Category Archives: NHS

Are you the lady with the swollen cheek?

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Life is very busy at the moment with lots on the go and a number of projects starting to bubble away under the surface.. However, for the last month I’ve been struggling with a cheek problem that led to renal complications, numerous hospital visits and a lingering sense of -well its all not quite cleared up…

The meat of this post was prompted by this blogpost:  Lets Talk Sepsis by Vannesa Garrity. This is the story of my recent brush with what has not been admitted to as sepsis but as you will see…

I am a T2 diabetic, control could, to put it bluntly, be better. I’ve had a small fatty, soft lump/ cyst on my face for a few years now, always the same size  or near enough. Just before the end of February, in half term, it started to get sore to the touch.  Seeing as I had a review appt for my diabetes on the following Monday, I decided to let it lie until then. Was seen by the nurse for the clinic so came back to see the nurse practitioner the following day.  Got a script for Flucloxacillin and advised to come back if it got worse.

Everything was okay until Sunday – it hadn’t got any larger or smaller in that time. Woke up Sunday with it throbbing away (previously it had only been sore to the touch). After a bit of indecision, I finally rang 111 so that I could go and see a Doc in the OOH service.

I have used the NHS Direct service before but it obviously the service has changed and not, I think, for the better. All I wanted was to be told, yes you can go to see the doctor, because I knew that was what I needed. At no point was I asked about pre-existing conditions just the operator obviously going through a series of templates which required information that I’d already given her (by the end of the phone session about three times or so.) . She told me at the end that I didn’t need to be seen urgently,  that within 6 hrs should do and she fixed me up with an appointment at the local urgent care centre for a couple of hours hence. Phone call took about 15 mins in all.

Child care arranged, Hubby took me down – we both expected that they’d take action to lance it. UCC was empty apart from a couple of other people to be seen whereas the casualty waiting room across the way was very busy.  Didn’t have to wait long and was called in to see a Nurse Practitioner.  History given, temperature taken (apyrexial – more on this later) , medication queried and asked if it was due to hypertension or just diabetes? Shrugged my shoulders and said Diabetes, she checked my BP anyway. After checking my blood sugar and finding that it was up  and looking as though she was thinking of admitting me because of that (!), I explained that I’d only had lunch an hour or so before I came, but she looked at me as though I was lying… Anyway, she put a piece of granuflex on the abcess then some primapore (not asked bout any allergies). I queried this – had a bad reaction to adhesive dressings this time last year, she replied with oh there’s hardly any reports of allergy from primapore. I was told to keep it on until Tuesday at which point I could take it off  and I should see a blister forming or it might drain by itself – ‘one of her patients had one on her breast and it worked on her.’

Study day all the following day – really shouldn’t have gone, face was incredibly sore, abcess was throbbing. By Monday night it was actually painful to eat around that area of my mouth.

Tuesday am saw me in Nurse practitioner’s room at my GPs. She asked as I came into the room with dressing on,’what happened?’ I explained about the Sunday and then we took the  dressing off between us.  Cheek now very swollen, up to around my mouth and cyst had obviously swelled in size. Was put straight into see the on call dr who took one look and called another GP in. After some discussion between the two of them and me, I was given a script for double strength Flucloxacillin and Amoxycillin and given an appointment for the doc in the am with the word ‘admission’ hanging in the air.

Next morning, I’m feeling so bad, I can’t find my glasses before I leave to go to the docs and really feel ill and weak. Cyst is beginning to feel like a third cheek. At the last minute instead of driving the 1.5 mile to the surgery, or indeed walk to it like I had done the previous week, I call a taxi.  (£10 for the return journey  – expensive decision!) . Into see the GP. Temperature tested again – still apyrexial. Feel very weak and wobbly, no fight about the admission decision. Sent out of the room while she talks to the hospital – why do GPs do this? Back in again and she says to go to the acute medical ward at the local hospital and then she launches into a discussion about a certain overdue screening test.  By this point I’m leaning on her desk feeling basically c–p, managed to park the discussion for later, thank goodness!

Eventually got into the hospital a couple of hours later, walked into the acute medical ward and approached the nearest HCP.  I said I’d been told to report here, and he looked at me me and said, Are you the lady with the swollen cheek?” Well d’oh.

He wandered off to find where I should be. To my relief, as the ward was very, very noisy, with telephones ringing, trolleys being pushed, teams of docs stood chatting, nurses talking, I was shown around to the next ward which is part stroke unit / part urgent day care clinic (best way to describe it). I picked a chair by a stretcher. Usual processing obs – BP was nigh on textbook perfect (ie abnormally low for me ), bloods taken and seen by Dr running clinic. kind of a surprise but he had worked with Hubby. I was more disturbed by the fact that there was a sign stating  ‘please do not remove furniture as we won’t be able to see pts.’  Gave the impression of a clinic thrown together to meet a need.

Hubby goes, I’m left to get cannulated and 1st dose of abs. In between these two events, I manage to produce a hypo out of nowhere (no lunch) despite the fact that I’m supposed to be running a high blood sugar with the infection.  I get on the trolley, snaffle a packed lunch and then proceed to be a wimp while the incredibly skillful, efficient and friendly charge nurse cannulates me.  At this point I’m not bothered if they admit me – I’m feeling  so ill.

Sent home that evening with cannula in the crook of my right arm to return in the am for more IVs.

Return just after 8 and luckily IV still works to the relief of both me and said Charge Nurse.  BP is still down. Still apyrexial despite the fact that I now have three facial cheeks. The clinic dr refers me to the surgeons who eventually ring back and sy, ‘its on the face, refer to plastics’, Plastics say ‘its on the face refer to max-facs’ . Fax for urgent referral goes off (Thursday).

This is where it gets scary.  Nurse comes up and says we need some more bloods from you. I ask why and she says the Dr wants to send of some more immunoglobulin tests. I nod but then she gets distracted and she hares off to do something else . I look at the card she has left and see the words ‘acute renal impairment’.   Uh uh.

Bloods are done, Doc comes and chats with me, asking about flank / back pain. I shake my head. He says that the bloods yesterday show that my filtration rate has decreased significantly i.e my creatinine levels have shot up and a couple of the other results are badly off.  Function has severely declined since my last bloods in February.  I have an urgent renal USS which shows no blockages.  Doc says it could be down to a number of things, antibiotics (apparently I’m on high doses) etc. If I’m no better by Monday, he’ll arrange further tests. Instead of the three lots of ivs I’m scheduled to have, I only have two. Packed off home (iv free) to come back Monday. Blood electrophoresis will take a week.

Friday, Saturday, Sunday I languish at home, barely functional.

Arrange childcare for Monday (younger child had been excluded on Friday 😦 )  and then head back in for more bloods.  Third cheek is now fairly fluctculent and feels as if it could burst any second. I’m due at an AAP meeting at 6pm where I’m scheduled to contribute.  Bloods thankfully are improving.  The question is then asked, have the Facs-macs been in touch with you?  No.

The clerk calls  them up and reports back. Apparently the consultant had only just looked at the Urgent (!) referral. They’ll be in touch in a few days. The clinic doc calls me back in, does a physical exam of the thing and decides he’ll send me for an USS of it (I think just a subtle way of applying more pressure to it) and then get me seen by the macs -facs people.  USS done, (no pop) and off in a hospital taxi over to a nearby city where the macs-facs people operate from.

I land in the A & E waiting room and am called in for screening. Yay, for the first time in this whole saga, they take my oral temp – using some disposable thermometers that I have never seen before. Blood sugar done. Two nurses look disapprovingly at the BP monitor and the senior one asks for an ECG to be done.  Okay, yes, my heart is racing and my BP is up, I can tell.  ECG is done and I make sure she knows I have LBBB before she thinks I’m having a heart attack on her.

Head & Neck SHO appears and decides to take me into their room in A & E. All I can see is the chair looking really like a dentists chair, rather than a couch… He is really very patient  but really, really, this ‘thing’ is not like a giant spot that needs squeezing to get rid of. He jams my cheek full of local – that is most painful by the way.  And takes rather too much pleasure in slicing and dicing it – he’d be good on one of these TV RL medic shows.  He obviously enjoys his job and is good at it.  Off home with a reduced antibiotics and instructions to get my GP to refer to them so that they can take the cyst sac out. Couldn’t get to the meeting as the local decided to spread around the lower part of my face for the rest of the early evening – I could only drink with the aid of a straw!

The next week I’m back at the GPs getting yet another script as there is a sizable lump left.  Back on the double strength antibiotics. No report back yet from the hospital day clinic but one from the head & neck people and strangely also an outpatient appointment arrived for head & neck for the middle of April.

I’ve finally finished the antibiotics. I still feel very tired and my appetite is dipping up and down. Diabetes feels very labile at the moment and concentration is still not up to what it was.  There’s still a small sore lump on my face with tracking swelling but nothing major. Just don’t feel up to yet another course of antibiotics though. Not sure whether I need to get some bloods done – if only just to reassure myself that everything is okay.

Thanks for reading – I believe that if not septic by the guidelines, I was  or on the verge of being so – even if all I had was a swollen cheek.

Don’t worry, it isn’t Appendicitis… random failures of communication and information in the NHS

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This is my personal story of a series of random failures in information and communication systems that affected me when I was an inpatient nearly 3 1/2 years ago. I never made a complaint – because really what was the point but if this happens in a (relatively ) well run and respected district hospital, what else happens elsewhere?

In May 2009, I began to suffer episodes of intense upper (Right quadrant) abdominal pain. I was eventually admitted three times over about a period of 4- 5 weeks with further follow up being done in outpatients.

Over that period:

 

  • I went through the admissions procedure three times – asked the same routine questions of tel no, address etc by the same team of admitting nurses three times.
  • Clerked in by the same team of drs three times. Only on the last admission did anyone react to the fact I told them about my LBB (NOT MI related!) so that they requested an ECG (perhaps previous requests had been made and ignored/ lost)
  • Had to go for CT scan. It was up to me to read the bottle of contrast medium and ask the nurse, “There’s a warning about Metformin here”Nurse: “Oh that’s right, you’re on Metformin aren’t you? I’ll ring the department!”  (Contrast media interacts with metformin and can result in acute renal failure) . Nurse came back and said, you haven’t had it for 24 hrs so you ‘should’ be okay”
  • When I got back from the scan I asked the nurses to put an interaction warning on my med kardex to say I couldn’t have metformin for another 24 hrs (according to the info I had been given by the US scanners) . Cue the med round at night, nurse said “No metformin for you.” I nod, “Yes drug interaction.” “No, you are NBM”
  • Scan results – this is over 24hrs since I was admitted.  Ward round, no mass seen  and don’t worry its not appendicitis either. (by this point I am in such pain that I need controlled drugs to control it.) . My next question is “Are you sure that is my scan result?” “Yes. why do you ask?”  “I had my appendix removed 10 years ago…” “Where are this patient’s notes?” (I was discharged a  few hours later with a promise to refer me to the ‘pain dr’.)
  • Finally got an appointment with the ‘pain and unusual syndromes dr’ after much contact with his secretary.  Arrive at OP to find that my appointment has been cancelled by the consultant. After much negotiation (ie stomping of my feet) I got into see him that day ( but at end of his clinic).  Found out that he’d called my home number to get a pre-history and because I hadn’t replied to his answerphone message, he thought I didn’t need his services. On checking of phone numbers we found that the number they had down on my notes wasn’t my home phone number. Remember, I’d only been through the admissions procedure three times and been for a gastroscopy, Barium enema during that period…
  • This one is a perpetual grouse for me. I’m diabetic T2 , why is it whenever diabetics are admitted they are suddenly considered too mentally feeble / unreliable to take their own blood sugar and then decide whether they need help or not? I had a bm taken one morning and it had dropped to round about 3.5 mmol/l (48 hrs NBM with IV in situ) . I didn’t think it was too bad but the nurse overruled me and gave me a 500ml bottle of lucozade to drink. I complied and expected to have another bm in a couple of hours. Next one was done about 8hrs later just before I was discharged home…
  • The first time I was admitted, I had been nbm for nearly 48 hrs and was told that I should have some breakfast and that I could the n go home. Nurse said she’d be back with it in a few minutes. This was 8.30. By 11.30 she hadn’t returned and I had asked again. By this time I *was* experiencing hypo symptoms, sweating, shakiness … The paper trolley was around so I bought  some *ahem* glucose off the trolley and self medicated. When I felt a little better, I wandered off and still recovering from the disturbance in my blood sugar and found a staff nurse to say I’d had a hypo and I’d had some sweets to sort it in lieu of any breakfast… Breakfast was promptly found and then she said I’d better do a blood sugar *rolls eyes*.

 

I’m mouthy and will ask questions, take things into my own hands, and am a person that will read instructions and look stuff up on the internet.  My story of what I consider to be some critical and what should be, avoidable, failures in the information systems is one that didn’t have any particular effect other than make some things harder for me – dealing with the pain (still undiagnosed) , numerous admissions to hospital, dealing with daily life and two SEN children amidst tests and OP apps, didn’t thankfully have any real effect on me but what if I wasn’t the person I am?  If these sort of random systemic failures happen to  me  then what chance does the public have.

Information and communication (both part of the same process) are vital to any sort of care system .  If information isn’t shared then it can’t be acted upon, if information isn’t recorded correctly then it cannot affect the subsequent care by any health professional, if information isn’t collected at the appropriate time then the right care can’t happen at the right time and in the right place.