Consider this as a rant of traumatic parents who had just found out that their worst nightmare was a reality after days in limbo. By writing this I do not intend to offend anyone involved. This is certainly a space where I believe emotion is justifiable. Stuck in hospital like this, thousands of ‘what if’ questions hover in my mind. With the timeframe for our work coming to the end, the pressure is definitely compounding. This could also be a lesson for us, as well as anyone going through the same situation. Whatever it is, for me in writing this is to find a means to heal the trauma that still lingers in my mind.
When Farhan started his tummy pain on Tuesday last two week, we moved from a GP to another GP, from a hospital to another hospital trying to find a definite answer. Throughout 6 days we met 4 GPs, and countless number of doctors and a few surgeons in the first hospital at Epping that we went (I referred to here as 'the first hospital'). But what we had for more than a week was mere possibilities. (We must have cross expectation about certainties and possibilities in this medical world). And we dealt with the possibilities on the horrifying pain that he had for more than 72 hours before we know for certain that it is late - his appendix has popped out and released its content infecting his lower tummy; knowing for certain that his complaint is real pain, his pain is severe.
GP and the first opinion on appendicitis
On Wednesday night, 9 January 2013, we brought Farhan to see a second GP, after his tummy pain did not recede. Earlier in the morning, we met a GP at Broadmeadow who believed that he was having ordinary tummy upset. The second GP in Roxborough Park believed that he had all the symptoms for appendicitis after a urine test is done and his condition checked. She gave us two options, either give him a painkiller to see if he is ok and wait until a few hours if his tummy got better; or proceed to a hospital. For her the second option is better as he had had pain for more than 24 hours.
The stay at the first hospital: ‘no, it is not possible’
We took the second option and arrived at the first hospital, about 10 km away from the Roxborough Park clinic, at about 11 pm. We waited a few hours before he was checked. A doctor who examined him felt that it was not possible for him to have appendicitis, looking from his ‘look’ and ‘level of pain’. There was no fever, and his lips were red. She told us that we would have to wait for about two hours if we wanted tests to be done. She may had concern for Ainaa and Ammar who were there waiting in the wee hours. But I asserted that we would wait for the tests to be done. After all, we had been there and we had waited for hours. Farhan was in pain, in his tummy - it was impossible for us to go home without knowing what the problem was. Later he had his blood and urine tests done and we waited in the waiting area in the emergency department. A few hours later, the doctor came again telling us that his blood tests revealed a ‘big’ amount of inflammation, blood in his urine; and Farhan certainly would have to stay there.
After a while a surgeon came checking on him, and also made the same ‘ruling’ as the earlier doctor did before the blood test done. He did ‘not seem to suffer from appendicitis’.
Because he had sign of dehydration, he was admitted, and was treated for gastroenteritis for three days before he was discharged on Saturday. Throughout the stay in the ward until the day he was discharged, he continued to have pain in his tummy but coming and going. But he said the pain was lesser. Only once so far that I was aware he had a mild fever. I think, the panadol given every four hours might help to reduce the pain.
Increased level of inflammation; but ‘cannot be’
On the second day, he was able to take his own food and later had good appetite. On Friday, the third day of stay, a Doctor had him done a blood test. The test revealed ‘increasing level of inflammation’, as she told me, (that later I knew as white blood cell count). A nurse personally told me that there must be something else other than gastro in his tummy with that pain and level of inflammation. The doctor told me that she believed that Farhan should be checked again by a surgeon and she went to consult him/her. Later she came again only to tell me that the surgeon dismissed any possibility of appendicitis. The increased inflammation, she told me, as the surgeon said, might be caused by something else. It is normal for boys of the age to have bruises, may be because of childish fighting, she tried to assure me, I believed. If he had appendicitis, she said, the painkiller won’t have worked.
The day of discharge; non-stop pain but ‘he is on the mend’
The next day, Saturday, when he was discharged, Farhan complained that his tummy pain was continuing. It did not stop as before. But he said the level of pain felt lesser than before. I told this to a nurse who later, gave him panadol to relieve. I later overheard, that the nurse made a call reporting about the pain. But when a Doctor came, Farhan said that at the time his pain was ‘only a little bit’ – I believe, because he had just had his panadol. I told the doctor about the continuing pain that he had since morning. But the doctor told me that ‘I think he is in the mend’. It might be gastro rather than appendicitis.
We brought him home after lunch with great relief that Farhan was not suffering from appendicitis. His pain still continued although he could eat on his own. He just lied down on his back the whole weekend. A friend doctor, who asked about him, suggested that we brought him to have an ultrasound done on Tuesday. (His clinic only has ultrasound done on Tuesday and Wednesday).
But on Sunday night his pain worsened. He frequently went to toilet with diarrhoea, his poo were more watery and looked like mixed with mucus. He told us that it was so painful to sit in the toilet and his urine was hot. I poured water on his private part when he relieved himself hoping that it might help.
Second GP: it is appendicitis
Early in Monday morning, daddy brought him to a clinic at Fawkner hoping to have ultrasound done. I felt that the pain looked like he had some injuries in his tummy. It would not be possible for us to wait until Tuesday before we could go to the friend’s clinic. But the GP told daddy that his condition was urgent and must be brought to a hospital. He asked whether we want to go to another hospital. But daddy felt that it would be difficult for the process to start all over again, and felt that the fisrt hospital might be able to take action based on the record that they have before.
The first hospital again – ‘no it’s not possible!’
Off daddy and Farhan went to the first hospital again. By the time they reached the hospital, Farhan had high fever of 39.6 degree Celsius. He was given panadol upon arrival to help with the fever.
But the doctor, who checked Farhan after more than four hours of waiting in the emergency department, did not share the same urgency as the GP in Fawkner. He insisted that such a pain was normal for gastro, and assured daddy that it will recede. Some people suffering of gastro, he said, could have ’tummy cramp’ for up to 14 days. When daddy asked whether ultrasound could be done to see what the problem, the Doctor told daddy that, ‘we don’t do that at the moment’. Panadol he said will help relieve the pain. No further investigation was done.
Daddy brought Farhan home again only for him, and us, to be tortured with his excruciating and horrifying pain throughout the night. He woke up almost every hour because of the pain asking me to rub his tummy. His diarrhoea was now yellowish fluid with more burning urine. He soiled his pants several times and the bed sheet. We had to carry him to the toilet every time.
The third GP: ‘it is so bad!’
The next morning, on Tuesday, daddy brought him to a GP, who is also a friend, requesting to do an ultrasound. To our horror, the physician told that there are 'a lot of inflammations and swellings inside his stomach. He could not ascertain about the appendix, but believed that appendicitis might be the factor for the swelling. The GP advised us to go to Royal Children Hospital with reference letter suggesting appendicitis.
The Royal Hospital: ‘Yes it is, but ..’
When we arrived at emergency department at the Royal Children Hospital, upon examining him, the doctor was almost sure that it was appendicitis. She requested a surgeon to check him. We were aghast when the surgeon told us that he believed that the appendix had burst, and the diarrhoea was the result of it. After all that we had gone through, after all of the clinic and hospital visits that we had, it was shocking to know that the pain that he had for more than 72 hours was awfully unbearable. This was confirmed by an ultrasound done later.
He is now being treated with antibiotic to heal the infection. A surgery to remove his appendix will be done after he recovered from the infection to avoid major operation.
As parents, and after all that we had gone through, we were really angry and regret.
What we regret most is that we were in a hospital where Farhan was admitted for care four days and three nights but it was like we had not done enough to make a life threatening decision. He was referred by a GP with possibility of appendicitis with history of tummy pain for more than 24 hours. But appendicitis was ruled out without further investigation.
Second, despite increasing level of his white blood cells, found out the day before he was discharged, the hospital asked him to go home.
Third, despite my complaint in the morning of the day of his discharge, that he had continuous pain which before was coming and going, the doctor said he was io the way to recovery.
Fourth, despite he came again to the hospital with high fever, he was asked to go home and to come again the next day for appointment after 4 hours of waiting.
Fifth, despite his dad asking for an ultrasound to be done on his tummy when he had high fever with tummy pain, they thought that it was normal for gastro.
Sixth, all of the doctors in the hospital told me that he had all the symptoms of appendicitis. His blood tests warrant something. The blood in his kidney is the concern. But, as the doctors said, as he ‘did not appear’ as a person suffering from appendicitis - he was able to eat on his own, his vomiting stopped - they dismissed further investigation. Are, in the medical world, appearance and impression overrule the scientific findings?
(Looking back, I was made to understand that the way of making investigation in the medical world began with a close-ended question - the strange form of question asked by the GP: “??? appendicitis.” Once you suspect the answer is no, no further question was asked for investigation. Instead dealing was made with a mere possibility.)
Seventh, we had come to see 2 GPs at different times with terrifying unanimous suggestion that it is appendicitis. The GPs told us that he must urgently be brought to a hospital. But in the two different occasions, he was denied further investigation.
Until now, I still have difficulty to sleep thinking about what Farhan had to go through. I am still shaking thinking about the pain that he had to endure on those nights. I kept asking myself, what if this and that, what had I failed to do, what had I done.
I understand that, as many have said and I read, diagnosis of appendicitis is normally difficult especially for children. I also met a four-year-old boy here who was misdiagnosed for chicken pox. I also understand that the job of this profession is not easy, busy and stressful. But what I regret is about the ruling which was made, that I feel, without sufficient resources.
I know that this - I mean, writing like this: as if finding fault; putting blame; asking reason that might be too complex to entangle - is not our way of doing things. Things happen, happen with Allah's will. But for me, in a way, it is a culture of justification, assurance to our own selves - the way we justify how things in life just happen.
But beyond that I hope no parents or anyone would go through the same experience.
We thank Allah for saving Farhan. To Ammar and Ainaa, for nights without one of us, the GPs, friends who are concerned, especially Faridah, Azman and family who helped us a lot, Dr Rahman and to all doctors and staff, both in the first hospital and Royal Hospital, may Allah bless you all.
16 January 2013
Royal Children Hospital, Melbourne