The under-diagnosis of potentially fatal late-stage cancers, heart conditions and other hidden illnesses is a growing concern as medical professionals continue to deal with the surge of patients sick with Covid-19.
And the experience of retired businessman Domhnall Mac a Bháird is a frightening reminder of the importance of considering illnesses other than Covid when patients contact their GPs.
The 68 year old, who had prostate surgery at the end of August 2020, contacted his GP asking for a Covid test – because he felt vaguely unwell and his wife – who was self-isolating in their home – had recently returned from the UK.
“I had had a prostate procedure and the catheter was removed two weeks later. I was back playing golf and things seemed to be working well. However, I was becoming increasing fatigued but didn’t have any pain or discomfort,” explains Domhnall who lives in Co Cork.
I've seen four people with sepsis in the last 30 years and I remember each one of them vividly. That it's so rare is part of the problem
Following loss of appetite and increasing tiredness, he requested a Covid test, but following a night in which he suffered palpitations and had to get up to go to the toilet about 15 times, he also contacted his GP, who said he would see him in person two hours later.
"He had a fast breathing rate, a slightly elevated temperature, cold hands and seemed a bit confused," says Dr Diarmuid Quinlan. "I said to him, I'm worried about you because I think that you have sepsis and you should go to hospital straight away."
Quinlan phoned Domhnall’s wife, Mary, to explain his concerns about her husband. “I don’t think he has grasped the seriousness of what I’m saying but he needs to get intravenous antibiotics promptly. I’m concerned he might just want to go home to bed for a few hours rather than go straight to the hospital.”
Mary immediately sprung into action, getting her daughter to drive Domhnall and her – she remained in the back of the car – to the hospital without delay.
Hospital protocols during Covid mean that patients cannot be accompanied into the hospital so Domhnall’s daughter liaised with a nurse in the emergency department by phone while her dad went into the hospital alone. This situation raised another red flag for Mary as she was concerned her husband’s confusion would delay the urgency of his treatment.
There followed a few very stressful hours as the family was unable to highlight the urgency of intravenous antibiotics to the medical staff who first saw Domhnall. “Our GP said, ‘Just say two things, sepsis and embrel.” Embrel is an immunosuppressant medication that Domhnall takes for rheumatoid arthritis, which would keep his temperature lower than that expected with sepsis.
“It was a nightmare for me sitting in the car because sepsis can take off and go past the point of no return and there was nobody there to vouch for him and to say, ‘All he needs are antibiotics’,” says Mary.
“I felt totally helpless, distressed and powerless. I calmed myself at times by thinking that surely his vital signs were being monitored – and maybe, his symptoms had improved – but I had no evidence that this was happening. When I phoned Domhnall, he said he was feeling much weaker than when he was at the GP’s surgery.”
Three hour later – and following a call from the GP to the head of the emergency department – Domhnall Mac a Bhaird was diagnosed with sepsis of the urinary tract and given intravenous antibiotics.
“The next morning I was a different man. It was like a cloud had been lifted. I felt my head was clear but the day before I was unaware that I had any infection at all,” he says. He stayed in hospital for four days, receiving intravenous antibiotics three times a day. He left the hospital with a further 10 day supply of oral antibiotics.
The Mac a Bhaird family decided to go public with their experience to alert people to how sepsis can often go unnoticed. “Dr Quinlan said that if he had seen Domhnall several hours earlier, he might not have picked up on it himself,” says Mary.
Domhnall adds, “What I took out of the experience is that one needs to be very aware of feeling different in any way after having an operation because something could be going on in the background.”
Fever is one of the first signs of sepsis, but in Domhnall’s case his immunosuppressant medication had kept his temperature lower than would be expected for a case of sepsis.
“Immunosuppressant medications can suppress the symptoms of sepsis which are usually sweats, aches and pains, nausea and vomiting. In these cases, the patient doesn’t know he is sick and neither does the doctor which makes it so scary,” says Dr Quinlan.
Feeling faint, weak or confused are other early signs of sepsis which can be confused with other illnesses, including Covid.
Dr Quinlan adds, “I’ve seen four people with sepsis in the last 30 years and I remember each one of them vividly. That it’s so rare is part of the problem, but when someone has sepsis they can deteriorate very rapidly.”
