Pain ignored at Yale Reproductive Health Clinic
July 10, 2023 4:50 AM Subscribe
Patients had agonizing pain in spite of fentanyl when their eggs were collected. It wasn't taken seriously. This is the first of a series from the NYTimes. Free link. These are podcasts with transcripts. In case you want the story without spoilers, I'm putting the explanation in the first comment.
… and some of the victims who think addiction treatment is more appropriate than punishment.
Good on them. To quote from a Ted Lasso episode, Hurt people hurt people. I am all for restorative justice, and the hallmark of this is what you choose when the harm is done to you.
posted by Silvery Fish at 5:07 AM on July 10, 2023 [5 favorites]
Good on them. To quote from a Ted Lasso episode, Hurt people hurt people. I am all for restorative justice, and the hallmark of this is what you choose when the harm is done to you.
posted by Silvery Fish at 5:07 AM on July 10, 2023 [5 favorites]
There is this related 2022 article from the Washington Post that includes this incident as one example of many in which women's reports of pain are routinely minimized or ignored. One pull quote is:
"There’s a pain gap, but there’s also a credibility gap. Women are not believed about their bodies - period.”
- Anushay Hossain, author of "The Pain Gap," Washington, D.C.
posted by mhoye at 5:11 AM on July 10, 2023 [29 favorites]
"There’s a pain gap, but there’s also a credibility gap. Women are not believed about their bodies - period.”
- Anushay Hossain, author of "The Pain Gap," Washington, D.C.
posted by mhoye at 5:11 AM on July 10, 2023 [29 favorites]
I have a friend who was sent home from a c-section with Advil. I was sent home after a bilateral salpingectomy (tubes taken out) with just Advil. If the medical establishment is abandoning pain care for people with uteruses, they should at least warn us so we have time to find a heroin dealer, because some pain is truly intolerable.
posted by vim876 at 5:26 AM on July 10, 2023 [49 favorites]
posted by vim876 at 5:26 AM on July 10, 2023 [49 favorites]
I have been listening to this, and it's infuriating. INFURIATING.
posted by BlahLaLa at 7:29 AM on July 10, 2023 [9 favorites]
posted by BlahLaLa at 7:29 AM on July 10, 2023 [9 favorites]
Also have listened to this. The worst? part is that two of them are lecturers/researchers at Yale who work on, respectively, (1) trauma and gender, and (2) addiction. The first woman immediately recognizes that her pain is being minimized because she's a woman of color; the second woman realizes in the moment that the nurse is probably stealing the fentanyl. And they have these analytic tools to name and recognize what's going on, but it's not enough, and they're still ignored.
posted by damayanti at 8:54 AM on July 10, 2023 [31 favorites]
posted by damayanti at 8:54 AM on July 10, 2023 [31 favorites]
If the medical establishment is abandoning pain care for people with uteruses, they should at least warn us so we have time to find a heroin dealer, because some pain is truly intolerable.
From Wil Wheaton's blog: two essays, the first called Thirty-Six Hours and the second called Eighteen Hours, which refers to his wife Anne getting misdiagnosed with "just a really stubborn kidney stone" when she turned up first at her doctor's office and then to an ER with abdominal pain and sent her home to wait it out. She spent the eighteen hours after the first ER visit in severe pain, Wil desperately trying to figure out how to help her, before they finally decided to go back - and saw a different doctor who noticed something on the CT scan from her first visit, and followed up on that and finally diagnosed it as ovarian torsion, a very different, much more serious problem - one that required emergency surgery. After the surgery everything was fine.
Anne later said on her own blog that ovarian torsion was worse pain than childbirth.
I have also had ovarian torsion. And the idea that a woman in that much pain was brushed off makes me want to punch each and every doctor who pulls that kind of shit in the groin.
posted by EmpressCallipygos at 8:59 AM on July 10, 2023 [39 favorites]
From Wil Wheaton's blog: two essays, the first called Thirty-Six Hours and the second called Eighteen Hours, which refers to his wife Anne getting misdiagnosed with "just a really stubborn kidney stone" when she turned up first at her doctor's office and then to an ER with abdominal pain and sent her home to wait it out. She spent the eighteen hours after the first ER visit in severe pain, Wil desperately trying to figure out how to help her, before they finally decided to go back - and saw a different doctor who noticed something on the CT scan from her first visit, and followed up on that and finally diagnosed it as ovarian torsion, a very different, much more serious problem - one that required emergency surgery. After the surgery everything was fine.
Anne later said on her own blog that ovarian torsion was worse pain than childbirth.
I have also had ovarian torsion. And the idea that a woman in that much pain was brushed off makes me want to punch each and every doctor who pulls that kind of shit in the groin.
posted by EmpressCallipygos at 8:59 AM on July 10, 2023 [39 favorites]
the podcast episodes so far have pitch perfect (extremely well thought out, written, and performed), and excruciating.
posted by progosk at 9:00 AM on July 10, 2023 [1 favorite]
posted by progosk at 9:00 AM on July 10, 2023 [1 favorite]
sent home after a bilateral salpingectomy (tubes taken out) with just Advil.
Horrific.
Another component here is reactionary, puritanical whiplash from the opioid crisis.
posted by Dashy at 9:46 AM on July 10, 2023 [9 favorites]
Horrific.
Another component here is reactionary, puritanical whiplash from the opioid crisis.
posted by Dashy at 9:46 AM on July 10, 2023 [9 favorites]
some of the victims who think addiction treatment is more appropriate than punishment
When you cross so many lines so far that you prevent innocent people in excruciating pain from getting pain relief because of your addiction, I think plenty of punishment is warranted.
It's one thing to suffer from an addiction, which is awful, but it's another thing to spread your suffering out to others and magnify it on purpose.
posted by cats are weird at 9:54 AM on July 10, 2023 [8 favorites]
When you cross so many lines so far that you prevent innocent people in excruciating pain from getting pain relief because of your addiction, I think plenty of punishment is warranted.
It's one thing to suffer from an addiction, which is awful, but it's another thing to spread your suffering out to others and magnify it on purpose.
posted by cats are weird at 9:54 AM on July 10, 2023 [8 favorites]
Back when we first got married, the Glee Gall saw a bunch of doctors for back pain, and they all told her to lose weight and/or tried to sell her supplements. Eventually, she got an MRI, and went from "lose weight" to "need surgery soon". After that point, every time she saw a doctor, until she had surgery, they upped her painkiller prescription. (The surgeon was surprised that she could walk.)
posted by Spike Glee at 11:44 AM on July 10, 2023 [4 favorites]
posted by Spike Glee at 11:44 AM on July 10, 2023 [4 favorites]
The first time I had a uterine biopsy, I lay in the recovery room in such pain that I was literally setting off the monitors, presumably because my heart rate was so high. But they said they couldn't give me pain meds because the doctor who did the procedure wasn't available. Eventually two pills were provided, and then that evening I had a minor panic attack because the pain was starting to come back and I was afraid it was going to get that bad again.
Though to my gynecologist's credit, when I explained to her that I needed that to never happen again, she took it to heart and was always very good about making sure I was provided adequate pain relief in my later procedures. I actually conducted an agile scrum from the recovery room at one point!
posted by tavella at 12:08 PM on July 10, 2023 [4 favorites]
Though to my gynecologist's credit, when I explained to her that I needed that to never happen again, she took it to heart and was always very good about making sure I was provided adequate pain relief in my later procedures. I actually conducted an agile scrum from the recovery room at one point!
posted by tavella at 12:08 PM on July 10, 2023 [4 favorites]
I listened to the first episode (amazing and will be listening to the rest) but something wasn’t answered. The patients were in severe pain during the procedure (presumably with the doctor there performing the procedure), and after with nurses, staff, and conversations later with the attending physician but yet everyone was “confused” and minimized the pain to an extent that some number of women were in extreme pain while in their care. Either they were all in on it or that many people DGAF about women’s pain and/or regularly don’t believe them who are practicing in an area of medicine that serves a narrow and precise subset of women?! Why would these people be so inured? That’s what terrifies me. I’m just hoping and begging that they were all in on it because the alternative story is so frightening.
posted by amanda at 12:44 PM on July 10, 2023 [4 favorites]
posted by amanda at 12:44 PM on July 10, 2023 [4 favorites]
I had an ovarian torsion brushed off as the stomach flu!
I finally went to the ER when I was throwing up bile every 30 minutes, and ended up with the emergency surgery. The doctor afterward was like "How did you deal with that pain for so long?!"
posted by that girl at 1:04 PM on July 10, 2023 [5 favorites]
I finally went to the ER when I was throwing up bile every 30 minutes, and ended up with the emergency surgery. The doctor afterward was like "How did you deal with that pain for so long?!"
posted by that girl at 1:04 PM on July 10, 2023 [5 favorites]
Either they were all in on it or that many people DGAF about women’s pain and/or regularly don’t believe them who are practicing in an area of medicine that serves a narrow and precise subset of women?!
Based on Anne Wheaton's story linked above, my money is on "that many people DGAF about women's pain".
...I know how bad ovarian torsion hurts. There is NO FUCKING WAY it was not obvious how much pain she was in. (In my case, it was pain bad enough that I nearly blacked out when I stood up.)
posted by EmpressCallipygos at 1:04 PM on July 10, 2023 [7 favorites]
Based on Anne Wheaton's story linked above, my money is on "that many people DGAF about women's pain".
...I know how bad ovarian torsion hurts. There is NO FUCKING WAY it was not obvious how much pain she was in. (In my case, it was pain bad enough that I nearly blacked out when I stood up.)
posted by EmpressCallipygos at 1:04 PM on July 10, 2023 [7 favorites]
I wouldn't say the pain was worse than childbirth for me, though. I think I went about 24 hours between the onset of pain to going to the ER. I managed to mostly sleep the first night, even!
posted by that girl at 1:06 PM on July 10, 2023
posted by that girl at 1:06 PM on July 10, 2023
... that many people DGAF about women’s pain and/or regularly don’t believe them who are practicing in an area of medicine that serves a narrow and precise subset of women?
We are all socialized to disbelieve women about their bodies, and their pain. Everyone in that room was acting out what they'd been taught or absorbed from the world around them, and reinforcing it for each other. Going along with the status quo. Believing what "should be" rather than believing the humans in front of them. And yes, deeply frightening.
posted by Dashy at 1:20 PM on July 10, 2023 [9 favorites]
We are all socialized to disbelieve women about their bodies, and their pain. Everyone in that room was acting out what they'd been taught or absorbed from the world around them, and reinforcing it for each other. Going along with the status quo. Believing what "should be" rather than believing the humans in front of them. And yes, deeply frightening.
posted by Dashy at 1:20 PM on July 10, 2023 [9 favorites]
Either they were all in on it or that many people DGAF about women’s pain
After a decade or of shoveling opiates into anyone in the slightest discomfort, the pendulum has swung far the other way and now everyone involved rather the pain levels be very high rather than even the hint of contributing a potential opiate addiction.
As someone who went through a similar sort of experience as these women (although in my case it was incompetence on behalf of my ortho surgeon in correctly prescribing my meds, rather than actual theft), the situation is no better for upper-middle class white dudes.
posted by Back At It Again At Krispy Kreme at 1:23 PM on July 10, 2023 [2 favorites]
After a decade or of shoveling opiates into anyone in the slightest discomfort, the pendulum has swung far the other way and now everyone involved rather the pain levels be very high rather than even the hint of contributing a potential opiate addiction.
As someone who went through a similar sort of experience as these women (although in my case it was incompetence on behalf of my ortho surgeon in correctly prescribing my meds, rather than actual theft), the situation is no better for upper-middle class white dudes.
posted by Back At It Again At Krispy Kreme at 1:23 PM on July 10, 2023 [2 favorites]
I broke my leg as a kid and it took hours for my parents to clue in that something was deeply wrong. I cried and screamed for hours, could not stand up, and it wasn't until they bought me ice cream and I refused to eat it (while crying) that they got the clue. THIS WAS MY PARENTS, not even doctors. Nobody believed me despite obvious screaming and crying and not being able to stand.
People don't believe women about anything because women are lying hobags, donchaknow. A friend of mine with whopping heart problems has said she's had to throw big ol' shitfits to get people to listen to her at times.
I can't even listen to this one, sorry.
posted by jenfullmoon at 3:32 PM on July 10, 2023 [15 favorites]
People don't believe women about anything because women are lying hobags, donchaknow. A friend of mine with whopping heart problems has said she's had to throw big ol' shitfits to get people to listen to her at times.
I can't even listen to this one, sorry.
posted by jenfullmoon at 3:32 PM on July 10, 2023 [15 favorites]
Oh yes it’s absolutely a habit of assuming people are addicts. Took my husband to the ER once when he was obviously in agony - sweaty, pale, like physically obvious, not just behavioral. We were barely tolerated until his drug screen came back negative. And then it was ‘oh, you’re not an addict? Here, have some morphine’.
posted by bq at 3:41 PM on July 10, 2023 [4 favorites]
posted by bq at 3:41 PM on July 10, 2023 [4 favorites]
I've heard plenty about veterans' symptoms being ignored, and I assume that includes a fair number of white men.
If pain and/or exhaustion are the major symptoms, the disease is unlikely to get attention, especially if it's a new disease. And "new" can stretch for a long time because the disease is getting ignored.
posted by Nancy Lebovitz at 4:02 PM on July 10, 2023 [3 favorites]
If pain and/or exhaustion are the major symptoms, the disease is unlikely to get attention, especially if it's a new disease. And "new" can stretch for a long time because the disease is getting ignored.
posted by Nancy Lebovitz at 4:02 PM on July 10, 2023 [3 favorites]
I had numerous egg retrievals and there was never any question that I was going to be sedated because needle in delicate area. This just seems to be good practice and not even an extra level of special.
posted by tafetta, darling! at 4:23 PM on July 10, 2023 [1 favorite]
posted by tafetta, darling! at 4:23 PM on July 10, 2023 [1 favorite]
Google Scholar seems to think that gender and racial disparities in pain management are well documented. But one anecdote probably cancels out the entirety of the published literature.
posted by hydropsyche at 5:32 PM on July 10, 2023 [5 favorites]
posted by hydropsyche at 5:32 PM on July 10, 2023 [5 favorites]
Wife: My back is out, really hurts, something’s wrong
Dr MD: oh rest up you’ll be fine
Wife (also an MD): I also can’t lift my toes toward the ceiling, fellow doc, how about it?
Dr: Oh, your surgery will be tomorrow then.
posted by drowsy at 6:41 PM on July 10, 2023 [7 favorites]
Dr MD: oh rest up you’ll be fine
Wife (also an MD): I also can’t lift my toes toward the ceiling, fellow doc, how about it?
Dr: Oh, your surgery will be tomorrow then.
posted by drowsy at 6:41 PM on July 10, 2023 [7 favorites]
As a very young gudrun, I started having severe stomach pain. My parents took me to the hospital, where the doctor decreed that I just had a stomach ache (and was exaggerating the pain). My parents took me back home, but fortunately my mother knew I was not the type of little girl to play up illness for sympathy (how many girls really are?), and kept checking me/my stomach, and could tell the already bad pain was increasing rapidly. Back we go to the hospital, where it seems I had an umbilical hernia that had strangulated. Some immediate emergency surgery later, my life was saved. Thanks, Mom. That male doctor discounting my pain is one of my earliest childhood memories.
posted by gudrun at 6:47 PM on July 10, 2023 [8 favorites]
posted by gudrun at 6:47 PM on July 10, 2023 [8 favorites]
Amongst many reasons that I do not want to relocate is my healthcare team. They are fantastic and I am so grateful to how seriously they take my questions and concerns. It upsets me that not everyone has this experience and I know how fortunate I am to have these folks working with me. I have never heard anything negative from any of their other patients, and both have a waitlist for new patients because they’re incredible providers who entered into medicine for the right reasons. Granted, I have a fair amount of years of experience as a medical provider, and maybe that does influence their responses when treating me. I had a bisalp last summer (yay my woman OB/GYN who believes every person should have control over their reproductive systems!) and she convinced me to fill the oxy prescription Just In Case, when I really only asked for a prescription of horse Advil (opioids don’t work for me - I’m still uncomfortable and just can’t poop for a week). She also gave me the horse Advil. I took one oxy as prescribed later that evening and then I was like ok I’m done; I’ll figure it out from here. I have a relatively high pain tolerance (thanks migraine! and quite a few injuries from the job) so when I’m in pain, I’m In Pain. I’m honestly a little terrified as to what I would do if I was in PAIN. Hopefully they’d just sedate me once I got to the ER.
posted by sara is disenchanted at 7:59 PM on July 10, 2023
posted by sara is disenchanted at 7:59 PM on July 10, 2023
As someone with poorly supervised access to controlled substances in periop, I have long advocated that everyone with such access should be randomly drug screened, at least once a year. A lot of the people in such a job find that idea insulting. I just think it’s an occupational hazard, and it’s hard to predict who’s going to run into it. Larger places will track the pain/opioid consumption of patients per anesthesia clinician to see if there is an unexplained bump that is probably them stealing drugs. With anesthesia clinicians specifically, being found dead is often one of the first signs people notice.
posted by a robot made out of meat at 5:28 AM on July 11, 2023 [5 favorites]
posted by a robot made out of meat at 5:28 AM on July 11, 2023 [5 favorites]
The anesthesia wore off during my cataract surgery. I communicated this to the medical team during the procedure but I think they just upped the "you'll forget this" medicine, because I have a blank in my memory for a bit. When I was still groggy immediately afterwards I again told them that I had been in some of the worst pain I'd ever felt. The medical assistant with me said something like "oh, you felt discomfort?" Fortunately I remembered thinking "this is a nine out of ten level of pain," so even though I was still a bit out of it I was able to stick up for myself and make it clear that no, this was not discomfort, this was up there with labor pain.
When I went back in for my second operation I again had to make it very clear that whatever anesthetic they'd used the first time was not appropriate, and the anesthesiologist used a different method.
I don't understand why there was so much pressure from the doctors and medical assistants to minimize my experience, both on the day of and when I came for my followup appointments. I wasn't angry, I wasn't threatening to sue, I just wanted to make sure that they understood something had gone wrong and that they needed a different plan for my following surgery. I'd thought we were all on the same side.
posted by The corpse in the library at 8:17 PM on July 11, 2023 [5 favorites]
When I went back in for my second operation I again had to make it very clear that whatever anesthetic they'd used the first time was not appropriate, and the anesthesiologist used a different method.
I don't understand why there was so much pressure from the doctors and medical assistants to minimize my experience, both on the day of and when I came for my followup appointments. I wasn't angry, I wasn't threatening to sue, I just wanted to make sure that they understood something had gone wrong and that they needed a different plan for my following surgery. I'd thought we were all on the same side.
posted by The corpse in the library at 8:17 PM on July 11, 2023 [5 favorites]
As a (pediatric) surgeon, I am finding this terrifying--is this going to happen to my patients? *has* it happened and I just don't know? I hope to god I am attuned enough to listen and pay attention but the number of doctors and nurses that ignored these women's pain is horrifying and makes me wonder if there is something deeply wrong with all of us.
posted by n. moon at 6:12 AM on July 12, 2023 [4 favorites]
posted by n. moon at 6:12 AM on July 12, 2023 [4 favorites]
N.moon - my dozen or so experiences with surgery are consistently that I wake up in severe pain. Eventually I am able to communicate this to a nurse, who says something like 'I have to go ask the doctor' which means a) delay and b) lack of planning. It ALWAYS takes a damn long time and many requests, enduring severe pain, for them so "find" the correct doc, get a thing ordered, fill the order, and get it into me. Nurses are busy, response times, wrong doc on call, yadda yadda. Writhing in pain.
Eventually I got around to being rather insistent during pre-op appointments that a better plan for post-op pain be in place, ordered, filled, bedside. But I don't think my experience, of being barely sentient, barely able to communicate, but in severe pain and well aware that I'm getting brushed off, is uncommon. I think it's something you would do well to watch out for. Before it happens, not hours later.
posted by Dashy at 7:58 AM on July 12, 2023 [6 favorites]
Eventually I got around to being rather insistent during pre-op appointments that a better plan for post-op pain be in place, ordered, filled, bedside. But I don't think my experience, of being barely sentient, barely able to communicate, but in severe pain and well aware that I'm getting brushed off, is uncommon. I think it's something you would do well to watch out for. Before it happens, not hours later.
posted by Dashy at 7:58 AM on July 12, 2023 [6 favorites]
I don't think my experience, of being barely sentient, barely able to communicate, but in severe pain and well aware that I'm getting brushed off, is uncommon.
I had surgery on a broken knee in 2020. During the intake at the hospital, I made the mistake of mentioning that once I'd thrown up after taking codeine; I say that was a "mistake" because that got the nurse to flag me as someone who was potentially allergic to opioids, even though I'd followed up by telling her that I'd had morphine without incident after major abdominal surgery.
And because of that flag, the hospital pharmacy ignored the prescription for Vicodin my orthopedist had written me, and sent me home with something else instead - something that totally and 100% did not work, and I spent the whole first night after knee surgery lying there in severe pain. I waited until the exact minute my orthopedist's office opened the following day and then called and screamed bloody murder; he hadn't been told they'd switched the prescription on him, and was very surprised. He advised I could supplement what I'd been given with a triple-dose of ibuprofen, and said he was going to call the hospital to sort them out.
I don't know what happened after that, because I took that triple-dose of ibuprofen with my next dose of whatever I got, and the pain FINALLY started to abate and I fell back asleep for 18 straight hours.
I think that some pharmacists are kind of hyper-correcting for the opioid crisis and looking for any excuse to not prescribe it. Or are just paranoid now.
posted by EmpressCallipygos at 10:27 AM on July 12, 2023 [3 favorites]
I had surgery on a broken knee in 2020. During the intake at the hospital, I made the mistake of mentioning that once I'd thrown up after taking codeine; I say that was a "mistake" because that got the nurse to flag me as someone who was potentially allergic to opioids, even though I'd followed up by telling her that I'd had morphine without incident after major abdominal surgery.
And because of that flag, the hospital pharmacy ignored the prescription for Vicodin my orthopedist had written me, and sent me home with something else instead - something that totally and 100% did not work, and I spent the whole first night after knee surgery lying there in severe pain. I waited until the exact minute my orthopedist's office opened the following day and then called and screamed bloody murder; he hadn't been told they'd switched the prescription on him, and was very surprised. He advised I could supplement what I'd been given with a triple-dose of ibuprofen, and said he was going to call the hospital to sort them out.
I don't know what happened after that, because I took that triple-dose of ibuprofen with my next dose of whatever I got, and the pain FINALLY started to abate and I fell back asleep for 18 straight hours.
I think that some pharmacists are kind of hyper-correcting for the opioid crisis and looking for any excuse to not prescribe it. Or are just paranoid now.
posted by EmpressCallipygos at 10:27 AM on July 12, 2023 [3 favorites]
The Sentencing. I'm not up for summarizing this. I'm not seeing a transcript link, but I assume there will be one.
There will be another episode in two weeks about the hospital.
posted by Nancy Lebovitz at 3:45 PM on July 13, 2023
There will be another episode in two weeks about the hospital.
posted by Nancy Lebovitz at 3:45 PM on July 13, 2023
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The second episode gets into the nurse having been off-balance because of having a grossly abusive ex-husband, and some of the victims who think addiction treatment is more appropriate than punishment.
There will be further episodes about the response from the justice system.
posted by Nancy Lebovitz at 4:54 AM on July 10, 2023 [13 favorites]