Okay, my post is a little late - only about 24 hours. We are on the go right now, and last night stayed in a hotel with the WiFi down. I know it sounds like an excuse…actually, it is an excuse, it just happens to be a true excuse. I wrote my post, I just wasn’t able to get it posted, so now, here it is. An essay related to something I learned so many years ago I almost had time to forget it.

THE HEART OF A WOMAN

I was having chest pains today. No, this isn’t a bid for sympathy, it’s just what led me to think about something I hadn’t given much thought to in years. Once upon a time…don’t all good stories start with once upon a time?...in the deep dark ages when car radios were only AM/FM and social media was not yet a thing, I worked as a disability examiner, making decisions who got Social Security disability, and who didn’t. Heart conditions were a frequent complaint for individuals seeking disability, but not a particularly easy way to get on the rolls (hint: there really isn’t an easy way, in spite of all the anecdotes about all the people claiming disability when they are as able as you or me).

What, you might ask, does this have to do with Women’s History Month? Or women? Other than, of course, the author being a woman. Good question. I will tell you. The disability standards for heart disease were difficult to meet in part because they were based on the standard, classic picture of a heart attack…a man’s heart attack. Women often suffer different symptoms, and so they might not have the chest pain that is key to getting on disability with heart problems. Women might present with a belly ache, for instance, or neck and jaw pain. But the doctors have traditionally examined for standard (male) symptoms. A woman could die of a heart attack before anyone realized she was having one, because she presented with an ‘atypical’ picture. Not atypical for a woman, of course, but atypical for a person. A male person.

Most, if not all, of the disability standards were the same…written by men for men, based on how men reacted to diseases. While there are a number of diseases where men and women have the same symptoms, there are others, some fatal, that are quite different…and researchers who looked into diseases studied men. Women were just considered sort of not-men. Any differences in symptoms were dismissed, put down to hysteria, or maybe a wandering womb (that sounds quite…odd…but was once really considered to be a legitimate diagnosis).

When you don’t study half the population, you might become puzzled by some of what you see in that half the population. Are these aberrant symptoms of something? Not really. Not aberrant for a woman, that is. They might not be the norm for a male. (FYI: Males don’t always present with heart attacks in the classic manner, either.) Male doctors…and they were all male at that time…were puzzled and disturbed by the women they treated. A belly ache? Pregnant? No, she’s sixty-five. Ate something that didn’t agree with her? Gas? No, doctor, she is having a heart attack, but you don’t recognize it because she is not having the ‘right kind’ of heart attack.

Until sometime after the middle of the twentieth century, long after modern empirical medicine appeared on the scene, women were ignored as research subjects, or even as people of interest. Suddenly women started attending medical school in record numbers, and started doing research in science labs everywhere. Women were inclined (some of them, anyway) to be interested in women. So they studied the forgotten majority…those who just didn’t react to things quite like males did. They didn’t find a lot of incidents (like, none) of wandering wombs. They did find heart attacks that looked ‘atypical’ to a medical establishment that based everything on men.

Even after that point, we still saw (and still see in many cases) medicine based around the male ‘norm’. Social Security Disability was determined based on what was expected in the male population because no one ever considered it worthwhile to study women. Medicine left women behind for a long time. When they did get interested in women, it was for the purpose of medicalizing normal female conditions, such as pregnancy, menstruation, and menopause. There were some positive for pregnancy in that, because maternal death rates and infant death rates went down. Now we are swinging back to the middle, where pregnancy is seen as a normal thing for a woman, not some sort of medical aberration, and women are reclaiming control of their own pregnancies. They can opt for the medical treatments, such as pain killers, or they can go the natural route.

Still, heart disease remains a man’s condition, at least in the way it is diagnosed and evaluated. Maybe someday doctors will become used to women presenting with different symptoms; maybe. I am not going to hold my breath waiting.