When it Hits
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 it wasn’t an emergency that would require a visit to the hospital A&E (Accident & Emergency). But the pain only increased in intensity, as I knelt on my blanket, hunched up in agony.
After four 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 powerbank, 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 different doctors. Sometimes the hospital pharmacy doesn’t even carry these drugs, so I still need to advocate for myself whilst there. Missing a dose can multiply the pain. I dialed for 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.
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 available 24 hour clinics and hospitals in Singapore.
From the Calm, to the Eye of the Storm
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 needing to wait for hours in pain. 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 after a wait, 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 a doctor who is 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, 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 (there is no government subsidy for A&E cases in Singapore). Whilst there might not have been a need to inject them all, I believe that the doctors made the right decision. 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 most likely have been done already.
Coping with Pain at the Emergency Department
The extra shot of tramadol they gave me wasn’t enough; I was still in pain. The bright, harsh lights and insistent bleeping of machines made me feel even more anxious and agitated. The patient-doctor conversations 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 didn’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 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.
When a Hospital Refuses to Accept and Treat You
As TTSH didn’t have a gynaecology department, I needed to be transferred to the Singapore General Hospital (SGH), which has both a gynae and rheumatology team. 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 their A&E department the most, out of the ones I’ve visited in Singapore (yes I’ve been to a few, and could probably do a review!). Putting the insane crowd aside – which is common in public hospitals at night anyway – I’ve always found the healthcare staff at their 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 four 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 within the past 24 hours, for ‘patient safety’ reasons. But my blood pressure tends to be on the low side 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?
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 (let’s exclude the super crazy 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 up until this point were having trouble finding blood for me, and it has taken days in the past to find me a perfect match. To do a surgery or not were both major risks. (If you’re reading this, please consider donating blood, especially if you are O negative, aka emergency blood, the blood of life 😉 )
The doctor 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.
Difficult Life Decisions You Need to Make on the Spot Whilst in Pain
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 eight 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 to 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. 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 two hours ago, I requested for an updated reading, to know if the bleeding had been staunched. I don’t know how many needles had pricked my skin by now – 20, 30? Both big green and small butterfly ones. They 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. And so I chose not to be transfused for now.
After living with chronic illnesses for 20 years, you learn how to lead in regards to your own health at least. A decision always has to be made. Even waiting something out is an action that could affect you in drastic ways.
Experience 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.
I 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 gynae if I ever get the chance to become pregnant!
She also gets bonus points for allowing me to go home after a three day stay, after confirming that my condition was stable! That is a considerably short stay, if 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 meds or painkillers is also frustrating. Ignorant or rude nurses also have the power to make your life a misery. The 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.
*Note: This article is meant for educational purposes and is based on the author’s personal experiences. It is not to be substituted for medical advice. Please consult your own doctor before changing or adding any new treatment protocols.
Read More: This is What Hell Must Feel Like
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- For More Insight
- What to Do if You Think an Ovarian Cyst Burst (self.com): http://bit.ly/2yJyY7N
- What causes pelvic pain in women? (medicalnewstoday.com): http://bit.ly/2KvLygu
- Your Blood Type is a Lot More Complicated Than You Think (smithsonianmag.com): http://bit.ly/2GRg4Ao
- The man with the golden blood (mosaicscience.com): http://bit.ly/2M6Dq9q