"Abdominal pain and heavy bleeding"

I was flown into Kalgoorlie through the Royal Flying Doctors Service (RFDS) after having right abdominal pain and heavy bleeding at work (suspected appendicitis or ectopic pregnancy according to RFDS).

During my initial consultation with Dr, I was asked a series of questions about my sexual health history. After disclosing my various past sexual partners, I recall their immediate response to my current medical status was, well yeah…probably a STI or infection then. It seemed the inappropriate nature of this comment was presumed without any/limited clinical investigations. The doctor then proceeded to carry out these investigations in the form of blood tests and a cervical swab.

Similarly, these tests were also conducted in Perth at a different hospital as a precaution before flying out to work the following morning. At this point in time the status of those results was still pending. My treatment in Perth was the opposite of that in Kalgoorlie. The attending Registrar was conscientious and cautionary when he conducted the same intervention, such as: appropriately asking questions when conducting a cervical swab and during my blood tests. I was made comfortable during my treatment and felt that my health was prioritised over the circumstances of my admission. To reiterate, I felt I did not receive the same kind of empathetic approach, kindness and patient advocacy at Kalgoorlie Hospital. As an example of how uncomfortable I felt, this scenario comes to mind:

During the cervical swab of my uterus, I naturally felt bewildered and anxious about my arrival to hospital. The introduction I had with the doctor contributed to this feeling and it took me some time to orientate myself to the environment. During my cervical swab, I tensed during the procedure and I recall this was met with the abrupt response to stop clenching.

Along with this, I felt that there was a direct lack of communication between the doctor and the mannerism involved with the type of assessment to be conducted. This was in relation to a HIV test. During the process, the doctor’s ability to seek informed consent was limited to a single HIV test, which I believe was also an opportunity for them to negatively comment on my sexual health history. Having done little research into the doctor’s medical judgement, I believe that their delivery of patient education was limited and undertaken with a judgemental tone. With the aim to belittle and ridicule me for my personal and private choices. I feel that their judgement was invasive, inappropriate and was conducted under a tactical prerogative to shame me and discredit any other clinical findings outside of STI’s.

After this a nurse came into the room and suggested that I get a hotel room for the night but I informed them that I don't have anywhere to go as I'm not from Kalgoorlie. My results were still pending at the time this interaction took place. Afterwards, the nurse offered me pain relief, whereby I verbally accepted. However, this offer never resulted in me actually receiving pharmaceutical treatment as a means to alleviate my pain.

The doctor returned at approximately 8:30pm and stated that my blood tests were fine and there were no signs of infection from these results. The decision was made to discharge me. At this point, I told them that the doctor who called the RFDS was concerned about an appendicitis or ectopic pregnancy and wanted me to get an ultrasound. I recall this medical opinion was also shared with the Nurse/Midwife who attended my care at the time.

I was also told by the Kalgoorlie Hospital doctor that my white blood cell count wasn’t high enough for it to be an appendicitis, along with having pain in the incorrect location and as such refused further investigations in relation to appendicitis. However, the pain I was experiencing was in the exact location they were referring too. As my pregnancy test was negative, they again refused further investigations for possible ectopic pregnancy. I was not informed by the doctor if it was a urine or blood pregnancy test.

It seemed the doctor also didn’t communicate that they were testing for this or that they weren’t doing an ultrasound if these tests were negative. They told me that my situation wasn’t considered urgent, but I can wait in Kalgoorlie until Monday if I wanted an ultrasound. Therefore, they had limited reasoning to admit me at the time. At this point I was still actively bleeding and having right abdominal pain with no pain relief as suggested earlier.

I had to state to the doctor multiple times that I was experiencing abdominal pain and the pain was still persistent. They then examined my abdomen again and I had pain in the exact location that they stated appendicitis would cause. I feel this doctor would have known this if they had taken the time to properly listen to me instead of making assumptions. I believe the doctor still had the opinion it was not likely appendicitis and refused further investigations. The doctor suggested that it was probably my period. They then prepared me for discharge and at this point I was crying due to having nowhere to go. They asked if I was okay and I told them I have nowhere to go, it was nighttime at this point and the chances of me being able to get a hotel that late at night were slim and I didn’t know anyone in Kalgoorlie. The doctor dismissed me and said my workplace should book accommodation for me. I called my employer to try and help me find a hotel. After searching for available accommodation, we discovered there was nothing and I had nowhere to go.

During this time another nurse came into the room and asked what was wrong because I was still crying. I had to tell them about my circumstances surrounding a lack in accommodation. They also suggested that I should call my supervisor and get my workplace to book a hotel for me, to which I explained my situation and that there was nowhere for me to go. I felt that I had a right to tell the nurse that under their duty of care, it was their responsibility to make sure that I was safe. Therefore, making me leave late at night went against this, knowing that I’m not from Kalgoorlie and I stated that there was no accommodation for me at this stage. The nurse explained to me that they have done the necessary tests and it isn’t considered urgent, therefore they have no reason to admit me. The nurse asked how I got to the hospital in which I told them the royal flying doctors flew me here to which I recall they replied, so what did I expect to happen when I got here. I told them that I thought I would need to stay overnight. As I wasn’t aware that the hospital could discharge a patient at 9:00pm at night with nowhere to stay. I believe the nurse’s response to this confusion was that the hospital, isn’t a hotel and it isn’t their responsibility.

I called my supervisor again as I didn’t know what else to do. He told me that I could stay with his family, but his child has COVID and the family was still within their isolation period. I accepted as I didn’t have any other options at this point. It is also worth mentioning the apparent passive aggressive treatment I received from the nurse after my conversation with them. I recall they would enter my room, clean sporadically and had a tendency to stare me down as they were cleaning, in my opinion.

I started packing up my stuff to leave. The nurse’s only interaction with me at this point it seemed was a smirk after they heard my phone conversation with my supervisor. I told her the nurse I could stay with my supervisor’s family who are currently isolating as I don’t really have an alternative. I believe this nurse has unprofessional mannerisms because I felt they were trying to intimidate me in order to get me to leave sooner. As I understand it, they also refused to give me the doctors name as I recall they couldn’t remember how to spell. I said I would just ask the doctor myself then, I believe after rolling their eyes the nurse said they would write it down for me.

In short, I felt judged and minimised by the doctor who wouldn’t accept that my symptoms were anything other than a STI due to my sexual history. I was put in an uncomfortable position by the ED staff by discharging me late at night, knowing I’m not from the area and with little information. I feel that it is the hospital’s duty of care to ensure that I have an appropriate place to stay after experiencing a stressful and compromising situation. I was dehydrated due to the possibility of me undergoing a surgical procedure. This wasn’t followed up after their knowledge that any surgical procedure would not have been conducted. The hospital discharged me dehydrated with no pain relief, I was still bleeding, and my right abdominal pain was still present. I understand that hospital staff are under pressure due to limited resources, however, given unprecedented circumstances surrounding my admission I believe that I would not have been emotionally distraught if proper considerations for my wellbeing were put in place.