Pain \peyn\ n.
3a. Physical or bodily suffering; a continuous, strongly unpleasant or agonizing sensation in the body, such as arises from illness, injury, harmful physical contact, etc.
–Oxford English Dictionary (2024)
My origin story begins with pain, or, at the very least, an attempt to avoid it. I was born by cesarean, the doctor believing my size too painful for my mother to push through. Since then, I’ve lived to avoid pain—no diving into a lake or pool for fear I’d hit the bottom and break both legs, quitting volleyball because the ball jammed my piano-playing fingers, staying away from action films because every punch or crash would send intense pain sensations through my body. Avoiding pain was a preoccupation; not wanting to cause pain or discomfort to anyone became a skill. However, thirty-six hours after returning home after routine surgery then waking up in excruciating pain, I realized two things: 1) I needed to do something, and 2) it didn’t matter who I’d inconvenience. Plus, I was a practicing physician. And knowing all that could go wrong, I didn’t want to die. I glanced at the clock: 4:02 AM. Way too early. I bit my lip to keep from screaming, crawled out of bed to where my mother – who had flown in the night before to support me in my recovery—lay soundly asleep.
“Mom,” I whispered.
“What is it— are you all right?”
“I’m in a lot of pain.”
She studied my face and suggested we go to the hospital. I hesitated. Deep in the recesses of my mind, a vague memory of being embarrassed by an attending physician in front of my patient. I couldn’t face that demoralizing “Oh, you’re just overreacting, sweetie,” look again. I’d also seen colleagues do it others. Twenty minutes of nauseating pain later, we arrived at the emergency department (ED) of the hospital where I had undergone surgery. The time: 4:53 AM.
“What brings you in this morning,” the triage nurse asked.
He pulled out an intake form and waited for my response.
Tell him everything and he’ll make sure you get the care you need, I thought.
Through clenched teeth I hissed, “I am having 12/10 pain, sir.”
He wrote “2/3 priority category” on the form and asked me to wait to be called.
*
In 9th grade, I had a crush. He asked me to be his girlfriend. We sealed our fate with a horribly wet kiss. That was Friday afternoon. By Monday afternoon, he was kissing someone else and denied he had any relationship with me. I had no words to articulate the pain. I didn’t confront him. Who would believe me?
Doctor, it hurts.
Where does it hurt?
Everywhere.
Well, I don’t see anything wrong.
As a pediatrician, I took complaints of pain seriously, whether with infants and toddlers, who can’t verbalize their pain (non-verbal cues like jaw clenching, crying, not eating, may be the only sign of pain) or, with older patients, like those with sickle cell anemia, a disease that causes debilitating and life-threatening pain crises. Many hospitals establish elaborate pain protocols and algorithms for each patient with sickle cell to ensure that medical staff satisfactorily manage or eliminate their pain.
A nurse interrupted my thoughts to measure my vital signs. They were higher than my normal. I attributed this to my pain.
“Might I have something for the pain,” I asked.
“Not until the physician sees you,” she said firmly.
And how long would that be, I didn’t ask. She removed the blood pressure cuff from my arm. I waddled back to the waiting area.
Moments later, led to a patient bed, a tall woman with long black braids and a gentle smile approached where I lay and introduced herself as Chinwe,[1] the nurse who will take care of you. She took my vitals. I told her my chief complaint. Once more, I asked for something for my pain. Her response: not until the doctor evaluates you.
I gave her a wearied look.
“It shouldn’t be too long,” she said. “I’ll let him know you’re in significant pain.”
A half-hour passed. Then 45 minutes. Over an hour after I first met Chinwe, she returned to say her shift was over and a new nurse would oversee my care. I asked again for anything to relieve the pain. She sang reassurances that the doctor would be seeing me shortly. Then, she pointed out the doctor sitting in front of a computer about 100 feet away from us. My heart dropped. The doctor had been sitting there for almost thirty minutes. Not even a minute later, he disappeared.
***
Pain \peyn\ n.
4.a. (c1330–) Mental distress or suffering; anguish, grief; an instance of this.Sometimes difficult to distinguish from distress.
–Oxford English Dictionary (2024)
The new nurse, Alma, approached me with pen and notepad in-hand to ask the same questions I’d been asked when I first arrived. Exhausted, I curled up in a ball and let my mother speak for me. I caught bits and pieces of what her words: writhing in pain… two and a half hours… where is the doctor … how you treat minorities? I heard Alma hurry away to find the doctor. She returned fifteen minutes later with an IV, needle, vials, and a cup for urine.
She took my arm, searching for a vein.
“What are you doing?”
“Doctor’s orders,” she replied, tightening the tourniquet with one hand while prepping the needle with the other.
“The doctor hasn’t even seen me. Please stop. I’m in pain.” Then, “Can he at least come see me so you can give me something for the pain? Then we can do tests.” I laid my head back down. Exhausted.
She hurried out of the room to share my “concerns” with the doctor. I felt helpless; their inability to address my chief complaint left me dumbfounded. It was like the beginning of a bad joke – “a physician and her pharmacist mom walk into a hospital…” – turned nightmare reality. What is happening, I asked myself. I desperately tried to convince myself otherwise, but, with tears in my eyes, I knew better. This is America; no matter educational achievements, to be both Black and woman in this country carries with it a high-risk of morbidity and mortality. The pain in my body was surpassed only by my distress over my symptoms and requests being ignored.
Would I have to die to be heard?
***
Pain \peyn\ n.
from Latin poena “punishment, penalty, retribution, from Greek poinē “retribution, penalty…,” from PIE *kwei– “to pay, atone, compensate” (see penal)
–Eytmonline.com
Years ago, while taking care of an adolescent patient who was in sickle cell crisis, the hospital team (which included me, the intern) debated whether the adolescent was abusing pain medication. I have relatives who have and have died from sickle cell anemia. It was difficult for me to verbalize my discomfort with our debate with the more clinically experienced members of the team. These debates didn’t happen around children with cystic fibrosis (CF), who are predominantly white. The bias against populations with sickle cell anemia is well documented. The fact that it persists is, at best, troubling.
Medical students are taught that 99% of all medical diagnoses can be determined by obtaining a good history and physical, long before any type of blood tests, procedures or imaging is required. Relying solely on tests could lead to inadequate treatment and potential adverse events, not to mention increased out-of-pocket costs to the patient. That night in the ED, I surmised that the medical staff:
a) doubted my narrative,
b) were disinterested in my case, or
c) the ED was too busy. (In fact, the ED was slow that night.)
I informed Alma that I would not pee in a cup and that my arm was not hers to poke. The doctor must see me so I could get something to provide pain relief, a fact they’d repeatedly told me that night. Alma let me know that I’d have to have blood tests before the doctor would see me. It was 8:42 AM. Four hours since I’d arrived. Realizing that not even an ice pack would come my way before seeing a physician, I made the choice to leave. Alma warned me about leaving against medical advice. I pitied her in that moment, and, admittedly, laughed out loud which exacerbated my pain. What medical advice, I asked. I hadn’t seen a doctor the entire time I’d been there.
*
When Serena Williams revealed that she nearly lost her life while delivering her daughter because of her healthcare team’s inability to hear her complaints, I cried. When Shalon Irving, a fellow federal government employee at the Centers for Disease Control whose life work was to address the disparities in maternal mortality, died after multiple attempts to get assessed after delivering her daughter, I cried. When my sister sent a text that a young Black woman had died “from pain” after giving birth at Centinela Hospital in Inglewood, CA, not far from where we grew up, I cried. The realization that institutions purporting to care for all people, including Black women, were routinely dismissing our concerns sat heavy.
An astute Shonda Rhimes, recognizing the medical establishment’s bias toward Black women, wrote an episode for ABC’s Grey’s Anatomy—(Don’t Fear) the Reaper—to illustrate this point. The fictional character Dr. Miranda Bailey, the Chief of Surgery and a Black woman, entered a hospital with symptoms of a heart attack. The hospital staff, including physicians, interrupted her and dismissed her claims. At one point, the medical staff requested a psych consult to determine if Dr. Bailey had a mental illness. In fact, she was having a heart attack. In real life, I hear Black women, particularly physicians, recount similar scenarios. Real or fictional, I saw and continue to see myself in these Black women’s experiences; but the healthcare system—that that I work in and for—would not see me.
As I gathered my belongings in the ED, a fourth nurse came in to “check on me.”
“Can you help me,” I asked, despite now feeling unsafe.
He said he’d get help right away, but he never came back.
Despite healthcare advances, health inequities in the U.S. healthcare system persist. Primarily because our “system of care” was built to disregard care of individuals relegated to the bottom of America’s racist caste system. Black people are less likely to be treated adequately for pain than white people, including chest pain, a sign of a potentially fatal condition. Clinician bias against the appropriate treatment of patients based on the color of their skin is well documented, not to mention the inherent gender-bias in pain management. We don’t have to go back far to see an entire medical specialty (Obstetrics & Gynecology) develop through the literal pain of Black women. Even in the field of pain medicine, racism impacts pain management. The mistreatment of Black and Brown people, as a necessary punishment to advance society, is codified in our healthcare system, our schools, and the very soil we live on (what Benjamin F. Chavis, Jr. coined “environmental racism”). There are predominantly Black neighborhoods where pharmacies don’t carry prescription pain medications, a way of redlining our ability to live pain-free. What obligation does an institution of care have to us who entrust them with our lives? What do they have to do to open their ears to our cares? Whose sin are we, am I, atoning for?
On the drive home, I imagined Alma returning to the room, not finding us there. Perhaps she shrugged her shoulders, jotted a few notes on her yellow notepad, or said nothing at all. I faced the passenger-side window, a mix of holly and beech trees whizzing by, hot tears streaming down my face.
***
“Objectivity has a history.”
–Daniel S. Goldberg, “Pain, Objectivity and History: Understanding Pain Stigma”(2017)
Two weeks later, I wrote the hospital’s CEO a letter detailing my experiences and offering recommendations, sending copies to the CFO, CMO, and COO. A few days after, she contacted me by phone. She did not apologize or express regret about my experiences. Instead, she concluded that after careful review of the doctor’s notes no bias (racial or otherwise) existed in my care. She shared an anecdote about her son receiving “the best care” at the same hospital as reassuring evidence of non-bias. Despite the evidence that shows she and her son or significantly more likely to receive better care than I, she could not fathom it. Such ignorance is also a privilege.
The etymological roots of the word “pain” lead back to the Greek poinē meaning “retribution, or penalty, a condition of atonement.” That sentiment persists in expressions that penalize or glorify feeling pain (“no pain, no gain,” “suck it up,” “no pleasure without pain”). This distancing from pain and others’ pain, this objectivity, has a history, a history rife with prioritizing one group of humans above everyone else at all costs. A history that insists on Black and Brown people performing atonement for white supremacy’s sin. Our care system’s lack of care for all human beings is the sin that must be rectified.
In the first season of Netflix’s comedy “Survival of the Thickest,” the lead character Mavis is admitted to the hospital after becoming unconscious. When one of the healthcare staff seemingly dismisses Mavis’ concerns, her best friend launches into a speech on the harm the healthcare system inflicts on Black and Brown women. In the Season Two premiere of the since-cancelled NBC television series “New Amsterdam,” two of the lead characters — one white, one Black, both physicians — discussed the racial bias in pain management for Black versus white patients. When the Black physician told his colleague that a Black person presenting with the same level of pain as a white one would get “a lecture on how to tough it out and a handful of Tylenol,” I laughed. I couldn’t even get Tylenol for my pain.
Despite my assertions, the medical staff ignored my chief complaint: pain. To read this and ask, “Well, what was the diagnosis,” both misses the point and validates it. Centering the pain experienced in Black and Brown bodies and addressing that is the point.
Pain \peyn\ n.
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,”
— Official Definition of “pain” by the International Association for the Study of Pain (2020)
Years later, I ended up in urgent care for what could only be described as four days of severe ear pain, like an ice pick being rammed into your ear canal. I sat in the waiting room thinking about my history of pain in healthcare. I wondered if stating my credentials upfront might save me heartache. The white urgent care physician rushed the room, peppering me with questions. She stated that a virus had caused my ear pain. (Later, I’d learn she was wrong.) As she hurried out the door, she instructed me to follow up with my primary doctor. Before the door slammed behind her, I yelled, “But what about my pain?”
###
Edited by Non Fiction Editor, Ravynn K. Stringfield, Ph.D.
[1] All names have been changed.
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