Profile Series: The Unbearable Wait
After years of dismissal for her chronic pain, Angela Hartlin grieves for the time she's lost
This is part of a series of profiles focused on life with various illnesses and disabilities. If you’re interested in being profiled, feel free contact me at zoecunniffe@gmail.com or through Substack direct messages.
Angela Hartlin had already waited a painstaking eight months to get a doctor to refer her for a hip replacement when the surgeon she visited declared that he was unwilling to perform this procedure on patients under 40. Hartlin, a thirtysomething from Nova Scotia, was used to forcing herself to remain calm in front of doctors, but this time it was impossible to restrain her anguish. “I had such a huge meltdown,” Hartlin recalls. “I sat out in the hallway and I demanded that someone give me a hip replacement.”
This followed twelve years living with a physical disability that drastically limited Hartlin’s mobility, overwhelming her with grief about the time she’s lost. Of course, this isn’t to say that people don’t live normal and incredibly fulfilling lives with mobility disabilities—the difference is that Hartlin’s condition is both severely painful and something that could’ve been treated a decade earlier if the medical field had done anything but fail her repeatedly.
Learn more about Hartlin’s work as a mental health and healthcare advocate at the links below:
Hartlin’s website: www.skinpickingsupport.com
Hartlin’s memoir: FOREVER MARKED: A Dermatillomania Diary
Hartlin’s upcoming book: EMBRACING DERMATILLOMANIA: Through Pain & Recovery
Facebook: www.facebook.com/skinpickingsupport
Instagram: @angelahartlin & @skinpickingsupport
TikTok: @angelahartlin
As a child, Hartlin struggled with lower back pain, which progressed into knee and hip pain as a teenager. However, because her symptoms were mild, Hartlin’s doctors never looked too deeply into it, telling her instead that some people just live with pain that has no clear explanation. This lasted until Hartlin’s twenties, a tumble down a set of stairs triggered excruciating pain in her hips and lower back, which, after another three years of her doctor relentlessly refusing to treat this or refer her to a specialist, was diagnosed as piriformis syndrome. In this condition, a muscle called the piriformis muscle agitates the sciatic nerve, provoking extreme pain and mobility issues.
Because Hartlin had this syndrome in her left buttock, she spent the years preceding her diagnosis essentially hauling her left leg around because she couldn’t put any pressure on it—and over time, the continuous strain on her right hip created a tear in the ring of cartilage surrounding her right hip’s socket, which is known as a labrum. And when Hartlin went to get this diagnosed, she learned something startling: she’d been born with an acetabular retroversion, meaning her hip sockets are backwards,
which finally explained the symptoms she’d had since childhood.
Instead of fixing these issues, though, Hartlin’s doctors only made them worse. Hartlin was given an arthroscopy, which is a surgical procedure where the physician inserts a narrow tube with a camera on the end into the joint. While arthroscopies intended to be easier to recover from than more invasive surgeries, Hartlin’s caused excruciating pain that the exercises prescribed in physiotherapy only made worse. This time, her doctors weren’t just slow to detect the issue—they actively denied its existence and asserted that she just needed even more physiotherapy, even after an MRI showed that the procedure had damaged the capsule surrounding her hip. By the time she finally found a doctor who didn’t turn her away for the hip replacement needed to correct this, her labrum had almost entirely worn away.
Dismissal from doctors is disturbingly common for people with chronic illnesses, but she also faces a few personal barriers that make getting taken seriously especially onerous. Aside from being young and female, Hartlin is in recovery from dermatillomania, a psychiatric condition involving a persistent urge to pick at your skin, often as a coping mechanism for negative emotions or as a way of correcting perceived flaws like acne. This can lead to visible lesions on the skin, which may become permanent scars. While Hartlin’s own markings have faded, she remembers camouflaging the blemishes on her face with makeup so she didn’t feel conspicuous in social situations—and this wasn’t the only situation where she had to worry about how people would perceive her skin picking. In doctor’s appointments, clinicians would make judgmental remarks about her skin picking or even withhold medications that are easier to abuse, taking her as a drug-seeker because the markings on her skin resembled the sores associated with substances like meth.
Through a combination of cognitive-behavioral therapy (CBT) and acceptance-commitment therapy (ACT), Hartlin logged her skin picking to figure out what triggered it and learned to reframe the thoughts underlying the desire to pick. Now, she considers herself essentially recovered. “I don’t think my skin picking will ever be gone,” she says, “but there are times where it’s so nothing that it just doesn’t affect me in any way.” She’s grateful that she doesn’t have to fret about this impacting her interactions with doctors anymore, but it’s still upsetting to know she could be denied treatment for one condition simply because of the presence of another. For example, she says, “I found out that if my legs looked the way they did in 2015, I wouldn’t have been able to get the hip replacement that I desperately needed.”
Hartlin also recognizes that doctors tend to shove patients into “generalized boxes,” pigeonholing them based on their appearances and body language, and she worries that her characteristically flat tone of voice will work against her. Because of this, she tries hard to carefully manage her demeanor during appointments, but it can feel demoralizing having to focus so intently on the way she presents herself just to receive basic medical attention. “How do I have to act to show people I need help?” Hartlin finds herself asking. “It's taken a lot of humanity out of me.”
Not only that, having to fixate incessantly on the way others perceive her doesn’t help her already “shot” self-esteem. As Hartlin explains, she’s spent years unable to socialize regularly—both because her pain drained her of the energy to go out and because she knew seeing other people would mean “subjecting them to [my] severe negativity” when it was too hard to fake being okay.
“It feels like a lot of my social interactions ended up being with healthcare professionals,” Hartlin says. Unfortunately, these interactions mostly consisted of repeated insistence that her pain was exaggerated or straight-up fake, and the nonstop invalidating was almost too much to take. “Why am I just suffering over and over and is anybody going to help me?” Hartlin asks. “How long are they gonna make me completely disabled, unable to walk around?”
After all seeing this many unsympathetic medical providers, Hartlin has thought deeply about the logic behind their callousness. For example, she’s realized that even if doctors are society’s healers, not all of them enter the field because they’re passionate about helping others. “A lot of people are in the profession to carry on their family name,” she notes.
Plus, she’s learned about research finding higher rates of psychopathic traits in physicians when compared to the general population—possibly because, in some instances, lacking empathy actually makes doctors better at their jobs. Doctors are particularly likely to display a psychopathic trait called stress immunity, which involves an absence of physical and emotional arousal in stressful situations, something that can work to a doctor's advantage on the job. As Hartlin points out, someone with lower empathy could remain composed even during fraught emergency surgeries where the stakes are literally life or death, while a more sensitive physician might flub the procedure out of anxious compassion.
However, Hartlin still resents the indifference doctors have shown about prolonging her suffering. “You tell them it's been two years, it's been six years, it's been eight years, it's been twelve, and it's just numbers to them,” she explains. “It doesn’t actually compute.” Meanwhile, she remembers the doctor who told her she was too young for a hip replacement actually “chuckling and smirking” as he denied her.
“I find that it's more acceptable for doctors to just cast judgment on their patients instead of empathizing,” says Hartlin. She’s noticed that status seems to play a role in how clinicians treat her, with those from less prestigious professions, such as physiotherapists, being more affable, while physicians seem to separate themselves from patients, disparaging them because they can’t “imagine people of their ilk being in the situation that I am,” as Hartlin puts it.
“I get hesitant talking about this because obviously doctors are the ones who help us,” she adds. She wouldn’t have gotten her hip replacement and regained her mobility, for example, if it weren’t for the doctor who overheard her melting down in the hallway that day and promised to do the procedure if Hartlin left without saying any more. But it’s still unbearable to be trapped in a position where the only people equipped to help you seem to be doing everything in their power to keep you in agony.
Clinicians don’t understand what it’s like to deal every day with the endless emotional strain of her disability. At times, even sitting down was too painful. She gave up on shaving her legs for months because she couldn’t stoop over to reach them. Her daughter was conceived only at the very end of a narrow window before Hartlin’s steadily increasing hip pain got too severe for her to tolerate a pregnancy—and later, her pain intensified to a point where she couldn’t have sex with her husband at all. She’s also had multiple cases of thyroid cancer, which she privately suspects is the result of her body existing in an uninterrupted state of distress for years on end.
Being unable to take on everyday tasks also comes with a devastating shame. At one point, after nonstop dismissal, Hartlin had to give up seeking care at home in Canada, where public healthcare is free, and get an exorbitantly expensive surgery in the US, which was partly covered by the GoFundMe she set up. “I was willing to throw money at them that we didn't even have,” Hartlin says, but she also found herself asking at times if she was even worth the money when she couldn’t work and her husband was tackling all the chores alongside his full-time job.
Her guilt was so profound that when her thyroid cancer returned last year, she told her husband she wasn’t going to get it treated unless her hip could be fixed. “That’s horrible to say,” says Hartlin, “but I was done being in that much pain, being that much of a burden, being unable to be a mom.”
This is the part that stings the most: for all five years of her daughter’s life, Hartlin has been confined to the couch or else using a computer chair to get around, barring her from typical mother-child activities like playing together and walking to school. “I feel like I lost a lot of those cute little years that I could’ve been picking her up and chasing her around,” Hartlin says.
At the very least, there’s finally some good news for Hartlin—after finally getting her hip replacement this past winter, she’s hopeful that this next phase of her life will be “completely about being able to walk around.” Already, she says, even some of the most ordinary moments feel astonishing. “Being able to just stand is amazing,” she says, and she’s “fascinated” with the simple act of wiping crumbs off her kitchen counter because bending down to do this was out of the question for so long.
Recently, Hartlin’s daughter has been elated seeing her mother walk. “She’s like, Look, Mommy, you can walk,” Hartlin says. “And then my heart just breaks. As much as she loved wheeling around the house with me on the computer chair… You know, that was her normal.” She also dreads the possibility of her daughter someday having to deal with the same healthcare system that’s done nothing but betray her repeatedly. “I don’t want her to go through a tenth of what I’ve gone through,” Hartlin says.
Now that Hartlin is reclaiming her mobility, she’s actually able to go places with her daughter, and she lights up describing how her daughter holds her hand in the grocery store. “As long as she doesn’t remember these days, doesn’t remember her mommy being this way, I hope I can put it all behind me,” Hartlin says. But as much as she wants to believe this, she knows she’ll eventually need a replacement for her left hip as well—which could mean another bottomless halt to her everyday routine while she waits for someone who will do the bare minimum of just listening.