"Perforated appendix in emergency department"

First time in my life I visited Fiona Stanley hospital ED last month at midnight, it became a traumatised night.

I went to FSH ED at midnight with severe abdominal pain and during triage, I explained that I had severe epigastric pain and vomiting and provided a list of the medications I had taken  a nurse checked my vital signs and administered ondansetron and celecoxib orally. Within 10 minutes, I vomited again and my pain intensified, feeling as though my stomach was burning.

I was in extreme distress. I cried privately in the bathroom but attempted to remain composed in public, I reminded myself that I am a civilised human and I don’t want to be nasty person in public. I informed the nurse that I was experiencing severe pain and persistent vomiting. My vital signs were rechecked, and I was given ondansetron and oxycodone; however, I vomited again within minutes.

The pain I was experiencing exceeded that of childbirth, I went back to triage and asked the triage nurse “Will this take a long time?” They said the waiting time is 7 hours. After already waiting for approximately three hours, I asked whether it would be acceptable to go home and return at 7:00 am, as I was unable to sit or walk due to the pain, and I had no idea what to do. I felt as though if I was able to go home then I will be abIe to lie down or cry loudly. I was told that this would be fine and that I would be seen in fast track upon my return. At approximately 3:30 am, we went home. I remained in agony and vomited repeatedly.

At around 5:30 am, the pain localized to my right lower abdomen. I suspected appendicitis, possibly perforated. We returned to the ED at approximately 6:30 am. I felt like an unwanted guest, I can’t blame the nurses, they looked very tired too. I was informed that as I had left when my name was called, I would need to be triaged again from the beginning. The waiting time was now ten hours. I couldn’t even argue or talk due to the discomfort and pain.

I reported my pain score as 11/10 and stated that it was the worst pain I had ever experienced. I was offered Panadol, but I explained that I was unable to tolerate even small sips of water. I requested information about initiating an Aishwarya Care Call, as I was confident that I had a perforated appendicitis and feared for my life.

The nurse said they will speak to their supervisor and let me know. When they came back, they sat on the chair near me. I really appreciated it, it meant a lot. I whispered to them, “I am a clinical nurse for more than 10 years, I am very sure it is a perforated appendicitis, this is the first time I am in FSH, please help” I was actually begging and threatening to save my life. Before they finished their shift, I got a trolley in ED, changed my clothes to hospital gown, offered again for oral painkillers.

I do not clearly remember the next one to two hours due to the severity of the pain. One memory I had was telling my spouse in a low voice, “I can’t do this.” I was frightened and genuinely felt that I might die with sepsis. I even told my spouse where to find my will and life insurance documents. One nurse looked at me, I stopped, and tried to look composed, I felt so scared. I don’t know why. I cried to my spouse, “I don’t want to die with appendicitis which was easily avoidable.”

At approximately 10:00 am, I received an IM injection which was helpful, An ED doctor, who was compassionate and professional, assessed me. IV access was difficult due to dehydration, but bloods were eventually obtained. My results showed a white cell count of 22 and CRP of 360.

With ultrasound guidance, after multiple events an IV cannula was inserted and intravenous antibiotics were commenced. A CT scan confirmed perforated appendicitis. I was referred to the surgical team.

While awaiting surgery, I was transferred to a chair again 

I underwent surgery and was diagnosed with perforated appendicitis with a necrotic tip and four-quadrant pus contamination. Post-operatively, I received excellent care in theatre recovery and the short stay unit. I was treated with intravenous ciprofloxacin and amoxicillin-clavulanate. My drain was removed on a few days later, and I was discharged a few days after that.

I am deeply grateful to the surgical team, theatre staff, and short stay unit for their outstanding care. They gave me my life back.

However, my experience in the Emergency Department raises serious concerns. As per my experience in Fiona Stanley ED, I would say that Fiona Stanley ED is the culprit to extend the patient length of stay, our healthcare system completely forgot about early recognition and early treatment. Based on my experience, if a patient came into the ED with 30% symptoms, the ED waiting time could cause the patients to have 100% symptoms before they get transferred to the specialised area. I strongly believe that earlier recognition and intervention could have significantly reduced my suffering and possibly prevented perforation. If blood tests and imaging had been initiated during my first presentation, and if intravenous prophylactic antibiotics and anti-inflammatory treatment had commenced promptly, my clinical course may have been very different.

I believe that implementing a rapid assessment team, allowing experienced triage nurses to initiate blood tests and imaging within 10–15 minutes of arrival, and commencing early treatment could significantly improve patient outcomes and reduce overall length of stay.

I believe that as Australian citizens and taxpayers, we deserve timely and responsive healthcare. I think that no patient should feel that they must beg or fear for their life while waiting for basic medical assessment.

This was my experience, and I believe it is not mine alone.