Brave men and hysterical women

"First, do no harm"

Hello ji,

When I was 15 years old, a table made of cast iron fell on my foot at school, crushing my toe. That evening, I told my parents when my toe started turning black. When they took me to the doctor, he pressed my toe and I screamed in pain. He gave me a smile and said, "Well done! Aap chot nahi khaoge toh Doctor uncle ki dukaan kaise chalegi? (If you don’t get hurt, how will Doctor uncle's shop run?)"


When I was 25, I had to undergo surgery on both feet. The surgeon chose to operate using only local anesthesia, which didn’t numb my feet enough. When he sliced through my feet, I felt all of it and screamed in pain. He smiled and said, "Don't scream so much. Someone will think I am delivering your baby in here."


A few years back, early in my pregnancy, I woke up at 5 am to find that I was bleeding. My husband and I rushed to the hospital. An irritable doctor, clearly upset at her sleep being disturbed, gave me a very harsh and painful internal ultrasound - one that I knew could be done with zero pain. Already worried sick about the baby, I told her she was really hurting me. She looked at me coldly and said, "If you can't even bear this much pain, how will you have a baby?"


Do you see a pattern here?

For the longest time, I didn’t.

I thought these were isolated experiences, happening only to me because I was too ‘accident prone’ and had a ‘too low a pain threshold’. And I thought these doctors I was meeting were isolated cases too - my accident proneness was just landing me in the offices of exceptionally insensitive docs.

And yet, medical journal after journal has found that when it comes to having gender biases, doctors are as fallible as the rest of us. Doctors fail to treat women patients like grown adults - capable of accurately assessing their symptoms, reporting them, and knowing the difference between real and imaginary pain.


“Have faith in God. Or me.”

Uma recently met with an accident when a truck hit her bicycle from the side. Bones in her arm and leg broke in the accident. She had to undergo emergency surgery to place a rod in her arm.

"My surgeon had told us that he will answer all our questions after the surgery. So, I had a list of questions ready. E.g. how did they place the rod in my arm, when can I start walking again, can I get the second shot of my covid vaccine, etc. He told me he did not have time to answer any of my questions and it wasn’t a part of his job anyway. He then asked my parents to meet him outside the room."

The fact that her doctor had something he could not say in front of her scared Uma.

"I thought it was some terrible piece of news. Maybe the surgery did not work, or I had an infection they could not control. I was lying in bed, imagining the worst. But, when my parents came in, they told me he was offended by my questions, and said they should teach me to have faith - either in God or in him."

Her parents tried telling him that Uma was a mechanical engineer, so she was naturally curious about how her surgery worked. They said her questions about recovery were very reasonable. This made the doctor even more enraged, so they chose to drop the matter.

"I feel that doctors have a God complex. And when it comes to women that God complex becomes heightened. I'm a 36-year-old woman paying for my own surgery. This man - who did not have 5mins to answer my legitimate questions about my surgery - spent 20mins lecturing my parents on faith and philosophy."

The pattern continued through her post-operative visits to the doctor as well.

“He would check my arm, then tell me to wait outside in my wheelchair. He would ask my husband and father to stay and only brief them about my recovery. He never told them anything that couldn’t be said in front of me, but just wanted to show me my place as a woman.”

“After that, I started routing all my questions through the men, and was careful not to use any technical terms in front of him, so that he felt comfortable in my dumbness and muteness."


What is a brain swelling, in comparison?

In 2010, Shefali went through brain resection surgery to remove a scar that was causing epileptic seizures.

"It was a complicated surgery, and I suffered from extreme headaches during recovery. When I told my neurologist to give me something for the pain, she addressed my parents instead of me, 'Tell your daughter she has to bear children, what is this pain in comparison?' We later discovered that my brain had actual swelling post-surgery which was causing the severe headaches. I kept begging for painkillers but my own doctor made light of my pain."


“He was treating my body like he would treat a man’s”

Shortly after delivering her second baby, Suman had to have hernia surgery.

"After the surgery, I woke up with incredible pain - much more than the hernia pain itself. The doctor told me he was ready to discharge me within a few hours itself. But I could not even sit up in bed. I had to ask him to let me remain hospitalized for another 48 hours."

"A month later, I was still taking a painkiller just to get through each day. When I told my doctor, he said the pain was just in my head. I personally pride myself on my high pain threshold, so I came home feeling a bit ashamed."

But when she got home, she looked up medical papers written about her surgery.

"I discovered that the kind of hernias women get are very different from those that men do, and come with more post-operative pain. But most of the medical research on hernias is centered on men, so my doctor probably did not even know what to expect with a woman. He did not know why I had pain because he was treating my body like he would treat a man’s."

A few years later, Suman's mother-in-law had to have knee replacement surgery.

"Both her knees were replaced. I took a month off from work and moved in with her to help with her recovery. She was in such excruciatin pain that she could not even get up from bed."

Sensing that her pain was not being managed properly, Suman took her back to the hospital.

"Her surgeon was irritable and short with us. He said she just had a low pain threshold. I told him that she had delivered two children before epidurals were even invented. So her pain threshold was higher than all of us, thank you very much."

Ultimately, her mother-in-law's pain medication was increased and her recovery finally became more comfortable.

"I could not believe the gaslighting. He saw a soft-spoken old lady and decided she was frail and weak - decided to overrule her own judgment of her pain. I wonder how many children he has delivered that he gets to do this."


A woman’s condition

Swati lives with fibromyalgia - a chronic disorder which amplifies pain by affecting the way the brain and spinal cord process painful and nonpainful signals.

"In my case, my condition causes exceptional pain in my limbs. I sometimes limp and find it hard to climb stairs. On bad days, even routine activities - like washing my hair, typing for long, turning door knobs, brushing my teeth - can be excruciating for me."

90% of people afflicted with fibromyalgia are women. And yet, blinded by their bias against women reporting pain, doctors usually fail to diagnose it.

“There is little awareness, even among medical professionals. On separate occasions, doctors have told me that:
(a) I need to lose weight,
(b) I should correct my posture,
(c) I should stop imagining the pain as it is 'all in my head', and
(d) My pain is not really as debilitating as I say (apparently they know the extent of my pain beter than I do!)”

“It took me a long time to get even the correct diagnosis, and much longer to get medicines for pain management. I have now found an entire community of people (mostly women) living with fibromyalgia and the bias around it. We hope and pray for more awareness and less apathy among doctors, so that others don't have to go through what we did.”


“The most hellish time of my life was caused entirely by my own doctors”

Midway during her pregnancy, Ekta discovered that her doctor had missed some vital prenatal tests. So she went to another - more efficient - doctor, even though she made her feel like a burden in every interaction they had.

"Once, I called her mobile to ask a question, she shouted at me, saying that her number was ‘for emergencies only’. On my delivery day, when I was screaming in pain, she casually remarked, 'Baccha paida karna sabke bas ki baat nahi' (Birthing a child is not everyone's cup of tea.)"

A few days after her delivery, Ekta went to the doctor for a follow-up.

"I was suffering from severe postpartum depression and had lost my appetite. Instead of counseling me, she shouted at me for losing weight and alleged that I cared more about my figure than my child. It broke my heart."

Ekta mentioned she was feeling extreme pain during breastfeeding.

"She scolded me for not feeding my child enough. She had never told me what 'expressing milk' was but told me the pain was my own fault for not doing it enough. Two days later, I developed high fever - 104 degrees - and my husband called her. This time it really was an emergency but she didn't respond on her ‘for emergencies only’ number. I was rushed into emergency surgery for mastitis.”

“A simple breast pump and some empathy from my doctor could have saved me from this surgery."

The surgeon who performed Ekta's surgery told her it was a 'simple procedure' and she could go home and feed her baby the next day.

"He never told me I will have an open wound without stitches on my breast, which will have to be dressed every alternate day at the hospital. When I asked him how he expected me to breastfeed with an open would, I was told, 'Humein nahi pata tha ki tum itni kamzor ho.' (We didn't know you are this weak.)"

"Every time I came back to get my dressing changed, he would make me wait 1-2 hours, knowing fully well that I had left a 6-day old baby back home. My husband's meager paternity leave had ended so I had to regularly hail an auto to the hospital in that condition. It was the most hellish time of my life and it was entirely caused by my own doctors."


“I will never forget the pain and terror I felt that day”

Kriya had an appointment with a gynecologist for a PAP test and a consultation for birth control.

"On the day of the appointment, I had a painful UTI (Urinary Tract Infection). I was in no shape to get a PAP, but went to the appointment anyway for birth control advice. I wasn't married at that point, so the doctor gave me a lecture about the immorality of being sexually active before marriage."

When it came to the PAP test, Kriya clearly told the doctor that she would like to reschedule it because of her painful UTI, and asked for advice to treat the UTI instead.

"She said she would take a look first. Before I knew what was happening, she had shoved in the speculum, ignoring my protests and cries of pain. I don't think she even used a lubricant for the PAP. She did the test without my consent - in fact despite my express denial of consent. I have a pretty high tolerance for pain, but this pain was so unbearable, I fainted at the chemist shop, a few minutes later.”

"I have never blacked out with pain at any other point in my life. I will never forget the pain and terror I felt that day."

There is a term for the crime of violating a woman’s body against her consent. And our country is known to have hanged people for committing it.


“There is no pride in pain”

Dr. Isha works in a government hospital. She says that the bias in doctors when it comes to male vs female patients is well-documented.

"I see it at work everyday. When I did my MBBS over a decade back, we were taught medicine, but nothing about treating all patients equally. As a result, you have doctors who carry all the gender-based biases that the rest of society does. Except when a doctor lets such bias cloud their judgment, the effects can be disastrous."

Dr Isha recalls a patient who had recently been in the Covid ICU for a couple of weeks.

"She began exhibiting physical symptoms of anxiety. She would lash out at staff members, try to remove her oxygen mask, etc. I overheard the medical staff saying 'Ye toh pehle se hi paagal thi' (She was always a bit crazy.)"

Dr Isha decided to speak to the patient's doctor because she knew what the patient was suffering from

"ICU Psychosis is a well-documented condition. ICUs have bright lights and loud beeping machines running 24x7, so patients lose track of day or night. Plus, the patient was a young mother, separated from her kids, not even able to see her husband. The loneliness of quarantine naturally amplifies the psychosis."

The patient was started on the medication for ICU Psychosis and almost immediately began showing signs of recovery.

"She went on to fully recover from covid too. I can't help but think how she might have lost her life if the staff's judgment of her ‘pre-existing craziness’ was allowed to prevail. Women patients are seldom shown any empathy when it comes to mental health."

Dr Isha works with cancer patients and recalls her mentor's approach to pain management.

"We often treat terminal patients. My mentor taught all his students to be uncompromising when it came to pain management. If we cannot save the patient's life, the least we can do is make their last days bearable."

"Everyone's pain threshold is different and there is no pride in tolerating more pain than you can. It is the responsibility of the doctor to respond to the patient's own measure of their pain - instead of trying to belittle it, especially based on their gender."


The Wandering Womb

I read a literature review of gender bias in medical journals, titled “Brave Men and Emotional Women”. It found that men bearing pain were written about in medical journals papers as stoic, in control, brave. Women living with the same (or worse) pain were represented as emotional, sensitive, and hysterical.

It also found that women reporting chronic pain are frequently told that “the pain is all in your head”, making them feel dismissed and causing shame around pain. Meanwhile, the overload of family responsibility on women is an obstacle to their recovery.

"Compared to men, women have more pain… it is more accepted for women to show pain, and more women are diagnosed with chronic pain syndromes. Yet, paradoxically, women's pain reports are taken less seriously, their pain is discounted as being psychic or nonexistent, and their medication is less adequate than the treatment given to men."

This bias in medical science is not new. In fact, the word 'hysteria' actually comes from the Greek word hystera which means 'uterus'. In the 1800s, it was believed that hysteria was caused by a defect in the womb. By extension, most women reporting health disorders were dismissed as ‘hysterical’.

Even physically diagnosable disorders were blamed on the ‘Wandering Womb’ - a notion that the uterus actually moved all over women's bodies, pressing on other organs. So as a woman, you might have a cough or you might have cancer - it was all to be blamed on that pesky womanly uterus.


In the name of God (Complex)

These ridiculous theories have long been debunked. Yet, women continue to be treated by the medical profession as dumb, hysterical, and fundamentally incapable of reporting their own symptoms accurately.

There are people doing admirable work to counter this bias. Websites and apps like Pinky Promise and Veera are committed to providing dignified and scientific reproductive healthcare to women. Young Doctors like Dr Tanaya, Dr. Abhinaya, and Dr. Amodita - who are living in a changing world - answer women’s reproductive health queries without judgment. Young women on Twitter recently crowdsourced a list of “Gynaecologists We Trust” in all major cities of India.

But while the medical profession works on its systemic sexism, consider googling the experiences other women have had with your next doctor before you see them. And definitely leave a negative review on apps like Practo when you come across one that doesn't bother treating you like a human being - so that other women can be saved from becoming their victims.

The first step towards getting doctors to overcome their God Complex is for us to stop treating them like Gods, and start treating them like the flawed humans they are - when one isn't working out for you, move on.


I realize that this is not the best time to be writing a piece criticizing doctors. Doctors have sacrificed their safety, their families, their life in the past year. I have nothing but respect for the profession and those who choose to follow it in the true spirit of service.

At the same time, as Dr. Isha said, doctors are a product of society too. If we, as a society, don't respect, trust, and believe women, how can we expect just one profession to behave differently from the rest of us? As we change, so will they.

Mahima


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