Expat Bostonians

It’s worth stating at the start that I’m fine, now.  It’s also worth stating that my surgery was gyn related, so male readers and squeamish readers might want to take a pass on this entry.

Ravi and I have decided to add another child to our family.  In order to start that process, I needed to have my Mirena IUD (intra-uterine device that emits a low dose of a hormone that supresses ovulation and thickens cervical mucus to make it more hostile to sperm) removed.  The other thing that Mirena usually does is to keep the lining of your uterus thin.

Two days after removal, I began to bleed.  I shrugged it off, not terribly worried, assuming it was a period brought on by the lack of the progestin hormone that the Mirena gives off.  By day three of the bleeding, I was worried.  Rather than slow down, the bleeding was getting worse and I was passing very large clots as well.  I stopped by the OB/GYN’s office to pick up a medication and brought it up as a source of concern.  My (male) OB basically patted me on the head and told me that I was a silly little girl and that I should only worry if my next period was heavy, too.  Day five and I was coming close to the definition of hemorraghing.  Day six and I was meeting the definition of hemorraghing.  I called the OB again, explained this to him and he said to come in and get a shot of the same hormone that was in my IUD…which I now know would have been the worst possible thing I could have done.  I chose instead to end my tenure as a patient of his.

I found another OB’s office, and made an emergency gyn appointment. They were also in favor of the shot, but only if an ultrasound showed no reason for the bleeding.  The ultrasound showed that I had grown an alarmingly heavy lining during the two years on Mirena and that there was either an extremely large blood clot or a polyp present in my uterus as well.  A D&C was scheduled first thing in the morning.  Which was a good thing, as by this point I was starting to become dizzy and weak from blood loss.

This is about as graphic as I’m going to get in terms of what the blood loss was like, but let me say that on day six I wore black shorts for a reason.  Between the start of dinner and the end of dinner I had soaked through a pad to the extent that my thighs were covered in blood and when I touched the fabric of the front of my shorts, my hand came away red.  Ravi and I were both pretty frightened at this point, and it was only knowing that the D&C was less than 12 hours away that kept us from the Emergency Room.

On Saturday, Ravi took me in and I had a D&C (dilation and curettage–basically they go in and surgically remove all the tissue and lining in your uterus).  This is the same procedure I had done in September, 2007 when I miscarried Hope.  Saturday sucked in terms of pain, and I spent most of it asleep.  Sunday I also rested and did a lot of sleeping, but the post-surgery bleeding (extremely light) pretty much was over.  I’m taking it easy this week, and I’m on pelvic rest for two weeks until my follow up appointment.

In terms of adding to our family, there is a recommended wait of two months post-surgery before it’s advisable to begin working towards pregnancy, so we are putting that on hold at least until the spring, and possibly longer, depending on other factors.  Believe me, when we have news, I’ll share it.

What struck me most about my experiences on Friday (the ultrasound) and Saturday (the D&C) were how different the US and Singapore are.

A consistent criticism I’ve had of Singaporean doctors is their lack of bedside manner.  This extends into surgery–when I had a D&C in the US, a nurse came by and explained the procedure, the anetheisiologist explained in detail what she was going to do, and the doctor came by beforehand and said what they were going to do, afterward everyone walked me through how the procedure had gone as well.  Perhaps explaining past what I wanted to hear, especially as I was grief-stricken at the time.  In Singapore–nothing.  I was wheeled to the surgical floor, the anesthesiologist took a history, I was wheeled into the surgery room, the IV was put in, the mask was put on and I was knocked out.  I woke up in recovery.  The extent of instructions I got was how often to take medicine.  The nurses did have a lovely bedside manner, but it didn’t make up for the lack of information NOT coming my way.

Having to fight to get my husband into rooms with me.  Imagine that you are hemorraghing blood (or your wife is) and they’re going to do an ultrasound.  She wants you in that room/you want to be in that room.  The u/s tech is all “husbands don’t want to see that/we don’t let them in.”  Basically I flat out refused to go into the room until my husband was with me.  This was not a pretty scene, by the way, and I’m certainly not looking forward to the cultural differences rearing their ugly heads throughout the pregnancy.  When Ravi can make it, he WILL be in the room with me.  It is his child (or in this case, his wife’s messed up uterus) and his support is always needed, especially when I’m scared to my toes.

I’m sure there’s a disseration to be done on all the ways in which Singapore (and Asia in general from I’ve heard) is fat-phobic/unfriendly.  But the last place you want to be dealing with this is your medical care.  I keep getting high blood pressure readings (which I learned wasn’t the cuffs so much as it was the close to panic attack I feel in Singaporean doctors offices–on Saturday was I was too tired to be freaking out, I got a normal reading) and often the offices don’t have a plus-sized cuff (a too small cuff can cause a too-high reading).  The little panties they put on you before and after a D&C didn’t go past my thighs.  Instead of stirrups, they use these supports that your thighs sit in, unless your thighs are too wide in which case they are just extremely painful and humiliating.  I am normally a very strong woman, and I have no trouble advocating for myself, calling doctors on fat-phobic bullshit (another reason OB #1 was fired…he kept insisting I’d need fertility aid, which if he’d stop looking at the fat girl and making assumptions and listen to the fact that I got pregnant on tries #1 and #2 with Hope and Elanor respectively he’d know we have no reason to believe I’ll have trouble getting pregnant again), or other advocacy (insisting on the right blood pressure cuff, etc).  But when I’m scared, I’m hemorraghing, and I just want to know why or to have it taken care of, it is beyond upsetting that I’m being confronted with size-ist issues like this.  It’s not that I never had a fat-phobic doctor in the US (my first OB who said I’d never carry a baby to term unless I lost weight…days after my miscarriage…what kind of soulless bitch DOES that to another woman?) or an embarassing medical experience, but here it happens more frequently and it’s almost like I’m waiting for the blow that more often than not DOES come.

In the US, the only medication I was given after my D&C was some vicodin or percoset.  Here I was given nothing with a painkilling agent.  After the surgery, I was in a level 8 (on a 1-10 scale) pain and my uterus was spasming like I was in heavy labor.  I had to beg, and beg loudly, and get my husband to push too for painkillers.  That they’d never heard of vicodin or percoset was not helpful (even when we gave the generic names).  Finally I got some tramadol (which is sort of a cross between morphine and codeine, according to Ravi’s googling).  But the doctor was all “patients usually don’t hurt like this.”  I don’t know if it’s a cultural thing or what, but having to wait almost an hour for pain relief sucks.

Then there was the whole “eating and drinking” thing.  In that they had to see me eat and drink something.  I had to refuse milo (that vile chocolate drink) and tea multiple times and just insist on ice water (which my nurse thought was very bad for me…cultural thing).  Also, I don’t eat Asian food and I don’t eat tuna sandwiches or sandwiches of any kind.  So I had to insist on crackers, forgetting that the crackers here are vile too.  So I had to force down something that made my stomach more nauseous to get out.

They also wanted me to stay in recovery for 4 hours, for no reason.  Once the painkiller kicked in, I felt fine and I didn’t want to sleep/couldn’t sleep there.  So we had to keep saying that I wanted to leave, and finally they let me.  Now, some would say it’s a measure of how awful the US health care system is that you’re kicked out of the hospital once you’ve urinated and are down to a level 5 or lower pain (about an hour after the operation, especially as you’re given painkillers IMMEDIATELY, amen).  Personally, I’d rather be in my own bed without strangers hovering over me and trying to force milo and tea down my throat.  I got home, ate an apple and peanut butter, and passed out for a good five or six hours in the privacy and comfort of my own bed.

Granted, my care only cost about 2000SGD  (1520 USD), and our health insurance faxed a letter to the hospital to say “don’t charge the patient, we’ve got it” so we didn’t pay a penny, and that’s nice, I suppose.  But that fax took a long and frustrating conversation with our insurance company, an emailed cell phone picture of the paperwork describing the condition of my uterus, and some additional calls at the time of check out.  In other words, it was no different than dealing with Blue Cross in the US.  Which, for the record, included someone delivering a bill to me while I was sitting in the recovery room.  Ravi went out and dealt with everything, and we got our deposit back (we’d had to give them a 1500 SGD deposit the night before when I pre-registered).

Overall, I’m happy that a frightening and potentially dangerous condition was dealt with.  I feel like the facilities, for all that they are more run-down than the ones in Boston (specifically my D&C was at Newton-Wellesley-in pre-op/recovery each person had a room with a tv, instead of a curtained area maybe a meter or two in width–not that it’s a huge deal, it just shows the “niceness” factor), the procedure was done correctly and I’m not bleeding anymore.

But it does raise larger issues I have with the medical establishment in Singapore.  That doctors are doing what a checklist tells them to do (Fat girl–will have trouble with fertility, Diabetic–should be induced at 38 weeks, etc) instead of listening to the patient in front of them.  There are issues with the way the (fired) ob wanted to manage my diabetes…taking a drug past the first trimester, in defiance of the Joslin Diabetes Clinic’s (the world-wise gold standard of diabetic research and care) rules on that drug.  That husbands are largely marginalized (from everything I’ve seen and my own experience).  In the end, I just don’t have trust with any of the doctors I’ve met here, and when I tried to give it (to fired ob) it was abused (he said he’d abide by my US OB and endo team’s recommendations and then ignored them).

One of the things I struggle with constantly as an expat is comparing things to the way they’re done “at home.”  Slowly, every so slowly I’ve been able to make adjustments in most areas of my life.  I’ve found local food options to replace my preferred brands of X, Y, and Z to cook with.  I can cook using the metric settings on my oven.  I’ve found more restaurants I’m willing to eat at besides the safe and (generally) consistent McDonald’s.  I miss Target dreadfully, but I’m (mostly) over that I don’t have it here.  I’ve learned which movie theater seats I like.  I understand how to get things fixed in my home.

Medicine is the one area where I haven’t let go.  To be fair, given my (and specifically Elanor’s) history, I have a great deal of post-traumatic stress syndrome surrounding pregnancy and pediatric care.  It is beyond frightening to deviate even an inch from the care that got Elanor born safely.  As I stated, it turns out my high blood pressure readings in the OB offices have all been the result of trying to fight off a panic attack.  I’ve had doctors say to me (more than once) that if Elanor had gotten sick here, she wouldn’t have made it…can you even begin to imagine what that does to my anxiety levels, which were very high to begin with?  The care here is very different…there are no doctors with the same training as my perinatologist in the US.  For me, that’s like saying “here, let this first year medical student take care of your highly medicalized pregnancy”–and I have about as much respect for them as I would for a first year medical student.

In the end, it’s a good thing that I had the IUD pulled when I did.  However, I never would have had it pulled if I had known that the OB who removed it was going to violate my trust and start changing regimens that weren’t broken to begin with.  I now know that for me, at least, the Mirena probably isn’t a good fit for birth control (although I am still very much an advocate for it and would recommend it to anyone).  I also know from experience (and because I’m a trained sex educator) that condoms are highly effective.  But Ravi and I are glad for the two month prohibition on getting pregnant…because I’m not sure where we stand on it anymore, if having a baby means having it in Singapore.  In the end, I may just be too traumatized by my experiences with Hope and Elanor to go through this again.

Filed under: Boston, medical, Medical, Singapore, US | 10 Comments »