Bioethics Forum Essay
The Retrievals: Women’s Vulnerability to Injury, Violence, and Pain in Health Care
Pain can be tender, throbbing, lacerating, shooting, burning, and wrenching.
Pain is also a protective, finely wired warning system primed to defend the body from harm. In the field of medicine, pain can be an essential marker of underlying pathologies and sometimes can be used to direct treatments. However, the science of pain measurement is frustratingly imprecise, presenting challenges in clinical settings. Importantly, pain assessments rely on information provided by patients, who are sometimes asked to characterize the severity, intensity, and duration of their pain.
But what happens when a health care provider decides that the patient is not a reliable narrator of their own pain?
The Retrievals, a recent documentary podcast from Serial Productions and The New York Times, explores this question and the excruciating pain that 12 women endured while receiving fertility treatments at the Yale Reproductive Endocrinology and Infertility Clinic. Because egg retrievals involve passing a long needle through the vaginal wall to access the ovaries, patients typically receive fentanyl and midazolam to induce moderate sedation during the procedure.
Many women at Yale reported being wide awake and feeling “everything” during a procedure when they should have felt practically nothing. Naturally, these patients requested more medication to manage their pain, which they described as “excruciating” and “like someone was ripping something from the inside of your body.” However, when the women voiced their discomfort, they were told by clinic staff they had already received the maximum legal dose of painkillers. Later, it was discovered that a clinic nurse had pocketed the fentanyl and replaced it with saline, leaving the women to endure their retrievals without any pain control.
Pain and its shadows give shape to the disturbing story behind The Retrievals while raising important questions about discrimination in health care. It is important to note that of the 12 women interviewed in the podcast, most were White. The one Black woman in the group was often the only person of color in the clinic waiting room––this is not unusual, as fertility clinics mostly deliver care to White women due to access issues and systemic barriers that prevent Black women from seeking fertility care. Notably, clinicians are more likely to dismiss, ignore, or downplay the concerns of Black and female patients, compared to their White and male counterparts. Gendered racism in health care makes Black women especially vulnerable when seeking reproductive health care and reporting pain.
False beliefs about racial differences in pain, established during the era of slavery, fuel medical mistreatment and cause harm to marginalized groups, especially Black women. Even today, racial biases in pain assessment and treatment among medical professionals persist. Dorothy Roberts, an acclaimed scholar of race, gender, and the law, explains that the use of race in medical decision-making is not only a symptom of bad medicine, but also a sign of stereotypes at play, including harmful ideas that “Black and Brown people feel less pain, exaggerate their pain, and are predisposed to drug addiction.”
Racial disparities in pain treatment intersect with and perpetuate other well-documented reproductive and maternal health inequities. When Black women report chronic pain for conditions such as endometriosis, they are less likely to be taken seriously and receive a timely diagnosis. They are also less likely to receive adequate postpartum pain control. Inequities are further amplified when reproductive health care providers ignore women who vocalize their concerns and then blame these patients when they experience adverse maternal and perinatal health outcomes, even for preventable conditions.
Take, for example, the story of Jennifer James, a Black feminist ethicist and medical sociologist who “was not believed when [her] epidural failed” and then “was chastised for yelling out in pain” during the birth of her first child. Or consider Kira Johnson, a healthy 39-year-old Black woman who hemorrhaged to death after a routine cesarean delivery despite her husband’s many pleas for help. When he asked staff to investigate the blood clouding Kira’s catheter, a nurse responded, “Sir, your wife just isn’t a priority right now.”
As evidenced by the stories of countless women and those interviewed in The Retrievals, women and patients of color tend to be targets of medical gaslighting, the dismissal of patients’ concerns, feelings, or complaints by their health care providers. In other words, medical gaslighting occurs when doctors fail to trust their patients or refuse to acknowledge their pain.
The Retrievals highlights something that many of us working in health equity and bioethics know all too well: until we fully acknowledge and address the historical and contemporary injustices that fuel longstanding harm in reproductive health care, all women are vulnerable to injury, violence, and pain in health care settings. To be clear, these injustices are exacerbated by biases against minoritized groups which must be addressed in order to holistically care for all women.
Sophie L. Schott is a clinical research coordinator in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Her research explores the intersections of medicine, history, and health humanities to advance a more nuanced understanding of reproductive health and community well-being. @MyBestSchott
Faith E. Fletcher, PhD, MA, is an assistant professor in the Center for Medical Ethics at Baylor College of Medicine, a senior bioethics advisor to The Hastings Center and a Hastings Center fellow of The Hastings Center, and a nationally recognized expert in health equity and bioethics. @FaithEFletcher