induced extinction. I’m also convinced we’ll take a good many other species with us before we’re through. But Earth herself will outlive us, and thrive in our absence. …Unless we figure out a better balance with nature, within and around us, as individuals and as intersecting collectives, before our spectacular self-destruction.

So assuming and accepting that our taxonomic lifespan is finite, I propose to embrace a beautiful and exhilarating paradox: As individuals at any given time, in any given place or situation, none of what we do may matter at all, and it all matters like life or death. Everything about our survival depends on how we relate—to ourselves, one another, our environment, our times—everything! How can I, myself, bend the arc of the moral universe toward justice? I grab it when it swings my way, and hang on with all my might—in all that I do. I call on my friends to grab on, too. Iterative, incremental change, a fraction of a degree at a time, nudges the vector’s direction toward something better. As I imagine sailors know: a small shift in tack here and now translates to a very different destination over a long enough distance and time. What might it look like? I think it has to be better polar reconciliation–letting go either/or and embracing both/all/and: Purpose and profit, humility and recognition, freedom and responsibility, diversity and inclusion, individual and collective health and well-being.

Every day we live is another day closer to our eventual demise. And every day we wake, we have so many breaths, encounters, and opportunities with which to shift the vector, to bend that arc.

Until such time as humanity actually succeeds in killing ourselves, and I really think we will, we still have a chance. We can still work to be our best, most creative, generative, communal, and symbiotic selves.

Onward, friends, ODOMOBaaT!