I began reading Karen Havelin’s debut novel Please Read This Leaflet Carefully with the intention of reviewing it. Havelin’s protagonist Laura, a Norwegian expat who has settled in New York, lives with endometriosis and the chronic pain it causes. I was determined to be a good literary citizen and review as many books as I could before the September release of my debut essay collection, Codependence, which centers in part on my intractable headaches. A novel centered on another woman’s chronic pain seemed a good place to start. But as I got further into the book and learned that Laura’s health issues have their roots in Havelin’s own experience, I became less interested in writing a straightforward review and more curious about what we could learn from putting our books and bodies in conversation.
Havelin was diagnosed with endometriosis at age 29, though her symptoms went undiagnosed for 10 years. Endometriosis affects over 170 million women worldwide, and according to the CDC, women are more than twice as likely as men to suffer from headache disorders; although more women report chronic pain than men, studies show that doctors and researchers often dismiss or overlook women’s pain. Havelin and I arranged a video chat—no easy task when one of you is in Norway—and discussed her novel and its aims, how pain affects our writing lives, inequities in pain treatment, and more.
Amy Long: In telling people about your book, I’ve called it “a novel about a woman with endometriosis,” and it is that, but I also know that description is reductive. How do you describe the book? What did you hope to explore or communicate or accomplish with it, particularly by centering the narrative on this specifically feminine pain syndrome?
Karen Havelin: I’ve been thinking about it a lot recently because I’ve been filling out questionnaires for publishers in three different countries [the U.S., the U.K., and Norway], and the book gets presented in different ways in different countries and by different editors. It’s important to me that the book is viewed as a work of art that explores larger ideas about human frailty, human bodies. At the same time, I want it to reach people with endometriosis and other illnesses, I want to get people to talk about endometriosis, and I want the book to reflect an experience I’ve never read or seen in media. I grew up reading books, and I never read a book that I saw myself in. Every time I read a book about someone who was sick, they always had cancer, and they always died or were cured. The narrative arc was predictable, and I wanted to subvert that with the structure of my book.
AL: I wanted to ask you about the reverse chronology. So many illness narratives sort of go, “I was sick, and then I got better, and I’m so grateful to my illness for teaching me XYZ.” I really wanted to avoid that in writing about my chronic pain, and I think you did, too. How did reversing the timeline help you challenge that typical narrative arc?
KH: Mostly, the structure allows me to loop over the same issues again and again. That way, I can depict Laura’s pain and how it’s still there even at points when she’s doing “better.” And at some points, she has the illness, but she doesn’t know what it is, but it’s still influencing her. So, as readers get further into the book, they know more, and Laura knows less about her illness, herself, her relationships. She’s pretty young by the end of it, so we see her change a lot.
The structure also creates a kind of multitude of potential endings. I go into a moment of her life in each section of the book [Please Read is divided into eight sections], and at the end, she’s kind of sick, and she’s going to get sicker, but she’s also okay at that moment. There are all these scenes in the last chapter that show her loving her body and using it and having fun and feeling a sense of expansiveness. I think of it as a lighter part of the book, but I hope all the different parts will resonate with each other since they do circle back to the same themes again and again from different angles.
AL: What would you say those themes are?
KH: Bodily frailty and what happens when it encounters love and relationships, growing up, anger. Self-presentation is something I think about a lot, both in terms of gender and being a patient. With pain management you have to present yourself in the right way so you get what you need from a doctor who might not really be listening to what you’re saying because he has, like, 10 minutes, and he’s going to judge everything you do and say even if you are perfect.
Recently, I was talking to the chairwoman of the Norwegian Endometriosis Association, who is a nurse. She was at least in her 30s when she got sick, so she was an adult and she had a formal medical education; she was a professional, and she still couldn’t advocate for herself. It seems like, no matter how perfect you are and no matter how well you present yourself, you can’t get away from the stigma. Being a female patient alone in a room with a male doctor trying to make yourself understood and heard is really difficult, and this is part of the picture with endometriosis, why it takes so unnecessarily long to get a diagnosis.
AL: Exactly. Did you ever read that study “The Girl Who Cried Pain”? Leslie Jamison mentions it in her essay “A Grand Unified Theory of Female Pain.” The researchers found that, when men report pain, they tend to get painkillers for it, and women more often get tranquilizers because our pain is “all in our heads.”
KH: Oh, yeah, I’ve heard of that. It’s so interesting, but I can’t even read that stuff because it makes me want to set myself on fire.
AL: Do you think you captured the complexities not just of gender but of race, class, and sexuality in pain treatment?
KH: I’ve tried to be cognizant of the intersections of gender, race, and sexuality. I certainly am not the person to enlighten a lot of people about race. U.S. racial stuff is different and more complex than it is in Norway, and I’m always nervous talking about it because, though I’ve learned a lot, I need to learn more. And I know that women’s pain gets downplayed, and race is definitely a part of it. There have been some studies that find that black women and women of color have it even worse. There’ve been a lot of moments in my life when I feel like I’ve barely squeaked through, and I have a lot of support and privilege, and I don’t even have to pay medical debt. And, still, it’s almost too hard.
AL: I wanted to ask you about the ice-skating sections. You use definitions of ice-skating moves to sort of introduce or expand on themes and plot points. But Laura is also a former figure skater. Can you talk about that formal element of figure skating as a plot device and a way to explore the body in pain?
KH: I had this book about figure skating, and I looked at all these definitions of jumps and pirouettes and stuff, and I thought there was a weird kind of poetry to them. Even as a former figure skater, I can’t really picture it. It sounds like it’s magic or ridiculous—like, how could anybody do that? It’s a kind of art and a kind of bodily mastery, and I just like the poetry of these weird little snippets. I think it reflects trying to do something that’s basically impossible but that you can somehow still do.
AL: Which is sort of like dealing with pain all the time. Like, you think you could never do it—
KH: But somehow you do.
AL: There have been a few recent nonfiction books that focus on endometriosis or on women’s pain specifically, but I don’t think I’ve ever seen a novel centered on it. Why did you choose to write Please Read This Leaflet Carefully as a novel, and what do you think fiction allows you to do that another genre such as memoir wouldn’t have? And what were the biggest challenges you faced translating something you’ve experienced into fiction?
KH: Yeah, Abby Norman wrote a brilliant nonfiction book last year about endometriosis, Ask Me About My Uterus, and it’s like my worst nightmare medical experience interspersed with the whole of patriarchal medical history, so it’s a tough read for me, but it’s so good. Writing this as fiction is, again, like, doing something impossible and somehow still doing it. But, no, writing fiction means you can do whatever you want, and writing is hard enough without having to stay true to real life. So, I think all writing for me is a question of trying to create a little bit of private space somehow. Or, like, be left alone.
I made a very radical change when I left Norway to do my MFA at Columbia. I changed language and genre. I’d mostly written poetry before. It was kind of an insane thing to do! And it also meant that I didn’t have any backlog [of stories to turn in for workshops and classes], so I had to start writing a lot very quickly when I got there, so I couldn’t really help that the writing reflected what had been happening in my life. I had to submit a lot of pages, so it was an intense time. Everything I was reading and doing just kind of came out. And then I had these different sections, and it took me a long time before I figured out how to combine them into a novel. Or whether that could even be done. I didn’t just want to write a story about someone who gets sick. Not that there’s anything wrong with that story. There aren’t enough stories like that either.
AL: Is it the distance that helps you—the idea that this is a character and not you—or did you add in things that haven’t happened to you?
KH: Laura has a lot in common with me in terms of physical health. She isn’t me. She actually gets off really easily compared to me! So, she gets a pretty good deal in the end, which is also something that I definitely wanted. I wanted to make sure that it had a happy ending: like, she’s okay, but she’s also not okay, but she’s okay. There’s that balance at the start of the book. She has a job, she can write. When she’s out in the world, no one really knows she’s sick. She has her limitations, but they’re not as harsh as they could be.
AL: In an early scene, Laura describes her shoulder pain as hot and nauseating, which stuck out to me because I use both those terms to describe some of my headaches. Do you ever worry or just wonder how people who don’t know chronic pain will interpret your descriptions and if they’ll make sense? How do you think the book will read to an audience for whom this is all totally unfamiliar?
KH: I’ll certainly be interested to find out. In a way, I feel like I’m trying to force the reader to be inside that pained body. And I want to give them some of that experience, which maybe is not going to make people want to read the book! But it will hopefully bring out readers’ empathy. In a way, though, I’m kind of writing more for people like us, who will hopefully read it and go, “Oh, yes! That helps a little bit.”
AL: There’s something sort of validating about seeing your experience represented, especially in fiction because, in nonfiction, it’s often, like, “This is my totally crazy, unique experience.” But, in fiction, the emphasis is often more on universality, so to see something described in fiction is sort of to make it real—more comforting, less alienating.
KH: Yeah. I hope so, anyway.
AL: When Laura is in New York, she feels a sort of freedom that she doesn’t feel in Norway. Do you think, in terms of pain treatment, that she’s better off in one place or the other? What does she have to trade for the freedom she feels in New York?
KH: She gives up a certain safety by not going back to Norway, and that gives her a lot of anxiety, but she feels more free because she feels like nobody’s watching her. She feels like she has more in common with people in New York, people whose lives are strange and unpredictable. And people live these crazy lives right next to each other, where Norway is a small and very conformist type of country where you can feel like you’re very visible. In New York, you get a sense of anonymity, and you’re not in your home country or your home environment. For Laura, it’s maybe not a rational choice, but it’s a choice she feels compelled to make.
AL: The book also features multiple love stories. In her essay collection, Pain Woman Takes Your Keys, Sonya Huber writes that “all pain sex is queer sex.” Laura is also queer, and we see her negotiate pain and sex, particularly with men, a lot in the novel. How does that idea—of pain sex as queer sex—resonate with you?
KH: I love that idea. There’s something important to me about these different identities intersecting and how, for Laura, it’s incredibly freeing to think of herself as queer and have this pride concept that she can use. Even though it’s, like, 10 years before she hears anyone talk about disability or illness in a way that reflects that, it sort of works for her anyway. It comes down to maybe being on the outside a little bit or having an experience that’s not typical. There’s also something about that—how people think that the sex that people with physical trouble and queer people have is more difficult and weird or something.
AL: And kind of gross. Or that people with disabilities or illnesses are kind of sexless.
KH: Yeah. People who are heterosexual and healthy often think that they can go their entire sex lives without ever talking or figuring out anything for themselves. They just try to do what they see on TV, and that’s a terrible idea! If you’re doing something that you’ve never seen—if you’re not trying to reproduce sex you’ve seen in media or something—you have to figure it out for yourself. You have to be open to what the other person wants and realize that not everyone likes the same things or has the same kind of body. All bodies are singular, and even if you are a healthy, heterosexual person, your sex life will be better if you realize that!
AL: Do you see pain always being part of your work, or do you want to move on to something else next time? Do you feel like you can? Do you feel like it’s a thing that will always attach itself to your stories or something?
KH: Oh my god, I would love to move on to something else! But we’ll see. I’ve many times tried to write something different, and it always comes back in. I do feel like there are plenty of stories about pain left to tell; there’s kind of a whole world that I’ve never seen reflected in art. But I would love to write, like, a sexy, action-filled romance next!