A Deeper Sensitivity: The Female Relationship To Pain

I WAS WORKING the overnight shift not long ago when a woman came in with vulvar pain.
Yes, vulvar pain. Her whole perineal area was so inflamed and swollen that she couldn’t even sit down. And no one could figure out what might be causing it.
I got her on sign-out, which meant I was responsible for determining whether she could go home, even though the exams performed by the previous attending physician hadn’t produced any answers for her.
I grabbed my resident, saying, “Let’s go see her. We need to get into her head space and see if there’s anything we can do.”
I could see the moment I opened the curtain that she was in real distress. A few minutes into our conversations, I’d learned that the woman, whose name was Margaret, was seeing her primary care doctor about this issue and had an MRI scheduled for a few days later, but she couldn’t wait until then to find a solution to her pain. The Tylenol she was taking at home wasn’t even taking the edge off.
In a lilting Yorkshire accent, Margaret told me that this pain had been going on unabated for weeks, and she still didn’t have any answers. She was hoping the upcoming MRI would provide them, but even that wasn’t certain.
I wanted to be able to offer her some relief—to give her a reset point—so I offered morphine.
“No,” she said. “It’s awful, the way that makes me feel. It’s worse than the pain.”
“Has there been anything that actually worked for you?” I asked.
“The first time this came on, I came here in an ambulance, and they gave me something in an IV. I think it began with a T? That helped for a while. But nothing else has.”
“I think you’re talking about Toradol. That’s one of the alternatives I was going to recommend. Let’s get you set up with that.”
Even though I wasn’t able to offer Margaret more than a few hours of relief from her pain, she was incredibly grateful. As the Toradol took effect, her whole body began to relax. You could literally see the tension go out of her face and shoulders. By the time she called her sister to drive her home, she was yawning.
“This will be the first good night’s sleep I’ve had in days,” she said.
Margaret was well cared for by medical standards. Her primary care physician was doing everything she could to figure out the problem and even responded to our middle-of-the-night request for more information. But while the wheels were turning and tests had been scheduled, Margaret was still waiting in pain—and that pain was bad enough to drive her out of her house and into the ED at 2:00 a.m.
I see a lot of frustrated women come and go through the doors of my emergency department. They’re between tests or doctor’s visits, and for myriad reasons, they aren’t getting the answers they need and deserve. They come in because they can’t see any other way to get through the day or the night. They aren’t “drug seeking”; like Margaret, they just want to be able to function until someone helps them figure out what’s wrong.

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