I broke my foot in a crosswalk on a Wednesday in October. Specifically, I broke the fifth metatarsal in three places and tore a ligament, and I did not learn either of those two facts until Friday, because on Wednesday, in the emergency room, the intake nurse wrote a four in the pain column of my chart and I said an eight.
I know the number I said because I said it three times. I said it to the triage nurse. I said it to the resident. I said it to the discharge attending. Each of them wrote it down. When I asked to see my chart later — a right I had to be told about by a friend, because the discharge folder did not mention it — the number said 4/10 in three separate boxes. When I asked why, one of the nurses I spoke to on the phone, kindly, said, well, if you were an eight you probably wouldn’t have been able to walk in. I had walked in on the other foot. I had explained this at intake. I had, in fact, said the sentence, I am walking on one foot because the other one won’t bear weight. The chart still said four.
The literature on this is not subtle. Studies of pain treatment in emergency departments have found that women wait longer than men for analgesia after acute abdominal complaints, and are less likely to be given opioids for similar pain scores (Chen et al., 2008). The mechanism is not a single villainous doctor. It is a cumulative posture — the reflex, absorbed from training and reinforced by culture, that a woman’s eight is probably a six, and a woman’s ten is probably a scene. The reflex has a name in our own pages, and we take it apart at the claim that women have lower pain tolerance, and whatever lab studies say about pain thresholds, none of it is a reason to discount the number a patient gives you.
I got ibuprofen. I was told to elevate. I limped out of the ER on the walking boot they gave me because they didn’t want to admit me for imaging, and I filled a prescription for Tylenol with codeine at a twenty-four-hour CVS on the way home, because I was crying by the time we got to the parking lot. I did not go to work Thursday. I called an orthopedist myself Friday morning. He x-rayed me, told me it was a Jones fracture with a torn ligament, told me I would need a boot for eight weeks and probably a screw if it didn’t heal, and looked at the ER chart and said, quietly, they underscored your pain. The size of the gap he was describing shows up whenever we lay out how women and men are actually treated in medical settings, and it does not go away when the injury is visible on a screen.
The reason I am writing about a broken foot and not a broken heart is that a broken foot has an x-ray. There is a picture of the thing I said I felt. There is a bone that is not connected to the other bone anymore, and I said an eight, and someone wrote a four, and the picture is what proves the eight. Most of the women whose stories I have collected since — a slow, private list of the same experience across other bodies — do not have the x-ray. They have the sentence and the four in the chart and no bone to hold up in court. I hate that my proof is a picture. I am grateful, in a way I am not proud of, that I have one.