Before I get this party started, I feel like I should begin with a few disclaimers. For starters, this blog takes a generally overdramatic approach to humor. And uses a LOT of cursing. If you're here you probably already know that, but it bears repeating. Secondly, I hate hospitals. Like, medical stuff in general is just squicky. If I could go the rest of my life without ever having to interact with a doctor again, that would suit me perfectly. And finally, my doctors were excellent. While parts of my experience weren't entirely to my liking, the two doctors I primarily interacted with (the gynecologist and the interventional radiologist) were fantastic and - possibly most importantly - very patient with my histrionics. Which is why I have left out names...this post is more about experiencing a fairly major medical procedure as an expat (I know, I know...I don't really write about the expat stuff much these days, but this was a doozy of an experience, and I thought it was worth writing about).
The previous paragraph makes it sound like I don't go to the doctor much, and that's definitely not wrong. I DO avoid doctors (they can't tell you you're dying if you don't go to them in the first place), but it's not like I've never been to one overseas. Actually, I think I've actually seen a doctor in every country I've ever lived in, not only for the standard visa health check, but for some small ailment or other. Foot pain. Constipation. Food poisoning. Mostly the kinds of things that they give you a prescription for and send you on your way in 15 minutes. This time, though, was different.
Content warning: Lady Parts. Also, Gratuitous Use of Capital Letters, but back to the first warning: if you're squeamish about women's reproductive health, I'm not sure what you're doing here, (my target audience is made of sterner stuff), but this is probably the time to close the tab.
So. Back up about 6 years. The first time I remember anything weird was my fourth Junk-To-Punk fashion show. That morning the school went down to the river en masse to pick up trash, and my period went batshit crazy. According to my estimates, I should have been fine with the tampon I used before leaving the school, but when I took the fashion victims back to the school I had to make a quick stop in my apartment to change clothes, which irritiated the fuck out of me. Over the course of the next year, "batshit crazy" became normal, but while that was irritating, I was in my late 30s, and every woman my age that I talked to reported similar issues, so I figured this was just getting old. Along the way I learned the "lite/regular/super" system of tampons I'd been using since my 20s also had "Plus Ultra" and "Bloodbath" iterations...which was good to know because super was no longer enough.
(If you're regretting sticking around for this, sorry, but I did warn ya. Women bleed. Fuck off).
Well, among the women I discussed this with, one was the Evil One. She is probably the best friend I will ever have in this life, and she loves me very much, enough to be straight with me even when I would very much prefer to just Not Go There. And she said, "Yeah, you really need to go to a gynecologist and get that checked out." I ignored this the first time she said it, but eventually, for something else entirely, I took her advice (it was two years later, okay, but I DID go in the end). That is another story that I won't be sharing in this blog post, involving High Blood Pressure and an Awkwardly Answered Question...but for the purposes of this story, the doctor found myomas. I had to Google to figure out what the fuck those were, but before I could get "non-cancerous growths" out of the internet, she was explaining that they would try to remove them surgically, but based on the size and number they would probably need to do a hysterectomy.
I've always found the fact that this procedure is called a hysterectomy a bit comical as well as insulting. Like just because I have a uterus I'm a bit unhinged? But when the doctor suggested that they would need to remove it, I did get kind of hysterical (and this is definitely one of the reasons for the aforementioned high blood pressure). I maintained my composure pretty well until I got back to my apartment, and then I Lost It. Ironically, when I first learned about body changes in 4th grade and discovered that I would be stuck bleeding from anatomy I was previously blissfully unaware of ON A MONTHLY BASIS FOR THE NEXT 40 YEARS OF MY LIFE?!?!? I would have done anything to get rid of it. Which I guess means I've matured somewhat since then, because a hysterectomy has huge consequences, and without even being aware of all of them, I knew I wanted to avoid them.
I wasn't thinking clearly enough to ask Google about alternatives until after 1 AM that night. Imagine my shock when I learned that there are LOTS of alternatives, none of which the doctor had mentioned. I'm not blaming her, BTW...skipping over everything else to surgery seems par for the course with uterine fibroids. I kind of figured that maybe they weren't really options here...Mongolia isn't exactly on the forefront of medical technology. But you know who is? Korea - and I had already booked a ticket to spend my fall break there. So I did some research, found that Seoul St. Mary's has a whole Uterine Myoma team, and made an appointment to get a second opinion.
I prepared myself for this visit by doing the bloodwork my doctor prescribed, and the MRI that she suggested. I had a small freak out because the MRI came on a CD, and who the hell uses CDs anymore? And the day before I left, the radiologist here talked to me about the MRI, and said that if I decided I wanted to, that they could do a procedure called uterine fibroid embolization here. This was actually the procedure that I felt the best about. UFE is clever. Rather than cutting you open (or, possibly more horrifying, going in through your vagina past the cervix to nip the little bastards), the interventional radiologist goes in with a teeny, tiny tube through puncturing your artery (either the one in your wrist or the one in your leg) and uses real time x-rays to find the blood supply for the myomas. When he gets there, he blocks it by shooting nanoparticles into the artery, which eventually causes the growths to shrivel up and die. It's about 90% effective in alleviating symptoms, which in my case means I hopefully won't experience shark week on a monthly basis anymore (there are worse symptoms, btw, like needing to pee all the time or getting constipated...comparatively, a little anemia doesn't seem that bad). And apparently it was a procedure that they CAN do here, if he was recommending it.
Which was all well and good, but I had already pretty much decided that I'd hit Seoul up on my way back at Christmas, get my procedure, and spend a couple of weeks crashing on my friend Happy Tree's couch til I was safe to fly. The only problem was, when I talked to the doctor in Korea, she said I could just wait and see. My anemia "wasn't that bad," and if two excruciatingly bloody days out of the month were my only symptom, it was okay (she has obviously never had that symptom while teaching a class of teenagers for 85 minutes straight, fully knowing that her feminine hygeine was NOT going to make it to the end of the block). Maybe I should have said, "That's reassuring, but I'd rather have UFE and get it over with...can you make that happen?" but I didn't. I went and paid my consultation fee back at the international clinic and left to eat a burger.
I guess I could have tried to schedule it with a different hospital in Seoul, or elsewhere. The US is kind of out due to financial reasons, though, and other than Korea, I wasn't sure there was anywhere I wanted to try and get it done. Maybe Japan, but that seems like it would be expensive, too. The idea of putting it off didn't really appeal to me, and I also thought there were probably going to be more hoops - initial consultations, more tests. Under the circumstances, I decided that if I could get it done here, that would be best, or at least easiest. Although I did have one small trepidation...I didn't want to be the first one done in Mongolia. I didn't ask that question directly, but I asked our office manager if there was any way to find out if a doctor had done a certain procedure, and she said she'd talk to her mom. Within 24 hours she knew his history, and while she wasn't sure that he'd done UFE, he had 14 years of experience and was well known for being a good doctor. From the previous interaction I'd had with him, his English was good and he had a reassuring manner, so I decided to go for it.
Well. It was not quite as simple as that. I had to schedule an appointment again with the gynecologist for the pre-procedure consultation. In addition to scheduling me and telling me I needed a bunch of tests (including Covid...goody), she informed me I would need to stay in the hospital the night before and the night after, which freaked me the fuck out. There's the fact that no matter where you are in the world, hospital food is shit, and trust me, that was pretty high on my "FUCK NO" scale, but there were more rational reasons I wanted to avoid a hospital stay. See, thanks to the previous high blood pressure, I was now the proud owner of a wrist monitor, and I knew for a fact that it wasn't just that the pandemic had Done Things to my health...my blood pressure was completely normal when I took it at home. It was only while I was at the hospital that it shot up. Having Everest-scale blood pressure for an extended period of time seemed like a really, Really Bad Idea. I also didn't think that I would be able to sleep at the hospital, and I've been in my skin long enough to know that rest is probably the most vital component to maintaining my health.* Followed by food, which brings me full circle. In the end, I didn't have to stay in the hospital, but there was a long, circuitous route to get there, and they really only let me leave because I told them I was staying with Engrish, so there wouldn't be stairs and if there was any problem she could help me get back to the hospital. I should buy her a really nice Christmas present...
This is turning into a really long post...you might want to go get a drink if you didn't have one when you started. I swear I'm trying to avoid unnecessary exposition, but this really has been an ongoing saga over the last two and a half months of my life, occupying most of my mental space. That said, we've gotten all the way to the procedure itself, so hang in there.
So I was scheduled for Tuesday, November 29. This is probably not the best time for a teacher to take a week off (the typical recovery time til you're back to work), but the week the doctor originally suggested we already had two teachers out, and the following week was my period, and I couldn't think of anything worse than that, if it was even possible. The 29th was really about as late as it could be and me still be cleared to fly home for Christmas (officially there are no restrictions, but everything I read recommended avoiding travel for two weeks). I got my leave approved, made my lesson plans - boring writing assignments that my students should have been able to do without me, although I haven't worked up the courage to actually read any of them yet) - packed so much stuff in a bag that it probably looked like I was moving in for a week, most of which I didn't use afterwards, because I was too weak to look at my phone, let alone crochet my blanket (seriously. The nurse had to get my phome off the floor multiple times while I was in "day care"). And then showed up to the hospital over an hour late on the day of the procedure, because the traffic was fucking ridiculous. And that was because I walked the last block...if I'd stayed in the Enkhaa Express, I probably would have been over an hour and a half late.
All things considered, I was flustered from the get go, but my doctors agreed to consider sending me home that day, they found hospital clothes in my size, and tested me for contrast dye allergy (apparently it's a different dye than they use for the MRI). Somehow I managed to not chicken out, and found myself lying on a zoomy motor bed thing, with screens positioned down by my legs and a little x-ray device overhead (overhips???). They started the contrast dye, and gave me another IV for my NSAIDs - not sure which one they used, but I was feeling pretty detached by the time they all came in and started the procedure. They had to use the artery in my groin, which I wasn't happy about, because it meant I had to lie down for at least two hours afterwards...according to what I read online. In actuality, it was 5 hours before they agreed to let me stand up. You may be wondering what that means for going to the bathroom, as was I. Initially they didn't put a catheter in my bladder, for which I was profoundly grateful...
Okay, you may be wondering about this hyperactive hospital phobia (nosocomephobia, if you like to know these things). Please remember that all of this was 100% new to me. In addition to the fact that I don't even like going to hospitals to visit, I've never actually been to one for myself. The only time I've been under anaesthesia was when I got my wisdom teeth taken out. My primary mode of dealing with illness is "ignore it and hope it goes away" and this has served me pretty damn well, even if I do say so myself. So yes, having someone stick a pee-pipe in me was a major point of anxiety for me. Until the procedure was over and the pain was kicking in, and I just KNEW that part of the reason it felt so bad was that I probably needed to pee. When I told the nurses and they said I would need a catheter, I requested that a female nurse assist me with it, but otherwise bowed fairly gracefully to the indignity. Maybe I covered my face while they were up in my bizness, but Baby Chicken Wing was telling the truth when she reassured me it wasn't that big a deal, even if I had to experience it for myself to believe her. I honestly hardly felt it.
The procedure ended up taking 3 hours. Everything I'd read online said it was usually over after an hour, so I guess I'm special. The doctor explained afterwards that my uterine artery was longer than they were expecting, and it took them some time to locate the correct access point to block the blood flow. Which, I mean, it takes as long as it takes, but by probably halfway through I was no longer in a state of dreamy detachedness brought on by a combination of sleep deprivation and pain meds. I was pretty much fully lucid after an hour and a half. I told them so, but I wasn't really experiencing any pain, so it wasn't really an issue - until it was. Probably about the last half hour or so I could begin to feel the cramping that I'd read about, and I told the doctors that, but I still had to wait for the anaesthesiologist to come before they gave me anything. And while she was administering the fentanyl, she remarked on my low pulse, seeming to think I had an irregular heartbeat and that I should come back to see the cardiologist. To which I wanted to reply, "FUCK YOU." Like, let me get through the current health issue before you conjure up a new one.
Which brings me to the vindicating portion of this post: IT REALLY MIGHT GO AWAY.
Because my previous approach is not entirely off-base - I'm not being completely frivolous. Turns out iron deficiency triggers a bunch of related shit. Everyone thinks if you're anemic, you're just tired all the time. Which I am, but let's write that one off to being a teacher, because that is definitely a truey. On the other hand, at some point in the last two and a half months I have googled everything I've experienced over the last 5 years that made me go, "Hmm, that's weird...guess this is what getting old is all about." All those things can be triggered by anemia. Slower metabolism, lowered immune response, allergies, and yes, even arrhythmia can all be effected by the fact that your blood is too weak to carry around all the oxygen it needs. Sure, it might not be fixed just by getting my iron up, but I'll still take a hard pass at immediately freaking out and going back this week to see a cardiologist...once the Red Sea ebbs and I've been taking these stupid iron tabs a bit longer, then I'll go in and see if it's still an issue.
I'm not going to lie - waiting to leave the hospital was a nightmare. Maybe this was my fault for insisting that I wanted to be an outpatient, but I didn't have my own recovery room. As they wheeled me past the door I saw a sign that said "Day Care" (haha, so many jokes to make), and noticed there were two Mongolian men in the room. I asked about the curtain and they pulled it, but it didn't go all the way around the bed, so I still had one old guy on an IV for something within view. They gave me my phone, my tablet, my plushie, and a call button, and then they left. Which, I guess I wanted to be left alone, but I also wanted to be comfortable, and that was Not Happening. For example, I had to ask for pain meds three times before they finally gave me an IV of something (and I still have no idea what it was). By the third time I asked I was on the brink of tears. They also only gave me 9 tablets of ibuprofen to go home with. From everything I've read, it sounds like UFE patients typically get a narcotic painkiller which they can take up to twice a day, as well as a prescription strength OTC painkiller and a stool softener. Maybe something for nausea. I didn't want to go home with a whole pharmacy, but if my pain had been worse, this could have been problematic.
And - oof - the pain was bad enough! I feel like The Literature kind of glosses over this one. I mean, doctors tend to do that, tell you you'll feel some pressure or a little pinch when they mean it's going to hurt like fucking hell. And I'm not even that sensitive to pain! However, the websites I read gave the symptoms of embolization syndrome (crampy pain, flu-like symptoms including fever and chills, and nausea), without giving the degree. For example, "crampy pain" should be interpreted as, "IMAGINE THE WORST CRAMPS YOU HAVE FUCKING HAD IN YOUR LIFE, EVER, AND THEN MULTIPLY THEM BY 10."** Also, when it comes to nausea, someone should mention that you probably won't have had anything but small sips of water since midnight the previous night. You're still going to throw up, but nothing's going to come out but bile (at least, not the first three times; the fourth time I had gotten to casa de Engrish, and she had bananas, so it was banana puke the fourth time, for a fun new twist).
Well. Nothing lasts forever, and eventually they released me to go to Engrish's place. I mean, first I had to pay my bill, and that was mendokusai, because the hospital doesn't do direct billing with our insurance company. I only owed a little less than $2,000,*** and I had plenty of money in my accounts to pay for it. However, there's a little problem with Mongolian banks...they don't like you to spend more than 3,000,000 tugrugs in one go at the same place. So the cashier tried to put 6.5 million tugrug on my Mongolian bankcard, and my card said, "Nope!" So I had them run 3, successfully, and then they tried to do another 3. And of course that didn't work. Well, fortunately the day before I'd dropped the last $700 of my fall bonuses into my US dollar account, so I had them put 2.5 mil on that card, but that left me with one million left to pay. I was able to pay the rest of it by using my mobile app and just skipping the card entirely, but I feel like this is a flaw in Mongolia's banking system. If you are paying a hospital and you have enough money in the account, the charge should just fucking go through.
So that was it. This is Day 6. I finally started to get some rest on Day 2 (back in my own bed cuddled up with my dakimakura). Gradually regained my appetite by Day 3. Stopped freaking out about constipation on Day 4. I've left the apartment today and the previous 2, and feel like I'll be okay at work tomorrow (it's the day I only teach 2 classes anyways). I'm not totally Over It yet, but I'm getting there. The first 24 hours or so, I questioned if I'd made the right choice, but compared to the recovery time for myomectomy or hysterectomy, this has been a cakewalk. All the same, I'd still rather go the rest of my life without visiting a hospital again. Hopefully this will make it more likely.
*Fact: I never used to take OTC meds because I believed my immune system was Tough Enough. Then I took a Nyquil once when I couldn't sleep from coughing, and after a full 8 hours of sleeping like a baby I woke feeling fresh as a daisy, and decided that being Tough Enough was bullshit - quick recovery was MUCH better.
**This is somewhat subjective...my cramps have never been that bad. On the other hand, I feel like I only made it to an 8 on the pain scale at the worst I felt.
***Fun fact: According to the internet, you're looking at about $10,000 for the same thing in the States.
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