Our Dialogues with Pain: Ovarian Torsion, Surgical Menopause, and Identity

Today we’re going to change tack. A lot. And talk about that day last spring when everything and nothing changed.

It was April 5, 2018.

My husband was traveling for work and it was otherwise a normal Thursday morning before school with the boys. I’d woken up a little crampy but dismissed it as muscle soreness and hopped in the shower before getting the kids up and dressed. I was getting noticeably more uncomfortable but still dismissing it, as it was a school day morning and I had things to do. Pain was not on the allotted schedule.

Then suddenly I landed myself in the bathroom and things started spiraling out. It must have been food poisoning. Or the aftermath of some stupid colon cleanse I’d gotten on Amazon a few weeks before in my never ending quest to rid my body of imaginary toxins. Suddenly I was sweating through my clothes. In and out of the bathroom. Dry heaving. Balled up on the floor. Trying desperately not to alarm my kids, who really did not need to see this.

As calmly as I could, I asked my 7 year old to make breakfast for himself and my 5 year old. I had absolutely no idea what was happening but my single mission in life became getting my kids to school so that I could deal with whatever the hell was going on in time to pick them up again at 3.

I tried showering again. I curled up on the floor. I changed my clothes no less than 3 times since I kept sweating through them. And at some point I got myself into a position on the house steps that seemed to be relieving whatever was happening enough for me to speak and otherwise function.

To this day, looking back I have no idea how I did it but I got my kids into the car, dropped off my 7 year old at elementary school, and then walked my 5 year old into preschool. The fact that I had to get out of the car and walk him into school was the single most terrifying part of the first stages of that morning. I have no idea how I did it but I somehow walked from my car to his classroom and back that morning, even said hello to people along the way, masking what was fast becoming the most excruciating pain I’d ever felt – childbirth included. During that first hour or two my single mission in life was to get the kids dropped off and buy myself the 6 hours of school day to deal with what at that point I’d convinced myself was just a really, really, really horrible case of food poisoning.

I got home and got to it. Ran a bath and got into it to ease the cramping. It didn’t work at all. I ended up curled up in the bathtub in blistering pain that was by that point radiating into the rest of my body.

I decided I was dehydrated and that that was what was making it so bad. I sipped a little water. It came back up. Violently. At this point I had given up on clothes and was curled up on my bed, or dangling off the side (depending on the minute), starting the “wagering with God” portion of the morning.

It was at this point that I decided that at least telling my husband what was going on was a good idea. It was around 10:30 at that point and things were only getting worse. As I’d mentioned, he was out of town. The call went something like this:

“Hi – honey? I need you to stay really calm right now because I do not have the bandwidth to process your freaking out. Something is wrong. Everything hurts. I am going to get it under control but, um, I just felt like you should probably know.”

He started asking “problem solving” questions and I basically hung up the phone.

This is roundabout the portion of the morning and early afternoon when my wagering with God expanded to rationalizing the pain. I became deliriously exasperated with myself. This was only pain. Pain is temporary. Pain is in my mind. I can control this. There is no reason that pain should be able to overwhelm me like it was. I am not my body. I am not this pain.

By around 12:30, a handful of failed attempts at solving this little problem, and a few increasingly panicked phone calls from my husband, later, I began to admit to myself that whatever was going on it was not going to be fixed in time for me to get the kids from school and carry on with my day. Whatever was happening had become so painful that I was basically just crying at that point, hitting the bed, bargaining with God, and deliriously continuing the whole “what’s wrong with you – pain is in your mind dammit” inner dialogue. My vision was actually blurring but I somehow managed to dial my husband and tell him that he needed to reach out to our friends here and figure out what needed to happen in order for them to pick the kids up from school for me. My husband told me he was calling 911. I begged him not to. I was completely fixated on the image of them strapping me onto a stretcher to take me to the hospital. I was balled up in fetal position on the floor in an attempt to relieve the ball of fire that was centered in my abdomen and remember just repeating to him over and over again that I could not lie straight in the way that they would make me to strap me down. That vision of them strapping me down onto the stretcher had completely taken over in my mind.

A few minutes later my phone rang and it was my friend saying that she was on the way. (Clearly my husband had not listened when I’d told him that his only job was the kids….) I had no idea what was happening but something snapped and I just begged her to hurry.

I feel like it’s important to clarify a few things at this point. The pain was worse than anything I’d experienced in childbirth – and I’ve gone through unmedicated transition twice. But I think what made it worse, and scarier, was that this was pain without a known end or reason or purpose. Something was just very, very wrong.

At this point I realized that *someone* was going to call 911 and all I could think to do was pull on some clothes so that I wasn’t naked when people started coming in and stumble down the stairs to crate my Great Dane so that she wouldn’t pummel a bunch of strangers busting in and starting to work on me. Once I got her crated I fell onto the couch on the first floor – well I was sort of half on and half off – and cried and prayed and bargained and, in my spare moments, continued to berate myself for letting pain overcome me like this.

At some point my dear friend, God bless her, came busting in and I could half hear her talking to the 911 operator. I heard her telling them I was bright red and sweating through my clothes. I heard her tell them that I was delirious and incoherent and I heard them tell her to keep me talking so that I wouldn’t pass out. This all somehow felt accurate and melodramatic at the same time. I slurred something about food poisoning.

The paramedics came running in soon after. I’d been braced for having to answer questions. The thought of it was completely overwhelming to me. That said, every medical professional that came into the house that afternoon was wonderful. I remember dry heaving – not dainty gags but big, awful, full body noises as my body tried to exorcise whatever the hell was happening to it. I kept apologizing to everyone in between, mortified.

They ran over with a huge trash bag for me to throw up into. They ran an IV and gave me fluids and Zofran to calm the nausea, which actually did help a tiny bit in that it began to help to confine the pain to my abdomen again.

Then I had my real moment of glory. One paramedic asked me to rate my pain on a scale of 1-10.

Now, understand that I have always heard a 10 described as surgery without anesthesia. And I have “non-alarmist” so heavily ingrained in me that what happened next can only be explained by my desire not to appear overly dramatic combined with my bizarre need in that moment to be able to go up a number or two if it got even worse.

“Um…a 7?”

Even in my fog I could sense the room going a bit quiet for a beat. Looking back, I was the definition of a pain level of 10 in that moment. The friend who was with me later told me that she has never wanted to kill me quite so much. My sheepish explanation, later, was that I was afraid that they would dismiss me as dramatic if I just blurted out 10. The 7 just felt like a….thinking (wo)man’s answer.

I pled for pain meds – but they explained that the hospital had the good stuff and that if they gave me anything else in the meantime it might delay their ability to give me anything stronger once I was in the ER.

Suddenly I was belted onto the stretcher and being wheeled out. My little street was covered in emergency vehicles – fire engines, a standard emergency response vehicle, an ambulance. Granted not much happens in my little town, so they tend to bring out the big guns for anything – but holy embarrassing. I do not like being a spectacle. I hid my face.

And at one point I remember crying, “I run marathons. I swear. I’m stronger than this…”

They put me in the ambulance. This is all a blur, as all that I remember was lying there in horrible pain but wondering if I should be making polite conversation with the paramedics that were in the back with me. I think at one point I tried and they told me to just relax. Then I remember crying about my kids and they were pretty wonderful about distracting me.

When I got to the (first) hospital they got me into an ER room right away and gave me a painkiller called Toradol. I was so relieved when I knew it was coming…but equally as horrified when the minutes started ticking by after I’d gotten it and it wasn’t doing a damned thing.

It is very hard to judge your own pain in a way that allows you to advocate for yourself in the way that you would for a loved one. How was a potent intravenous dose of Toradol not doing anything for me? Recommence the inner dialogue about the pain being in my head. About not wanting to be the patient that complained.

I was alone in the ER room at that point and weeping. Someone walked by. It was the chaplain. She came in and tried to talk to me. She put her hands on my head and prayed for Jesus to help me. This all became very awkward, as I am Jewish but didn’t want to interrupt her. She also kept talking to Jesus about how I was all alone, which kind of added insult to injury. Still, I figured it couldn’t hurt and let her do her thing. I needed any help I could get.

The doctors came in and the chaplain excused herself. There was a brief moment of comic relief when I shared the whole Jewish thing with them. One of them joked that at least my lashes looked good. This is the good thing about extensions. They look good even when you’re otherwise at your worst.

In short, everyone was trying to distract me.

Some quick conversations clarified that the only thing likely to cause this level of pain in this area of the body was an ovarian torsion. With kidney stones being a remote second possibility – but apparently they aren’t as bad. (And yes, I have heard that they are quite bad.) In my delirium I told them that I’d had an ovarian torsion already once before. When I was 8 years old they’d found a grapefruit-sized cyst on my right ovary and fallopian tube and I’d lost that side of my reproductive system.

Lucky for me my left side had picked up the slack since and, while it hadn’t been easy, I’d managed to have 2 successful pregnancies with my boys to show for them. That said, another torsion seemed like winning some horrible lottery.

They started morphine. It did nothing. I cried and told them that I swore I could handle pain better than this. I needed them to believe that this was real – but even as much as that, I needed to justify this to myself. Looking back, again I think this was 1,000 times harder because I was alone. I had no sounding board. No one there who knew regular me or that my pain tolerance was insane and that something that I was reacting to like this had to be very real and very serious. They gave me more morphine. And more. Still nothing.

There were cat scans to check for stones. And then the ultrasounds started. I laid there crying through all of it. The pain was unimaginable and my imagination had started to get the best of me. My husband and mother were both on their way to Florida at that point but it wouldn’t be until late that night that either arrived. I was alone in the ER crying through ultrasounds and begging them to tell me what they were seeing as they went from external to internal and I kept hearing the telltale “measuring something” click-click, click-click, click-click. I cried from the pain. I cried about my kids. I begged them to tell me what they thought they saw. They finally told me that my remaining ovary just looked “very enlarged”.

It was becoming clear that I was going to need some sort of surgery and they didn’t operate in the facility where I was at that point. I would need another ambulance ride to another hospital. I’d had a strong dose of Toradol and several doses of morphine to no avail. It was at this point that they started giving me Dilaudid. The first dose of that was the first thing that even began to take the edge off. Praises.

I got into the next ambulance. I again laid there and wondered if I should make polite conversation with the paramedics. They were, again, wonderful. They got stuck on I-4 and turned on the siren. Again, it felt half appropriate and half melodramatic. I got to the second hospital. They got me settled and gave me more Dilaudid. For the first time since around 7 o’clock that morning, I could function beyond the pain. I was still scared but I could think coherently. I became aware of the number of people that had gotten piecemeal messages from me or loved ones throughout the day and decided to check in on social media with a quick update and a trite-ish request for any good juju that people could send my way.

To this day, I got more engagement on that Instagram post than any other image I’ve ever shared. God bless that wonderful community.

The surgeon finally came in and mentioned that she’d been told I was in excruciating pain but “I seemed okay”. I might have hissed that I’d had a dose of Toradol, several doses of morphine, and 2 doses of Dilaudid to get to this state of apparent “non-urgency”. She started trying to talk over my head, flying through questions on a form like she was crossing t’s and dotting i’s. I told her to slow down and please explain what was going on. To her credit, she very quickly changed tack and talked me through the situation.

The short answer was that at that point no one knew. My ovary was extremely enlarged but they didn’t know if that was the root cause of the pain or something else was at play. They’d go in initially to explore the area. Especially since I’d already lost one ovary, they would save this one if they could. (Spoiler: They couldn’t.)

At around 8 o’clock that night, they wheeled me into surgery. I went to sleep. When I woke up my mother and husband were there and my last ovary was not. My kids were home with our then sitter. The surgery had been laproscopic, so I didn’t have much for scars, and short of being forced to spend a few days in bed healing – during which I indulged in a Marvel movie marathon (say that 10 times fast) and tried to come up with ways to be productive from bed – I was honestly fine and with a level of love and support from friends and family that was amazing.

I later saw a picture of the ovary when they removed it. It was huge and black. Completely dead. Looking back, there had been other instances where I’m sure it had twisted and then gotten itself undone. One night in Epcot when I was in horrible pain that suddenly released. One afternoon in the queue for Navi River Journey at Animal Kingdom with my mother and her friend when I’d gone down to my knees a few times and been afraid I wouldn’t be able to take them on it – but, again, it had released and I’d gotten on with my day. I have no doubt, in hindsight, that the organ had been tortured for awhile before finally going out in flames that April day.

My physical scars healed quickly in the days and weeks that followed. I tried my best to take it easy at everyone’s advice and listened to my body as best I could, but I also went ahead and ran all three races, a 5K, 10K, and half marathon, of runDisney’s Star Wars race weekend two weeks later. Because I am a stubborn fool.

The Aftermath

It’s hard to say what’s “changed” since I lost my second ovary. The on paper answers are easy. I can no longer get pregnant. My body does not produce its own hormones. I went into surgical menopause overnight – which is a process that most women experience over the course of a decade or more.

I will have to take medications and supplements every day for at least 10 years, and on from there, and, over time, my risks for certain things, like cancer, are increased as a result. I need calcium and vitamin D3 and a few other things to keep the results of early menopause at bay.

Speaking of which, I also have to wrap my head around the word “menopause” – which sounds old and craggy to me in a way that makes me hesitate to type it out here without paragraphs of proof that I am still young and vibrant and overflowing with life. My apologies to older readers for having to admit to that – please be gentle with me here and try to understand that it’s something that happened to me overnight. I have not had years to ease into this label.

All of this said, my day-to-day life isn’t really different in any way other than taking some more meds – which seem to be working as well as anything to keep any symptoms at bay. We have two beautiful children and I was very decidedly finished on that front. I had, and have, no desire for a third child. I love my children but I also love my current life and I have absolutely no desire to go through pregnancy or parenting an infant again. But the ability to carry a child was a part of my identity as a woman and there is something not-so-subtly different between choosing not to become pregnant again and its simply being something that my body cannot do. There are people who have heard what has happened and reminded me gently about adoption. I do not want to adopt a baby any more than I wanted to have a baby before all of this took place. This is not about wanting a baby that I can no longer have. It is about coming to terms with my body’s no longer being capable of doing something that I so strongly identify with being a woman.

I do not write any of this without understanding just how lucky I am to have had 2 babies before I lost my second ovary or just how many women aren’t in that boat. Philosophical identity issues are a luxury that many people don’t have. But they are still valid and worth exploring.

Pain and Identity

Setting that aside, the whole experience has also made me think quite a lot about pain and identity. Why was it so much harder for me to advocate for myself than it has been in the past to advocate for loved ones? Why was I so furious with myself for not being able to mentally overcome the pain? Why did I feel the need to rate my pain a 7/10 or to swear to the medical professionals around me that I ran marathons and was strong and had a pain threshold so high that this HAD to be real? Why was I so intent on not coming across as a hysterical woman alone in the hospital?

Why did I feel the need to apologize to the paramedics when my body was heaving violently in a way that insulted my usually composed and proper and ladylike demeanor? Why did I lie in the ambulance in excruciating pain and wonder if I was being rude to the medics around me? And why, through all of this, was I more worried about picking my kids up from school in time than what the hell was wrong with me?

Why was it so hard to ask for help? And if, God forbid, anything like this ever happened again, how much kinder could I be to myself that time around?

Also? My God. I apparently went through this same thing when I was only 8 years old. It had been the same telltale twisting and untwisting for weeks before it got itself tangled in a way that wouldn’t come undone. Weeks of being an 8 year old that was complaining about excruciating pain that would suddenly disappear at the snap of a finger – so of course the adults around me, at no fault of their own, thought I was overstating things. How strong was my 8 year old self to have gone through this? My older son turns eight in just under 2 weeks. Like any mother, I would take that pain tenfold for him before letting him experience a fraction of anything remotely similar.

I don’t know exactly why I’m sharing this today. It’s been a number of months since it happened. I think it’s taken me that long to look back on the full scope of the day and its aftermath with the sort of gentle memory that allows me to tell it. And, while it’s a very different story than the sort that I usually tell, I think it speaks volumes about our abilities, and inabilities, to honor our own needs and be as kind to ourselves as we unthinkingly are to those around us.