“Why are you making these noises? You’re fine.”
This isn’t exactly the first thing a thirty-weeks-pregnant woman moaning in agony wants to hear from her ER nurse. And yet, I wondered: Was I exaggerating my distress?
I was bleeding, sweating, and in excruciating pain. I could hardly utter a lucid word. My husband demanded, “Where is the room with an ultrasound?” and, against the staff’s protests, wheeled me in himself. It turns out that they didn’t need the machine. Upon examination, the nurse declared that I was ten centimeters dilated. The room flooded with so many people that I lost count. Wires and needles were stuck into me faster than I could fathom. I gave birth thirty minutes later after an emergency episiotomy. It was more than a year later, though, when my husband revealed that he’d had to force his way into having me triaged amidst a waiting room full of patients.
I look back on this harrowing time with both resentment and shame. I wonder what would’ve happened had I done as the nurses asked me to and waited “my turn.” What if I had sat in that lounge with the dozens of other patients, trying to talk myself out of the pain I was feeling? What if my husband hadn’t been there to advocate for me? What if he resigned to play by the rules as the other patients had? What damages would our baby have suffered? Would she have survived?
I have two children who were preterm. My daughters suffered colic, gastroenteritis, and reflux. They’ve also not been immune to the usual fevers and infections that many infants are subject to. As you might imagine, I’ve spent my fair share of time in the ER. Going to the hospital because of an emergency is never a fun experience, but my trials have taught me that going to the hospital as a woman can make matters even worse.
‘She’ll Have to Wait Her Turn’
In an article that was recently published by The Atlantic titled “How Doctors Take Women’s Pain Less Seriously,” Joe Fassler recounts waiting more than fourteen hours in the emergency room with his wife, Rachel. She was writhing in so much pain that she couldn’t keep her body from convulsing during the CT scan (a test that requires one to be as still as possible). In spite of his and her desperate efforts to plead, “Something’s wrong!” they were met with assurance after assurance that “this was not an emergency.” The nurse was certain it was a case of kidney stones, and Rachel’s emergency was deemed, in fact, not emergent.
“She’ll have to wait her turn.”
“You’re just feeling a little pain, honey.”
Well, stones it was not. The next doctor on duty helped discover that Rachel had an ovarian cyst, which had grown undetected into an ovarian torsion. It’s “a true medical emergency,” states Case Reports in Emergency Medicine. This doctor was horrified to learn that the first doctor hadn’t even performed an exam. Confident that it was kidney stones, the first doctor had diagnosed her, prescribed routine painkillers for this type of ailment, and left it at that. Missing the best chance for surgical intervention for ovarian torsion by more than six hours, Rachel lost her ovary that night.
My husband and I are familiar with the dismissals that Joe and Rachel heard so often that night. Some may say that what the Fasslers or my husband and I have experienced is mere protocol—standard ER practice. Some argue that ER patients often exaggerate (even feign) symptoms, and doctors simply don’t have the resources to treat every “11 out of 10” pain scale as a “real emergency.”
But wait times, in general, aren’t what’s at stake here. What we’re talking about is a discrepancy between the sexes. The question at hand is this: Is sexism, as Fassler argues, an inherent problem in medical treatment? He writes:
“Nationwide, men wait an average of forty-nine minutes before receiving an analgesic for acute abdominal pain. Women wait an average of sixty-five minutes for the same thing. Rachel waited somewhere between ninety minutes and two hours.”
I’ve definitely waited longer.
And I’ve heard both nurses and doctors utter things like:
“Why is she walking like that?” (Whispering as they observe me doubled over, hobbling in pain toward the examination table post-surgery.)
“I’m sure it’s not that bad.” (Really? How would you know?)
Like the couple in the Atlantic article, I too have witnessed a stark difference between how triage nurses and doctors treat me versus my husband. In the ER I’m always relegated to wait, no matter how much I insist that my child needs or I need immediate attention. Whereas my husband has urged, “My wife/child needs to see a doctor right now,” and at the very least, someone will usher us into an examination room. I’m not exaggerating. I’ve asked him at least ten times, “How did you do that? What did you say to them?” wishing I had the same magical powers.
Sexism in the workplace is one thing. But sexism when it comes to our health—and not just any health, but urgent care? It’s the literal difference between life and death!
It’s a subject that’s been of interest to Verily before. In “That’s Hysterical: A Short History of Sexism in Medicine—and Hope for the Future,” author and journalist Molly Caldwell Crosby writes:
“In trying to find the cause of chronic abdominal pain, I visited six specialists—five were women, one was a man. The male physician was the only one to suggest my pain was psychological. Eventually, the physical cause of the pain was discovered and treated by one of the female doctors.”
Again, I’m not the only one noticing these not-so-subtle differences.
Crosby hopes for “gender-neutral medicine.” To me, this seems a tall order. I’m not here to point fingers that men or women are more guilty of sexism in medicine. In fact, my anecdotes above came from a range of female and male doctors and nurses. The most compassionate and delicate health-care professional who has treated me in the ER was a man. And the most inconsiderate and judgmental health-care professional I’ve had the misfortune of being under care of was a woman. I still think about suing her for malpractice to this day.
Still, it was comforting to read that I wasn’t just making up the possibility of health-care sexism in my head. (Leave it to an article written by a man to affirm my own observations). But, I wonder, would The Atlantic have published this article if it had been written by Rachel Fassler? And if so, would it have been as widely read? Would the comments be as supportive? While the majority are, one commentator, Penny, writes, “This is a public health problem, not a ‘women are oppressed in health care’ problem—plain and simple.”
‘The Gap Between What We Know and What We Aim for Persists’
To whatever degree sexism does or does not exist in urgent care, I’m here to explore what we can possibly do to help combat it. For me, the first place to start is by continuing to educate myself on feminine health care, going to regular checkups, and acting confidently on my convictions. But it’s tougher than it sounds.
I recently visited a new OB-GYN to discuss my medical history and options moving forward for future pregnancies. After explaining to him more than once the unusual thinness of my cervix during my past two pregnancies, he blinked and asked, “Are you sure?” (Yes.) “Are you sure it was 2 millimeters?” (Yes.) “At twenty-four weeks?” (Again. Yes.) “You do know what 2 millimeters is, right?” looking at me dead-serious. “It’s two-tenths of a centimeter.” (Yes, that’s right, doctor. I’m aware.) “That’s nothing. That’s like paper.” (Yes. I know. I mean . . . I’m pretty sure . . . I guess I’ll have to bring you my medical records next time). And that’s where I started to doubt whether I was remembering it correctly at all.
The irony is that I was 1,000 percent sure. Yet in that moment, I allowed my surety—indisputable as it was—to falter in the face of someone else’s questioning.
Embarrassingly, this is typical for me. I can take care of my health all I want. I can bemoan the injustice, however real or imagined. But in an emergency situation, how prepared am I? When I’m surrounded by doctors and nurses I’ve never met before and who don’t know my prior history, I am my biggest and best advocate.
Acting on my better judgment and knowledge (requesting a physical exam, demanding to see an OB-GYN or pediatrician stat, ensuring clear communication and ample time with the doctor, clarifying misunderstandings, Googling symptoms and possible causes, not being in denial about needing to seek medical attention, or even early prevention with more checkups if one has a history of health issues) could mean the difference between appropriate and inappropriate treatment—or worse, no treatment at all.
In his book Complications: A Surgeon’s Notes on an Imperfect Science, Dr. Atul Gawande writes:
“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.”
I don’t see excuses here. I see reality wrapped up in humility. But whether it’s sexism or just poor health-care practices and coincidence at play, I’ve noticed a difference in treatment between myself and my husband in the emergency room, where much “habit, intuition, and sometimes plain old guessing”—along with high tension and emotion—play critical roles.
As indicated by Crosby’s story for Verily and Fassler’s piece in The Atlantic, others have noticed disparities, too. It’s concerning enough for me to ask my husband to be present whenever I need to make a visit to the ER. Trust in the science and the system are not enough. Dr. Gawande sums up well why we must advocate for our own health so that we can be self-assured and proactive at the same time that we can demand better care. Let’s help them help us. It’s the least we can do for our practitioners. And it’s the best thing we can do for ourselves.