BY ANDREW BOMBACK
The Middlepause, 208 pages, published by Catapult.
I wonder if Marina Benjamin considered another title for her excellent book, The Middlepause. Specifically, I wonder if she thought about using “Mental Menopause,” a catchy moniker used by one of her friends as they discuss their mutual exploration of middle age and beyond. “It’s more a mental menopause I’ve been struggling with,” this friend shares, “with every significant choice I’ve ever made suddenly up for review – education, career choice, where to live, children; even your key relationship, which is so established, it requires work.”
I’ve been drawn to these kinds of books lately, in which authors in their 40s and 50s dissect what’s come before and what lays ahead and whether there’s a chance to actually enjoy the here and now. Mental menopause, in other words. Claire Dederer’s recent memoir, Love and Trouble, bears the subtitle “a midlife reckoning,” which I consider the perfect description for this genre.
I turned 40 last year.
When my older brothers turned 40, they bought sports cars. I didn’t have that kind of disposable income, so I immersed myself in “midlife reckoning” books and, like many of their protagonists (Marina Benjamin included), I set about trying to slow down the aging process by toning up my body. I’d been jogging on and off my entire adult life, but save for the rare stretches when I’d train for a charity race (5K, 10K, half-marathon), I hadn’t been systematic about my exercise since high school, when I spent each winter as an average wrestler competing at a slightly above average rate 15% below my body’s normal weight range. Put differently, I hadn’t obsessed about my body, about my naked weight and what my chest and abdomen looked like in a bathroom mirror, about how certain pairs of pants and shirts fit, about how to run off heavy meals, in over 20 years. Now, entering my fifth decade, and armed with a Fitbit watch I’d received for my 40th birthday, I started counting the number of days I ran. I obsessed over my mile times and the distance I ran each week. I created playlists of running songs on Spotify.
By Thanksgiving, I’d lost about 10 pounds. At Christmas, my mother-in-law commented on how thin I looked, and my healthier patients, who only see me once a year, made similar appraisals. When I jogged on the local high school’s smooth track, as opposed to the hilly terrain of my town, I could approach 7-minute miles. On more than one occasion, I experienced that high long-distance runners brag about, when I felt I could keep running for miles and miles and miles.
At the same time, I ached. My back hurt a little, my knees a bit more, but my feet were the greatest source of pain. I could easily self-diagnose plantar fasciitis, and I knew all the beneficial exercises for this relatively common condition. My toes were another matter, though. Despite buying an expensive pair of shoes “expertly fit” to my feet at a local running store, my toes formed calluses that began to resemble an extra set of toenails. When my wife caught me cutting these calluses with a nail clipper, she suggested I go to a salon for a pedicure, where these calluses could be shaved down. Instead I saw a podiatrist.
In The Middlepause, Marina Benjamin has the kind of problem that only a great writer can suffer: there are too many picture-perfect endings in the book. Composed of 11 chapters (I am counting its prologue and epilogue as chapters), The Middlepause could have easily ended after the eighth chapter, which details the 50th birthday that Benjamin has been dreading, to some extent, in all her prior pages. The book begins about a year earlier, as she abruptly enters menopause after a hysterectomy to treat painful fibroids. Suddenly, she is suffering from hot flashes and insomnia and word-finding difficulties, and she struggles with the decision to use estrogen to alleviate these symptoms (her review of the history of hormone replacement therapy, and in particular the experimentation that one Brooklyn-based obstetrician did on his poor wife to advance this treatment strategy, is a paradigm of stimulating science writing). But by the time she allows herself to have a 50th birthday party – and insists on doing most of the work for this party herself, so that the gala is her creation and not her consolation prize – Benjamin has settled into an acceptance of where she’s arrived.
There is a road map for much of our lives, neatly plotted out. In simplistic guise it goes something like this: your teens are for studying, your twenties for experiments and fun; in your thirties you consolidate (careers, relationships, finances) and start parenting; then in your forties you acquire stature and kind of peak; and in your fifties, the horizon I am now looking toward, the lucky few get to peak again, while others experience middle age as a kind of mugging, robbing them of a feeling that the future might actually hold more than the past.
She is ready to peak again and, as a parent, recognizes the role of her daughter in such an endeavor. Earlier, we learn about how she and her teenage daughter frequently measure themselves up against each other in the kitchen, and how her daughter is just about caught up to her in height. She laments the way her husband teases, “Looking at the two of you is like witnessing time travel.” But now, turning 50, she sees her daughter and her youth not as an affront but as a reward.
My daughter in her blue lace dress is holding a guitar. She will sing and play for us. She has chosen Cyndi Lauper’s “True Colors” – a song whose lyrics make my tear ducts tingle. There is a hush as her honeyed voice fills the room, and my soppy heart swells with pride. Glasses filled with golden bubbles clink. Laughter and warmth abound and I am more content than I ever imagined I could be. This is what I remember. And I will remember it always.
I wanted to close the book at that point.
Benjamin, however, demands something more serious, and her ninth chapter is devoted to reflections on the loss of her friend, Kirsty, who was about the same age and spent the last year of her life fighting off metastatic lung cancer while finishing her doctoral dissertation. This chapter, like the preceding one, centers on a beautiful scene: Benjamin reading the beginning of Kirsty’s dissertation, now a book published by a prestigious university press, via Amazon.com’s “Look Inside” feature. The Middlepause is, to some degree, a scholarly attempt to stave off aging and achieve some artistic version of immortality, and Kirsty’s book provides validation for that attempt. Chapter 10, then, might feel unnecessary if it didn’t have its own indelible ending. In this penultimate chapter, Benjamin details the deterioration of the body, hers included, during the aging process and how this metamorphosis can be accepted gracefully. She ends by invoking the arcades at British seaside towns, and the game in which a youngster tosses a coin into a slot and hopes that when it hits the tray below, filled with old, weathered pennies, it will generate enough of a shove “to tip a few of the old-timers over the cliff edge, falling noisily into the gutter below. The funny thing is I don’t mind the shove.”
The epilogue, the book’s true ending, closes with a cautionary tale about the tree surgeons working to tackle the overgrowth in the square outside Benjamin’s home. One of these young, graceful tree surgeons falls from his safety rope, dropping 60 feet and impaling himself, like a vampire, on the railing below. A few days later, when the workmen return to her square, Benjamin asks whether the young man survived his fall and is relieved to find out he is still alive. One of the tree surgeons relays the hospital doctors’ assessment that, if the man had landed on the road from that height, he’d have surely died. “Landing on the spike, then, had perversely saved him,” Benjamin considers. “The wound, the injury, the unbelievable pain he’d endured, had been his good fortune.” It’s hard not to read her own assessment of middle age into that summation.
Perhaps if I’d read The Middlepause earlier, I might not have seen a podiatrist but rather accepted “the wound, the injury, the unbelievable pain” of trying to become a runner at age 40. Dr. Feldman’s office was in the same building as mine. He’d seen me a few months earlier to work-up and treat his high blood pressure. Now I was asking him to return the favor with my feet. “I’m sure most, if not all, of this is just normal wear-and-tear of aging,” I said, taking off my socks and shoes, “but I just wanted to make sure there wasn’t anything you could do or suggest to improve things.” I waved my bare feet in the air, wiggling my gnarly, callused toes in his face. He asked me to stand up. He stared at my feet. He then told me to take a few steps around the office, still staring at my feet.
“Your feet are very flat,” Dr. Feldman said when I sat back down on his exam table. “And your pronation is somewhere between moderate and severe.” I nodded, to let him know I understood what flat feet and pronation meant, although I was less clear on the latter descriptor. “I’m running a lot, too,” he continued. “Ever since I saw you, you really put a good scare in me with the blood pressure. I’m up to 10 miles a week now. How about you?”
“12 to 16 miles a week,” I said, more competitively than I would have liked, “depending on my schedule and how much the weather cooperates.”
“Yeah,” he said, taking my right foot in his hand, running his thumb along my sole. “I wish I had more time to run. Does this hurt?”
“Yes,” I said. He took the other foot in his hand, did nothing with his thumb, and then let go of the foot. “That one hurts, too,” I added.
He looked at my chart for a moment and pushed up the glasses that were slipping down his nose. He smiled at me. “I can’t do anything for those toes,” he said. “They’re pushing up against the shoes, and that’s why those calluses have formed. They’ll just reform if you shave them down.” He made his right hand into a fist and pressed his knuckles up against his left palm, over and over, to simulate the clunkiness of my toes hitting my shoes. “But you’re 40, thin, and healthy, so the plantar fasciitis shouldn’t be that bad. I think you’ll feel better with an orthotic.” He ran his hand through his hair. He was at least 15 years older than me but had a great head of curly, salt-and-pepper hair. He looked like he’d never go bald.
His assistant entered the room armed with supplies, apparently prompted by the office’s magic word, “orthotic.” Dr. Feldman scanned my face for a reaction, an affirmative nod, a smile of agreement. My 73-year-old father used orthotics in his walking sneakers, and I therefore associated the equipment with old men who used the phrase “walking sneakers.”
“Look,” Dr. Feldman said, putting a hand on my knee, “you’re too young to be in discomfort like this, and I know you’ll feel better with the kind of orthotics I make. I’m going to make you a beautiful orthotic. You’re going to feel great after a few weeks.” He must have sensed, from that hand on my knee, that my body was easing up. “It’s going to be a before and after thing,” he continued. “Trust me. I’m going to make you a great orthotic. And I’ll give you a professional discount on the price.” He took his hand off my knee, pushed his glasses up his nose again, and started to leave the room. His assistant motioned for me to sit on the edge of the exam bed and began to roll up my pant legs. “They usually take three to four weeks, but I’m going to rush them for you so they’re back in two weeks,” Dr. Feldman said from the doorway. “I’ll see you in two weeks.”
I swung my bare legs in the air, smiled back at him, and said, “Thanks.” His assistant made plaster casts of my feet, cleaned off my legs with a warm towel, and then escorted me to the front desk so I could pre-pay for the orthotics.
Marina Benjamin, I realize, did not try to craft four separate endings for her book. Dissecting her own words, it’s possible she was aiming for something more lasting than an ending. In The Middlepause, when she reviews the work of molecular geneticists who are trying to postpone cellular senescence by creating a hiatus in the aging process, she writes, “For if middle aged is reconceived as a kind of plateau, there’s no reason we shouldn’t linger to enjoy the view.” In that light, perhaps those final four chapters are a version of the plateau, enjoying the view – which is sometimes glorious (her daughter singing “True Colors”) and sometimes painful (the chronic discomfort from her slipped vertebral disc) – as well as the opportunity to linger. Maybe the greatest reward of middle age, whether it’s my turning 40 or Benjamin’s turning 50, is being able to proceed along this plateau, where we no longer need to sweat through the upward dance of career, love, family and have yet to fully slip down the decline, sometimes steep, of true aging.
Was I lingering when I took the stairs back to my office after my podiatrist appointment? I was moving vertically in a stairwell, but was I – in a more general sense – stepping onto what I hope is a long, expansive plateau? In the span of those six flights, I rehashed the entire encounter with Dr. Feldman, replaying every moment of chicanery in our brief exchange. He flattered me by calling me young. He established trust by acknowledging there were some things – my toes – that were beyond his control and then exploited that trust by identifying other things – my plantar discomfort – that were treatable, albeit based on specific terminology (flat feet, pronation) that were only truly understood by an expert. Who knew if my feet were really too flat and pronating too much? But he’d promised me I’d feel better, and I was eager to hear that kind of optimism, eager enough to buy into the doctor-knows-best thinking of which I, as a doctor who’s often not known best and done a fair share of bluffing and trust-exploitation with my own patients, should have been skeptical.
He was going to make an orthotic for me. He, himself, would do the handiwork for my flat and pronating feet, crafting something great for me alone. It was all bullshit. His assistant, at the end of the day, would be sending off casts of my feet along with casts of a dozen other patients’ feet to a factory that produced everyone’s orthotics – not just mine – in two weeks’ time. In all likelihood, the most honest, accurate thing he said was that he was going to charge me slightly less than the other patients, as a courtesy for my helping him get his blood pressure under control. In truth, I didn’t do much other than counsel him on the importance of healthy eating and exercise, which he didn’t need to see a hypertension specialist to learn. And I probably didn’t need to see a podiatrist or place an order for orthotics. I probably needed to accept the pain in my feet as part of the aging process and perhaps tone down my exercise goals. In other words, linger and enjoy the view.
Despite knowing all of this, I picked up my speed on the stairs, going two steps at a time and raising my heart rate. I was happy I’d seen Dr. Feldman and looked forward to wearing the orthotics. I told myself I’d be pain free. I convinced myself that I’d done the right thing. I put my trust in Dr. Feldman and my own judgement in choosing his office over a nail salon. I went jogging that night and ran 7:15 miles, coasting along my own version of a plateau. I showered, put on pajamas, and got into bed anticipating a deep, contented sleep. Instead, the pain in my feet woke me up every hour until I finally got out of bed to take 800 mg of ibuprofen.
Andrew Bomback is a physician and writer in New York.