Warning: Grouchy post ahead.


26 March 2015 (Thu)

The 2nd night was indefinitely better. Hubby had delivered a sleeping eye mask so the lights no longer got to me. Snore Machine got discharged. The night shift nurses were different. They kept their phones off and were discreetly quiet. I slept...

And I woke up feeling so much better. The pain had dwindled down to a sharp pain concentrated at my lower abdomen and the pain in my torso was more or less gone.

The Morning Rounds doctor said they'd monitor the pain and check again in the afternoon if a 5pm discharge was possible.

I was excited at the prospect that I could go home soon. But my excitement soon turned to confusion.

Yesterday, the patient opposite my bed was told more or less the same thing. Except the hospital seemed to have forgotten all about her. It wasn't until really close to the discharge time before she panicked and asked Dr. Ignoramus, who said: "Oh I'm not sure, why didn't you clarify with my senior doctor this morning". Confusion ensued but she did eventually get discharged.

I didn't want the same thing to happen to me. So I wobbled out to the corridor looking for someone to clarify what to expect.

The first person I saw was Dr. Ignoramus keying stuff into his laptop. I asked him what time would they do the next check up. Cue catchphrase: "Oh I'm not sure, why didn't you ask the senior doctor just now?"

Oh god, this guy is like some broken record Non-Playable Character in a RPG game.

So I tried my luck with the next nurse I could find. She did the most logical thing and grabbed my folder. What the folder said was a total surprise:

"Discharge at 5pm."

That's it. I asked her if the doc was coming back to check on me again as promised said so just 15 minutes ago. The nurse went looking for help, got waved off by Dr. Ignoramus, and fetched me another 'doctor'.

One look at this new bespectacled player and I knew she was another Houseman (I confirmed this with a nurse later on). Dr. Marissa Chua was the polar opposite of Dr. Ignoramus and a real piece of art. She was arrogant, condescending, and totally bordered on rude. She had 'Singaporean Chinese' written all over her face but put on a grating pretentious accent.

I told her I wanted to clarify my status, am I being discharged at 5pm?

Dr Marissa: "If you want to go home, then go."
Me: "That wasn't what the doctor said just now... "
Dr. Marissa Chua: "So do you want to go home or not?"
Me: "Yes I do! But I want to be sure I am certified fit."
Dr Marissa: "Ok, we're certifying you fit to go home."

-Takes deep breath-

Me: "Can I speak to Dr. Liu?"
Dr Marissa: "She's a consultant. She will see you if she wants to, you don't get to ask to see her."
Me: "The senior doctor this morning said I'd be checked again this afternoon before giving me a confirmation on discharge."
Dr Marissa: "Ok, we'll check you in the afternoon again if that's what you want."

Turned around, rolled her eyes and stormed off.

Wow. Just wow.

What's wrong with the Housemen in this hospital??? 

Why can't they act a bit more... normal.

15 minutes ago, the test results for my blood wasn't even ready yet for a conclusion and 15 minutes later a Houseman acts like I'm the one who wants to hang around the ward.

Or maybe she's actually a fabulous doctor. The sudden exasperated fury I felt took my mind off the pain for a short while...


Breakfast came along.

I am out of vocabulary to describe how bad my Vegetarian Kway Tiao breakfast was. But I am proud to say I ate 3 bites of it. 3 WHOLE BITES! I must have been famished.

My stomach threatened to hurl if I put another piece of morsel into my mouth so I drank Milo instead.


A Houseman a Day Keeps Your Sanity Away

Since I was likely to be discharged soon, I was given a feedback form from the nurse. I nursed my silly little wounded pride for a while and decided to write something after all. So I tottered to the Nurse Station with feedback form in hand (I could walk with less pain now yay!) and asked for her name. That was how I knew she was "Dr. Marissa Chua".

For some reason, parading around the Nurse Station with a feedback form asking for names gets you attention.

The creepy Houseman suddenly appeared from behind me as I was setting my laptop up by my bed. I almost jumped as her fake accent sounded "Is something wrong?" I snapped around in time to see her eyes flutter to the feedback form lying at the foot of my bed.

Gosh, some people need to learn how to do proper damage control. Dr Marissa's face was almost twitching as she tried to restrain herself not to punctuate her sentences by rolling her eyes this time. I was unimpressed as she repeated that I could choose if I wanted to stay or leave. Why on earth would she imagine anyone would choose to stay in the hospital??

So I asked her about the medication. Do I continue the previously prescribed medication? She didn't have an answer. I gently suggested perhaps she may want to ask a doctor who actually knows what's going on. "It is not normal protocol to call on a consultant for such trivial matters."

Well then give me an answer to the trivial matter! She couldn't, and said she'll go check. That was the last I saw of her for what I hope is forever.

5 minutes later, in pranced Dr. Ignoramus. I could hear his answer before asking but I asked him anyway about the medication. Indeed:

"Oh why didn't you ask the senior doctor this morning?"

I wanted to cry. What kind of answer is he expecting every time he fires that question back at every patient's query??

After 3 days of hearing him say the same thing, it was my turn to twitch my face as I restrained myself. And no he can't call Dr. Liu o ask either. He explains:

"For C wards, it is not standard protocol to call a consultant if the consultant didn't choose to come herself."

Ladies and gentlemen, that sums up how healthcare works in Singapore. Pay for an expensive ward to get a real doctor's care or shut up.

I was in B ward actually, but I think it was the same to them. I didn't pay enough.

Should I use my 2-week hospitalisation leave to join the priority queue at the Parliament House to pay last respects to LKY?

To his credit, Dr Ignoramus did eventually call Dr Liu for instructions. I think we're both glad he did as the medication and injection she decided on was not that straight forward. (This is sad, did I just applaud him for doing his job)


Let's see, I've griped about the Housemen, the food... Oh yes, 1 more thing...

The day I was admitted, a young physiotherapist measured my ankle to get my size for the compression stockings. (Supposed to prevent blood clots. Compulsory for inpatients to wear.) She then told me to turn my ankles 10 times every hour to prevent stiffness.

This whole 5 minutes affair cost me $65 on the hospital bill under "Physiotherapy session". Not including stockings. (Photo of said stockings here)

------

Ok, I'm done with my hospital adventure. I promise my new posts will be more positive and less grouchy!


OHSS Log - Today's BMI: 20.2 (OMG)

Backstory on my BMI:
The last time my BMI was 20.2 was more than 5 years ago when I was binging like a cow. I reached 20.3 (60kg) before I decided I was getting too chubby. I adjusted my BMI to 17.6 (52kg) in less than a year and hubby started complaining that I had gotten too scrawny. I lost another kg, reaching 51kg (BMI 17.2) before deciding it was ok to put back some pounds. Since then, I've consciously controlled my BMI to fall around 18.5. Seeing a 20.2 BMI today was kinda demoralising.

The Vegetarian Kway Tiao breakfast.

Day 2 in the hospital...


25 March 2015 (Wed)

How do anyone sleep in a shared ward??

Here I am at KK Hospital, warded in what they called a B2 ward, together with 5 other luckless ladies. Hubby had tried to admit me to B2+ ward but beds were fully packed.

B2 ward according to the brochure comes with:
- 6 bedder
- Common bathroom
- Public telephone
- Common TV at waiting lounge

B2+ ward comes with:
- Air condition
- 5 bedder
- Shared bathroom
- Public telephone
- Common TV at waiting lounge

The only plus point in the B2+ ward in my opinion was the aircon. But the room I was in was very near the nurse station. And the air condition in the corridor for the nurse station gets filtered in. So the ventilation and temperature was rather comfortable. The common toilet was right outside my room too. So it wasn't that much of a difference from a B2+ ward.

Until night fell.


Night Time Non-Adventure

I assume an officially air conditioned ward would have a door. Because this ward doesn't come with one, and the walls beside the corridor was semi open at the top. This meant the light from the corridor and nearby nurse station comes in strong. This and the CHATTER at the nurse station.

First night was hell.

The pain had settled in a bit after the painkillers and nausea injection and I was looking forward to a good night's rest.

10:30pm. A party of 10 must be taking place at the nurse station. They sounded happy. There was laughter, the chattering was excitable. I'm pretty sure there must have been pizza too. It was impossible to sleep. IMPOSSIBLE. I tried.

11:30pm. I gave up. Wincing at the throbbing pain in my abdomen as I got up, I pushed my drip stand slowly out of the room to the nurse station. To my absolute surprise, there were only 2 nurses there. Neither paid me any attention while they continued to gossip boisterously about this patient they were dealing with. Finally, one of them looked up at me when I stood in front of the station and said "Yes?"

I swear I put on my most apologetic smile and asked "Could you please keep the volume down a little please..?" I hope they don't spike my drip.

They looked surprised. And indignant. But a split second later, "OK." I'm not sure what to make of her smile but I ambled back to bed.

It took them more than 15 minutes to finally settle down. But the message tones on their mobile phones continued to chime throughout the night.

It didn't end here. I didn't know exactly how the other patients were sleeping, but the bed beside me apparently slept like a pig. Well, she sure did SNORE like one. It was so loud that I could hear her inside the loo during one of my toilet trips.

I must not be the only person who thought so, or possibly asked for help. Because later on, a kind nurse, while doing her rounds taking blood pressure, passed me ear plugs, unsolicited. She's an angel from heaven!! The 3M ear plugs worked like a charm.

In between the nurses coming in and out, switching on and off the lights, I think I slept a total of 2-3 hours the entire night before the senior doctor and his entourage came in at 7am.

Dr Liu visited me a little later on too and determined my case was relatively mild but had to be observed a little longer.

So I spent the day taking little walks as recommended by the doctor, fighting my nausea, and continuing to measure my pee.

My pee was looking good. It got clearer with each cleansing. It was no longer the gross cocktail from yesterday, and by the end of the day, it was almost clear.


Pregnant with Water

A side effect of OHSS was a very low morale. My tummy is so bloated now that I look like I'm 2 months pregnant. Except there's no baby. I've also put on 4kg over the last few days thanks to the distension.

My abdomen have always been relatively flat, but now my ribs have gone completely into hiding.  I coped a feel at my self-esteem and I think it dropped a bit.

I think all women will understand. I mean, I'm all ready to inflate my belly for a baby, but certainly not for a bucket of water!

The only consolation is that both the doctor and nurses experienced with OHSS kept telling me my tummy still looks normal. I assured them this was NOT normal for me. "Well, your case is mild then" said one nurse. She had seen women suffering OHSS looking full term pregnant. Those they need to stick a pipe up the side and pump out the water.

Well ok I'll take 2 months pregnant.

Today's lunch. Sucks.

Take a deep breath. This is a long post on my OHSS peak experience.


24 March 2015 (Tue)

I got woken up by knives twisting in my abdomen in the middle of the night. I restrained myself for a couple of hours from waking hubby up to fly me to the 24 hour hospital clinic. This is Singapore; the most expensive city on Earth. The 24 hour clinic bill was not going to be funny. So I writhed in bed until the knives eased themselves back into their sheathes and I fell back to sleep. At daybreak, they danced inside me again. I woke hubby this time.

We're clean freaks. Or maybe it wasn't that painful enough. But we took the time to do the morning grooming thing.

I almost passed out in the shower.

I couldn't see a thing. Before my knees gave way, I managed to shut the tap and found my way to the toilet bowl. I slammed the seat cover down and plopped myself down to catch my breath and will the darkness away.

Then someone punched me hard in my guts.

I immediately pivoted around and slammed the seat cover back up, retching all my innards into the potty.

Water. All water. This was the first time in my life that all I threw up over 10 minutes was clear water. Since when did I drink so much water??

Time had stopped. I dressed myself with my life.

Dr Jerry Chan decided I had to be admitted for observation and commanded a drip to be put on me immediately. He was still adamant that my pain placements were not typical symptoms of OHSS although everything else pointed towards it. He had to leave the country in a few hours so the hospital shall do observation on me.

Hospital bills. Singapore. Not funny.

The first thing I said to hubby to the news that I had to be admitted was "Please check my insurance."

I entered Ward 44 with much grandiose, hurling resoundingly into the plastic bag while the nurse wheeled me across the corridors and to my designated bed on the wheelchair. The world was the bag in front of me. Water regurgitated out violently into it while my guts convoluted.

Amidst all that, I managed to comprehend all the patients and nurses alike that stared in horror and basically took a step back.

No vomit, all water. The nurse took a visible deep breath before taking the bag from me after the spectacular display.

The moment I was helped onto the bed, the nurse whipped out a piece of paper and started asking all sorts of questions for the registration. (Hubby was doing paperwork at the admission department. Probably answering the exact same questions) I was still breathless and could hardly squeak out the string of numbers on my ID. But she wasn't giving up. It was her SOP. We went through her pointless questionnaire (This same hospital have asked me the same questions like maybe 50 times since last year. Can't they pull up the information from their internal system goddamit) and I finally got a chance to catch my breath.


Hospital Stay - Day 1

The first thing they did after I sinked into the bed was to serve me lunch. I hadn't eaten a morsel the whole day but my guts were angry at me for some reason. The food might as well have been slabs of stone. The soup tasted like what I puked out not too long ago. The sweet and sour chicken was actually delicious but all I could take was 2 bites before my guts threatened to hurl again. The lychee jelly was comforting, but all I could manage was to slowly slurp down half a cup over 3 hours.

And that was all I ate.

Compression stockings they made all inpatients wear. Quite comfortable to sleep in actually. (Photo taken day of discharge)

The drip the doctor had demanded on me had still not arrived. But my mum did. She looked sick with worry. I struggled to explain OHSS in detail to her in Mandarin and failed hard at it (Found out later that it's called 卵巢过度刺激征。Very literal). Hubby was still caught in the web of admission paperwork somewhere, not that he would have been of much help with the explanation.

A young male doctor pranced in then. He brightly asked me to explain to him why I was there. Seriously. Surely there's a folder with my details somewhere in KK hospital. I certainly wasn't here for the food. Thank goodness I more or less had my breath back and managed to recount the ordeal of the past few days, wondering with every sentence why couldn't he just flip my folder.

At the end of it, I asked how was my condition. He then apologetically said he's just a junior doctor and doesn't know much. I should ask the senior doctors who will do the rounds tomorrow morning. I tried to quiz him a little more and he said he's really not the best person to answer. I later learn that this was his catchphrase. Along with "Why didn't you ask the senior doctor just now" to every single question. The nurses were way more helpful with my queries than him.

(By the end of the hospital stay, I would be so annoyed with his whiny "I don't know anything I'm just a junior doctor why didn't you ask my senior just now" answers that he is really lucky I didn't... that I didn't.)

His name? Really hard to pronounce. His name tag read something like Dr Ignoramus Chua.


So How Exactly Was My Condition?

Thank goodness for me the consultant decided to visit me soon after Dr Ignoramus failed miserably to draw blood from my arm in front of a couple of smug intern nurses. (The senior staff nurse saved the day.)

Dr Liu is an angel. And she managed to describe OHSS to my mum in Mandarin flawlessly!!

According to her, there is no actual medication for OHSS, just some drugs to suppress and calm my hormones down. It is a condition with a curve where the symptoms will peak and then I will get better afterwards. She thinks I have not peaked and that's why I'm at the hospital being observed to catch the peak. (Thankfully, looking back now, I think the violent hurling WAS the peak.)

The worst case scenario was a long hospital stay. Expect a tummy so distended with liquid that it will have to be pumped out via a tube at the side of the body. That and even more severe pain.

They had to make sure the water in my body goes out. So I had to record my pee schedule religiously.


All About That Pee

My job hereafter was to pee, pee, pee.

Easier said than done. I dreaded every trip to the loo.

By now, I amble slower than hubby's 85 year old granny. The impact of every step sent a bolt of lightning up my abdomen. Every trip to the loo was a mission to battle with the intensely crippling pain in my torso. When I finally reach the toilet located outside the room, the toilet seats were usually dirty and the floor wet. So I struggled with my balance on the wet floor, trying to clean the toilet seats with one hand, and holding on to the drip stand with the other.

By the time I was done, I would sit down breathless onto the potty. But not before placing the measuring cup holder on the seat.

A searing fire will then build up in my lower abdomen, burning fiercely while I clench my fists and piss fire.

The. Pee. Was. Gross.

Pungent thick orange liquid with white styrofoam-looking stuff floating in it. I assumed the white 'styrofoam-balls' were remains of cultured progesterone. I wasn't that enthusiastic to find out more.

As instructed, I sample-peed into a cup for them to do tests on the first time I peed there. When I tried to hand it to the intern nurse standing outside the toilet, she looked at the cocktail and panicked. She nervously and desperately looked around and in relief pointed to the nearest staff nurse to pass my pee to.

I think she's cute.

First meal there. Spoiler Alert: The food department went downhill hereafter for the rest of the hospital stay.

The pain didn't go away. It got worse. After 3 doses of the gastric medicine on Sat and Sun, the conclusion was this was no gastric pain. I could still eat. But nausea had started to settle in at the same time.

Peeing and pooing were painful, but I went regularly.

21 March 2015 (Sat)

The pain was intense. It felt like gastric pain, except I still had the bizarre appetite of a hippo.

I was supposed to do my very first fresh cycle embryo transfer today.

The lower abdomen was all cramped up, while my torso was attacked by knives. The impact of every step would send a searing pain to my abdomen. I walked like a granny, face twisted in pain, close to tears.

And several people in the waiting area of the KKIVF Center stared at me aghast. I could so hear their petrified thoughts screaming: "Oh my god! Which procedure did she just do?? Am I gonna suffer that pain too??"

Sure the queue there had always been long. But I really suffered physically at the painfully long and my patience tethered. I  was at risk of OHSS due to the sheer amount of eggs harvested (36 eggs), and was supposed to get a blood test done at 9:30am to clear the risk and the procedure at 10:30am after the blood results are out.

I never saw the point of an appointment time if coming on time meant having to wait an hour at least. But that's apparently how Singapore hospitals work.

The doctor couldn't wait past 11am though, so I was ushered into the procedure room soon after my blood was drawn, before the results were out.

I popped on the same operation gear from the Harvesting. Hubby could join me this time and he put on a simplified version of the gear too (a pullover gown, shower cap, and shoe covers).

Dr. Jerry Chan confirmed that the pain I was suffering was not typical of the pain induced from the egg extraction. Yet, from his quick ultrasound, it didn't look like OHSS as there was no abnormal liquid quantity in my lower abdomen.

He decided it was not sensible to go ahead with the Embryo Transfer in this mysterious pain. I was devastated and relieved at the same time. The pain was getting hard to cope and I wasn't sure if I could deal with the transfer at the same time.

So the new plan is a Blastocyst Day 5 transfer. He'll give me gastric medicine and hopefully the pain goes away, and we go back for a transfer next Tuesday.

Have you ever met the dude who goes "Oh is test tube baby the one where you grow the baby in the test tube?"

Anyway.

IVF Intro For Noobs

IVF (In Vitro Fertilization) in a nutshell works like this:

1. They take out the female's ovaries.
2. Your man squirts into a cup.
3. You inject the strong-looking sperms individually into pretty-looking eggs, cultivate them some, get 'em all fertilised and create embryos
4. You put the successful embryos back into the female's womb.
5. Pray hard for the embryos to mature in the womb and grow, grow grow.

That's the summary. Sounds pretty straight forward and easy peasy yes? Wrong.

The details are painful shit.

All the needles I used over the past few weeks. Felt like some kinda junkie

IVF - Slightly longer version on how it works.

Before you enthusiastically yell "Take my eggs!" there are a bunch of steps you need to do to prepare your body for the tribulation. I did the long cycle and here's what transpired.

1. Inject yourself with hormone suppressing drugs called Lucrin on a daily basis. (I did this for a total of 25 days)

2. 2 weeks into the Lucrin injection, also inject yourself with Menopur to stimulate your ovaries to produce follicles on a daily basis for approximately 2 weeks (I injected this for 11 days).

3. Go through Transvaginal Ultrasound to check your follicle count and size every other day after you start on the Menopur injection.

*Transvaginal Ultrasound is painful shit. I dread this part.

4. After they are satisfied that you have an adequate number of follicles of adequate size, they'll inject a final dose of this drug called Impregnyl into your bum.

5. They harvest the eggs a couple of days later.

6. You gotta insert this sticky little white ball progesterone down there for the next few weeks.


Complications / Side Effects

The hormonal side effects from messing with your hormones from Lucrin is relatively a walk in the park. You may or may not get migraine, heat flushes, and some other PMS stuff off-schedule. Personally, I got heat flushes, really bad migraine, and insane thirst for the first few days. It went off after a while.

Then there is this more serious side effect that affects about 1-2% of the women who do IVF called Ovarian Hyper Stimulation Syndrome or 'OHSS' in short.

Basically, I struck lottery.


OHSS

OHSS happens when your body reacts way too well to the drugs and produce much more follicles then expected. The hormones go haywire and start pumping liquid around your body. You get all bloated up and god, it hurts like hell. Serious cases will land you in the hospital bed for up to 3 weeks while they pump the liquid out of your system through a tube. Mild cases go away after a while. Mine was probably 5 on the scale of 1-10 in terms of seriousness based on what I read in other forums.

The average number of expected stimulated eggs to be harvested are around 10-15. I had 36 eggs. Well, this was apparently not a case of 'the more, the merrier'. This just meant I was in serious risk of OHSS, which I did eventually get.

More on this brouhaha in The OHSS Ordeal.

The needles all lined up.