The Pain Is Just In Your Head....
The pain is just in your head...that's how I felt when I went to the Cleveland Clinic downtown ER just over a week ago. The doc implied I was in pain because I was fat, had over-exercised, or that I was simply drug seeking. It was such an awful experience that I wanted to see if I was the only one. I felt very much alone and I started to doubt myself which I rarely do. Then I started reading. And holy shit. Sorry not sorry for the length of the post. It's important shit, and if it's 400 words over what people will typically read, well, if you can make it through a Stephen King novel, you can hopefully hang on long enough to make it through here.....
This isn't made up - it's a valid problem, as reported on by the NY Times, Harvard Health, and the Washington Post.
So what's happening? Well, unfortunately, if you aren't a white cis male and in pain, good luck:
Why? Why does this happen?
You can't ignore that white cis men have certain societal privileges, leftover from a thousand years of being the top dogs. I have nothing against white cis males - my problem is with the people that afford them the privilege at the expense of others. There's a historical connection that can't be ignored - for example, studies have shown in the case of women, doctors are much more likely to assume women’s pain is caused by emotional issues and/or hysterics rather than rooted in actual physical causes.
EVEN WHEN CLINICAL TESTS CLEARLY DEMONSTRATE THEIR PAIN IS REAL AND IDENTIFIABLE.
Not only that, but women with emergent or chronic pain are much more likely to be misdiagnosed as having a mental health issue and prescribed anti-anxiety or psychotropic drugs. I guess that's progress from the forced masturbation doctor's prescribed in the 1800s. Additionally, lady folk with biologically female issues in the ER and out of the ER, who complain of pain associated with fibroids or endometriosis are still often dismissed in high numbers as having pain “normal to being a woman.”
It boils down to doctors believing women are more emotional and irrational than men, and so over exaggerate their pain, if they are actually having pain at all.
This isn't anecdotal - Karen Calderone, for example, found doctors tend to treat men and women differently when they’re in pain, even when they exhibit the same symptoms. And they’re given sedatives instead of pain-managing drugs. Because the pain is in their head and will go away if they get their hysterical vaginas under control.
The internalized discrimination is immense in the medical community.
In 2016 nearly 50% of those medical students and residents surveyed believed at least one myth regarding race and pain – like believing black people had nerve endings that are less sensitive than whites. Uh, what? Like, what the what?
Doctor’s also erroneously believe that women and persons of color are more likely to become addicted to painkillers, because they’re more likely to abuse them.
And these are only a few examples.
If you’re attractive? Ha. Good luck to you. The ER is one place that shit will work against you. Why? Because is you’re pretty on the outside, it means you’re healthier on the inside and therefore you’re less likely to be treated for serious health issues.
Basically, unless you’re a white, heterosexual male, you’re kinda fucked. Older? Told the pain is part of aging and to suck it up. LGBTQ? Hysterical. Children? Whiney.
The list goes on.
So what kind of ramifications does this have? The answer is….a lot.
Medical research on women lags behind, and it's killing us - A study published in 2000 by The New England Journal of Medicine found that women were SEVEN TIMES more likely to be discharged from an ER in the MIDST OF HAVING A HEART ATTACK. Why? Because all the studies on heart attack symptoms are done on men and women have different symptoms.
What about abdominal pain? Head pain? Back pain? Pain is an indication that something is wrong. Get the pain under control and then figure that shit out. Don’t send us home. Don’t ignore us. Don’t patronize us. When you do, we live in pain and illness much longer than necessary. Sometimes, it's never treated.
Women and persons of color are also less likely to seek medical attention, out of fear of being dismissed or ignored. So the problem worsens. Or we just die.
I run a group for misfits - those that don't fit the stereotype of the "typical" outdoor person. Outdoors adventures. Sometimes we're going to get hurt. Sometimes we're going to have chronic problems and/or pain. We also deserve to be cared for, to be treated in a fair and equitable way. When you don't, you further limit our access. Stop it.
I posted what happened and I've now looked in to why it happened. Next up, what can be done? It's not enough to complain, I want to find solutions. What do YOU think people can do? What the solution is? Post below or contact me here.
I was in the parking lot after a hike last week, when I took a step and as my father would say, that was all she wrote. My lower back exploded in pain. I managed to drive home, took some pills, and settled in for what I assumed would be an uncomfortable evening. But the pain kept increasing, and at 1:00 a.m. woke my husband up to take me to the downtown ER at the Cleveland Clinic.
Going to the Cleveland Clinic Main Campus ER was a big, big mistake and ended up being a traumatic experience instead of a healing one.
They took me back quickly and a resident came shortly thereafter. His examination, moving everything everywhere, increased my pain intensely, but I'm sure it needed done in the manner he did it. He was confused because they'd put me down as having flank pain, not back pain. He asked a lot of questions about my hiking: Oh, you were hiking? First time out? You really hiked four miles? Are you sure you didn't fall? You hike how many miles a week? These were the gist, both then and when he came back later. It became clear he thought I was a fatty out for exercise above what I could do, probably the first time I'd been out in years, and had managed to hurt myself. I also got the feeling they thought I was drug seeking, based on the course of treatment that was yet to come and some of the off-hand comments that were made throughout.
They did not ask what medications I was currently on, nor if I had any allergies. Then a nurse showed up to give me some steroids and Tylenol. Which I am allergic to, which was noted in my chart (Cleveland Clinic has integrated systems, so they had my chart), AND I was wearing an allergy band. Even after my husband and I explained the allergy, the nurse STILL tried to get me to take it. Finally, he left and said he'd speak with the doctor. Thirty minutes later, he came back with a Lidocaine Patch and some heating pads.
I'd like to take a moment to mention I wasn't calmly sitting in a chair. I was crying, laying in a bed, and I'd explained over and over my pain was at a 6-7. I was REALLY in pain.
By 3:30 a.m. no one had come back and the pills I'd taken at 9:00 p.m. had worn off. The pain hit a level nine, and I was crying pretty hysterically and fairly incoherent. My husband kept going and trying to find someone. They couldn't find the Resident. There must have been a shift change, because a nurse helping another room heard me and came in. His name was Michael, and asked what was going on. He was pretty horrified and went to get help. He also brought a blanket and kept me pumped full of ginger ale. Michael was amazing.
Help came in the form of the attending, since no one could find my doctor. They then tried Valium - which is a muscle relaxer, but also treats anxiety. This was followed an hour later by one 5 mg hydrocodone. Followed another hour later by the ORIGINAL resident coming and saying they couldn't give me intravenous drugs, the next step, without admitting me. My pain had gone from a 9 to a 7, but I was still crying. He said to be prepared to do PT and do some work. I responded, again, telling him I'd been in PT for several years and did exercises every day, to which he answered, "Uh, ok." I responded along the lines of, "Whatever you have to do to actually get me some relief, please just do it. Seriously. I've had enough. The first doctor was here and disappeared for two hours, I just need help" I then felt the need to apologize - though I'm not sure why - it wasn't like I was yelling. You could see he was clearly pissed, and he just turned and walked out.
Michael came back a few minutes later to give me morphine, saying the doc was discharging me if I could walk after taking it. But then he discovered I didn't have an IV in, which apparently no one had noticed. One was put in, I got the morphine, and was discharged. The morphine brought the pain to a four, and they gave me scripts for a steroid, five hydrocodone, and more valium. No imaging was done, despite telling them over and over that the pain was different from my original injury and despite numbness in my leg, which I still have.
My self diagnosis is a new herniated disc. I needed help getting the pain under control, and I needed to know that was the issue (and the numbness would go away). They never followed up on the leg after the initial exam. My pain is better than what it was, but still significant.
I feel, frankly, traumatized. I've cried a lot. I was dismissed. I didn't know how to get them to believe me, to help me. I've had nightmares about having to go back, or running in to the doctor in another capacity.
I've worked for years to get to the point where my daily pain level is a 2. I've worked hard to take the least amount of medication possible, to start hiking again. I'm proud of what I accomplished.
I shudder to think if my husband hadn't been there, as I was in too much pain to advocate for myself.
I was dismissed and treated without respect by most of the staff (not Michael) at the Cleveland Clinic Main Campus ER. I felt small, judged, and unworthy.
Because I'm fat.
Because I'm a woman.
Because they assumed I was drug seeking.
I feel embarrassed and ashamed writing this, like I did something wrong. But I didn't. It was their incompetence and bias.
I've been doing a lot of reading on women, pain, and the ER, which I'll post in my next blog update. It's been eye opening.
Shame on you, Cleveland Clinic. Do better.
I'd like to note that the Cleveland Clinic is huge, and all my doctors are with them. This is a review of only one of their ERs/centers. My regular doctor, who is helping get everything back under control, is absolutely amazing. I can't rave about her enough.
Have you ever had a negative ER experience? Been dismissed or marginalized by the medical community because of your gender, skin color, size, etc? Comment below or email me here.
Lack of Diversity On The Trail...
I'm sure many of you have seen the viral video of Amy Cooper calling the police on Christian Cooper, an African American bird-watcher who was enjoying the Bramble in New York earlier this week. She called the police because he asked her to put her dog on a leash (park rules). She says in the video, "I'm going to tell them there's an African American man threatening my life." She tried to use this man's race as a weapon against him.
The outdoors is political, don't let anyone ever tell you otherwise.
When I first googled top 25 hiking blogs of 2019, I was really surprised. The first several sites that listed blogs included very few women and I didn’t visually identify (or see in the descriptions) any minorities. Or people with disabilities. Or Pride Pack members. Or fat people. Everyone looked very, very white.
I taught Diversity in America for quite a few years at several local colleges. I don't know why I was surprised at the lack of diversity in the online presence for outdoor adventures in the U.S., since there's a definitive lack of representation on trails.
When my friend told some co-workers he was going backpacking for the weekend, his African-American buddy responded along the lines of, “Only in America would white people go in to the woods and pretend to be homeless.”
It bothered me on a level that was difficult for me to define, because I view the outdoors as such an important part of who I am. It's a privilege. And privilege and access is a big part of the problem - because it isn't that way for everyone.
The Outdoor Foundation, who conducted a survey in 2013, found that 73% of participants in outdoor activities were white, and 47% had an income above $75K (You can read the entire report on their website here.).
And when whites in the U.S., on average, are the ones making that higher income, it's indicative of a problem and not just in relation to getting folks in to the great outdoors.
Who's involved matters, too - from how outdoor events and activities are marketed to who runs the parks programs, you'll see primarily white people. The Green 2.0 Report demonstrates a clear lack of diversity in the government agencies, foundations, and NGOs that oversee outdoors recreation and upkeep:
The world is a changing place, and it’s time for more outdoor activities, and the folks that are already involved in those activities, to change with it.
Race and ethnic minorities made up 40% of the U.S. population in 2016, and those numbers continue to increase. Consider the words of Teresa Baker, a contributor for The Bold Italic, when she wrote “The climate is changing, and so are the demographics of our country. What will happen when, in two to three decades, our new, non-white majority in the US doesn’t care about the environment due to a lack of involvement now?”
While I fit the definition of a Misfit Hiker & Adventurer for a number of reasons, I am, in fact, white. So I come at this, clearly, from a very different perspective. I'd like to note that I am not here to define for anyone else what experiences they should have in the outdoor world or how they should feel about those experiences and/or interactions.
However, what I can do, is try to make those outdoor spaces more welcoming. I can conduct and relate research in to different issues. And I can showcase others opinions, viewpoints, and experiences.
Misfit Hikers is about inclusion and representation, and you're going to find a lot of emphasis on how people access (or don't access) the outside world of adventuring. And what actions can be taken to address identified issues.
As a former teacher, I'm a big fan of education and considering other viewpoints - it forges a connection and helps shape how we view the world (and others).
My very small first action is to start gathering resources on different topics regarding inclusion and representation in the outdoors. You can find the start of my efforts here.
If you know of an article, website, Instagram, etc. that you'd like to see included, please comment! Or feel free to email me.
What happened to Christian Cooper shouldn't ever happen. As stewards of the outdoors we need to - have to - do better.