There’s a kind of pain that strikes and dies at the speed of a blink. You’ll still feel its sharpness. Your eyes may still well up, but you’re not sure if it’s the pain making you cry or the memory of it.

There’s also a kind of pain that simmers. It arrives and stays, like a drop of ink on a white dress. Its constancy puts you on edge, and you wonder if the pain is getting worse or if you’re just being alarmist.

*

I can’t count the number of times I went to the hospital during my childhood. It was malaria today, allergies tomorrow and cough the next day. Doctors and nurses at Lacor Hospital in Gulu were so used to seeing me, some gifted me the green bingo sweets for how brave I became facing the needle. And yet around me, my seven siblings thrived with hardly a sneeze. Luckily, most of my health woes fizzled out once I hit my twenties.

Occasionally, I still get knocked down. Such was the case in August 2019 when I woke up with excruciating eye pain and a splitting headache. I was barely a semester into my writing program at Columbia University. When I visited an ophthalmologist, he said I reminded him of the fairytale about The Princess and the Pea. Even with twenty mattresses atop a tiny pea, the princess woke the next morning complaining of a hard object that made her sleepless. The doctor’s examination showed that my eyes had outgrown my glasses by a tiny fraction. After getting new glasses five days later, my pain was history.

That my body can trumpet pain—even when the source of the pain is ‘a pea’ is a two-edged sword. One, a health problem can be nipped in the bud before it worsens. Two, I could also be ignored on grounds that my complaints are an exaggeration.  My ophthalmologist had prescribed new glasses, but his ‘princess’ comment also alerted me to the fact that in dealing with the healthcare system, I will have to keep proving my pain.

*

The next serious health issue took me to my first emergency room in America. A burning vaginal pain had kept me awake for two nights. At the ER, a stone’s throw away from my Columbia student apartment, two nurses stood by the bedside, asking questions about my sex life. I didn’t really mind if their guess was that I had an STI. What bothered me was their accusatory tone.

‘Are you sexually active?’ the white nurse asked.

‘No.’

‘You’ve never had sex before?’ Her brows were arched, a thick, black rainbow.

‘I have.’

‘When was the last time you had sex, honey?’

Even with honey dripping from her mouth, her tone held the chap-chap impatience of a commander readying for battle. No time for foreplay. I was staring at a corner of the ceiling, trying to kill the discomfort of baring my nakedness to two strangers. My legs were propped apart by stirrups, my butt on the edge of the slim bed, waiting. For a moment, she scribbled furiously while her Black colleague stood by with a tray of tools.

‘Two years ago,’ I said, my eyes locking with hers this time. Her eyebrows tilted upwards again, a poorly hidden disbelief. She reminded me of the senior women teachers at our secondary schools back home who kneaded our tummies every new term to see if we had let boys in our pants during the holidays. Even girls who had never had sex went for the check-up feeling pregnant because of how slutty the teachers made us feel. My New York nurse would make a terrific senior woman teacher.

She passed the pen and notebook to the tray-holding colleague and gloved her hands, picked up the speculum and went in. A yelp. Silence. Wet face. She turned the speculum, scooped the sample she needed and pulled the plastic device out.

‘Alright, honey. You’re all set,’ she declared.

I marveled at how easily she said honey, unaffected by my wet face. She placed a pack of wipes on the table before they left, the energy in their steps undisguised, my own body, breached. There was no time to say it hurts or go slow. In the washroom, I peeled the tiny packet and unfurled the wet wipe. I bent over the toilet seat and cleaned up. The white tissue got painted red.

I tried to ignore the reality that my New York nurses had matched the awfulness of the ones in Uganda. The ones who, together with their boss doctors, squirmed at the mention of vagina—preferring to call it by any other name. I could blame culture for the euphemisms we used in place of vagina—my member, my woman part, the thing, etc.—but I never got used to the judgment from people who earned a living by dealing with our bodies. Women and girls sat on their reproductive health issues because they knew their beloved medic would attribute it to sleeping around. Imagine my confusion when, at about eight years old, I overheard a nurse taunt a wailing pregnant mother, ‘Were we there when you were opening your legs for him? You thought it was all sweetness, eh?’

As I left the New York hospital, I tried to convince myself that this place was definitely better than the sick health facilities back home. It’s true that my nurse had been overly enthusiastic in how she dug me with the speculum. She didn’t bother to use a smaller device like my doctor at my university health center did during my pap smear when I told her about my sexless life. This nurse had honeyed her way through the whole sample extraction, quick and sharp like she was on a deadline.

Perhaps it was too soon to make conclusions about an entire health system based on this one bad experience. Besides, I had left with a diagnosis and pills that cleared the fungal infection in days.

*

Eight months later, I woke up wondering if, by some magical powers, a knife had slipped into my stomach. I felt a sharp twist and a slice in my lower right abdomen. This could be the usual ovulation pain, I thought. When it persisted the second day, I gave my vagina proper audience since any abnormality there can exert pain onto the lower abdomen. Burning sensation? No. Discomfort when I washed? No. An itch? No. Odor? No. Strangely coloured discharge? No. Chills, fever or headache? Nope.

This was May 2020. COVID-19 was ruling the air. Hospitals only offered telemedicine except for emergency situations. The facilities were packed, and priority went only to badly-off Covid patients. I sat on my pain. Maybe I was the princess sleeping on 20 mattresses with a tiny pea underneath. But by the end of the third day, I couldn’t sit or stand or turn in bed without groaning.

I took Tylenol and waited for daybreak. The sun rose, and I couldn’t lift myself off the bed without feeling excruciating pain. My body was a taut metallic string I was trying to strum. I called the university health center, weeping into the phone. The doctor listened, the phone shaking in my hands. The key suspect was appendicitis owing to the position and nature of the discomfort.

‘Go to the ER right away, and use the word severe. Okay? That way, you won’t have to wait in queue. Okay? Tell them you’re in severe pain. Okay?’ I held onto the musicality of her okays—how she took her time saying it like she was lulling a baby.

It was the same emergency room across the street. I limped from my eighth-floor apartment to the elevator. On the ground floor, I walked to the building entrance, hunched over like a granny without a walker. Because of COVID-19, our student housing was almost empty. My two roommates had left for home as soon as schools suspended in-person classes—one to India, the other, somewhere in the US. Running into students or the building staff was highly unlikely. I heard no footsteps, no voices, and met no one. Stepping down the two rows of stairs before I got onto the sidewalk felt like falling from the eighth floor and somehow surviving it.

I snail-paced towards Amsterdam Avenue, stopping at intervals to lean against walls to catch my breath. The few people on the largely deserted street poured curious glances at me. An infectious bug was turning the world upside down, and the chance of anyone coming to hold me up was zero. I was on my own.

The traffic lights turned clear, and I ambled across the road, clutching my stomach and willing the hospital building to meet me halfway. On both sides of the road, I felt eyes behind wheels climb my body with curiosity like tree creepers. My own eyes were glued to the tarmacked road, watching my every step, my jaw sore with all the teeth gritting.

On the veranda of the emergency room, two medics in their green garbs stared between chit-chats. They had watched me from the time I wobbled out of my apartment building. Every time I lifted my head to see how close I was to the hospital, I found their eyes trailing me. Behind them were two ambulances and a police officer, probably guarding the temporary morgue that had sprung up to cater to the piling bodies of those dying of COVID.

The medics—one leaning against the wall, the other on the opposite end—stopped talking as I passed between them. The water pot shall not break by the doorstep, I told my body. It listened to the proverb of my Acoli forefathers, and I made it inside, in some form of whole.

In the triage room, two white medics who seemed to be in their mid-40s beckoned me in. ‘Can I have your ID, please?’ one of them asked. I stared at him, speechless. He seemed to regret the question quickly enough and pointed me to a chair. Even with my masked face, my eyes clearly broadcast my pain. My curled body explained my internal turmoil. I took my time sitting.

‘You’re in a lot of pain, uh!’ It was a statement.

I nodded.

A third nurse who was seated at a desk, her back to us the entire time, now turned and listed symptoms of COVID. Did I have any of them? I muttered no. She came over and pointed an infrared thermometer to my forehead. Temperature normal. I took a deep breath. She wrapped my arm with the blood pressure cuff and keenly watched the numbers. ‘All good,’ she said after a beep from the monitor.

It was a quick triage. A wheelchair arrived. I was trundled into an examination room, past wards and corridors overflowing with patients. I started shivering even with the blanket the nurse had draped my body with. Occasionally, a nurse or a doctor arrived with the same questions about my pain or to just check, I guess, if I was still breathing.

For the blood work, I pointed to the back of my right hand. ‘You’ll only get one there,’ I told the white male nurse. My veins are stars at playing hide and seek. On many occasions, inexperienced or just incompetent nurses will prick and pull, slap and pinch in a futile attempt to find a vein from my upper arm. Eventually, they turn to the back of my hand which is reliable but more painful.

The nurse drew blood from the tiny vein he had slapped to visibility at the back of my hand. ‘It hurts more on this part, I know,’ he said, more like a question because I didn’t wince even when the syringe went in. No pain could compete with what was happening in my lower abdomen. My eyes had done a good job of staying dry since I arrived at the hospital, but the clock served more ache as it continued turning. As the nurse packed up his tools to leave, I stopped acting superhero and set free whatever dam was inside. The nurse returned with another blanket and spread it on me as if that would soak the tears.

‘Let’s get you morphine, okaayy?’ he said, his voice gentle.

A Black female nurse arrived, holding a tray with more tools. I silently prayed that none was headed inside my vagina. I still had memories of that militaristic nurse and her speculum from this place. The nurse told me to lie on my right side.

‘It hurts so bad if I move,’ I said.

‘I need to get a proper IV line in your arm for the morphine, honey,’ she said. The honey was here again, and it was nothing close to the one I put in my tea each morning. I took what felt like an hour, turning from my right to left side. The vein search began, and after much slapping, prodding and pricking, she found one and inserted a cannula. The morphine came afterwards, coursing through my body like liquid fire; then, calmness.

The morphine didn’t take away all the pain though. Even when I got wheeled to another room for a pelvic ultrasound minutes later, my body still tried to pull away from itself. A short, slim MRI technologist explained that I’d be rolled into a machine. But before that, he needed to give me an IV—a contrast dye—to allow them to see my organs properly. He looked at the IV line on the back of my left hand.

‘You should use this,’ I said, lifting the flappy sleeve of my hospital gown and pointing to the IV line on my upper right arm. He looked distracted as if he’d had a long day even though it was just midmorning. Hospitals were overwhelmed with COVID-19 cases; I empathized with him. He connected the syringe to the cannula on the back of my hand and injected the liquid. A dose of pain shot through my body. My face mask happily drank the tears.

It hurts was all I could say.

He rubbed the back of my hand gently and pressed the syringe again, pushing more IV into the tiny vein. When I pulled my hand out of his hold, he called his colleague who was seated at a table by the door. He was a tall Black man who looked like he was the boss of the section.  He held my hand and injected twice the amount of fluid the first technologist had served. I yelped.

He walked back to the desk and called the nurse to ask why they had not found a proper IV line for me. Everybody, or at least these medics, knows the back of the hand is the last part of the body to go to for any IV fluid. It has too many pain-sensing nerves. Why he didn’t think he needed to go gentle with me beat my understanding.  The nurse told him I had a second IV line on my right upper arm. He stomped the floor as he returned to the scan area.

‘Why didn’t you say you had another IV line?’ he asked, staring.

‘I did. I told him,’ I said, gesturing at his colleague.

The tall technologist didn’t look convinced from how his eyes widened. He continued staring as if he wanted to force some particular truth out of me. I was more worried about the first technologist than the disbelief in my explanation. If he was an intern, the short technologist would probably receive some tough talk. Or maybe not. The contrast dye was eventually administered from the right arm, as painlessly as it should have been from the beginning.

Six hours later, an Asian female doctor with a perpetual smile told me all my tests had turned out negative. My appendix, the first suspect for the pain, was normal. My uterus, ovaries, pelvis and kidneys were in perfect condition. There was nothing abnormal in my blood or urine. ‘You probably had a cyst that ruptured,’ she said, sounding genuinely unsure.

Studies show that seven percent of women worldwide get ovarian cysts at some point in their lifetime. The National Health Service says the fluid-filled sacs naturally develop in an ovary and go away within a few months without any treatment needed. If there’s severe pain, it probably means the sac has ruptured.

‘Does the scan point to a cyst?’

‘Not really,’ the doctor said.

I didn’t ask more questions. I had come with pain and needed to leave before they inflicted more pain.

‘Do you feel well enough to go home?’

I said yes.

Six hours after limping into the ER, I limped back to my apartment with a ten-page document showing how perfectly healthy I was.

*

The search for what was troubling me was only beginning. My primary care doctor at the university health center—a jolly and attentive Black woman—was as puzzled as I was about the inconclusive diagnosis. She wrote two referrals. My first stop was with a radiographer at Columbia Doctors in midtown Manhattan. Once there, the middle-aged white radiographer explained what would happen, even though curiosity had made me Google the procedure—a transvaginal X-ray. I breathed. Deeply. She spoke, softly, while tapping on the keyboard in front of her.

‘I’ll show you the images from here,’ she said. How wonderful! I thought. I’m here for another intrusive exam, but at least I’ll leave familiar with the anatomy of my vagina.

‘Here,’ the radiographer said, handing me the lubricated transducer. ‘Could you put that in?’

I was happy to participate in the search for my comfort. Throughout the 15-minute process, she got me talking about Uganda, the weather and the new normal amid COVID-19. Her eyes moved from the computer to my face, noting the different times I winced as she worked the transducer.

‘That hurt, right? I’m sorry,’ she said at intervals. Sometimes I just said that hurts, without her asking. She would pause and mutter a sorry before continuing.

The transvaginal X-ray takes the cake for how intrusive and painful it can be. Forget pap smears where a speculum goes in, picks whatever sample and exits in some five minutes. Here, a handheld transducer—almost 15cm long—is inserted into your vagina. What follows is a probe; no corners and depth are spared. If you’re already in pain, the exam will come close to what our mothers did when we got mouth sores: pick a spoon and scrape the walls of the mouth until every swollen skin was deflated.

Meeting someone who acknowledged my pain and tried not to make it worse was more than I could ask for.

Thirty minutes later, my transvaginal exam showed there was nothing wrong, confirming the outcome of the pelvic scan and blood work in the ER. If I didn’t know better, I would’ve sworn an unappeased ancestor was the source of my torment.

Next stop was the gynecologist’s office. She spoke loudly and smiled widely. Energy oozed from her steps, like someone who enjoyed her work, or perhaps I was her first patient of the day. Her beautiful, shiny Asian hair waved over her shoulders. Even with results and notes from the radiographer, she took me through another transvaginal X-ray. Don’t they trust each other, these doctors?

Like all the tests before, the gyne’s machine revealed nothing—even when she took her time combing, raking and shovelling my vagina with her tool like an experienced farmer. At some point, she switched to using her hands. Apparently, even the machine couldn’t be trusted. I lay there, taking deep breaths in between sobs. When she pressed the problem area, I squealed.

‘Oh my God, you are in so much pain!’ she exclaimed.

Of course, I’m in pain! Did my sobs sound like moans of pleasure to you? I didn’t say that out loud because it would mean nothing, just like the 9/10 pain level I had mentioned earlier didn’t mean a thing.

I was stunned at how shocked the gyn looked when my body crumbled at her touch. I had told her I was in pain. My recent hospital visits pointed to a problem. Her response to my scream showed she didn’t believe the severity of it, that she thought my pain was the size of a pea.

My predicament was not novel, and neither would it be the last. In a Black woman’s body, the gravity of pain is never believed, especially if the source of pain, like mine, is unknown. Words or even the sound of pain don’t count. Various research studies have captured the voices of many Black women who are told their gynecological pain only exists in their heads.

My gynecologist did further theorizing: ‘It must be chlamydia,’ she said, ‘or maybe gonorrhea.’ I didn’t have the energy to laugh. I had been tested for all tribes of STIs barely five days earlier. All tests were negative. She had the results on file. But I let her pleasure herself with another set of blood and urine tests. When the results turned out negative, she prescribed a pill whose name I can’t recall. ‘Perhaps there’s a problem the machine can’t see,’ she explained. ‘The medication I’ve prescribed is what we give for unexplainable pain like yours,’ she said. ‘Are you okay with taking it?’

‘Yes,’ I said. A woman in pain is a woman desperate for relief.

Two weeks later, the pain was gone. I don’t know if it was the medication or if my body was just tired of rebelling against itself.

*

June was a long month with me waiting for my period and wondering if the bloody flow would be preceded by another visit to the ER. It wasn’t. Instead, ten days after my period ended in July, the same pain I felt in May was back.

At the same hospital across the street, a vaginal X-ray was done. For the fifteen or so minutes I lay on that examination bed, I defined and redefined my pain in English and my mother tongue—Acoli. I wept, groaned and complained, but the white radiographer stuck to her silence, doing her thing, her face steel with concentration.

By this time, I had realized that regardless of their colour or background, a medic will serve you various forms of disappointment. You had to be ready.

Later, as I waited outside the X-ray suite to be wheeled back to the examination room, the radiographer returned with papers in her hands and questions in her mouth. I had been wondering if her words got lost in my vagina during the X-ray. My loud sobs and ‘it hurts so much’ had not elicited a pause from her.

‘Is this the same pain that brought you to the ER over a month ago?’

‘Yes.’

‘And what did the doctor say?’

‘That everything looked perfect!’

‘Have you always had this issue in the past?’

‘No.’

I leaned back in the wheelchair, hospital gown hanging loose on my body. My eyes moved between the bloodstained band-aid holding my cannula in place and the whiteness of the hospital walls.

‘I’m sorry about earlier. I never meant to hurt you,’ she said. I wondered if she meant it, or if the sound of my pain had traumatized her to muteness. I didn’t turn to look at her. I didn’t want our eyes to meet. I was not ready to gift her my tears again. Instead, I said, ‘I know!’ as she walked back to the X-ray room to prepare for the next patient, probably another vagina to rummage through.

That night when I left the ER, the diagnosis read ovarian cyst. It probably ruptured the first time I went to the ER as the doctor suspected. How the previous scans and X-rays didn’t catch it was a puzzle my African brain couldn’t solve. The doctor explained that it would most likely happen again. ‘…but it’s not dangerous, and there’s no treatment needed.’ Wasn’t the pain sufficient danger to my mind and body? I didn’t ask her though.

A month later, when I went back to the gynecologist with the beautiful hair for a review, she took me through another transvaginal examination. ‘I need to check to see if the cyst is still there,’ she said. I was beginning to wonder if there was something else doctors in New York look for inside distressed vaginas.

She saw the cyst and recommended contraceptive pills. She said they would make the cyst disappear and prevent a recurrence. ‘There are some good ones I can prescribe,’ she said. It was the first time I was hearing someone describe contraceptive pills as good. I’d seen the adverse side effects on two family members. I had heard similar experiences from hundreds of women during my work as a journalist. But I also know women need them for birth control and that others have not had serious problems with them. I was intrigued the pill had another purpose other than birth control.

‘What will it do to my body? What are the side effects?’ I asked the gyn.

‘I can’t really say. It varies from person to person. For some, it may be a feeling of tiredness. For others, maybe a small headache….’

‘I really don’t want to take pills.’

‘I understand.’

But she wasn’t giving up yet.

‘You know, with the pill, your period will be less heavy and less painful.’ My periods had never been heavy or painful. But she was the expert, and if this would prevent another ER visit, so be it. She prescribed Aranelle. Over the first ten days on the pill, the migraine I’d wrestled with as a teenager returned. My energy level took a nosedive. On the eleventh day, I sent a complaint to the gyne through the patient portal. I insisted I should’ve been clearly told about specific side effects.

‘All pills have side effects,’ the gyne said during a follow-up phone call. ‘I can’t say you’ll experience this or that effect,’ she added.

I could feel the heat of her unhappiness through the phone. In Uganda, a doctor said I’m a too-much patient. I asked too many questions instead of nodding in agreement with the experts. I asked about tests and pill burdens and side effects. I went for my appointments with as much information as I could find about my suspected ailment. They mess you up less that way. I had the evidence.

In 2014, a doctor at a reputable hospital back home prescribed medication that had sulfa—a component I’m severely allergic to. My file had a big label alerting doctors to that allergy, and I reminded her too as I did with every doctor I saw. But I still got the deadly tablets anyway. The next morning, I woke up in the intensive care unit, saved by my landlady’s son who heard me gasp and groan next door. They knocked down the door and rushed me to the hospital, without which I would be six feet under.

After my complaints, my New York gyne switched my contraceptive pill to Kurvelo. This pill came with insomnia. I slept for only four hours but hoped my body would adjust to the medication eventually. It didn’t. My doctor at the university hospital recommended melatonin. The sleeping pill didn’t help either. Because I wasn’t sleeping enough, the migraines returned. Still, I continued taking the Kurvelo.

A month after getting on contraceptives, a new radiographer at Columbia Doctors conducted another transvaginal X-ray. For the first time in five months, I didn’t feel pain during the exam. The cyst was gone. When the gynecologist called to follow up on the scan results, I mentioned the headaches and insomnia from the pill. I explained that I couldn’t afford sleepwalking through the weekly eleven-hour classes of my writing program, in addition to the reading and writing assignments.

‘Well, you can continue taking the pills or stop. It’s up to you.’ The gyne sounded disappointed, like she knew what option I would take. She hadn’t forgotten my initial hesitation about the pill. I’d told her I didn’t want it. I had fourteen more pills to go. When she got off the phone, I started counting down the days to when I would pop the last pill.

*

There’s a pain that strikes and dies, its effect still as dizzying. Then there’s a pain that simmers, its teeth blunt but still as gutting. In New York, I experienced pain that consumes the way fire ravages dry grass. A hungry pain. It spread from my body to my mind when some medics kept downplaying my agony, when I saw no diagnosis or healing in sight.

But I also believe there are more shades of pain, each experienced differently. The depth of any pain shouldn’t be measured by the tininess of a pea or the hugeness of a whale. It shouldn’t be placed on a continuum. Its existence should be enough for it to be believed.

*

It’s been over two years now, and luckily, I’ve not had to reach for a pen to scribble another distressed vagina diary.

Remember To Rest Issue 1