The $75 million Go Red for Women public health education campaign has done a lot of good, or so I thought. As a critical care cardiac nurse, it gives me a sense of pride come February when I see posters all over the hospital touting the benefits of dark chocolate and urging women to take charge of their own heart health.
Every 80 seconds in this country, a woman dies from cardiovascular disease. Most women know that we may have different symptoms from men. This knowledge seems to be widespread among health professionals. Yet on February fifth, when I became a woman seeking treatment for crushing chest pain, I found out differently.
Research consistently has shown that women will ignore symptoms that indicate heart attacks. I am definitely in this category. My chest pain had been intermittent since June 2017. But on this day I decided I couldn't deny my body’s anything-but-subtle message: Something was definitely wrong.
Four days before, my primary care physician captured a picture of my heart rate and rhythm on an EKG. It read borderline abnormal, possible cardiac ischemia. She prescribed nitroglycerin for chest pain and a medication that decreases the workload on the heart. But days later, before I could get in with a cardiologist, my mid-sternal chest pain became severe. Nitroglycerin tablets decreased my pain to tolerable, an indicator that something definitely was happening. I decided to drive myself to the emergency room, being the independent American woman that I am.
My primary roles in life are mother, sister and nurse. I am a caretaker. That’s my nature. Driving to the ER my thoughts were not focused on “I could die.” They were more like:
I cannot afford this co-pay. I haven’t met my deductible for 2018. I'm so happy the nitroglycerin worked so I didn't have to bother anyone for a ride…an ambulance would be embarrassing! This is a waste of time—I'm sure it’s nothing. I'm just going because I promised my sister I would. How can I get my son to basketball practice tonight?
Upon arrival, I quickly encountered the profound disconnect between public health campaigns and healthcare as we know it. What I realized is that a woman's voice is still comparable to a well-trained dog wearing a muzzle.
Ten minutes later, when I could not find a parking space, my chest throbbing in pain, I called the ER receptionist and explained my predicament: Woman in parking lot alone with heart attack symptoms. “I need someone to help me,” I said. “You can just drive across from our medical center and park in the employee parking structure, then the shuttle back to the emergency entrance,” I was told. The pressure in my chest mounted.
My first thought was to comply with this ludicrous request. As a younger woman, I would have assented to this option. As a 46-year-old woman, I decided assertiveness was warranted. The receptionist reluctantly sent one security guard to park my car and another to escort me to triage. I thought, I’m tired. I’m tired of being forced to evolve into a woman who must fight for her rights—healthcare, a universal right for every human being. It is an injustice to be treated by our healthcare system as if we are an imposition.
Standing at the triage window, I was short of breath, scared, in pain. The triage nurse launched into a swift, no-eye-contact assessment. She was herding cattle and I was one of cows. As a nurse, I’d been on the other side where the triage nurse stood. Health history? Medication allergies? Family history? When I stated I had a history of anxiety and depression, the nurse pounced on “panic attack,” to the exclusion of “heart attack.” I have no history of panic attacks. I do have heart disease in my family history. I had just told her this. It reminded me of how women take away other women’s voices. It is not just men who do this. We do this to one another.
I started to wonder if I was caught in the unreality of an episode of “The Office.” What I couldn’t have known then was that the level of un-care would only get worse. No room was available for me, so they parked me on a stretcher in the hallway outside of a supply closet. Blood was drawn, a lab test they would later botch, and I was put on what I thought was a cardiac monitor where I really and truly was receiving the courtesy of having my heart monitored. This would turn out not to be true. It was 6:15 p.m. I had arrived in the ER at 4:50 p.m. A new nurse offered me 325 mg of aspirin, Cardiac Care 101. I’d waited one hour and twenty-five minutes for this.
The new nurse and a nurse practitioner implored me to let them know immediately when the chest pain occurs, so they could do an electrocardiogram (EKG.) An EKG performed while asymptomatic will not be what is necessary to complete a thorough assessment. This pleased me because from being a cardiac nurse I had this knowledge. I relaxed and thought, finally, I’m getting care.
I asked a very important question. “Where is my call light so I can let you know right away?” Again, I was parked in a hallway outside a supply closet. No nurse’s station was in sight. Some patients and random people in scrubs walk by, but I was alone with absolutely no one’s eyes on me. My nurse apologetically said, “Oh, you don’t have a call light?” He was visibly embarrassed because all health professionals know this is an accreditation requirement that all patients have a call light within reach at all times. This violation is something for which the hospital could be fined a healthy sum of money. “You just have to yell.”
At 7:30 p.m. my nightshift nurse stopped by to introduce herself. I asked her what my chest X-rays showed. “They looked OK from what I could tell, but I really don’t understand why they do chest X-rays,” she said. I never saw Kim, my nurse, again.
About 8 p.m. my heart and vital sign monitor shut down. With cardiac monitoring, it is required that someone immediately checks on the patient in such an event. This usually occurs within seconds. No one came running to check on me. I looked back at the monitor and realized the battery had died. I also pieced together that my heart rhythm was never being remotely monitored as it should have been. There I lay, unmonitored, no call light, parked in a hallway by a supply closet.
At 8:35 I realized no one was coming. Medical professionals passed by, too busy to notice me. No eye contact, no “do you need anything,” or “can I get you your nurse.” Hospitalization requires that each patient be seen at least once every hour. I’d had chest pain twice since my monitor shut down. I was invisible. I am not receiving care here I thought. I decided I was busting out of this illusion of care.
While contemplating my escape, I reviewed what would have been improvement in my healthcare or lack thereof. Maybe a cardiology consult? Oxygen to decrease the workload of the heart is also a standard treatment. With nurses and doctors passing in the hallway, I ripped off my EKG leads, my nonfunctioning heart monitor, and my blood pressure cuff. I pulled the IV out of my arm and stopped the blood with a medical glove available on a cart left in the hallway. While I removed the IV, two medical professionals passed me within an arm’s length and did not notice.
I gathered my purse and coat. No one will stop me, I thought, and amazingly they did not. I asked for directions from two employees in scrubs. They directed me out of the ER while I still wore my patient armband. Free at last!
At 9:35 p.m. I received a call from my nightshift nurse Kim. I had been gone for one hour. Kim hadn’t laid eyes on me for two hours. “I will have to call the police on you,” she said, “because you left with an IV in your arm.” I calmly informed her that I removed it myself prior to my leaving an hour ago. I explained I was unmonitored since 8 p.m., reminded her that I had no way of calling for help in the event that I had chest pain and that I hadn’t seen her face nor had any health professional check on me for two hours. She had little to say at this point, not even something like, “Ms. Flynn, are you still experiencing chest pain?” Or, “In the event that your symptoms recur, let me explain what you need to do.”
If you are contributing to the $912 million every year invested in the American Heart Association, you have no doubt made a difference in research and prevention for women. But I wonder where your money is going when the first responders, hospitals and other healthcare providers aren’t even achieving basic protocols. The AHA’s Mission: Lifeline strives for 30-minute door-to-needle timeframe and seeks to address gaps in care. Gaps in care would be an understatement here. All the fashion shows featuring celebrities like Marisa Tomei, all the discounted red dresses available at Go Red sponsor Macy’s, all the free screenings available at 1,100 CVS locations across the nation won’t matter if the places we go for care don’t care.
As a nurse, I’ve devoted many years to the cause, saved lives, and been part of giving people more quality years of life. I take pride in the fact that what I do allows women more years to be with their loved ones. This is an honor I do not take for granted.
On the day that I sought treatment, I would never have imagined that such a disconnect could exist between my heart health knowledge and the reality of healthcare. I never thought the only remedy available to me would be a stash of dark chocolate and red wine already in my apartment. What I really wanted was professional medical care.
Heart disease is the number one killer of women in the United States. February is our month. We need to be better aware that this is more than a public health crisis—it’s a crisis of uncaring. In what should be our month of empowerment, we are still invisible. Next time we go red, let’s truly go red.