Sunday, February 20, 2005

The Hospital Saga

Abby developed a swollen face on Weds 9 Feb.
She was seen by a locum GP on Thursday 10 Feb, who thought it may be sinusitis or an abscess and prescribed Co-amoxiclav, which she hated. It was a battle to get her to take it , and she is normally very good at taking medication.

By Friday 11 Feb, her face and eye were badly swollen, so our own GP saw her, prescribed Amoxicillin and said he felt it was a dental problem. He advised us to contact him if her face was not significantly better by the following day, and also to see our dentist urgently.

We saw the dentist within half an hour of leaving the doctor, and he immediately diagnosed the problem as a dental abscess. He also agreed with the advice our GP gave.

Well, Abby took her Amoxicillin, but on Sat 12 Feb, it was obvious her facial swelling was increasing, so we called the GP who arranged urgent admission to the hospital for IV antibiotics.

At the hospital, the admitting doctor agreed it was most likely to be a dental abscess and started an IV line with two lots of IV antibiotics being administered simultaneously. He told us that if we hadn`t brought her in, the infection could have damaged her eyesight on the one side if left untreated.

On Sunday, the swelling around her eye was very slightly bettter, but her cheek was rock hard.
The consultant paediatrician did a ward round and verbally and publicly took me to task about our very carefully considered decision to withhold the MMR vaccination, which I thought was a bit strange. Basically it became obvious that no-one really had a clue what was wrong with Abby.........

On Monday, 14 Feb, the consultant came round again and examined Abby, and was most conciliatory. It was decided that an ultrasound scan of her cheek might be beneficial, and this took over 6 hours to achieve. A huge pocket of pus was identified on her cheekbone, and the radiologist said he felt it was of dental origin.

On Tues 15th, everyone continued to look blank.
At one point, I was told she could not have a dental abscess because she was still eating, and it wold be too painful for her to eat (!)
No-one had got the results of the blood cultures , which were taken on Sat am, and are available normally in 48 hours. Although the swelling around her eye was improving, the swelling on her cheek was not.

By mid-morning, someone actually decided to call in the Maxillo-Facial team. They are based at Hospital Two, but run a clinic at Hospital One, where we were.....
The junior doctor who saw her said he wasn`t sure, and wanted the consultant to see her.
Fair enough, so at 2 pm we trundled up to the Maxillo-Facial clinic where a lovely gentleman close to retirement age took one look at her as she walked through the door, and declaimed "This child has a dental abscess !!"
When he found out that she had been in the hospital on IV antibiotics since Saturday, and had not been referred to his team, he was most upset, and said that Abby should have had urgent surgery to drain the abscess on the day she was admitted !

The upshot was that he insisted she have emergency surgery that same day, and we were advised to take her in our own car (because it would be significantly quicker than waiting for ambulance transport) to Hospital 2 where the surgery would be done that same evening.

When we got to Hospital 2, we only had a referral letter from Hospital 1, which had retained her notes, so when the new admitting doctor saw her, he said that she had apparently initially been suspected of having Mumps at our first hospital.

I was incandescent with suppressed rage at this point.
I am not stupid; I am a midwife, and I do know the very major differences between a dental abscess and mumps.
I find it very frightening that these doctors in Hospital One obviously didn`t.......

Think about it....if a child possibly has a highly contagious disease, would you put her in a 6 bedded ward with other children ?

Anyway...Abby was on her way to the OR within two hours of arriving at Hospital Two, and she was treated wonderfully and highly professionally.
She was in theatre for 45 minutes, and had to lose two right upper molars and have the abscess drained via an incision in her mouth. She was put on yet more IV antibiotics, but within 12 hours , she was looking brilliant, with very little facial swelling, and she was full of beans.

We were allowed home on Weds 16th Feb on the understanding she would religiously take her two oral medications for 5 further days, and Glory to God, she is now doing brilliantly well.

I find it really frightening that there can be such lack of communication between various medical specialties, and also such apparent lack of knowledge about differential diagnostic techniques.
Why should it be possible for the medical and nursing staff at Hospital 2 to be so much better than most of those at Hospital One ?

The National Health Service is a lottery, I am sad to say.
I could say a lot more, but it is time for me to stop ranting before I raise my blood pressure :-0
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Dave Holford said...

I'm so glad to hear she is so much better. We have been praying for her daily.

Laura said...

Whoa...what an experience! We have kept Abby and you all in our prayers. I am so glad that things are now looking up! We will keep you in our prayers for a speedy recovery.