Resolute Zebra

you see, it was an unfortunate affair. your father had hoped for a boy, and his disappointment hung foul in the air. but your mother, with her smile like a summer dream, was bewitched. just by the face of you. her eyes followed the crook of your chin, the wrinkle of your nose, spellbound by the glow of your eyes. and you, howling from the storm in your lungs. surprisingly fierce, face flooded by candlelight. and your mother understood, all at once. she saw you. and so, shaking, she held you tightly to her chest and prayed in a quiet rhythm, a desperate chant lost to the wind.

by seven you were unseemly, for asking so many questions. your mother found you once at night, in light of the full moon, which, it is said, was cursed. eyes full of sin and trying to read the book you had taken with unholy hands. the words were long lines that made no sense, but they tasted like magic on your tongue. i wish to eat it whole you confessed, guilty and trembling. that night you were taught your first incantation during the witching hour, when all the men were fast asleep. and when you grinned, your eyes were ravenous, your laugh wrapped up in the air.

by thirteen you knew spells by way of women. blackberry to calm an upset stomach, sumac to encourage healing. sometimes men would catch you in the forest, hunting wild rose or yarrow or greenbriar for your potions and that was entirely inappropriate, but you did not care for their sharp stares. as it was in nature that your heart would beat with tender ferocity, so full of spirit, beastly. here was where you collected charms, uprooted them. hoarded their secrets in your sleeves. and oh how you would laugh, alone in the forest. the village could hear its echo carried on the wind, all the way down to the river.

by sixteen you had no suitors, which was unbecoming of you. not that you spared a thought for such behaviour. it was widely known you were an unusual girl, who did odd things like disagree and talk back. and you spent so long in that forest. dirt coating your skin, hair untamed. the men of the village knew of your peculiar ways, but they did not have a reason. they would never have thought you were mixing mint and bruising leaves (which, as some could tell you, would help with itching). and that was okay by you, for you knew they would disapprove. women are made for their hips you were reminded, their minds are not built for thinking. that was often followed by an absent chuckle, their amusement washing the idea of it away. still, you preferred to spend your days slipping astragalus root to your neighbour, for you knew how it would help in her old age.

by twenty the women knew you as: helper, woman of herbs. when the men caught wind of your hobby, for surely that is what it was, their mouths foamed, lips curled. witchcraft, they wailed, girl enchanted. even you had to admit, it was certainly unorthodox. a woman has no business being a doctor, they insisted, for who would raise their sons? it was dangerous work surpassing men, as men did not like it at all. and you knew this, of course you did, but it was also dangerous indeed to leave the village women to the mercy of men and their science. for their bodies were a language no man had time to learn. and so you continued with your sorcery, and the men’s wrath was white hot. 

when the men condemned you, as men do, they found you in the forest, for it was your home, in a way. you had recently finished preparing a potion of aloe vera for a girl in the village, who had a wound festering on her skin. and you did not shrink under their fists. it was strange of you, to be so pleasant, as it was commonly known that women have a tendency to be so very hysterical. but your mother raised you with a rough hand. and when the men clutched at your skin, you did not fuss, as your fate was settled. they said, devil in your eyes, misfortune on your tongue. and when they tied your limbs and stood aside and set you alight, you felt their temper in the fire. their triumph. they yelled witch and, laughing, you spat with a rage so unfeminine in its power: no, healer. and by morning, your body was ash and you left the world behind.

i have been warned of the witch and her wicked hands, you know. my brother cautions her name at night under a half moon. he says she never really died, that her spirit haunts the village and that sometimes, she likes to eat little girls for being too curious. i hear her by other ways, too. in murmurs, swift and quiet. in wisdom passed to daughters at the witching hour. blackberry to soothe an upset stomach, greenbriar helps with burns. and one time, when the full moon lit my path, i found my way to a friend by the river, feverish with infection no man could cure, for it truly was a nasty cut and her arm was surely gone, and i whispered the secrets my mother had told me and offered a potion of my own.

Since 1989, cardiovascular disease has been the leading cause of death in US women and, following a heart attack, women are more likely to die than men. This disparity in deaths has been the case since 1984, and young women appear to be particularly at risk: in 2016 the British Medical Journal reported that young women were almost twice as likely as men to die in hospital. This may be in part because doctors aren’t spotting at-risk women: in 2016, the American Heart Association also raised concerns about a number of risk-prediction models ‘commonly used’ in patients with acute coronary syndrome, because they were developed in patient populations that were at least two-thirds male. The performance of these risk-prediction models in women ‘is not well established’. 

Common preventative methods may also not work as well in women. Acetylsalicylic acid (aspirin) has been found to be effective in preventing a first heart attack in men, but a 2005 paper found that it had a ‘nonsignificant’ effect in women aged between forty-five and sixty-five. Prior to this study, the authors noted, there had been ‘few similar data in women’. A more recent study from 2011 found that not only was aspirin ineffective for women, it was potentially harmful ‘in the majority of patients’. Similarly, a 2015 study found that taking a low dose of aspirin every other day ‘is ineffective or harmful in the majority of women in primary prevention’ of cancer or heart disease.

Perhaps the greatest contributor to the numbers of women dying following a heart attack, however, is that their heart attacks are simply being missed by their doctors. Research from the UK has found that women are 50% more likely to be misdiagnosed following a heart attack (rising to almost 60% for some types of heart attack). This is partly because women often don’t have the ‘Hollywood heart attack’ as it’s known in medical circles (chest and leftarm pains). Women (particularly young women) may in fact present without any chest pain at all, but rather with stomach pain, breathlessness, nausea and fatigue. These symptoms are often referred to as ‘atypical’, a designation to which the British Medical Journal took exception in a 2016 article, saying that the term ‘may lead to the underappreciation of risk associated with this presentation’. And under appreciation of the risk may in turn explain why a 2005 US study found that ‘only one in five physicians across multiple specialties was aware that more women than men die from cardiovascular disease each year, and most of these physicians did not rate themselves as effective in treating sex-tailored cardiovascular disease’. 

Atypical or not, for certain types of heart attacks, women (and again especially young women) who present without chest pain are at particular risk of death – which makes it extremely concerning that current NHS England guidelines specify ‘acute cardiac sounding chest pain’ as part of the criteria for a patient being referred for primary percutaneous coronary interventions (PPCI) at one of the country’s specialist twenty-four-hour heart-attack centres. PPCI is an emergency treatment that restores blood flow during a heart attack, and which according to one doctor I spoke to has ‘massively improved survival and outcome’. But this treatment is only carried out at the twenty-four-hour heart-attack centres and, perhaps as a result, 75% of those who receive this treatment are men. The tests doctors use to determine what’s wrong with a patient are also likely contributing to women’s higher death rates following a heart attack. Standard tests like the electrocardiogram or the physical stress test have been found to be less conclusive in women. A 2016 BMJ paper refers to recent work from Edinburgh which showed that the ‘normal’ diagnostic threshold for troponin (a protein released into the blood during heart damage) may be too high for women. And it’s not just about ‘standard’ levels for biomarkers being incorrect in women, we also need to establish new female-specific biomarkers. A biomarker is a biological characteristic (like troponin) whose presence can act as a diagnostic criteria for a specific disease, and a 2014 literature review of sex difference studies suggests that this may be a fruitful area to research. Unfortunately, it concludes that the work done so far is too limited to be able to say whether or not female-specific biomarkers will be found. 

Because women’s heart attacks may not only present differently, but may in fact be mechanically different, the technology we’ve developed to search for problems may not be suitable for female hearts. For example, a heart attack is traditionally diagnosed with an angiogram, which will show where there are obstructed arteries. But women often don’t have obstructed arteries, meaning that the scan won’t show up any abnormalities, and women who turn up at hospital with angina (chest pain) may simply be discharged with a diagnosis of ‘non-specific chest pain’ and told they have no significant disease. Except they do: women with ‘normal’ angiograms have gone on to suffer a heart attack or stroke shortly after being discharged from hospital. Assuming a woman gets lucky and has her heart disease diagnosed, she must then navigate the obstacle course of male-biased treatment: sex differences have not generally been integrated either into ‘received medical wisdom’ or even clinical guidelines. For example, say a man and a woman are both diagnosed with a swollen aorta (the aorta is the main blood vessel that runs from the heart down through the chest and stomach). They are both suffering from an equal level of swelling – but their risk is not the same: the woman has a higher risk of rupture, which carries with it a 65% chance of death. And yet, in Dutch clinical guidelines, the thresholds for surgery don’t differ for each sex.

you see, it was an unfortunate affair. your father had hoped for a boy, and his disappointment hung foul in the air. but your mother, with her smile like a summer dream, was bewitched. just by the face of you. her eyes followed the crook of your chin, the wrinkle of your nose, spellbound by the glow of your eyes. and you, howling from the storm in your lungs. surprisingly fierce, face flooded by candlelight. and your mother understood, all at once. she saw you. and so, shaking, she held you tightly to her chest and prayed in a quiet rhythm, a desperate chant lost to the wind.

by seven you were unseemly, for asking so many questions. your mother found you once at night, in light of the full moon, which, it is said, was cursed. eyes full of sin and trying to read the book you had taken with unholy hands. the words were long lines that made no sense, but they tasted like magic on your tongue. i wish to eat it whole you confessed, guilty and trembling. that night you were taught your first incantation during the witching hour, when all the men were fast asleep. and when you grinned, your eyes were ravenous, your laugh wrapped up in the air.

by thirteen you knew spells by way of women. blackberry to calm an upset stomach, sumac to encourage healing. sometimes men would catch you in the forest, hunting wild rose or yarrow or greenbriar for your potions and that was entirely inappropriate, but you did not care for their sharp stares. as it was in nature that your heart would beat with tender ferocity, so full of spirit, beastly. here was where you collected charms, uprooted them. hoarded their secrets in your sleeves. and oh how you would laugh, alone in the forest. the village could hear its echo carried on the wind, all the way down to the river.

by sixteen you had no suitors, which was unbecoming of you. not that you spared a thought for such behaviour. it was widely known you were an unusual girl, who did odd things like disagree and talk back. and you spent so long in that forest. dirt coating your skin, hair untamed. the men of the village knew of your peculiar ways, but they did not have a reason. they would never have thought you were mixing mint and bruising leaves (which, as some could tell you, would help with itching). and that was okay by you, for you knew they would disapprove. women are made for their hips you were reminded, their minds are not built for thinking. that was often followed by an absent chuckle, their amusement washing the idea of it away. still, you preferred to spend your days slipping astragalus root to your neighbour, for you knew how it would help in her old age.

by twenty the women knew you as: helper, woman of herbs. when the men caught wind of your hobby, for surely that is what it was, their mouths foamed, lips curled. witchcraft, they wailed, girl enchanted. even you had to admit, it was certainly unorthodox. a woman has no business being a doctor, they insisted, for who would raise their sons? it was dangerous work surpassing men, as men did not like it at all. and you knew this, of course you did, but it was also dangerous indeed to leave the village women to the mercy of men and their science. for their bodies were a language no man had time to learn. and so you continued with your sorcery, and the men’s wrath was white hot. 

when the men condemned you, as men do, they found you in the forest, for it was your home, in a way. you had recently finished preparing a potion of aloe vera for a girl in the village, who had a wound festering on her skin. and you did not shrink under their fists. it was strange of you, to be so pleasant, as it was commonly known that women have a tendency to be so very hysterical. but your mother raised you with a rough hand. and when the men clutched at your skin, you did not fuss, as your fate was settled. they said, devil in your eyes, misfortune on your tongue. and when they tied your limbs and stood aside and set you alight, you felt their temper in the fire. their triumph. they yelled witch and, laughing, you spat with a rage so unfeminine in its power: no, healer. and by morning, your body was ash and you left the world behind.

i have been warned of the witch and her wicked hands, you know. my brother cautions her name at night under a half moon. he says she never really died, that her spirit haunts the village and that sometimes, she likes to eat little girls for being too curious. i hear her by other ways, too. in murmurs, swift and quiet. in wisdom passed to daughters at the witching hour. blackberry to soothe an upset stomach, greenbriar helps with burns. and one time, when the full moon lit my path, i found my way to a friend by the river, feverish with infection no man could cure, for it truly was a nasty cut and her arm was surely gone, and i whispered the secrets my mother had told me and offered a potion of my own.

All curves are beautiful unless it’s in your spine

So how should I fix it?

Like a circus seal, should I balance books on my head,

So you can see me in my amusing elegance?

How could this work?

Each word tying me down

Page by page, Bending my neck

until it’s planted into your ground rules

Maybe I should lay flat on my back

Perfect for packaging in sturdy cardboard

Display me behind transparent cellophane

So you can serve me with a smile

Maybe I should have something to lean on,

Like the branches of women buried before me

Who cannot reach the sun without your oppressive hand

Gasping for perfection instead of air

Why should it matter anyway?

You want me to carry myself up

But you want me to keep my head down

Anti-feminist: men are naturally rude and heartless, if they harass someone thats just because men are born that way. all men are just terrible due to their biology

Feminist: im a feminist