When you receive the methotrexate injections to treat an ectopic pregnancy, they tell you that there will be ‘mild pain’ and that if the pain ever becomes severe, to go to the emergency room right away, because you could be having a rupture. I received the methotrexate injections at the hospital, late on the Friday night. We were discharged at 5am on Saturday morning. Come 12pm that day, the pain had started. And ‘mild’ is not the word I would use to describe it.
I called the doctor, because I didn’t want to overreact, but everything I was reading was telling me to go straight to the emergency room, if the pain wasn’t ‘mild.’ The doctor told me that the pain can get quite bad, and to take Tylenol to help, and only if the pain is severe after the Tylenol, should I go to the hospital. I then spent the next four days in terrible pain. But with a supportive husband, regular doses of Tylenol and the current pandemic allowing me to teach my classes from my bed, while in pain; I made it through.
That is, until early Wednesday morning, when I woke up at around 2am, writhing in pain. This pain was ‘severe’. I had Daniel google the other signs of a rupture, because I didn’t want to make a big deal out of nothing. But by 4am, I was crawling across the floor screaming and crying in pain. Daniel was no longer taking any chances, he helped me into the car, and rushed me to the emergency room.
The ER was amazingly quick to respond to my pain. Within minutes of being there, they had me on a morphine drip. I did not like it at first (it felt hot in my arm, and I felt like I could taste it), but I quickly appreciated the relief it gave me from the pain. The relief never lasted very long however, but they just kept giving me more morphine every time I told them the pain was coming back.
They sent me for an ultrasound to check for a rupture. Alone, I was wheeled down the corridor to another room, where a woman asked me what was going on, and once again I had to explain my situation. She began the scan, and I instantly began silently crying, facing the opposite wall so she wouldn’t see me. Only five days ago, I was getting a scan, in the hopes of seeing my baby. I tried to lay still while she moved the internal wand, looking for a rupture, but it was difficult because it was causing quite a bit more pain.
Then I heard it. A heartbeat. Is that my baby’s heartbeat? I quickly, instinctively turned and looked at the screen and asked, “is that the baby?” While the tears flowed from my eyes, she quickly turned off the sound and responded, “No, no. No baby, only ectopic.” Her words cut like a knife. I wasn’t allowed to say ‘baby’ because once you’re diagnosed with an ectopic pregnancy, it’s no longer a ‘baby.’ I told myself, it wasn’t the baby’s heartbeat. It was probably just my own heartbeat. But that thought didn’t bring me comfort either. I just wanted to be back with Daniel. I needed him in those dark moments where I couldn’t comfort myself.
She wheeled me down the hall, and then stopped, putting the breaks on the wheels, and leaving me for a moment in the middle of the hallway. Doctors passed me, as I lay in the bed, quietly choking back tears, alone. She came back, asking if I had dropped a flip flop (which is, I think, what she went back for). “No, can I please go back to my husband!” I snapped back at her, sounding far ruder than I had meant. At this point, I just needed my husband. And this lady wasn’t taking me there quick enough. Though, looking back, I do feel bad about the way I spoke to her.
Back in the emergency room, they gave me more morphine, since the pain was quickly coming back after the scan. They gave me the all clear for a rupture, and told me that a lot of people experience severe pain on the days that the methotrexate is breaking down the most tissue. They checked my HCG levels, and they had dropped significantly since the day before (I had been having them monitored), which supported their theory. They gave me a prescription of morphine pills to take home, and they sent me home to rest. They told me to take both morphine and Tylenol spaced out throughout the day. And to move around as little as possible, as there’s still a chance of a rupture until I reach zero HCG levels. But they were hopeful I was going to be fine, because my numbers were dropping so quickly.
I spent the next few days sleeping a lot due to the morphine pills. The severe pain went away within a week. But to this day (four months later) I still get sharp pains in the ectopic site (which apparently is very normal).
Throughout that journey, I had a lot of anger towards the word ‘mild’ and the doctors that used it when typing up the information sheet. Mild is certainly not a word I would use to describe the pain I went through. Since this experience, I have been on ectopic pregnancy support pages, and I can tell you that ‘mild’ is not a word that many women would use to describe their methotrexate and ectopic pain. Though, the experiences vary greatly, depending a large part to the variations in the ectopic pregnancies themselves. I will say though, that using the word ‘mild’ feels quite irresponsible to me. It leads to a lot of unnecessary stress due to worrying that you’ve ruptured. And stress can only increase the chances of a rupture.
I can only hope, that there will eventually be more information given to women that go through ectopic pregnancies, including the pain they should expect. I quickly learned throughout this process, that the doctors don’t tell you half of what you should expect in the weeks (or months) that follow an ectopic pregnancy treated through methotrexate injections.
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