All Fours Chapter 14 Summary & Analysis

⚠️ Spoiler Warning: This guide contains detailed spoilers for the entire novel. Proceed only if you've finished reading or are comfortable knowing the plot.

Summary

The narrator visits Dr. Mendoza for a routine gynecological exam accompanied by reflections on the other women in the waiting room—a pregnant woman and an older woman—and her own complicated birth history. Dr. Mendoza, a naturopath and midwife, asks about flashbacks related to the stillbirth of Sam, who ultimately lived. After the narrator mentions possible irregular bleeding, the doctor performs an exam but finds no polyp. She then questions the narrator about insomnia and hot flashes, leading to a diagnosis of perimenopause. Shocked, the narrator receives a prescription for Estradiol cream and a blood-test order. She researches perimenopause symptoms online, fixating on reduced libido and the sharp drop in estrogen. She calls Jordi to panic about the hormonal cliff and later tells her husband Harris the news, hiding her fear of losing desire. She then questions her mother about menopause, learning that her mother’s ovaries were removed without consent during a cyst surgery. A phone call with Mary reveals that Mary now experiences sex as purely mental and compares perimenopause to an Amish rumspringa. The narrator removes the rubber band from her wrist, recognizing she must stop suppressing her desire.

Key Events

The narrator waits for her gynecological appointment, observing a pregnant woman and an older woman in the waiting room.
Dr. Mendoza reviews the narrator’s chart, mentioning flashbacks from Sam’s birth.
The exam reveals no polyp; the narrator’s irregular bleeding is attributed to perimenopausal changes.
Dr. Mendoza lists symptoms and diagnoses perimenopause, prescribing Estradiol cream.
The narrator researches perimenopause online, focusing on the list of symptoms and the sharp decline in libido.
She calls Jordi, panics over the estrogen graph, and compares the drop to falling off a cliff.
At home, Harris comments on a large tropical bouquet meant for Caro’s birthday.
The narrator tells Harris about the perimenopause diagnosis but omits her fear about libido.
She calls her mother, who describes a surgery where her ovaries were removed without consent and recalls no libido change.
The narrator calls Mary, who describes feeling “dead down there” and needing a mental narrative for sex.
Mary suggests women should have a rumspringa-like period during perimenopause.
The narrator removes her rubber band, deciding to cherish her remaining desire.

Character Development

The narrator: Confronts her own aging and the medical reality of perimenopause. Her earlier fixation on Davey and desire shifts into a longer-term fear of losing that capacity. She begins questioning intergenerational silence about female sexuality.
Dr. Mendoza: Represented as both a holistic physician and a blunt diagnostician; she uses a casual tone about flashbacks and quickly issues the prescription.
Harris: Offers limited comfort, unaware of the full scope of the narrator’s anxiety. He remains focused on practicalities.
The narrator’s mother: Reveals a history of medical violation (undeclared oophorectomy) and emotional distance from her own body and desire.
Mary: Provides a frank, darker view of postmenopausal sex, but also the idea of a necessary “dangerous time” before the window closes.

Themes, Symbols, or Motifs

Perimenopause as a cliff: The narrator visualizes the estrogen graph as a sharp drop, contrasting with men’s gradual testosterone decline.
The waiting room fish-tank: A metaphor for generational separation—each age group trapped in its own sphere, unable to see into the others.
The rubber band: Previously used as a physical reminder to suppress desire; the narrator removes it, signifying a decision to embrace rather than eliminate her lust.
Medical authority and bodily autonomy: Dr. Mendoza’s diagnosis, the mother’s involuntary ovary removal, and the narrator’s silent compliance reflect power imbalances.
Intergenerational silence: The narrator’s mother cannot recall her menopause or libido, mirroring a broader lack of communication about female aging.
Rumspringa: Mary’s metaphor for a permitted period of freedom before the permanent change of menopause.

Why This Chapter Matters

This chapter marks a turning point in the narrator’s understanding of her own body and desire. It reveals that her recent intense obsession with Davey was not merely an affair but a last surge of hormonal drive. The perimenopause diagnosis forces her to reckon with the finite nature of sexual desire and the social myths around female aging. The conversations with her mother and Mary expose how little women are taught about the transition to menopause and how often the experience is defined by loss rather than possibility. The narrator’s decision to remove the rubber band signals her willingness to inhabit her desire fully before it changes.

Study Questions & Answers

Why does the narrator initially think she has a polyp?
She noticed irregular bleeding and assumed it was caused by a polyp, but Dr. Mendoza’s exam showed nothing abnormal—the bleeding is a result of perimenopausal cycle irregularity.
How does the narrator’s mother describe her own experience of menopause, and what is troubling about it?
She says menopause was not a big deal because her ovaries were removed during a routine cyst surgery without her prior consent. The narrator is shocked by this medical violation and the mother’s resignation.
What does Mary mean when she says women should get a “rumspringa” during perimenopause?
She suggests a permitted period of sexual freedom to explore desire before the hormonal drive ends, similar to Amish teenagers. She calls it a “dangerous time” for the woman herself, not just for her marriage.