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Ashanti Coleman, a nurse and stroke survivor, was discharged with what doctors call a migraine.
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She really did have a ruptured and blocked artery and could have died if she hadn’t been to another clinic.
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The way doctors dismiss their pain, she said, is common among black patients.
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Ashanti Coleman wished he could take his head off. In the past week, what started as a pain in the right side has become more and more persistent and intense. As a stroke survivor and nurse working at a pain clinic, Coleman knew that she was not having a common headache.
But in the May 2019 emergency room, Coleman said he waited several hours before being seen. Eventually, she was admitted with a diagnosis of “mini stroke”, but spent days waiting for the attention of a neurologist to determine the source of her severe headaches.
When the doctor saw her, he didn’t ask about her pain or conduct a neurological exam, Coleman said. Instead, he dismissed it as a migraine and discharged her – despite the fact that he treated his first stroke and therefore knew his health and profession record. “It didn’t do anything for me,” said Coleman, who lives in Memphis with her husband and two children.
That night, Coleman woke up with a terrible pain in his neck. “It looked like something was tearing up,” she said. Then she went to a different hospital, where she learned that her right carotid artery – one of the two main sources of blood for the brain – was ruptured and 50% blocked, and she needed emergency surgery right away.
It turned out that when doctors tried to remove a clot after their first stroke in 2017, they damaged that artery. It didn’t fully repair, creating Coleman’s tear, blockage, and symptoms.
“The whole right side of my brain was not receiving oxygen or blood, which was causing these headaches,” Coleman, now 41, told Insider. “Eventually, that tear could have gotten worse, and I could have died.”
Through a partnership with the American Heart Association, Coleman spoke to Insider about his experience as a stroke survivor twice and a black woman navigating the healthcare system. Even as a doctorate-level nurse, she said, she is subject to systemic racism that negatively affects care.
Coleman was 38 and healthy when he suffered his first stroke.
When Coleman woke up one morning in 2017 with a pain in the right side of his head and body, she ignored it and went to Starbucks. At home, however, “the headache kept throbbing, it just persisted,” she said. Then, her husband realized that his speech was distorted.
In retrospect, Coleman says the symptoms were a “classic” stroke. But she was 38, had a healthy weight and good blood pressure, exercised regularly and did not drink, smoke or eat red meat. “I was a little bit in denial when the symptoms started because I thought, ‘I have nothing wrong with me,'” said Coleman.
But then a sharp pain went down her left side, the left side of her arm was numb and tingling, and she lost her coordination. “That’s when I heard I was having a stroke,” she said. Her race and contraceptive drugs were her only risk factors.
At the hospital, she was promptly diagnosed with a stroke caused by a blood clot on the right side of her brain. The doctors first gave him a “clot-destroying” drug and then tried to remove it, but it was small enough to stay in place.
She then started physical therapy, occupational therapy and speech therapy to regain her lost functioning. At first, for example, Coleman could not open and close his left hand alone. “My mind was telling my hand to do this, but it wouldn’t do that, so it was very frustrating,” she said. “I couldn’t do my daughter’s hair, my hair or my clothes.”
Like some stroke survivors, she also developed an accent that lasted about six months. Hers looked Jamaican. “My speech therapist asked me where I was from,” said Coleman. “I was like, ‘Me from Chicago.'”
But after more than two months of rehabilitation, Coleman returned to work as a professor of nursing at the University of Memphis. “I was determined to get back up and running as soon as possible,” she said.
Coleman felt dismissed during his second stroke
Coleman doesn’t know why his second experience at the same hospital and with the same provider was so different. But she knows that feeling ignored and having the pain forgotten by health professionals is very common among black women.
“I hear a lot,” she said, “that African Americans, and specifically women, are simply dismissed with their pain.”
A 2016 study, for example, found that about half of medical students and white residents endorsed false beliefs about biological differences between blacks and whites, such as that black nerve endings are less sensitive and their skin is thicker. In turn, they rated the pain of black patients as lower and made less accurate treatment recommendations.
Coleman said her pain was not treated at first because, as the neurologist told Coleman’s primary care physician, “she doesn’t seem to be in pain.”
“They assume that individuals are not suffering because we are not presenting in the way that they think we should,” said Coleman. “I wasn’t squirming on the floor. I wasn’t using bad words. But each person’s pain is different.”
Coleman, who currently administers COVID-19 vaccines and works to publish research on women and cardiovascular disease, wants to teach his nursing students just that. “I hope to train them where they don’t look at a person that skin color,” she said. “I hope they are looking at a person as a whole.”
She hopes that patients also do not fit into a category, such as thinking that, because they are young and healthy, they cannot suffer a stroke. “I use my strength to move on and defend other people,” said Coleman, “so that another young woman doesn’t have to go through what I went through.”
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