KATE MANSEY: I nearly died of a burst appendix… after three GPs refused to see me face to face during lockdown
- Kate Mansey was refused three face-to-face GP appointments in South London
- She spoke to GP over phone and was initially diagnosed with viral gastroenteritis
- Mother discovered her appendix had burst after going King’s College Hospital
- GPs also refused to see Olly Bradford, five, in lockdown – and his appendix burst
The voice came from somewhere above my head: ‘She’s spiking.’ I’m no medic, but as I lay there, in A&E, it struck me that when they start speaking about you and not to you, it is probably a good indication that you’re really rather ill.
Within moments of the spike – medical terminology for a sudden, sharp rise in temperature – blood samples were taken from my arm, and penicillin and rehydration fluids were put in.
I lay back and watched the choreography of doctors and nurses moving in and out of my room, all of them trying to figure out how I had ended up here. With an agonising stomach pain – even worse than childbirth – there was no one more anxious for a diagnosis than me.
It had all started innocently enough. Five days beforehand, on Easter Sunday, I’d been absolutely fine. I was with my husband and two young children, visiting my parents in their back garden. The sunshine was glorious and as I watched the kids play, I turned to my husband and said: ‘This is the most relaxed I’ve felt in ages.’
Kate Mansey, pictured above, was refused three face-to-face GP appointments before going to King’s College Hospital in Camberwell and finding out her appendix had burst
That night was a different story. At 9pm I suddenly felt as if I had been punched in the stomach. I roamed around the house like a wounded animal, not knowing whether to stand, sit or lie down.
Neither paracetamol nor ibuprofen (I took both) made a dent in the pain. Then I started to vomit. All night and all the next day, too.
Was it food poisoning? A stomach bug? Probably not, given that no one else in the family had any symptoms. All I knew was that it was worse than anything I had ever experienced. By Tuesday, two days on and unable to keep even water down, I called my local GP surgery in South London.
For over nine months, this newspaper has been campaigning for a return to face-to-face GP appointments, so I know how, for many patients, being refused these consultations has been the cause of so much suffering and misery. And, although I didn’t know it at that time, I was about to become one of them.
The receptionist said consultations would be on the phone, and when the GP rang back he swiftly diagnosed viral gastroenteritis – a stomach bug – despite me explaining that no one I had been in contact with was ill. He prescribed anti-nausea drugs, which someone could pick up on my behalf from a local pharmacy.
The drugs seemed to work – for a while. The vomiting stopped and the pain decreased to a manageable level. Until, that is, the diarrhoea started. I’ll spare you the gory details, but suffice to say that the word ‘severe’ seems woefully inadequate here.
So on Wednesday, a day after my first GP telephone call, I was back on the phone to the surgery and a different GP confirmed the original ‘viral gastro bug’ diagnosis. On the Thursday – feeling weaker still – I tried again. This time, a third GP from the practice called back.
The pain, I told her, had moved from the middle of my stomach down to a focused area in the bottom right-hand side. This GP unhelpfully asked whether I had tried Dioralyte – the rehydration sachets you mix with water. Yes, of course, I had. Had she any other suggestions? It seemed not.
IT’S A FACT
Men are roughly 25 per cent more likely to develop appendicitis than women, according to the American Journal of Epidemiology.
So three calls from three GPs within three days. Not one listened to my concerns about the worsening pain.
I’m not a regular visitor to my GP surgery – I don’t like to ‘trouble the doctor’ with any little ailment. So for me to make so many calls – with my husband dialling and putting the phone on speaker because I could barely lift my head off the pillow – was, I felt, a big deal.
You may well wonder why I didn’t just go to the hospital. Well, hindsight is a wonderful thing and I respect GPs. I was reluctant to join the growing number of Britons resorting to using A&E as an alternative to their local surgery.
If three GPs tell me it’s a bug and I just have to ride it out, then I’m likely to believe it. By the Friday, however, my patience was wearing thin. I called again, and begged the surgery receptionist to let me see a doctor. ‘You’ll need to call 111,’ she said apologetically. ‘There’s nothing we can do for you now. 111 are more important than us, anyway.’
As I waited for the call back from 111, I made some strange attempt to pull myself together and carry on as normal. I called work and dialled in to a conference call. I sent emails. I was in pain – but maybe it would all be OK.
My husband was alarmed: ‘You’re sweating. You can’t walk. You’re speaking strangely.’
To be honest, I felt as if I was hallucinating. By now I was doubled over so much that I couldn’t walk unaided. In the bathroom mirror, someone completely different stared back. My brother called and told me to go to the hospital. My husband concurred. Within minutes, an acute care nurse from the 111 service called back to say the same. Sadly, I can’t remember her name, but I will love her for ever. ‘I don’t want to alarm you unduly,’ she said, ‘but I never like to hear about pain in the lower right side.’
She told me to get a pen and write down ‘pain in the right iliac fossa’, spelling out the unusual words.
I was to repeat this upon arrival at A&E. The nurse said: ‘My big worry is that it could be appendicitis.’ She was right. On arrival at King’s College Hospital in Camberwell, a trauma doctor saw me straight away thanks to my ‘iliac fossa’ codeword.
A CT scan, together with some ‘worrying blood samples’ and that spiking fever, confirmed the diagnosis. I was sent for emergency surgery. My appendix had already burst. A brilliant surgeon called Christo Lapa – the man who saved my life – later told me that my insides had been ‘a horrid mess’. He added: ‘You are very lucky not to be in intensive care.’
Close call: Kate with daughter Ivy, two, and six-year-old son Ted. She was told that GP consultations would be on the phone, and was initially diagnosed with viral gastroenteritis
The appendix is a small, thin tube located where your small and large intestines connect in the lower abdomen – the area, around the right side of the hip, is known as the iliac fossa. Intense pain here is commonly a symptom of appendicitis: inflammation of that tube. Doctors used to think the appendix served no vital function, but some now theorise that it may play a role in harbouring ‘good’ bacteria in the digestive system.
It’s also prone to infection – possibly due to its dead-ended structure – and this is what experts think triggers appendicitis. If the inflammation is untreated and worsens, the appendix can burst, allowing bacteria to be released into the surrounding abdomen. This can trigger widespread infection, known as peritonitis, and organ damage.
By the time mine had been picked up, my bowel had become stuck to my uterus, which had fused to my pelvis. They needed seven litres of water to wash out my insides and separate it all.
Mr Lapa treated me like a grown-up, and when I came round from the operation he seemed to like telling me the specifics, which I appreciated. He confirmed that it was likely my appendix had ruptured ‘some time ago’, and expressed amazement that I managed to walk (albeit with help) into A&E.
I was in hospital for a week on morphine, intravenous antibiotics to fight the infection and with a tube coming out of a hole in my stomach to drain blood and pus.
Thanks to the swift action by the doctors and nurses, I recovered. But I am still haunted by the first thing one of them said to me when I arrived at hospital. The doctor pointed to my abdomen and said: ‘Look. This part of your stomach is sticking right out. I can see just by looking at you.’
Aside from pain in the iliac fossa, this is another indicator of a ruptured appendix.
I go back to the doctor’s words again: ‘… just by looking at you’ – it was something that three GPs had not bothered to do. I understand that GPs are not gut specialists, but this was not a rare condition.
Acute appendicitis is the most common abdominal emergency in the world: about 50,000 appendectomies – removal of the appendix to prevent or treat rupture – are performed in the UK every year. And this is why I feel badly let down – in fact, doubly so, because there’s a twist to this tale.
About 50,000 appendectomies – removal of the appendix to prevent or treat rupture – are performed in the UK every year (file photo)
I had been in hospital two years previously with suspected appendicitis. After I collapsed at a spa day, a fellow guest, who happened to be a doctor, was ushered over to examine me while still in her towelling dressing gown.
‘I think it’s appendicitis’, she said. I went to a hospital in Hertfordshire but within a few hours the pain disappeared.
I was told my blood samples were ‘borderline’, not showing conclusively I had any infection – an indicator of appendicitis – and I went home. The next week I went to see my GP and asked if she could run some more tests on my appendix.
Using her best headmistress voice, she peered at me over her glasses and told me with complete certainty that ‘a grumbling appendix is a myth’. If it was appendicitis, there is no way it would have disappeared, she said. It would only have got worse.
She supposed instead that it was a gynaecological problem and sent me for a hospital scan on my uterus, which showed that everything was fine. It’s true that the idea of a grumbling appendix – long-term appendicitis, with central abdominal pain that then moves to the lower right-hand side, flares up then goes away – is a controversial one, in medical circles.
In decades gone by, patients with intermittent abdominal pain routinely had their appendix removed, without good evidence that it was the cause of problems, almost as a precaution.
In these cases, often the appendix turned out not to be inflamed. And so doctors have become more circumspect.
It would be true to say that, usually, symptoms of an initial attack of appendicitis do not just get better. In most cases, the pain is acute, and surgery is needed.
But to say that this is always the case, and that the idea that cases like mine never happen, is just wrong. In fact, when lying in my hospital bed, slowly recovering, I asked Mr Lapa if it was possible my appendix problems could have started several years before and he said it was entirely possible. I’m proof that a grumbling appendix is not a myth. And I’m not the only one.
Last week I spoke to mother-of-two Emma Bradford, 40, from Beith, Ayrshire. In October her son Olly, who was five, was doubled over with pain. GPs refused to see him due to the lockdown, even though the official guidance was that they should continue to see urgent cases. She said: ‘He was screaming in pain but the GP surgery said, “We can’t do anything. We’re not going to see him.”
‘I thought my wee boy was going to die. Even at the hospital they said it was a stomach bug. By this time he was on morphine for the pain but was told it definitely wasn’t appendicitis but they didn’t even give him a scan.
‘They said, “You were here last year with a similar thing with your son.” Olly’s pain was exactly the same about a year before. They made it out like I was a hypochondriac but I’ve got a 14-year-old daughter – I’m not a nervous first-time mum.’
Screamed in pain: Olly Bradford pictured recovering in hospital. GPs had refused to see him during lockdown – and his appendix burst
By the time appendicitis was diagnosed, Olly’s appendix had ruptured and his little body was being poisoned, just like mine would be. During his lengthy recovery, Olly had to have physiotherapy to help him build up the strength in his legs. His mother received an apology but is justifiably furious that her GP refused to see Olly at the start.
She remains baffled, saying: ‘Kids aren’t at risk from the Covid virus and this was an urgent case, so why didn’t they see him?’
The latest data compiled by the Royal College of General Practitioners shows that despite Government guidance, only half of all appointments are now face- to-face, and the majority of these are not with an actual GP.
Is your GP still refusing to see patients face to face?
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Our family doctors are the gatekeepers to all our health needs. They wield so much power. For two years, I believed my GP when she told me my stomach aches – which did keep coming back – were not my appendix. I believed them when they saw no need for me to go to hospital. I bitterly regret having trusted them. I’m now back at work.
I get stomach pain if I eat bread or pasta, so I have decided to cut out gluten, which seems to be working. My GP surgery is still not seeing patients face-to-face except for what it calls ‘urgent’ cases. It’s terrifying to contemplate how ill you might have to get to be considered ‘urgent’.
I have written to the surgery, not because I want to cause trouble or seek compensation, but because I want them to learn from their mistakes. I await the outcome of their next ‘learning from practice’ meeting.
Dr Steve Mowle, spokesman for the Royal College of General Practitioners, and a GP at a different surgery in South London, said: ‘We are sorry to hear of cases where patients feel they have not been able to get the care they need, particularly when GPs are working flat-out and delivering record numbers of consultations – nearly 14 million in the last four weeks.
‘General practice was under huge pressure before the pandemic but we are now at crisis point and don’t have enough GPs to meet demand.’
A crisis indeed. When an American friend and a French friend heard of my ordeal both said, independently of one another: ‘This would never happen in my country.’ Unfounded jingoism? Perhaps. But if you heard of this happening in the US or France, would you rush to say it could never happen here? I doubt it.
Covid Q&A: Are hospitals filling up and will freedom be delayed?
Q: Are Covid-19 hospital admissions rising?
A: On Thursday, Public Health England published data revealing a slight increase in Covid-19 hospitalisations over the previous two weeks. Last week, there were 923 patients in hospital due to the virus in the UK, up from 895 two weeks ago. The number of people seriously ill on ventilators also rose across the same period, from 124 to 136. It was always expected that these figures would increase when lockdown eased, as a significant number of people have yet to be vaccinated.
It is only if these figures were to rise substantially that the Government would worry that the vaccine rollout is not proving as effective as hoped at keeping people out of hospital. There is no sign of that happening just yet.
Health Secretary Matt Hancock said the Government would continue to keep a close eye on hospital figures. He added: ‘The vaccine breaks that link [between cases and hospitalisations]. The question is how much the link has been broken.’
Q: If the majority of vulnerable people are now vaccinated, why would we need to delay ‘freedom day’ beyond June 21?
A: Last week marked another major milestone for the Covid vaccine rollout: more than half of UK adults have now had two doses.
Perhaps more importantly, though, more than 90 per cent of Britons over 60 – those most at risk of serious illness and death – are now fully vaccinated.
Given that the justification for lockdowns and restrictions was to protect the vulnerable, it is easy to see why talk of delaying the removal of all restrictions beyond June 21 has left many confused.
If the UK were still dealing with Covid in its original form, then it’s likely there would be no need to push this date back. However, scientists say the Indian variant, also called the Delta variant, has dramatically changed things. Studies suggest the variant may be 70 per cent more infectious than the Kent variant, which itself was 50 per cent more infectious than the initial virus that arrived in the UK in January 2020.
Experts believe that if the Delta variant is allowed to spread, it is likely it will reach those who are unvaccinated. On Thursday, Vaccines Minister Nadhim Zahawi said that while there was nothing in the data to suggest the road map out of lockdown may have to be adjusted, ‘the next 12 days are going to be really important to see what the virus is doing’.
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