It is depicted in the pages of nearly every biology textbook. Next to pictures of plump red blood cells, delivering oxygen and nutrients to other cells, are pictures of dull red blood cells with a characteristic sickle shape — clumped together, unable to flow to where they are needed.
Sickle cell disease looks unpleasant on the page and is even more unpleasant in real life.
While most people might associate having sickle cell disease with fatigue or anemia, many do not know that it can also bring about pain crises so violent, patients are rendered immobile.
"It feels like somebody has stabbed me with a knife and then twisted it," said La-Tasha Davis, 20. "Now imagine that pain in several places at the same time."
Such episodes can occur as often as several times a month for people with sickle cell disease, a genetic disorder that affects the hemoglobin, the crucial part of a red blood cell that allows it to carry oxygen.
Davis, a junior at North Carolina Central University, was diagnosed with sickle cell disease when she was 8 months old and has since been in the hospital almost 20 times for pain crises. Sickle cell disease kept Davis from enjoying sports and going on longer trips and play dates as a child.
"My best play buddy when I was a kid was Shirley Temple," Davis said. She was not allowed to overexert herself or be unsupervised for long in case she suffered another pain crisis and needed medication.
Sickle cell disease is a hereditary disorder. Each parent must carry a copy of the gene for the disease and pass it on to their child for the child to have the condition. People with only one copy of the gene are called carriers and do not have any of the physical traits of the disorder, such as pain or fatigue.
Pain crises are a hallmark of the disease and occur when the sickle-shaped blood cells clump and slow blood flow to tissues and organs. Besides pain, this clumping can lead to multiple organ failure.
"Society doesn't acknowledge how severe of a disease it is and how horrible these pain crises are," said Dr. Rebecca Kruse-Jarres, a professor of hematology at the Tulane University School of Medicine in New Orleans.
Davis has been in school when a pain crisis has hit and her teacher did not believe she was in pain.
In fact, the frequency with which sickle cell disease can land patients in the emergency room with crippling pain stigmatizes people with sickle cell disease as chronic complainers and drug seekers.
Care providers will often have a bias against people who seek treatment for pain brought on by sickle cell disease because there are no objective ways to measure the pain a patient is experiencing, said Dr. Lennette Benjamin, clinical director of the Comprehensive Sickle Cell Center at Montefiore Medical Center in New York.
Kruse-Jarres said race potentially plays a role in such biases. Sickle cell disease predominantly affects blacks. There are 70,000 affected people in the United States, and one in 12 African Americans are carriers for the trait.
But even after taking strong narcotics like morphine or Oxycontin and trying at-home remedies such as warm showers, there is often no way to override a painful episode.