"Diagnostic skills and lack of communication"

Well, the saga has almost ended. After nearly twelve months of hospital emergency visits and admissions, there is finally light at the end of the tunnel.

It all started off amazingly well, after being diagnosed early last year with blocked arteries in my heart. After a failed stress test and angina, I was admitted to Fiona Stanley Hospital (FSH) and was almost immediately seen by an exceptional cardiologist, who performed an angiogram and inserted stents into a blocked artery. He also indicated that I would be programmed for another stent operation within a month to clear another not so blocked artery. Between stent operations I presented twice to my local hospital with pain in my chest. However, I was discharged after tests revealed my heart was working normally. The second stent operation went ahead and was discharged after two days. Now, this is where everything started falling apart.

The day after coming home from stent op #2, I was brought back to FSH via ambulance after collapsing unconscious, still with pain in my chest. There I was told, after another round of tests and scans, that the pain wasn’t from my heart, more so either muscular or skeletal. This I believe was doctor speak for either we haven’t a clue or it’s all in your head. It wasn’t until my follow-up appointment three months later with my original cardio surgeon that he suggested further tests with my GP to determine the cause of the pains.

Liver function tests revealed abnormalities so I had an ultrasound of the abdomen and bingo, I had gallstones. Now normally this would have been no great problem as gallbladder removal is routine keyhole style surgery. Unfortunately in my case after just having cardiac stents inserted, I was on medication that thins the blood and prevents clotting, so any kind of surgery presents a problem. I was told I would have to be on a low fat diet from now on for at least another eight to nine months until I could be taken off the anti-clotting medication. I thought that this was probably a good incentive to lose a bit around the middle, at 106 kg but over 6 ft tall I didn’t consider myself terribly overweight.

All was going well for about another month, I was losing a bit of weight, down to about 102 kg, then at work one day I started having pain in my right side, feeling sick and dizzy. I was taken to the local hospital where I was observed for a day however, they were unwilling to perform any treatment as I was still a recent cardiac patient and there was no resident cardiologist. I then transferred back to FSH where I had more tests and scans. These revealed a stone had escaped the gallbladder and was lodged in the duct. Needless to say I now know what jaundice looks like.

At FSH I had another stent inserted endoscopically into the bile duct, pushing the stone to the side, allowing a normal passage for the bile. I did ask why I couldn’t have the laparoscopic type operation to remove the gallbladder completely and was told it was because of the anti-clotting medication. I certainly wasn’t informed why I couldn’t stop the medication for a short period and have the operation. Now this is where I thought it couldn’t get much worse, but it did.

A month later I was in a lot of pain in my side and feeling very ill. I was driven to FSH, but on the way I was getting worse. We made it to the car park at ED before I passed out in the car. After being admitted I was then diagnosed with a severe infection of the gallbladder and biliary duct. Treatment was going to be that a drain was going to be inserted through the abdomen into the gallbladder. This couldn’t be done immediately as I had to be off the anti-clotting medication for five days. So in the meantime, I would be given a course of antibiotics. Unfortunately I have an allergy to penicillin, documented in my file, red coloured wrist strap and all. For three days I was given this antibiotic, with the nurses asking each time, what is your name, what is your date of birth and what are you allergic to. I answered the obvious, said I was allergic to penicillin and my patient number was checked. The drug was then administered along with the IV drip.

Each time the antibiotic was administered, an hour later I went into a state of feeling very cold, uncontrollable shaking and shivering, so much so that my temperature couldn’t be taken orally as my teeth were chattering so much and it was impossible to take a blood pressure reading as my arms were shaking. This lasted about an hour or so, after which I started to feel very hot, sweaty and nauseous.

This cycle went on for three days until the fourth day a nurse administering the antibiotic, going through the usual protocol, name, date of birth, patient number, allergic to what. When I replied my allergy was to penicillin, she asked me, then why are we giving you penicillin? Apparently I’d been given an antibiotic which is a penicillin derivative, intravenously for the past three days.

After complaining the doctor was very apologetic, saying that they thought that particular drug was the best given that type of infection. Their reaction to that complaint I believe was to move me to a different ward after I had the drain inserted. I heard nothing more about it and did not see that doctor again. After 13 days in hospital, hardly eating anything at all, I finally made it home, weight now down to 88Kg.

Ten weeks later I had the drain removed, after being told it would be in place for six weeks. Twice I presented back to FSH ED, once on the advice of the Silverchain nurse as the drain was leaking, the other a few days later in absolute agony as the drain was causing some kind of inflammation around the gallbladder. Both times I was sent home without so much as a cursory examination, the second time given Tramadol and a script for Oxycodone. Can’t see why people would ever get addicted to that stuff, it was so terrible I stopped after one pill. Over the next two months I had a CT scan at Fremantle and a follow-up appointment at FSH. Both times I indicated that there was a lump developing at the drain site and at FSH the doctor said it was just a small inflammation that would eventually disappear. Well, it didn’t!

By late last year this lump started getting bigger, turned a reddish colour, felt hot to touch and painful, so back to FSH ED again. As this was a Saturday I was told I would have to wait until Monday for an ultrasound and CT scan and for the time being, to stop taking the anti-clotting meds. So back to FSH again on the Monday where I had the scans which revealed the small inflammation had turned into a rather large abscess.

When the doctor tried to aspirate the abscess he found that it had become very firm and only a tiny amount was at the needle point. My temperature then started climbing up to around the 40 mark. He then said I would be put on antibiotics and my treatment would be reviewed. When the nurse came back and said I was to be given Flucloxacillin I reminded her that I was allergic to penicillin and I didn’t know what Flucloxacillin was. She said she wasn’t sure either and went away to investigate. Meanwhile, I whipped out the mobile, Googled Flucloxacillin and guess what? Penicillin!

The nurse came back with the same determination so it was decided I wasn’t having that. I then asked her, as the Ward Supervising Nurse, that I wanted to make a formal complaint, as this was now twice doctors were not looking at what I was allergic to. It took one of the Heads of Surgery to decide that I would have the abscess and gallbladder removed that week. After the surgery their reaction to the complaint I believe again was to move me to another ward. Didn’t hear a thing about it after that.

After a week I was back at FSH to get the biliary stent removed endoscopically, which I felt was done in record time, as I was in and out and felt I was shunted out the door that same afternoon.