On a cold and sunny spring morning, I hustled my partner, Sarah, and our nearly two-year-old child out the front door, grabbed the stroller that was folded on the front porch and headed down the steps, oblivious to a fine coating of ice that had formed overnight.
As I lay crumpled at the bottom of the stairs, I noticed how clear and high the sky was. I floated in that pleasant blue until the cold of the cement began crawling into me. I wasn’t sure if I could or should move. Then I began to feel the pain.
When my mind snapped back to real time, I heard Ezra’s panicked crying. The fall — or more likely my involuntary symphony of groans — had, understandably, freaked him out. The only words I could squeeze out were: “Take him inside!”
When Sarah returned, her voice was measured and low. “Are you okay? Should I call an ambulance?” I was enraged. “Don’t be ridiculous!” I snapped. “Leave me alone!” And then, because, even in the moment, I could see I was being a jerk, “I just need a minute.”
Eventually I got up. (I imagine it looked something like a robot twerking, poorly.) There was the searing pain in my back, sure, and the debilitating spasms, but I got to my feet. And I went on with my day. I tweeted something I thought was pretty funny about how falling down the stairs is a young, drunk person’s game. I didn’t go to the hospital or to a doctor. I didn’t even take a Tylenol until forced to by the person newly in charge of putting my pants on me.
That it’s-not-happening-if-I-don’t-let-it attitude is how I ended up getting a heart-stopping voice mail message five days later. It was my doctor. (I’d eventually gone to see her after missing several days of work.) The message said, “Your X-rays came back. You have multiple fractures in your spine. You need to get to the hospital right away.”
The word denial might be crossing your mind about now, but I don’t think that’s the whole story. I’ve had months to consider those first wounded-animal instincts and why it is that I have continued to struggle each time I try to communicate the severity of my pain to health care professionals and others. I’ve tried to dissect how much is my own weird reaction, born of unique personal factors (like, say, seeing my grandfather leap out of a hospital bed after a heart attack so he could get back to shimmying up trees at the cottage, chainsaw in hand), and how much is something else, something that other women might be contending with as well.
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I’ve landed, much to my surprise, on a very old idea that still seems to be haunting me and, I suspect, haunting others as well. I didn’t — I don’t — want to be seen as hysterical.
But hold up: Could I really be worried about an ancient idea about the power of a “wandering womb” to wreak havoc on my body and psyche? After all, the concept of hysteria from today’s perspective is, um, hysterical. Hippocrates coined the term back in the fifth century BC. He believed the womb to be a troublesome organ, which might take to moseying about a woman’s body, releasing toxins and causing all manner of ailments: mood swings, fainting, sexual forwardness, speechlessness. Widows and virgins were considered most susceptible.
The idea held on for the next couple of millennia but shifted from the belief that a dried-out uterus (lacking the irrigation of a man’s seed) might lodge itself near the throat and cause, say, breathing difficulties, to the conviction that our troubles are entirely in our heads. So where a woman in ancient Greece might be advised to rub honey on her genitals while chewing something pungent — you know, to encourage the devious, sweets-loving organ to go back to where it belongs — a Victorian woman might just be written off as insane, or in need of a good “hysterical paroxysm” (we call those orgasms nowadays). That’s when Freud picked up the ball and ran with it, pegging hysteria to trauma and, of course, sexual repression. His suggested cure actually involved listening to women, which was nice. (And all that kindly concern over women’s sexual repression led to the invention of the vibrator, so there’s that.)
It’s wacky, womby stuff. And yet, it describes something eerily familiar. The spectre of hysteria is the best way I can find to describe why I was gripped by fear each time I was asked to score my pain on a scale from 1 to 10 or why it was that calling an ambulance after a serious fall would mortify me: If I’m not believed, if I’m ruled an unreliable witness to my own body’s experiences, then I won’t get the help I need. Some kind of subconscious self-protection program launched in the moment I hit the pavement: Play it cool, or else.
And so, after a very tense drive to the emergency room, I mustered the lightest tone possible to explain to the triage nurse why I was there. The tiniest bit of surprise cracked her seen-it-all expression. And then she slid a piece of paper across the desk. It was the pain scale. Panic. Twenty-first century or not, I knew the math. Excessive emotion means out of control, which means not to be trusted. I circled the 6.
I have to confess that before all of this, I thought of the whole hysteria thing as kind of cute: one of those old beliefs we like to remember so we can laugh at it, and so we can be reassured that while we may not have eradicated violence or achieved equal pay, women today have it pretty good. I resisted believing that such an old, ridiculous notion could have any effect on me or any other sentient being today.
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But my attitude has changed. I’ve started to think of hysteria as a kind of cockroach of an idea: not really evolving, keeping just out of sight, frighteningly tenacious. Given how long it has persisted in the history of humankind and given, well, the new president of the United States, maybe it’s not as odd as it initially seemed that the fantasy of the hysterical female could still be affecting real women today. If a man can be elected leader of the so-called free world after derisively suggesting a journalist had “blood coming out of her wherever,” it’s not a stretch to think that the classic view of hysteria is alive and well. Lady parts: They make you crazy.
And they make you susceptible to some pretty alarming treatment by health care professionals too. Studies of gender bias in the treatment of pain have shown that women are often given sedatives for pain while men are given medication for, well, pain (studies also show that women are prescribed weaker drugs than men for treatment of the same painful symptoms). In an agonizing essay for the Atlantic in October 2015, Joe Fassler describes rushing his wife, Rachel, who was seized with extreme pain from an unknown source, to the hospital, where a nurse told her, “You’re just feeling a little pain, honey.” Rachel waited for hours without proper treatment. Meanwhile, her ovary was dying, a surgical emergency that causes “the kind of organ-failure pain few people experience and live to tell about.” In American emergency rooms, Fassler writes, “men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain; women wait an average of 65 minutes for the same thing.”
Researcher and academic Anne Werner of Akershus University Hospital in Norway has studied the internal calculations many women make when dealing with health providers. In her small-scale qualitative studies from the late ’90s and early 2000s (sample title: “ ‘I Am Not the Kind of Woman Who Complains of Everything’: Illness Stories on Self and Shame in Women with Chronic Pain”), the women she interviewed devoted an enormous amount of energy to presenting their pain in a way that optimized their chances of being believed. Especially for women with long-lasting, medically unexplained disorders such as fibromyalgia, there can be an enormous amount of “work needed to appear as a credible patient” — energy that’s taken away from coping with their actual medical condition. In other words, she says, the women felt they needed to “do” pain and “do” gender right.
All of this leaves women in a delicate position. Scream out your pain in an effort to get noticed; or undersell it, flirt with your inner martyr and hope that if you behave, you and your pain will be seen.
Somewhere a cockroach twists its lips into a smile.
I call up Dr. Michael Gofeld, a pain specialist at Women’s College Hospital in Toronto, for his view of all this. I ask whether women struggle to communicate with him about their pain, more so than men. “Sometimes I have this impression,” he says. So what does he think an individual woman can do — try to be as direct as possible without second-guessing herself? “Probably.”
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I’ve reached him while he’s driving; he’s keeping things succinct. Nevertheless, he impresses upon me that pain is complex, and individual. Then what was I supposed to do, I ask, when faced with that impossible pain scale. How do I know what your 1 is, or your 10? How do I know where my pain fits — what would be considered reasonable and rational and not at all excessively expressed?
What he says next kind of blows my mind. “It doesn’t matter. We are treating your subjective pain, not mine.” I could have just gone ahead and circled that 10.
It gets me thinking about an essay by Leslie Jamison, her “Grand Unified Theory of Female Pain,” in which she coins the term “post-wounded woman.” It’s kind of an update on the “work to appear credible” that Anne Werner talks about. “Post-wounded women know that postures of pain play into limited and outmoded conceptions of womanhood,” Jamison writes. “They are wary of melodrama, so they stay numb or clever instead.”
Women today are so over this women’s pain thing. We try not to play the game at all. I can’t be written off as hysterical! I took women’s studies! We hope the world has changed. We hope we can outsmart the ways it hasn’t. But it’s not a posture that works. Or, at least, it didn’t work for me.
Big chunks of bone had popped right off four separate vertebrae and were floating around all those very important nerves as I lurched about, insisting I could go to the bathroom on my own and then eventually yelling for help to get off the toilet. Four breaks in the bones that protect my spinal cord. I had walked around — sometimes crawled — for nearly a week without knowing whether my spinal cord was at risk. I had put myself in a dangerous position because of a very old fear of a very old idea that I didn’t even know I had.
The bone chunks found their way back to their proper place along my spine — no sweet enticements required. The breaks healed. Then the rest of the wreckage became apparent — discs and nerves that had suffered their own damage. The pain slowly got better, and then it stopped getting better. This pain, it seemed, was going to be a new feature of life in this body. It seemed like I wasn’t going to get better, ever.
That is, until I sat down with my doctor and told her just how much pain I was in. There was no scale. She met my eyes. She listened. She watched me sway back and forth in the cramped office, unable to sit or stand still months after the accident. She asked about the quality of the pain, about the effect on my life, whether anything relieved it, even temporarily (sadly, no). And then we made a plan. And then my pain got so much better.
It’s icy outside again. People keep telling me to be careful. I’ve caught myself giving the porch steps the stink eye before I descend, like maybe I can intimidate them. But lately, I’ve noticed a strange confidence growing in me — even if I fall, I’m ready this time. There will be more pain, falls or not. I know that. Those old beliefs may always be like a cockroach under the sink, but expose them to light and they scatter.
Lisa Bryn Rundle is a producer at CBC Radio’s Out in the Open.
Originally published February 2017; Updated November 2018.