The first time I went to the hospital for pelvic pain, I was 14 years old. It was nighttime, after dinner with my extended family. I think it was spring. My memory of the ER, though, is crystal clear: It was somehow both fluorescent and slightly dingy. After handing me a pale-green basin in which to vomit, the doctor asked my mother to leave the room and pulled a curtain around us. Had I been having sex? Was there any chance I could be pregnant? Be honest.
At this point in my adolescence, I’d only ever kissed a boy, so I was horrified by this question. I was also horrified by my body. The pain felt like someone had grabbed my insides in their fist and twisted, shredding my tissue with fingernails. Putting that into words for a stranger, an adult man, this adult man, was mortifying.
I wasn’t pregnant. It wasn’t appendicitis. I went home without any explanation.
This pattern would repeat for years. Dizzying, debilitating pain, followed by an ER trip, some intrusive questions about my sex life, and a deep shame that I was troubling anyone with my complaints. There were tests and several gynecologists visits but no conclusion other than that I must have a “low pain threshold.” Or maybe, they insinuated, I was seeking attention.
Only when I was 35 did a surgeon take me seriously. A new GP sent me to his office suggesting that it might be a hernia. The surgeon took one look at me doubled over and sent me to the hospital—the same one where I’d been a patient at 14. He met me there an hour later and whisked me into surgery, convinced that it was my appendix.
When I recovered consciousness, more than five hours later, my appendix was gone. But so were six inches of my intestines, and the severe endometriosis that had infiltrated both organs. I lay in the ICU, in pain and weeping, not relieved, but furious. I had always suspected something was deeply wrong with me, but no one had listened. And worse, they’d made me question myself.
Listening to the first episode of Susan Burton’s The Retrievals, the new installation from Serial and the New York Times, it all came rushing back. The women—all patients at Yale’s fertility clinic—described going through IVF egg retrieval, in which a large needle is inserted into the vagina and then into the ovarian follicles. The problem—the reason this is a podcast—is because they went through this with no pain control at all. The fentanyl they were supposed to receive had been diverted, and replaced, by an addicted nurse.
The experience of a large needle entering one’s body with no pain medication is what anyone might imagine. “I remember, like, thrusting my hips up, actually thrusting my hips up, saying, ‘I feel everything,’ ” said one patient in the show. What it was like to experience this as a woman was what I already knew: “And, like, nobody believed me,” that same woman said.
When I listened to her speak these words, I was on a walk in Prospect Park, and had to find a bench so I could cry. I had actually put off listening to the show because I feared this would happen. And there I was in public, sobbing. I pictured myself as a patient who desperately wanted to be believed. This so easily could have been me. In a way, it was. When I was just a girl.
Even though the show is in many ways a how-dunit, how the nurse at Yale’s fertility clinic replaced fentanyl and Midazolam with saline without anyone noticing, it’s really a show about pain. And how the medical system is built to minimize, explain away, or simply dismiss women’s pain completely. And every woman I’ve talked to who has listened, whether they have been through fertility treatment or not, has had this experience. With women of color, especially Black women, it’s even more extreme. (Every patient Burton spoke with identified as a woman. Most were white, and one was Black.)
In listening, I could have some tiny flicker of sympathy for Donna, the nurse in question. Her substance use disorder needed treatment, and as much as her actions (and her sentence in the case) enraged me, I could perceive her as an individual in crisis, assisted by Burton’s own clear empathy for Donna.
But what is galling, and what Burton captures perfectly, is the fault in the system itself. The system of medicine that has been constructed, over decades and centuries, to minimize and ignore women’s pain, to treat the female body as something that largely smashes up against the medical system when it is reproducing. Despite decades of progress, the medical profession is still primed to see women as vessels. As “mama,” as every nurse in labor and delivery maddeningly addresses women laboring. We are not considered people with lives that are equally as valuable as babies’ and men’s—we are bodies whose chief function is to bear a child, and because of that, as people who can—and should—bear more pain because our own experiences matter less.
“You wonder what each person, the doctor or the nurse in the room, what their experience of this was?” asks Katie, one patient who had a fentanyl-free retrieval, in Episode 4. “What were they thinking?” Why did no one stop the procedure? Realize that something was deeply wrong, that no patient should be in extremis like this? The women were primed to accept some “discomfort,” but so was everyone else watching the women. To accept that pain, agony really, was an essential ingredient of womanhood, and aspiring motherhood. Their pleas were unheard because clinicians are trained not to listen.
When I was in labor with my son, I screamed that the resident attempting to administer my epidural was doing it wrong. She patted me on the arm and told me to calm down. Only hours later, when I began to babble incoherently, did my OB realize that the doctor in question had missed my epidural space. I had had no pain relief.
In Episode 5, The Retrievals’ series finale, Burton manages to succeed where many other seasons of Serial have failed. There is no hand-wavy meditation on the nature of a crime, or a place, or on humanity and how we all weave narratives to our liking. There is actually a conclusion offered: Women’s pain is not treated equally because women are not treated equally.
Burton finds a study showing that suing for malpractice over subpar treatment, painful treatment, is harder if you are a woman. The standard of care, against which malpractice is measured, is simply lower for us. We are set up to hurt. This is not a theory, she further clarifies—this is something you can find in data.
But Burton also articulates something else in this final, masterful, episode, “The Outcomes.” There is another difference between women’s bodies and men’s bodies, a reason why they endure more pain, often willingly. The women she spoke with endured the pain of the retrievals, sometimes even going back for more, because they longed for a baby. The main goal of fertility treatment, after all, is a child. But it isn’t, and should never be, the only goal of medical care, or of how we care for female bodies. As she puts it: “The baby is what matters. But everything else matters, too.” How do we describe an outcome if you end up with a baby, but lingering trauma? Or, in post-Dobbs America, you are able terminate a pregnancy, but only after humiliation and tremendous expense? How do we count against our reproductive capacity? How can we count on our own?
After the long surgery that found my endometriosis, I would go on to have three more. I still encountered an astonishing wall of sexism in the medical profession. “What you should do,” said a friend’s father who was also a reproductive endocrinologist, “is get pregnant. That will cure you. Endometriosis is the working woman’s disease.” What he said was not even true, but it did tell me a lot about how he valued me as my own person.
When I sought endometriosis treatment, so many doctors I saw assumed I was there to prepare for an eventual pregnancy. After all, endometriosis is a major cause of infertility. But what I wanted was a life without pain. I remember being told once that my fallopian tubes were “pristine.” Good news, if what you want is to conceive. But utterly irrelevant if you simply wish to pass a month without Percocet, which is what my goal was. “You don’t have real endometriosis,” said a loved one once, making that assumption because mine wasn’t blocking my reproductive organs. Theoretically, I could still get pregnant. We don’t know how to think of a woman, if not as a pregnancy in waiting.
Eventually, I found a surgeon I adore. He severed a nerve between my uterus and spinal column that reduced my pain and dramatically improved my quality of life. He cheered me on when I made the choice to become a mother at 44. Upon listening to the final episode of The Retrievals, I emailed him to thank him for treating me like a person.