‘I thought I was insane’: Doctors kept ignoring Keira’s pain. It almost killed her

It is terrifying how swiftly and almost completely Keira Rumble came to believe she was going insane.

The first knock to her perception of reality was an emergency department doctor’s poorly concealed eye-roll and condescending tone.

“What makes you think that?” Rumble recalls him asking.

The 28-year-old had just told him she suspected she was experiencing an ectopic pregnancy, a potentially life-threatening complication in which an embryo implants and grows outside the uterus, usually in one of the fallopian tubes.

It was January 2019 and Rumble was about five weeks’ pregnant, living on the NSW Central Coast. She had miscarried twice before, but something about this felt alarmingly different. A sudden stabbing pain and waves of nausea, unrelenting pain in her shoulder tip and down the left side of her body.

“I saw the look on that doctor’s face, and I immediately thought: ‘OK, I have no idea what I’m talking about’,” Rumble says.

An ultrasound showed she was pregnant. Once that tiny sac in her uterus was visible on the screen, any further investigation was deemed unnecessary.

But Rumble had been right. Something was critically wrong, and for four weeks, no one would listen.

Rumble’s story and the stories of other women are being shared to launch an investigative series by The Sydney Morning Herald and The Age into medical misogyny.

We want to understand how this is occurring in Australia and share the best ideas to address it. To do that, we want to hear from you.

You can share your story with our team of health and investigative reporters using the form below.

Lack of research

A significant barrier for women experiencing pain is that doctors are trained that many symptoms they experience will resolve themselves, says the vice president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Dr Nisha Khot.

“We don’t research women’s health enough, [so] we don’t know enough about it; so we don’t teach medical students enough about it and the cycle repeats itself,” she says.

There is such a lack of emphasis in medical school training on gender-specific health, Khot says, that some universities proposed to drop rotations of trainee doctors through obstetric and gynaecological units “because it was too niche for the general medical student”.

The proposal was rejected in Australia but adopted by a couple of New Zealand institutions.

When women go to emergency departments with acute abdominal pain, they are treated differently from men, a study by researchers from the University of Queensland and Deakin University found last year.

They wait longer for pain management – median time from emergency presentation to analgesia was 80 minutes for men and 94 minutes for women. Women waited three times as long as men for a second dose of analgesics (94 minutes, versus 30 minutes).

Dismissive attitudes to women in hospital with pain were also highlighted by nurses and midwives in testimonies given as part of an Australian Nurses and Midwives Federation submission to a Victorian pain inquiry this year.

‘We are treated different and are often labelled as emotive or anxious.’

Nurse testimony to ANMF pain inquiry submission

Gynaecology patients reporting maximum pain (“10/10”) were given paracetamol and told to “wait and see”, whereas other surgical patients were given two or three lines of analgesia immediately, nurses said, and women’s subjective pain scores were mocked as precious, princess or “overreacting”.

“Men are believed a lot sooner and treated a lot sooner,” one nurse wrote.

“They’re often given more options. I’ve watched a man with a carpal tunnel be written up for 20 mg of iv [intravenous] morphine but a woman with a full reproductive system removal gets written up for only a max of 10 mg of iv morphine. We are treated different and are often labelled as emotive or anxious.”

‘Just a miscarriage’

When Rumble started bleeding so heavily that she soaked through successive menstrual pads every 30 minutes, she was told it was “just a miscarriage”.

It wasn’t, but even if it had been, this was a heartless way to describe it to a woman who desperately wanted her baby.

Rumble presented to the hospital four times in as many weeks with severe lethargy, dizziness and nausea, as well as shoulder-tip and right-side pain.

“It got to the point where a nurse or a doctor turned to my partner and said: ‘She is clearly not dealing with this miscarriage very well. She may need to see the counsellor or a psychologist’.

“My partner would look at me and say, ‘I don’t know what is going on. Everyone is telling me there is nothing wrong with you’,” Rumble said.

“I thought I was going insane,” she said. “Was my body having all these weird and intense symptoms because I was mentally unstable and I was not coping with another pregnancy loss? Because that is what I was being told.”

Hospital staff told her that they did not have the time or resources to scan her, but she could pay for a private ultrasound, Rumble said.

Rumble went to a private imaging clinic, not wanting to burden her partner.

“In my mind, I was just wasting everybody’s time.”

But as the sonographer moved the ultrasound transducer over Rumble’s abdomen, their face suddenly dropped.

She was bleeding internally. The private clinic staff called the hospital so they would be ready to receive her. They offered to call an ambulance, but Rumble did not want to be a burden.

“Walking into the hospital was so different. A team of people was waiting for me.”

Yet, her fears were still dismissed. “I was told that the chances of this being an ectopic pregnancy were very slim. That it was more likely to be a ruptured cyst.”

She learnt more about her condition as a spectator listening to ward rounds.

“One doctor said, ‘This could be a heterotopic pregnancy’. When I asked what that meant, I was told I didn’t need to worry about that, so I started Googling,” Rumble said.

A heterotopic pregnancy is a rare dual pregnancy in which one embryo implants in the uterus and the other outside the uterus. That is exactly what Rumble had.

What happened next in hospital is a blur. Rumble’s blood pressure and heart rate suddenly plummeted. Someone pressed a button, and people rushed into her room; she was rushed to theatre.

Yet, even after surgery to remove the embryo embedded in her fallopian tube, Rumble’s surgeon denied the diagnosis.

“He said, ‘Who told you that it was a heterotopic pregnancy? It was an ectopic pregnancy’,” Rumble recalls.

Once again, Rumble felt as though she was going insane.

“I remembered seeing a baby, a sac in my uterus on that first scan,” Rumble says. “But I had this doubt because I had been conditioned for four weeks to think that nothing wrong with me.

“I needed that diagnosis for my peace of mind,” she says. She was eventually vindicated when she obtained her medical records.

‘Just your lot in life’

Sarah White, chief executive of the not-for-profit Jean Hailes for Women’s Health, said women feeling their pain symptoms were ignored was common.

“We frequently hear … from women who have been dismissed by their doctor, from women who have been told it’s in their head – it’s very consistent,” she says.

White says health professionals need to recognise and challenge unconscious gender biases. “We are still being told, ‘It’s just your lot in life as a woman if you are experiencing serious abdominal pain’.”

Rumble, an entrepreneur and founder of Krumbled Group, says her ordeal affected every facet of her life, including her pregnancies with her two children, Hunter, 3, and Goldie, 1.

“I still have so much faith in the medical system as long as you are heard. Medicine allowed me to have a family,” she said of the IVF specialists who helped her conceive after the damage to her fallopian tube.

“But the impact of not being heard can be catastrophic.”

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