Margarette
Margarette was my first patient on my first solo shift as F1 in accident and emergency.
All of my work had to be signed off by my senior on shift, but I was left to run my shift and staff how I saw fit.
Margarette came in at eleven-forty pm with shortness of breath which was queried asthma. So I did my initial assessment.
Routine bloods, including a D-dimer, chest x-ray and an ECG.
I left these in the capable hands of nursing staff whilst I tended to initial assessments of further patients.
Most of the senior staff had left the hospital to go home by this point, leaving just two registrars with myself and four other F1s.
At one-forty am, I had checked Margarette’s results. Her ECG and chest x-ray showed no abnormalities, and her blood results were all within the normal limits I would expect for her except for her cholesterol levels, which were slightly elevated, to which her general practitioner would be notified and could start treatment as required.
At that point, her D-dimer hadn’t come back, so I had decided to go and reassess my patient, who admitted upon her admittance that she did suffer from asthma.
Taking this into consideration that her asthma could have been the cause of her shortness of breath, I prescribed her a nebuliser and reassured her that I would be back in due time to check up on her for the second time in fifteen or so minutes.
A little after fifteen minutes later, I go back over to Margarette. She had then seemingly been brighter and breathing much more effortlessly, and at a more normal pace, so I had listened to her chest, which appeared to be sounding normal.
That’s when I decided to go check on that last blood result that was still pending. The D-dimer still wasn’t back.
I found that slightly perplexing, but nevertheless, I went back over to talk to her, and she stated that she felt much better and agreed it must have just been her asthma flaring up. I was inclined to agree, so following protocol, I decided to take her case and my findings to my Registrar, where I claimed everything was normal, telling him that I believed her shortness of breath was due to her asthma.
I explained that I had given her the nebuliser and had already prescribed antibiotics and an inhaler to go home on.
He asked me about the D-dimer result, and I had omitted the truth and replied that all blood work was normal.
After briefly reviewing the notes, my Registrar congratulated me on doing a good job and agreed that my patient could be discharged to go home on the antibiotics and inhaler, and a letter was sent to the GP about her cholesterol.
I immediately told Margarette she was free to go and was quite happy with myself and the treatment she had received from me.
It’s quite something to treat ones first patient, alone, and she was an easy case for me.
We exchanged pleasantries as I sat on the nurse’s desk watching them leave, and as her husband and she were going through the main entrance, I noted she clutched at her chest suddenly before the weirdest look of terror crossed her eyes. And that was the last thing I saw in her lifeless body.
Some of the nursing staff and I performed emergency CPR for over twenty minutes to no avail because the ITU consultant had muttered those words a doctor never wants to hear.
Life extinct, time of death three-thirteen am.
After her death, I was quite shaken. She seemed happy and normal when I had discharged her and was even joking with her husband as they had left the bay she had been in.
There was an Accident and Emergency enquiry into her death, and after Margarette’s post-mortem, we discovered she died of massive pulmonary embolisms.
I had to go over all of my notes and was questioned extensively about my movements with her care that evening, especially over the fact that she was discharged before the D-dimer blood result came back.
The Registrar, too, was asked why he hadn’t checked that it had come back before agreeing to her discharge.
It had been a hectic night that evening, and the path lab had been snowed under with specimens from not only A and E but all other wards too, so we hadn’t received the result back until past four-thirty am, but with Margarette responding to the inhaler I had thought I had found the reason for her breathlessness.
Both the Registrar and myself were unofficially told off, and the coroner concluded that Margarette had had two large pulmonary embolisms and it would have been fruitless to carry on treatment and that, unfortunately, she would have passed away regardless of being sent home or being kept in accident and emergency.
I was put on with a senior member to shadow for a week, but it would be a further three weeks until the unfortunate event of my second loss.
