Journey to a Hysterectomy: The Big Day and Afterwards

Content Warning: Discussion of female anatomy, in graphic and unpleasant detail. Discussion of gynecological problems, in graphic and unpleasant detail. Description of medical abuse. Ableism, sexism, ageism, all of which are internalized, active, and institutional. Reminder: I refer to these things as “content warnings” rather than “trigger warnings,” because I do not take responsibility for the mental health of my readers, some of whom I do not know well. I have listed the warnings that jumped out at me, but I may have missed something. I do not take responsibility for knowing the inside of anyone’s mind other than my own. Also, all experiences are mine and mine alone, and may not be suitable for generalizing to any larger group.

The morning of my surgery, Friday morning, we drove to the hospital with “The Final Countdown” blasting through open windows. I cried with happiness.

Upon checking in, the hospital scanned in my advance directive, and entered in the information from my medical ID necklace, since I would have to take it off for the surgery.

Okay, a bit of a digression here, for information purposes. If you don’t have an advance directive, you can make one fairly easily. Most states have standard forms for them, through your state bar association or through your state board of health. A quick Google search should turn it up. Make sure you’re using the latest version of whatever form is available; I actually rewrote mine in the days before my surgery, because I had been using a form from 2007, and even though the information hadn’t changed, I wanted to make sure it was in the most up to date format, which was a form from 2015. Also, if you can, take the time to go over with your selected agent everything that’s in your directive; make sure that they have a chance to ask you questions, and write the answers into your directive. Hopefully you’ll never need it, but it’s like having 911 available on your phone: you hope you’ll never need it, but do you really want a phone without the capability?

Also, medical ID bracelets and necklaces. American Medical ID makes excellent quality ID bracelets and necklaces with lots of space for information. They also offer, for a one-time fee, integration with Integrated Health Records, a service that lets you upload a huge amount of information to a website that health providers can access, but only you can alter. This includes the ability to upload a copy of your advance directive, insurance information, allergies, medical history, contact information, and a boatload of other stuff. If you’re like me, and have more important information than will easily fit on a piece of jewelry, it’s good to have something like this so people can access it.

Alright, back to the surgery day.

My husband was allowed back with me into the room where I changed into the hospital gown, and then there was a constant stream of people coming through.

First a set of nurses going over my information as listed in the computer, including my medication allergies, history of seizures, risk of falling, and other information. They added fall risk and allergy alert wristbands to the hospital wristband I already had.

Then a set of nurses giving me an IV. They were wonderful in seeing to my comfort, covering me with warm blankets. They also put on a set of leg wraps that would prevent blood clots during the surgery.

Then another nurse to give me a scopolamine anti-nausea patch, since I’ve had nausea issues with anesthesia before.

The anesthesiologist came to talk to me, and we went over my history, including my anxieties about anesthesia (one of my greatest fears in the world is surgical awareness). I’ve had issues with dental surgery, with anesthesia cutting out very suddenly mid-procedure, so we went over that. She went over with me exactly what I would experience leading up to the surgery: first they would give me a sedative that would relax me, and also might make me forgetful of the next period of time (this varies from patient to patient). They would then take me to the operating room, where I would be positioned for surgery, and they would make sure that the position for surgery was okay for my back. Then they would administer the anesthesia, and I would speak a countdown from ten, or at least as far as I could get before falling asleep.

My gynecologist/surgeon came to talk to me, to go over the surgical procedure itself one more time, making sure I was clear on everything, and making sure I had no more questions going into the procedure.

Then everybody at once came back, made sure I was all ready to go, and they gave me the sedative. After that, I only remember flashes of going down the hallway, a brief flash inside the operating room, and then waking up in the bed after the surgery.

In retrospect, I should have known I was going to have problems with anesthesia from the moment I woke up, but I was really woozy from the anesthesia, and not really in a position to self-advocate.

It’s true that one incident does not make data, or a pattern. When I had my gall bladder out in 2007, I had all sorts of nausea issues, but we weren’t sure what their origin was: it could have been the fact that I was recovering from surgery on my digestive system; it could have been a reaction to the anesthesia; it could have been the infection I developed after the surgery. Now, after this surgery, we know that my body does not like anesthesia, and I need to stay an extra night in the hospital, no matter how fine I seem.

We didn’t know that yet.

I woke up shaking like a leaf, but otherwise doing great. The nurses helped me sit up to a position where I was breathing better, but I had a slight rattle in my lungs. I was given a spirometer, to breathe in and out. I would take this home with me that afternoon. It hurt, naturally, to breathe in that deeply right after surgery, but I did it anyway, which impressed the nurses. Apparently a lot of people don’t expect breathing to hurt – it’s something I’ve lived with so long, it didn’t even phase me. My pain levels were already, even directly after the surgery, lower than normal. I was just incredibly sleepy, and having a lot of trouble staying conscious.

The nurses helped me move from the bed to a reclining chair. I fell asleep again several times, and eventually woke up to my husband sitting by my side. I spent a long time in the recovery area, and once or twice he switched out with my father, who had turned up in case we needed him.

Eventually it came time to deal with the question of whether or not I should go ahead and go home. I felt woozy enough that I wasn’t sure it was a good idea, but apparently that was normal. I felt fine, other than that – better than I had in a long time before the surgery. So a nurse helped me to a wheelchair, and helped me to the car, and my husband drove me home, where I slept for pretty much the rest of the day.

The next day, I felt great when I got up, but the scopolamine patch had tangled in my hair, and it came off when I brushed my hair. I think that was the start of the problems.

I had been scheduled to go out to dinner with my father and stepmom on Saturday, but that was canceled when I projectile vomited very suddenly, about a half hour later. I spent most of the rest of that afternoon sitting on the bathroom floor, throwing up all the liquid and the few solids I’d ingested that day and the previous. I threw up until there was nothing left, and then brought up bile. We called my gynecologist, who called in a prescription for anti-nausea suppositories.

I lasted through that night and most of the following day, but it became apparent that the Phenergan suppositories weren’t lasting long enough by a long shot, and weren’t effective enough, so back to the hospital I went, on Sunday.

At this point, I was also in some serious pain, because vomiting causes all sorts of muscle contractions that don’t mesh well with abdominal surgery, and I couldn’t keep down any medications, including my normal medications for my usual conditions, so absolutely everything was flaring up. They gave me fluids, Toradol, Phenergan, and Zofran, intravenously, and that helped immediately. It was determined, after several hours at the emergency room, that I should stay the night at the hospital. My pain medications were switched from Toradol to Dilaudid, which I had never taken before but which I certainly found effective.

I went home the next morning with more suppositories and with Zofran pills as well, and instructions to alternate the two, and also a new scopolamine patch, this time covered with medical tape to prevent a similar mishap to the previous one.

Most of the last week has passed in a bit of a blur; all three anti-nausea medications cause sleepiness, and between the three I’ve spent the vast majority of the time unconscious, but I suppose it’s what I’ve needed to recover. I went gradually from three anti-nausea medications to two to one, and was able to go back on my normal medications as well. My incisions have healed up nicely. There are no stitches; they used a surgical adhesive instead, since the cuts are so small. They’ve started to itch slightly, in the way that cuts do when they are healing, but it’s ignorable.

My pain levels are amazingly low. There’s still some abdominal pain, because I’m still healing from surgery. Surgery hurts, obviously. But the pain that’s there is so much less than the everyday pain I experienced from my ovaries and uterus, and it’s not pain that radiates through my back and hips and legs. This is already an improvement in my quality of life, and it’s only going to get better from here. It doesn’t fix everything, but it sure does make a difference.

Blog Reactivated! My Journey to a Hysterectomy: Prologue

Hi, all. I’m back. It’s been a while, because I’ve been dealing with graduate school, a diagnosis of multiple sclerosis, and buying a condo.

It’s been a roller coaster ride.

Most recently, things are taking a wonderful upturn in that I’m scheduled to get a hysterectomy in early June. This might not sound at first like an upturn, but I have been trying to get this surgery for a little over a decade. It’s been a long journey to get to this point, and it’s going to be quite a trip going through the surgery and recovery.

Given the degree to which there are social justice issues of feminism and disability rights involved in my case, I’m going to blog it all here, among other entries, in the hope that perhaps someone else out there might not have to invent the same wheel. This entry can be considered a prologue of sorts: how I got here, what the last twenty years of my reproductive health have been like, why it is so important for people like me to be able to have access to this kind of care, and what has kept me from having it until now, and what finally made it possible.

Content Warning: Discussion of female anatomy, in graphic and unpleasant detail. Discussion of gynecological problems, in graphic and unpleasant detail. Description of medical abuse. Ableism, sexism, ageism, all of which are internalized, active, and institutional. Reminder: I refer to these things as “content warnings” rather than “trigger warnings,” because I do not take responsibility for the mental health of my readers, some of whom I do not know well. I have listed the warnings that jumped out at me, but I may have missed something. I do not take responsibility for knowing the inside of anyone’s mind other than my own. Also, all experiences are mine and mine alone, and may not be suitable for generalizing to any larger group.

The Early Days

I started menstruating late for people my age, late age 13, almost 14. My parents went out of their way to make it an affirming, empowering experience. It might have worked if I hadn’t started displaying similar symptoms to my mother – heavy bleeding, awful cramps, nausea and illness, unreliable cycles – from the very beginning. I started taking hormone treatments before I was 15.

I don’t know when I first started missing classes because of period symptoms, but it was before college. It can be hard to tell, even in retrospect, because it was also around this time that my health in general started to decline. As my gynecological symptoms got worse, though, which they did gradually year by year and sometimes even month by month, I missed more classes. Fortunately, I attended a women’s college, where people usually understood this, but because I didn’t have an actual diagnosis for any of my health problems, I wasn’t able to receive any accommodations, and my grades suffered.

I was constantly faced with skepticism regarding my experiences, except by my fantastic primary care physician and gynecologist. Specialists were convinced I was exaggerating. Insurance companies refused to cover tests, because I was “too young” to be experiencing chronic pain. And, though my gynecologist tried to get me tested for a number of things, insurance companies would not even consider any kind of testing that could lead to an intervention, because I was now considered to be “of childbearing age,” once I was 15 years old.

College, Graduate School, and Getting Married

I made it through college – barely. My gynecological problems were just a subset of my larger health issues, which still had no names attached. I started to learn during my college years just how dismissive emergency room physicians could be of a woman’s pain.

During my senior year of college, I participated in a health study, designed to help improve the bedside manner of young male doctors working with female patients. I was asked to submit a recording of a detailed description of my menstrual symptoms for use in their training program, which I did, in exchange for $50 and the knowledge that perhaps it might make a difference.
Only it didn’t, because they rejected my sample on the grounds that my description might scare the young male doctors.

This was when I first started realizing how broken our system is. Here is a rough approximation of the description I gave:

“In the week before my period begins, I experience depression, mood swings, anger, anxiety, and general peak reactions to all stimuli. It feels as though, if there were a volume knob on the world, it has been turned all the way up. Colors are bright enough to hurt, everything sounds loud, my skin feels everything more sensitively, and I get overstimulated in minutes. This then becomes even more intense on the first day of my period, finally calming down around the third or fourth day. During the first few days of my period, I usually feel an intense need to close myself in a small space for safety.
I haven’t ruined a pair of underwear in years. In addition to getting plenty of warning from PMS, when I start menstruating, I know it, because I feel a tearing sensation deep inside me, just above the center of my pubic bone, followed by an intense nerve pain going all the way out along my pelvis. I then experience what feels very much like the entire contents of my abdomen falling out, along with more tearing. I start bleeding intensely, usually going through menstrual products at two to three times the rate listed on the box. I bleed for about a week, with these symptoms constant throughout. I experience intermittent nausea, headaches, full body aches as if I have the flu, spasms in my arms and legs, and dizziness and blurred vision. About once a year, the bleeding gets intense enough that I pass out, or the pain gets bad enough that I can’t hold back vocalizing it, and I go to the hospital.”

Apparently male doctors can’t handle this information. The word “traumatized” was actually used in the feedback I received from the program.

If the people in whose hands I must put my healthcare decisions might be “traumatized” by my experiences, and this is considered a valid reason to discard my testimony, I thought, this explains so much about everything that has happened to me so far.

I started watching for signs of this disregard in the system, and it immediately leapt out. I couldn’t un-see it. I worried that perhaps I was acting on confirmation bias, and I tried to un-see it. I must be overreacting, I thought. I was being overemotional, irrational, refusing to take responsibility for my own problems.

I started doing research, and found that, in fact, my case wasn’t even unusual, much less unique.

My health continued to decline as I completed an intensive Master’s degree program, and I started the work of educating the men in my life, most importantly my husband-to-be, about these problems. Initially, I ran headlong into the stigma surrounding women’s health, but he was fantastic about breaking down those barriers for himself as well as me. It took work, before he was able to go down the family planning and women’s health aisle of a pharmacy and get my products without being embarrassed, but he laughed at himself until he managed – and the effects of that work have lasted through today, when he can roll his eyes right along with me at guys looking furtively around or even apologizing to cashiers while buying boxes of tampons.

The other, even more important, support he gave me was these three words: “I believe you.” He didn’t necessarily understand, and it took some work to really make that communication happen, but he was willing to start from the assumption that I was telling the truth, which was more than most of the people in my life, and more than almost any health care professionals, were willing to do.

The Last Ten Years

A few years into my marriage, in late 2006, I discovered I was pregnant, in just about the most traumatic way possible: I miscarried.

I thought at first it was just a really awful period; I was miscarrying early enough that the two were almost indistinguishable. I took a pregnancy test when it got bad enough that it was notably different from previous really bad periods, and it came back positive. And we went to the emergency room.

First, the people at the desk belittled my concerns, and I passed out on the emergency room floor from the bleeding.

I woke up in a bed in the emergency room, and the doctor proceeded to tell me I had fainted from the sight of my own blood, as if I hadn’t seen it every month for the previous twelve years.

He refused to let me see the hospital’s gynecologist, and said he would do the pelvic exam himself. I refused, and he told me I didn’t have a choice, and said he would have nurses hold me down while he performed the exam. Rather than do that, I let him – and it took almost a decade before I fully realized or admitted to myself that this was abuse and assault.

He then diagnosed me with hysteria.

Let me say that again.

He formally diagnosed me with hysteria. In 2006.

I was furious. I had connections with the hospital through my father-in-law, who ensured that this doctor lost his job. (Unfortunately, I discovered through a car accident about eighteen months later, he found a job at another hospital nearby. I made sure he lost that one too, because he handled my car accident about as well as he handled my miscarriage. I have no idea where he is now.)

About a year before this, my actual gynecologist had retired, after being diagnosed with breast cancer. She had done amazing work for many years, and earned her retirement, and I wish her all the best, but I still mourn the fact that I can’t work with her anymore.

I looked for a new gynecologist, and saw several, all with the same results: they see “fibromyalgia” on my chart, and immediately dismiss any and all claims I make. They would not give me painkillers for my symptoms, even non-opioid ones. They would not give me muscle relaxers for my cramps. They would not give me anti-nausea medications. And they certainly wouldn’t consider a hysterectomy, even though the final recommendation from my previous gynecologist had been to work toward one as soon as I turned 35, the age at which insurance companies would finally consider covering the surgery.

Where I Am Today

As a result of the MS and aftereffects of a concussion in 2013, I have a sleep disorder. I sleep a lot, and very deeply. One quirk of this is that pain sometimes shows up in my dreams, in some narrative form that interrupts whatever was happening.

I have had repeated dreams in the last year while menstruating, in which I get shot in the abdomen. Recently, there was a twist in this, that I had to have surgery, an emergency hysterectomy. I woke up sobbing, because it was not real. My husband held me while I cried for over an hour, repeating “I want it gone.”

By telling that dream to the my primary care physician at the right time, I finally managed to get a recommendation for a doctor who specializes in getting women the healthcare they need.

It turns out that doctors are faced with similar weaponized statistics as teachers: certain outcomes are categorized as “failures,” even if the patient feels otherwise, and a certain proportion of failures on a doctor’s record can put their license in jeopardy. (I am terrified of this happening to my primary care physician.) I have tried everything other than surgery, at this point, and even doctors who have admitted that it is probably what I need have then sent me away because they could not perform it.

I now work with a gynecologist who recently put together a practice entirely out of experienced doctors who can afford those “failures” on their records, and have decided as a group to take those on, in order to give patients the healthcare they need, and when they eventually build up enough failures that their licenses are revoked, they’ll be old enough for retirement. In the meantime, they’re racking up awards alongside the black marks, which means they’ll be able to last longer.

I have a hysterectomy scheduled at the beginning of June. I have never been happier about medical news.

It should not have taken me twenty years to get the surgery I need, first until some arbitrary group of insurers decided I was old enough that I might not change my mind, and then until I found a doctor who could afford to have “gave effective care to a patient in pain” on their record.

This attitude also further stigmatizes chronic health problems that can cause a woman to be unable to bear children, through hysterectomy or otherwise. In my case, literally the worst possible outcome was considered to be “woman is unable to have children.” Not “woman dies of excessive bleeding on emergency room floor,” which has nearly happened on several occasions, not “woman is disabled by gynecological symptoms,” which would be true even if my other health problems magically vanished tomorrow, or even “woman’s quality of life is drastically reduced by chronic pain.” My decisions about what should be prioritized in my health care were disregarded at every turn, until yesterday.

And now I still have to jump through administrative hoops to get everything covered, and make sure that I receive the care I need surrounding my surgery (e.g., make sure the hospital will give me painkillers afterward, since I have fibromyalgia and am therefore considered a drug seeker by definition, as I discovered the last time I was hospitalized).

This is, as my new gynecologist put it, “unconscionable.” And I am one of the lucky ones: I can afford my health care, I can advocate for myself, and I am supported.

I am thrilled and excited that this change in my life is about to happen. I want this so desperately I don’t have words for it. I cried all over my new gynecologist when he told me I could have the surgery. I am aware of the dangers and risks of surgery, but I have no qualms about this course of action.

This is right for me. It is so important that I be able to pursue it. It’s an amazingly novel feeling, being in control of such an important aspect of my health, and I am trying to remember to take the time to revel in it.

I am proud of this accomplishment. It has been a long road to get here, and I’m not done yet.

I am not a failure on the part of my doctor.

I am not broken.

I am not incomplete.

I am not a tragedy.

I will bear my battle scars proudly.