I read an article in The Guardian recently. It happened to be about menopause, a stage of life I have already graduated from (thank goodness!) But it was still interesting to me, as a person who once exhibited world-class projectile sweating during an event at which I was the guest of honour.
But that’s another menopause story entirely.
One particular line of this article leaped out at me. Not about menopause at all, actually, but about women who have opinions. .
The line was written by the smart and funny Guardian columnist Suzanne Moore:
“While we’re at it – and I am always at it…”
Have you, like Suzanne, started to feel this way lately? As if there is hardly a topic out there that doesn’t inspire a burning urge to share your enlightened opinions?
For me, being “always at it” describes the act of speaking up when you have something to say. This has fully blossomed only recently (thank you menopause!)
Before now, in most areas of life when I could have been “always at it”, I tended instead to weigh carefully whether it was polite, acceptable, prudent, considerate or especially in my best interests to publicly speak up. Usually, while I was busy dithering, the moment passed and it was, once again, too late to speak up.
But it’s surely not that I don’t have strong opinions, as my family and closest friends can readily assure you.
It’s more that, like many women my age, I’ve been socialized for my entire life toward public politeness. Little girls like me were raised to be polite. And nice. And not make a fuss. So I learned to keep my mouth shut when I should have been speaking up.
Oh, I did speak up about important issues, but I usually did this long after the fact, like during wine-fueled late night confabs with my girlfriends. We liked to review the events that were bothering us – but which we had consciously decided not to speak up about at the time. In our replayed conversations, this time we’d say what needed to be said. We’d ask for what we wanted, set clear boundaries for what we would and would not tolerate, speak up for ourselves and those we cared about – instead of swallowing the words, unchewed, polite, stillborn, silent.
It did not help us to rehash what we wished we’d earlier said. It only made us angrier at ourselves for not being able or willing to speak up. We also suspected that “being nice” was not all it’s cracked up to be. See also: Could Goodism and Self-Sacrifice be Linked to Women’s Heart Disease Outcomes?
It’s entirely possible to speak up without being rude, but “niceness” is a pervasive tradition that can still stifle many of us. We need only to observe the often ugly world of modern politics where female politicians are slammed for being “aggressive” when they speak up, while their louder, cruder and and ruder male opponents are lauded for being “assertive” or “strong”.
Sometimes it’s intimidating to speak up, especially in front of one or more people who are considered to be authorities. But consider the wise words of Michelle Obama, who, when asked during an Oprah interview if she ever felt intimidated sitting at big tables filled with smart, powerful men, replied:
“You realize pretty quickly that a lot of them aren’t that smart.”
I now wish that I too, like Suzanne Moore in The Guardian, had been more determined to be “always at it”.
Or to paraphrase the wise words of the famous philosopher, Madonna: “A lot of us are afraid to say what we want. That’s why we don’t get what we want.” We’re frequently justifiably afraid because we know from experience what can happen when we do.
For example, when I was misdiagnosed with acid reflux in mid-heart attack (despite my textbook Hollywood Heart Attack symptoms of central chest pain, nausea, sweating and pain down my left arm), I did attempt to speak up before I was sent home from Emergency. But I immediately learned what can happen to female patients who speak up.
The Emergency nurse came up to my bedside, and sternly warned me:
“You’ll have to stop asking questions of the doctor. He is a very good doctor and he does NOT like to be questioned.”
I felt like my face had been slapped. I was not only already feeling supremely embarrassed for having made a big fuss over nothing but a case of indigestion, but now I was further humiliated for being such an openly difficult patient.
And the question that I had dared to ask this Very Good Doctor?
“But what about this pain down my arm?”
The point is: I was a grown-up, mature, adult woman in my 50s when this scolding took place. Yet my response to being scolded like a naughty child was to regress to childhood, to get away from that Emergency Department as fast as I possibly could.
I’d had the temerity to speak up for myself, to ask a sensible question (I’m no doctor, but even I knew that pain down your left arm is never a sign of indigestion!) – and then I learned what can happen to women who speak up. See also: The Medical Hierarchy Shift
Mine was an unfair fight. I was vulnerable, alone and scared, so hardly capable of withstanding a sudden scolding from somebody who was supposed to be helping me.
So when my symptoms returned (which, of course, they did!), I knew that there was no way I was going to endure further humiliation by going back to Emergency to make another fuss over nothing. PLEASE NOTE: Do not be like me. If you’re experiencing alarming symptoms that you suspect might be heart-related, seek immediate medical help. Do not be embarrassed to death.
I did somehow survive that heart attack despite the dangerous delay in appropriate diagnosis and treatment, but I have never forgotten the way that the nurse scolded me for speaking up.
The more I thought about it, the more I realized that this nurse would never have spoken to a male patient the way she spoke to me.
I have also never forgotten how, with just her one shot, I immediately caved in.
While I couldn’t speak up for myself at the time, I know that when I speak up now on this Heart Sisters blog, at my Heart-Smart Women presentation audiences, or in my book, it’s almost always because I do not want other women like me to go through what I did.
Our existing cardiology gender gap means that women heart patients are still being under-diagnosed compared to our male counterparts, and – worse – under-treated even when appropriately diagnosed.
This has to stop.
THIS. HAS. TO. STOP.
But this reality will never stop until women and the clinicians who care for us speak up to demand change.
Ironically, it still seems easier for me to speak up on behalf of my heart sisters than it is to speak up for myself. I’m working on that imbalance, however, as I wrote about here and here, describing what my grown children call their Mum’s “advancing progress towards Cranky Old Lady Land”.
I’m increasingly unwilling these days to tolerate the intolerable, ever since I decided to stop meekly putting up with bad manners from health care professionals. See also: An Open Letter to All Hospital Staff
As time goes by, it seems to feel more natural to be, as Suzanne Moore says, “always at it”.
As this inspiring celebratory toast at modern baby showers urges us:
“Here’s to strong women.
May we know them.
May we be them.
May we raise them.”
Mask image: Annca, Pixabay
Q: Have you ever wished for a replay of a time when you were reluctant to speak up?
NOTE FROM CAROLYN: I wrote much more about speaking up about women’s heart disease in my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 20% off the list price).
Why doctors must stop saying: “We are all patients” (my guest post in the British Medical Journal (BMJ)