Get well soon Red

So, the manky appendix was leaking infection for a little while before they took it out and the op took so long because they were trying to clean up the yuck and have a look at his other organs while they were there, apparently the biliorubin (??) levels were high which might have indicated a problem with his biliary tract somewhere, but everything looks fine.

Now he's being treated for a dose of sepsis and is going to be in hospital all weekend. He's got two holes for his trouble, but he looks and feels so much better than he did yesterday, he's got colour back and is quite comfortable most of the time. He's been prescribed tramadol as well as paracetamol but he only needs the paracetamol and hasn't touched the tramadol yet.

I'm very relieved and have treated myself to a dose of migraleve before I go to bed and try to catch up on some sleep!

Sounds good. Sometimes when infection spreads, it can cause problems elsewhere and you can get pus in the gallbladder as an example.

That's what they said, at one stage they were checking is kidney function regularly because it looked like his kidneys were having trouble with the infection but that seems to have calmed right down which is extra-relieving Apart from the stupid woman at the out-of-hours clinic on Tuesday night, he's really had the very best care and everyone's been super-helpful and efficient.

What happened at the out of hours care centre?

We got there at 01:30 and had to wait half an hour while the on-call doctor made herself a cup of coffee and chatted about her New Year with the receptionist, even though Red was doubled over with pain, throwing up, sweating and shaking in the waiting room right in front of her. (We didn't know she was the on-call at the time or I would have challenged her) Then when we got to see her she asked for a run down of everything that had happened so far. We gave her the potted history of the previous 24 hours including Red's first trip to his GP.

The on-call was quite antagonistic right from the off, treating us like we were an inconvenience. She found out that he'd been prescribed an antibiotic by his GP who (at the time) suspected a bladder infection. (In fairness to his GP, Red didn't have a fever and wasn't vomiting at the time, he also only had blood and protein in his urine, the pain was also quite general around the belly-button region.) She asked a lot of questions about him eating spicy food, whether he'd had any takeaways at the weekend and seemed quite fixated on it only being a bladder infection. She gave us grief about him taking ibuprofen early on in the day, apparently that's the worst thing he could have taken (as if we were going to know that) and also made a big deal about why we hadn't been giving him flat coke or lemonade to drink instead of sips of water, again, as though we should just know that.

She effectively reduced us to about 5 years old, made us feel guilty about taking up her precious time with a mere bladder infection and sent us home to take paracetamol until we could see Red's GP again at 08:30. I put my foot down at that point, how exactly was I supposed to get paracetamol, antibiotics or anything else into him when he couldn't even keep water down? His vomit was brown and green which couldn't be good or normal when he'd had nothing but water for the last 16 hours and was clearly deteriorating almost before our eyes. I told her if she sent us away I was going to take him straight to casualty and refuse to leave until he'd been seen, she ended up calling the surgical consultant and asking him to see us as soon as possible, probably just to get me out of her office!

I can't understand why people like that become health professionals, they clearly don't want to actually help, she really gave off a 'couldn't give a damn' vibe, zero bedside manner and didn't even look at Garry the whole time we were there. He felt terrible by the time we left with the referral, felt so insignificant and as though he was wasting people's time, or it wasn't really very serious, but at the same time walking hunched over because of the pain, totally grey and shaking. I am sure that if I hadn't been there and stamped my foot, he would have gone home and suffered until the morning It was awful to see and a horrible way to make someone in that much pain feel.

Luckily, we got to A&E and they were lovely, gave him paracetamol right away to bring down his fever, got him onto a bed in a comfortable position and got a drip up to get some fluids into him and he's had nothing but solicitous and efficient care since then. The surgeon came in within the hour and got him into x-ray, tested his urine and discovered leukocytes and nitrates (?) in it, then they got him up to the Day procedures unit to spend the day getting him stable before he had surgery, he was still vomiting and his fever kept spiking so they had to work quite hard to get him rehydrated and get him some pain relief before they could anaesthetise him.

You might have grounds for a negligence case against the unit. I think such attitudes are more prevalent in the NHS since the push to make nursing a graduate position.

Where was the negligence? I would push for a complaint though. Will post more later.

You are probably right. I did think that the nurse failed in her duty of care.

I'm pretty sure that was a full Doctor, not a nurse, she had that no-uniform thing going on and it was a Doctor that we were expecting to see.

This might have been her one and only break during the shift, especially if she was the only doctor on shift. Certainly when I did out of hours, I could only see patients once they had been booked in by the receptionist.


Reasonable as she would had no notes or anything to access.


Reasonable to ask those questions. Not sure what the working diagnosis was but sounds like it was heading towards gastritis which would have been triggered and/or made worse by spicy foods and ibuprofen. I do have an issue with flat coke/lemonade as it has been shown to be ineffective for oral rehydration.


This depends entirely on what you said and what was found by the clinician. Very few people give an exact history of events and the better ones tend to be other clinicians. I have had patients tell me one thing and then tell the consultant a completely different story. I've also had people lie, forget or make stuff up. I've even had people start telling me stuff from years ago that are irrelevant. Not accusing you of anything but people come out with random stuff esp in an urgent or emergency situation.



She might have figured out that her initial assumption was wrong, or realised how poorly he was, or didn't know how to deal with the situation. You might be right and she may well have been crap.


Sounds v odd behaviour if she was definitely a doctor.

Whatever happened, I would recommend you carefully document everything to the best of your recollection. I would then put a complaint in about the clinician. If it was a doctor, something has gone very wrong. If it wasn't, the person needs to be informed as well as their supervisor. Scarily, some out of hours centres can't recruit enough doctors and so often use nurse practitioners instead. On the other hand you will come across some good and some crap doctors. The worst one I knew left medicine after a year of working as a doctor.

All good points and TBH, working diagnosis until that point had been bladder infection and everything she asked initially was quite reasonable, Red was having trouble catching his breath and speaking coherently because of the pain so I gave all the answers and the original summary. I explained in not excessive detail everything that had happened to that point and all the questions she asked were the same questions the surgeon in A&E asked afterwards, and the same questions his GP had already asked, it was really the way she asked them that irritated me, she didn't let me answer with more than one word and if I gave more info to clarify then she cut me off with another question. Her entire attitude was bristly which isn't helpful to either the patient or their worried wife!

I was also annoyed that she didn't even examine him, she didn't really "find" anything because she didn't look at him, even if she'd suspected gastritis or the like then surely if she'd done the poke and prod test she would have noticed that the pain had moved and localised in the classic appendix place (like the A&E Doc did) and the vomiting and fever would have just underlined the issue.

I have made a point of phoning the reception at the out of hours clinic to find out which Doctor saw him and I have her name, she is definitely a Doctor though and was one of 4 Doctors on call that night, all of whom were in the office with no other patients until one came in just as we were leaving.

The thing that is really making me make an issue out of this is the effect she had on Red, he's not a pushover in any way, but he has absolutely no experience of this type of thing, he's never been in hospital, never had an operation, never had a serious illness of any kind so he doesn't know how to be assertive in that situation, whereas I'm an old hand at it. If he'd been on his own and had taken her advice to go home, try to take paracetamol and wait until 08:30 to see his GP I doubt he'd be in as good a shape as he is now, which is saying something given that even now, 2 days later he's still being rehydrated and having massive doses of antibiotics for the infections that are still running through his body. This kind of thing can be really serious and she should have known that, I'd like to try and help make sure someone else doesn't have the same experience if I can.

Good advice thanks, I have written an account clearly and dispassionately saying everything that happened and I found the address to send it to for the trust. I will run it by Red when I finally get him home to make sure he's happy with it before I send it off as well.

I should probably also point out that I am the last person to begrudge any medical professional a break and a cuppa, I have nothing but the utmost respect for all the staff I have ever come across, I know they are doing a tough job in difficult circumstances so I make a point of being polite and friendly, even in bad circumstances but I also know that if I were in that profession and I had a patient referred to me by NHS Direct on a emergency out of hours basis, writhing in pain, vomiting, grey and shaking with fever less than 5 feet away from me, I would see them right away and drink my coffee while I was taking the history, not leave them crouched against a chair with their head in a bowl heaving away for half an hour.

In update, Red appears to be recovering well, they are keeping him in longer because his urine and blood tests are still funky, they have scheduled an MRI and are keeping an eye on his kidneys which are apparently still struggling, but have moved him onto a normal ward. His incisions are healing, his drain is out and he's eating, albeit not very much, he's not really up and about yet but he has gone to the loo on his own which he's very proud of

Google must be in a right state today - even a straightforward search hangs for me, and you can forget YouTube

A reaction to their policy change for Gmail and Google+?

Gesendet von meinem GT-I9300 mit Tapatalk

Wouldn't surprise me these days.