"Delayed diagnosis leading to complications"

I woke up early on a weekend morning with stabbing pain in my lower abdomen. After attending a pharmacist who gave me Buscopan and recommended I seek further help if the pain didn’t subside, I subsequently contacted OOH that evening. The pain at this point was intensifying and I made the decision to head to A&E to seek further help.

When I arrived in A&E, I was triaged promptly as it was not busy. I explained to the triage nurse that I had acute abdominal pain and described my pain score as 10/10. My temperature was high. I had a minimal wait before seeing a junior doctor. Bloods were taken. Infection/ inflammation markers were high. An examination revealed an intense feeling of pain within the belly button area and to the upper and lower right to this. There was no pain on the left side. Further questioning explored whether I had sickness and diarrhoea. I had taken lactulose earlier in the day thinking this may give me relief from the pain. The outcome was that I was discharged with gastroenteritis, without having been seen by a consultant. I was given Oramorph and told to take paracetamol and ibuprofen. 

Having taken the Oramorph, I went home and slept for a few hours. I then woke up with the same pain. Thinking I was dealing with gastroenteritis, I tried to cope with the pain but ended up consulting with my GP who prescribed codeine and informed me to go back to A&E if pain was no better. 

Late in the afternoon I went back to A&E as I could no longer cope with the pain and I felt more unwell and desperate for someone to help me. The waiting room was full and I had to wait for triage. My temperature at this point was very high and despite my clinical presentation, I was informed I would just have to wait my turn. I returned to the waiting area. By this point, I was crying out with pain and crying for someone to help me in desperation. Nursing staff and HCSW witnessed my distress but I was not prioritised to be seen. 

When I was eventually seen it was the same doctor that had seen me the previous night. At this point they diagnosed a high probability of appendicitis. My clinical presentation continued to deteriorate and despite the agonising pain I was only given small doses of morphine which did not alleviate the pain. I then waited 2 hours or possibly more for a surgical review.

It was only at this point that a CT was requested. The CT revealed appendicitis rupture. Initially despite my worsening clinical presentation I was going to be transferred to ward D9, but a decision was made to take me to surgery. I then underwent keyhole surgery.

I woke up to the news that I had indeed had appendicitis with rupture causing peritonitis - a life threatening condition. I then remained in D9 for 6 days. During this time I had symptoms of chest discomfort which was explained by a nurse as the consequence of the surgery as air was introduced into the abdominal cavity. I was discharged to recover with antibiotics.

Instead of improving with antibiotics, my condition worsened. I was unable to sleep due to right sided chest pain and fever. I contacted my GP who suggested I returned to A&E. For 3rd time I was seen by the same doctor. No consultant examined me. Bloods were taken and I made the decision to go home with the knowledge that I would be contacted if I needed to return.

The junior doctor phoned and asked me to return as infection/inflammation markers were still raised. During the further consultation at A&E they discussed that they had felt a further scan was required, but this was overruled by a senior member of staff who said they were happy for me to go home, despite not having seen or examined me themselves. So I went home. 

I continued with the same symptoms, wasn’t able to sleep or lie down so contacted 111 for advice. I attended OOH and was seen by a GP who diagnosed a MSK injury despite a chest examination and raised temperature. A prescription for ibuprofen was given and I was told to go home with no other escalation required despite my ongoing symptoms.

Subsequently on the Monday I visited the practice nurse for bloods who said a community nurse should have come out as I looked so unwell. I was asked to contact the GP given these concerns. I then phoned GP who asked me to attend the practice immediately. Having seen me and examined me, they contacted the surgical team in D9 requesting an urgent review.

I then went back to A&E. The triage CN took me directly to D9. A further CT revealed right sided fluid on the lung and infection. I spent further 5 days in B2 having had my lung drained and IV antibiotics.

The moral of the story: the delay in prompt diagnosis resulted in life threatening conditions and 2 prolonged hospital stays.

Why was I not listened to and red flags treated with, what felt like, ambivalence? I felt that I was perceived and labelled as a drama queen or a time waster. I’m fortunate that eventually I was listened to, but sadly too late to prevent the complications that then ensued.

Such lack of patient safety and care... a disgrace in my opinion.