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When Acute Pain Strikes, and You Know What It Entails
A sharp pain struck the left side of my abdomen whilst I was asleep, and I just knew. I hurried to pop a pain pill, in hopes that the ache would subside. Sometimes that’s a small, albeit hacky, hint that it’s ‘just’ one of those mysteries that sneak up on you. When you live with chronic illnesses, strange symptoms can strike any body part. I just hoped that I wouldn’t need to go to the dreaded A&E/ER. But the pain only increased in intensity, as I knelt on my blanket, hunched up in agony. What I didn’t know was that I would be refused treatment later on, so this was only the beginning of my ordeal.
After 4 hours, it was time. I got up and started to pack my hospital bag methodically, calmly. A well rehearsed routine on auto pilot, no need for emergency drills. I threw on a sweater – the frigid temperatures at the A&E always feels like they’re already preparing patients for the morgue. In went bottles of water, my phone, a spare power bank, and my wallet with most of the cash removed. Oh and don’t forget to use a bag with zippers; you don’t want the extra task of needing to keep an eye out for things falling out.
I usually bring two days of spare medications as well. Nobody has ever gotten my meds right, as they’re dispensed and titrated by 10 different doctors or so. Sometimes the hospital pharmacy don’t even carry these drugs, so I still need to advocate for myself whilst there. Missing a dose can multiply the pain. I dialed a cab, and braced myself for another harrowing experience at the A&E. I believe I’ve developed a phobia; it is always so stressful there, with all the harsh lights, cold air, and the pained expressions on people’s faces are contagious.
*Disclaimer: This article is meant for educational purposes, and is based on my personal experiences as a patient. I am not a doctor, and nothing in this article should be substituted for medical advice. Please consult your own doctor before changing or adding any new treatment protocols. This post may also contain affiliate links. It will cost you nothing to click on them. I will get a small referral fee from purchases you make, which helps with the maintenance of this blog. Read our Privacy Policy page for more information. Thank you!
P.s. If your symptoms are not too severe, visiting a 24 hour clinic might actually be a better option for everyone. Help to spread the queue out a little, and you also get to see a doctor faster. Here’s a list of 24 hour clinics and hospitals available in Singapore.
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When the Doctors at the Emergency Department Have No Clue
The waiting area at Tan Tock Seng Hospital (TTSH) where I usually go to was quiet for once, to my immense relief. It’s never pleasant when you need to wait for hours on end in agony. Especially when you already know what the problem is, how urgent it can be, yet the triage refuses to take you seriously.
They wheeled me in for an ultrasound scan, and I told the doctor to check for free fluid. She didn’t seem too knowledgeable, and kept asking me what she should do next. I actually don’t mind this so much, as compared to doctors who are arrogant or dismissive. She concluded that there was no free fluid, but I was fairly certain that there was. As usual, a senior doctor took over my case, and then it escalated from there. Parked at the Emergency Department meant for life-and-death cases, I was now under the care of several doctors who never once left my side.
They quickly realised that I was indeed bleeding internally. Worse yet, it wasn’t one corpus luteum cyst rupture, but two this time. My INR (blood clotting ratio) was also way over my target, meaning that my blood was very thin. They struggled to contain the bleeding as my blood count plummeted, and pumped me up with three different kinds of blood clotting agents.
I would find that these drugs alone would cost nearly $2,000 later in my bill, as there is no government subsidy for Emergency Department cases in Singapore. Whilst there might not have been a need to inject them all, I believe that the doctors made the right call. There is no gynaecological department at TTSH to perform an emergency surgery if there had been a need. For the average healthy person, a surgery to remove the acquired mass of clots would already have been done.
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Coping with Pain at the Emergency Department
The extra shot of tramadol they gave me wasn’t enough; I was still in severe pain. The bright, harsh lights and insistent beeping of machines made me feel even more anxious and agitated. The conversations with other patients I overheard in the ED were not reassuring either. “Aunty, we need to operate on you right now. It’s essential to save your life”. I hope that I wouldn’t need a surgery too; it’s always better when you have time to prepare for them, both mentally and physically. Elderly patients were wheeled in and out, their faces covered with giant oxygen masks and other huge medical equipment.
I was given a dose of fentanyl, which was when I finally found some relief. In fact, I felt a little high, and that felt nice after having been in immense pain. It was then that I understood why people could get addicted to it, and how Prince could have overdosed on it. It numbs you of pain in different ways. But the truth is, chronic pain patients would much rather be healthy and live a full, high quality life, as opposed to being drugged up, and bound by the invisible chains of pain, forever waiting for relief.
“But the truth is, #ChronicPain #patients would much rather be #healthy and live a full, high quality life, as opposed to being drugged up, and bound by the invisible chains of pain, forever waiting for relief.” #ChronicIllness #disabled Share on XRefused Treatment From SGH – the Hospital I Needed to Go to
As TTSH didn’t have a gynaecology department, I needed to be transferred to Singapore General Hospital (SGH), which has both a gynaecological and rheumatology department. The last time I was admitted there for similar abdominal pains turned out to be a less serious problem, so they had advised me to go to TTSH in future.
I also dread the A&E department at SGH the most, out of the ones I’ve visited in Singapore (yes I’ve been to a few, and could probably do a review). Massive crowds aside – which is common in public hospitals at night anyway – I’ve always found the healthcare staff at SGH’s A&E to be incredibly rude and dismissive. One of the doctors there once rolled her eyes at me, and shoved her nametag up into my face when I asked for her name. When you are in pain, such unkindness is doubly hard to bear.
The emergency doctors at TTSH tried for more than 4 hours to transfer me to SGH for proper care, but they refused to accept me, citing that I was ‘unstable’. Their protocol is to reject a patient whose blood pressure drops below 90bpm (beats per minute) within the past 24 hours, for ‘patient safety’ reasons. But my blood pressure tends to be on the lower end anyway – 90+bpm is normal for me – so that didn’t help.
The alternative was to transfer me to the nearby KK Women’s & Children’s Hospital, even though they had no in-house rheumatologist either. SGH would only accept me after a consultation with a gynaecologist there. Whilst I don’t see how all this shuffling around was helpful, better get going than going nowhere, hey?
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When There’s Not Much a Women-Focused Hospital Can Do For You, Either
The moment my ambulance touched down at KK, I was wheeled in and the doctor told me upfront that they didn’t have the capacity to support me there. It can be tricky to perform surgery on a patient with Antiphospholipid Syndrome, as I had the potential to clot whilst still bleeding. That can quite literally, make a bloody mess of things.
My blood count was already within the red zone, and to make matters worse, I have the rarest blood type (save the extra rare ones, such as ‘golden blood’, with autoimmune antibodies thrown into the party. What this means is that on top of matching the rhesus and blood group, the autoantibodies in the donor’s blood must also not interact with mine. The doctors always have trouble procuring blood for me, and sometimes it even takes days to find a match. Whether a surgery was performed or not, both options were still major risks. (If you’re reading this, please consider donating blood, especially if you’re O negative, aka a universal blood donor.)
The gynaecologist at KK didn’t even bother to waste time examining me, and called SGH up immediately to advocate on my behalf. She was a lovely doctor, and agreed that time was of essence here. It did take some time, before she finally managed to convince them. (I can only imagine what the conversation was like on the other end of the line…) I was now in my second ambulance, on the way to SGH. It was a private one which we had to pay a few hundred dollars for later.
Facing Mortality Once More
I was once again, faced with the very real prospect of my mortality. How many times have I trodden this path? I have become numb to it in all honesty. Whilst they may still sneak up as surprises, they have lost their shock value. In that sense, I have the upper hand, because there is less mental and emotional processing to undergo. I only need to make the decisions that I find most logical, in an attempt to preserve my life.
I have faced major life and death events twice, and even though I overcame them, I am tired and ready to let go the next time. But at that very moment in the ED, I realised that that wasn’t true, that I wasn’t quite ready to go yet. This time it wasn’t out of fear – death comes to us all. But for a hope and chance at a better life.
After 8 hours had passed, I was offered up that sole pack of least incompatible blood once more. What this means: I could either get allergic reactions from it, some of which can be rather severe. Or some of the extra autoantibodies in that pack of blood would stay in my system like a new horde of parasites, integrating themselves into my blood ecosystem, and/or causing haemolytic anaemia (Miraflor et al., 2012). This would make finding blood in future even harder.
Making Decisions Based on 20 Years of Emergency Experiences
As the last blood test had been taken 2 hours ago, I requested for an updated reading, to know if the bleeding had been staunched. I didn’t know how many times I had been pricked by then – 20, 30? Both with big green needles, and the small butterfly ones.
The doctors agreed to my request, and we found that the red blood count had actually increased from 6.8 to over 9. This can happen during moments of crises, where you’re either dehydrated, or when your blood vessels constrict to make up for the blood loss (vasoconstriction). Whilst this was a false reading, it was also indicative that the bleeding had stopped. Thus, I chose not to undergo more blood transfusion for the time being.
These were just little things I learned from my previous corpus luteum cyst rupture incident. And after living with myriad chronic illnesses over 20 years, you learn how to lead in regards to your own healthcare. A decision always has to be made. Even waiting something out is an action that could affect you in drastic ways.
“After living with myriad #ChronicIllnesses over 20 years, you learn how to lead in regards to your own #healthcare. A #decision always has to be made. Even waiting something out is an action that could affect you in drastic ways.” Share on XExperience is a Good Teacher, with Pain as the Best One of Them All
Pain is in a class of its own. After placing all sorts of body parts in the hands of various doctors and surgeons over the years, I have learned to decide for myself. These doctors and lab tests are here to guide me, but the final decision lies with me. No one else will bear the consequences or inhabit my body thereafter, and I need to be sure that I can live with that.
“These #doctors and lab tests are here to guide me, but the #FinalDecision lies with me. No one else will bear the #consequences or inhabit my body thereafter, and I need to be sure that I can live with that.” #ChronicIllness #surgery Share on XI was finally wheeled up to the high dependency ward, where the doctors were much more humane and humble. I was assigned to a gynaecologist whom I really liked. I hope that she is willing to keep me as a patient in future, and that she will be my high risk gynaecologist should I ever get the chance to become pregnant.
She also gets bonus points for allowing me to go home after a 3 day stay, after confirming that my condition was stable enough. That is a considerably short stay, compared to how urgent the situation had been a few days ago. I don’t think patients ever rest well in hospitals, with the plastic bed sheets, shared toilets, and bland, mushy food.
Having your usual medication cocktail mixed up, or needing to wait hours for common medications or painkillers you have access to freely at home is also frustrating. Ignorant or rude nurses also have the power to make your life a misery. The blood clots will take a couple of months to break up and dissolve, so for now and as always, I will simply need to practice patience.
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Pin to Your Emergency Department & Hospital Boards:
- Miraflor, E., Yeung, L., Strumwasser, A., Liu, T. H., & Victorino, G. P. (2012). Emergency uncrossmatched transfusion effect on blood type alloantibodies. Journal of Trauma and Acute Care Surgery, 72(1), 48-53. http://doi.org/10.1097/TA.0b013e31823f0465
You’ve dealt with so much over your life. For someone to look at your history and to doubt anything you tell them when it comes to your body is absolutely insane. You have grown strong and sure in yourself. If this had been earlier in your life with blood clotting, you might not have stood up for yourself and what would have happened? I understand over time, health providers can get jaded. Sure, they deal with people who are good actors and are only after the high. But, that can’t be the norm. Thank goodness for that doctor who was willing to do her job and advocate for you. But to be shuffled around like this when you were in such pain and dire straits is so scary.
I wish I could say that I can’t believe this happens, but sadly it does. It’s so frightening isn’t it. I haven’t been outright refused admission at A&E but twice they just observed me and said I was neither and accident or emergency despite horrendous symptoms. All at 3am both times. It’s so hard to advocate for ourselves when so unwell.
Transfusion is extremely safe today, however the general perception that transfusions are unsafe persists thanks largely due to the HIV pandemic and risk of post transfusion hepatitis. Today very often it is said, ” The best blood is the one that you have not received.” Preventable death due to wrong identification of blood still occurs and is largely occur due to human error. Ignorance among clinicians about how to transfuse blood adds further to these preventable deaths.
For sure, though am not sure you read this whole story as it specifically talks about autoantibodies on top of a clotting disorder and rare blood type (in my country) so it’s a little trickier than that 😉
Wow! That’s such a horrible thing to go through! No one should be turned away especially in an emergency
Exactly my thoughts! And Singapore is a first world country, so to speak. Oh well, that was just my experience! 🙂
What a horrible experience you have had to endure especially from trained medical staff, I am glad it is all sorted now and you are completely recovered
Thank you, it was a horrid experience indeed, and unjustified. To many of them it’s just a job, I suppose.
It made me feel angry reading about how you were attended to. My husband lives with chronic pain and it is frustrating every time I take him to the hospital to be treated for it. He has lumbar stenosis that is where his pain is coming from. He’d get a steroid shot only to be relieved of the pain for three weeks max. Steroid injections do not come cheap! One more thing I dislike with hospital admissions is the barrage of medical/nursing interns and residents asking the same questions, over and over again several times a day. How do they expect a person to get some sleep if they keep bugging them.
Hi Kristine, I’m sorry to hear about your husband’s pain. You’ve been to the hospital emergency many times too, it seems, so you know how dreadful it can be! But it was on another level, being rejected by Emergency themselves! I felt more shock than anything else, to be honest. It’s unfathomable to me, as a patient. I don’t know but healthcare can seem so cold and inhumane at times!
I can not even imagine being in this position. How frightening when the very place that is supposed to take care of you, refuses to help.
Hi Heather, yea it was a horrible position to be in, but I’ve been in it many times so at least I had an inkling of what needed to be done. It did indeed feel very unjustified to be refused help that was extremely necessary, though.
That was really a terrible experienced for you and I am so sorry for you to feel that. You are such a brave woman and I am so proud of you because you were able to managed yourself and everything even if you are in so much pain.
Thanks lovely Catherine. It was quite an ordeal, sadly not the first, but hopefully the last! Yes I wrote this to raise awareness, and hope that positive will change will happen, and that others can advocate for themselves as well.
I am so sorry that you had to go through this. That sounds horrible and unfair. Hugs to you.
No worries Ashley. I survived! Just wanted to put the story and my experiences out there so others can listen, and also advocate for themselves. Hopefully there are changes to the system, too.
What a terrible experience to endure! I am so sorry to hear you had to go through such a traumatic experience. I hope you are doing well now.
Thanks Catherine. Yes it was inhumane. I just wanted to share my experience and raise some awareness about this so that hopefully protocols get better in future at least.
To be refused treatment is a CRIME!!!! I am so so sorry you went through this, this is awful and unacceptable.
Thanks Chad, yes it’s inhumane I think. But what do you do when trapped in a system! Trying to do my bit by raising awareness!
Oh my gosh, what a horrible experience! I can’t believe they did that! That’s so unacceptable.
Yea it was definitely unpleasant to be lying in bed for almost 8 hours in pain and bleeding nonstop and getting rejected by a hospital 🙁
Thank you for sharing your experiences, even though they are harrowing. I hope you are feeling much better now. x
You’re welcome, Anne. I am sharing it really to raise awareness – am sure there are many cases like this out there, but without a voice. I am better now. Going to get a small surgical procedure done tomorrow in fact, to prevent further episodes!
Oh my gosh, Sheryl. I didn’t get very far into it due to distress caused by reading about certain things, but I saw some other bits as I scrolled down to comment…. Eek.
I’m so sorry you had to go through all that. It sounds awful.
I also hate A&E and will avoid it at all costs, mostly due to sensory issues and the stress of staff who are ill-equipped to help me, but I’m so glad you went as I imagine you have some potentially life-threatening conditions that do need emergency care.
I hope you are feeling better and recovering well. Sorry I didn’t read the ending… Sending big hugs and much love.
Hi Char, thanks for your comment. A&E is always a harrowing experience and nasty place in terms of sensory overload, isn’t it? Every little sound and light just really adds on to the distress of a person who’s already in pain. No worries about not reading the ending :p Thanks and I hope you are well too!
Good heavens! Sending lots of healing {{{hugs}}}!
Thanks dearie. Think I received all of the hugs! 😉
Omg I cant get over the ordeal you had to go through. I can only imagine how you had to process it all. It sounds like you were doing a lot of the doctors work for them. Thankfully you are so educated and experienced with your needs. It was a very expensive emergency but so glad you came out the other side Sheryl. Sending very soft hugs, Niamh x
Hi Niamh, well I guess most of the docs at the A&E aren’t too senior and probably covered our kind of illnesses briefly in school only. Having inhabited this broken body for 30ish years, I hope I understand it a little at least :p Yea and it wasn’t the first time it’s happened so at least I had a frame of reference! Most importantly really for clotting/bleeding disorders – that comes as #1 priority to control above all else (save an anaphylaxis) I think!
What a lot to go through, on top of having a medical emergency! Thank you for sharing your experience to raise awareness. While I’ve never been refused treatment, I have been sent home from the ER because they’re not sure what’s wrong with me and I “seem to be getting better.” Beyond frustrating.
I hope you’re recovering well and feeling better Sheryl!
Wow that must be scary – to be sent home not knowing what’s wrong! Though I think I’d prefer that whilst they investigated outpatient instead of being admitted (hospitals are just meh, aren’t they?). Thank you for reading. I’m sure I’m not the only one to have this happen to before, and it’s just heartbreaking.
Sheryl, these sorts of stories just break my heart. I’m so sorry you went through such a terrible ordeal. Thank you for sharing it and helping those who have been through similar understand they are by no means alone or singled out; it’s a systemic issue and it seems to be a worldwide problem in healthcare.
Hi Michelle, thanks for taking the time to read and share. I appreciate it a lot 🙂 Yes, hospital politics, unoptimised processes, general human behaviour, etc. I just hope for this to improve.
Massive love and hugs Sheryl, your experience sounds horrendous and I’m so sorry you had to go through that x
Thanks Laura! It was horrendous but at least I got out okay (for now, this time)! xx
I am so sorry you had to go thru this. Knowing the Hospitals and their ERs, I can totally understand what you felt.
Healing hugs coming your way Sheryl.
Thank you so much. I just wanted to share my experience, because I’m sure I’m not the only one 🙂 x
Oh wow. This was a really interesting read- so well written. But also really harrowing. I’m sorry you had to go through all this, it must have been scary. Glad that it all worked out okay in the end but what a rigamole!
Thanks Jenny! Yes harrowing. Antiphospholipid Syndrome is like that…it likes hitting you like an assassin! :p
So very sorry for what you went through. I don’t think I could have been as brave and determined as you. Just hope things get better for you. I have had chronic pain in the abdominal area since my cystectomy and hernia. 5. Years ago, and hear in the states, tried everything, and on Vicodin 5mg. Hope to try Kratom soon. Best of luck with lesser pain for you, howard
Thanks Howard. Thank goodness the pain didn’t last for too long (as compared to other experiences I’ve had, at least!). I am sorry to hear about your chronic abdominal pain…it must be really miserable on some days 🙁 I hope the kratom works for you.
Im so sorry with all you have to contend with being refused admission to an ED – emergency department . I hope your feeling better xx
I just can’t comprehend. I was in ED last Saturday with chronic blood nose. I have been having them on and off since April before we went overseas. Saturday was awful. It started at 2, by 3 pm I realized I needed help. Called ambulance and was rushed to our local hospital . It was Saturday…so busy with sport injuries heart attacks. etc. Oh and people who really needed to just see a doctor. It took them ages to see me, ages for the bleeding to stop. Lucky the doctor on call was amazing and she stayed way past her time to go home to treat me. She managed to quarterize one of the bleeds. I got home at 11.30.
Yea I feel sorry for the docs at the ED too – the ones who tried to advocate for me and stayed with me were on a 14 hour shift. They’re not all bad, but when you get a nasty doctor/nurse, they can make your life a living hell for a while. And a while is a long time when you’re in danger or in pain!
How are you feeling with the nose bleed? Hope it’s much better now. And yes, many people really need to just go to a 24h clinic instead – do they have those there?
Sending hugs xx
I’m so sorry you’ve gone through all this, Sheryl. I hope you’re feeling a bit better now. Sending hugs.
No worries Liz, I really just wanted to be a voice and get this story out, as I’m sure I’m not the only one. Sending hugs right back!