Despite the many gaps in my education at Harvard ľֱ School, there was one experience from my time there that became foundational to my understanding of medicine, and that was my experience as a patient. It wasn't until I got to medical school that I had my first brush with an illness that progressed to the point where it became so serious that I almost lost my life.
I was in the middle of pharmacology class -- sitting in one of those cavernous lecture halls with steep stairs and three large green chalkboards lined up at the front -- when I first started feeling strange. That particular day, the professor was teaching us about calcium channel blockers. They really are quite powerful medications, and I was paying close attention.
As I was sitting there, my stomach began to churn, and I started feeling nauseated. I ran to the bathroom. It wasn't pretty -- I had a lot of diarrhea. I went to find my sister and told her that I wasn't feeling well. Oni drove me home. On the way, I vomited all over the inside of our car. Back at the apartment, I crawled into bed. I knew something was wrong; I was having intense abdominal pain. I thought maybe I had food poisoning from a Caesar salad wrap I'd eaten the day before. Oni finally told me that she thought we should go to the emergency department.
I didn't want to go. It was one thing to study medicine, but to be a patient felt scary to me. I felt vulnerable. In fact, I hated the very idea of the hospital. Ever since our mother got sick and we'd had to spend weekends in her hospital room, I wanted to avoid them at every chance I got. Just the idea of going to the ED made me miss my mother more than ever. I was sick and frightened; I didn't know what was wrong with me. My mother had the kind of mix of firm love and tenderness that I needed at a moment like this. Instead, it was Oni who was loving and firm with me -- she persuaded me to get in the car and go.
We drove over to one of the Harvard teaching hospitals. By this point, I was sick enough that I could barely stand or speak. When we arrived there, my sister had to register me. The abdominal symptoms were so bad that at one point I lay on the floor of the waiting room in the fetal position, rocking back and forth. We waited for what seemed like an eternity. Should we tell the clerk at registration at the front desk that I was a Harvard medical student? Maybe that would help me get seen faster. But I felt uncomfortable using privilege in that way, so I decided against it.
Eventually, I was called into the ED, changed into a gown, and placed on a stretcher. I was seen by multiple residents and attendings that day. The first resident was a tall young Black man I knew, as we had gone to college together. He was friendly and polite, but I could tell he felt awkward about having to care for me, given that we were acquaintances. He asked me about my symptoms, and I told him about the nausea, vomiting, diarrhea, and the intense abdominal pain.
The second was a young white woman with her brown hair up in a messy ponytail, wearing scrubs and the usual Patagonia jacket with the Harvard residency program insignia on it. She wasn't overly warm or friendly. She asked me about my symptoms, and I repeated what I had told the first resident.
She nodded and then began another line of questioning.
"Are you sexually active?" she asked.
I told her that I hadn't been sexually active in over a year and that I didn't have a partner. Although I'd had a boyfriend in Chicago, we'd broken up and were no longer together.
"I want to make sure we're considering all possible diagnoses at this point," she told me, "including sexually transmitted diseases."
She explained she wanted to do a pelvic exam to check for pelvic inflammatory disease, an infection of the reproductive organs transmitted during sex. She went ahead and did an exam, taking the speculum and opening up my cervix while pressing down hard on my abdomen. I was in enough pain already and so this exam, uncomfortable at the best of times, was excruciating, all but taking the breath out of my body.
Finally, I was seen by the attending physician. He was an older, serious-looking white man with glasses whom I recognized from clinical observation in the ED earlier in the year. What I remembered most about him from observation was that he barely acknowledged my presence, even though I was standing at his elbow. Now that I was his patient, he asked me a few questions about my pain and pushed on my tender abdomen, then said he would order some blood tests, but not any kind of imaging studies. I think he spent a grand total of about 2 minutes with me before he left. On his way out, I heard him say to the resident that he was ruling out appendicitis because I didn't seem to be in that much pain. I never saw him again.
When the bloodwork came back, the resident came in and told me that she had talked to the attending physician and that the most likely diagnosis was gastroenteritis. She told me confidently that because I was able to keep down fluids, I could go home. I started getting dressed, and my sister, who was a year ahead of me at Harvard -- whispered to me, "Are they sure it's not appendicitis?" We were so early in our medical training that neither of us felt confident or empowered enough to speak up. The attending physician had made his assessment and we had to assume he knew what he was talking about. So, we left.
I spent the next day lying in bed with nausea and abdominal pain, wondering when these horrible symptoms would end. The next day, I was no better and so I decided to go to student health services, where I saw the nurse practitioner. I had chosen this nurse practitioner for my primary care at the beginning of the year because she had such a warm demeanor, and she seemed like she would listen to me. That day, she paid close attention to what I was telling her, examining my belly, and telling me that, like Oni, she was concerned that I had appendicitis. She sent me straight to another ED for a CT scan.
This time my ED experience was different, perhaps because I came with a note from the nurse practitioner saying a CT scan of my abdomen was indicated. At the hospital, they did the scan, but still managed to come back with a misdiagnosis of colitis, likely from infection.
I was put on intravenous antibiotics for a night. Thanks to the antibiotics, I felt temporarily better, but after, I was discharged and sent home the next day, I was still horribly sick. The nausea had returned. The abdominal pain had worsened. I felt cold, like it was freezing, shaking and shivering all over, uncontrollably so. Later, I would come to find out that the medical term for this is rigors, and they happen when you are badly infected and there's bacteria in the blood. Oni took me back to the same ED. I can't even remember who was caring for me or what was said by then, I was in so much discomfort. This time, they repeated the CT scan and finally someone came in to give me the correct diagnosis.
"You have appendicitis," the resident told me gravely. "Because it wasn't caught soon enough, it ruptured. We need to operate immediately."
Everything happened so quickly, I didn't have time to ask why my inflamed appendix hadn't shown up on the prior scan. Suddenly, five or six people were around my bedside, preparing me for surgery. They needed to get me to the OR as soon as possible. I was in danger, they told me, of losing my life.
I was terrified. I'd never gone under anesthesia or needed surgery before.
When I woke up, I was in the recovery room. Hours had passed. I was groggy and my abdomen was sore. I lifted up the sheet and saw bandages over my right lower abdomen and a drain with yellow-white fluid coming out the side. I couldn't move, but I was alive.
The surgeon came in. He was a short middle-aged white man, very matter-of-fact, but clearly concerned about me. He explained he had to cut open my abdomen instead of the usual laparoscopic approach, which meant I was going to have a substantial scar and a longer recovery time. Apparently, there was so much pus in my abdomen from the rupture, there was no other way to remove the appendix and the havoc it had caused in my body.
But this wasn't the end of my troubles. I was discharged home 3 days later, still not feeling like myself. While much of the pain in my abdomen was gone, my belly felt large and full, and I was still nauseated. At my follow-up visit a week later with my surgeon, he examined me and told me he was worried. He sent me back to the same ED for another CT -- my third -- and they found that my abdomen had not been washed out thoroughly after the surgery, which can happen after a perforated appendicitis, and I had developed an intra-abdominal abscess -- an accumulation of pus -- that needed to be drained. I was readmitted to the hospital.
I essentially had to leave my life in the hands of these physicians, but how could I trust them when it had taken them so long to give me a correct diagnosis? I felt certain that if my mother had been there at my bedside to advocate for me, the outcome might have been different. Certainly, Oni tried.
In total, I was out of school for about 5 weeks with postoperative complications. Most people who have appendicitis recover after a few days. Certainly, it's not unusual for appendicitis to be misdiagnosed: overall, as many as 30% of patients with appendicitis are discharged by a physician before a correct diagnosis is made.
Does this mean that the misdiagnosis that had cost me so many weeks of school and could have taken my life was simply an awful mistake? Many times since then, I have wondered if the color of my skin was a factor in my misdiagnosis.
is an emergency physician and thought leader on bias and racism in healthcare. This piece was excepted from Blackstock's new book, , published by Viking, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright 2024 by Uché Blackstock, MD.