The partner and relatives of a Dunedin mother-to-be were called to her hospital bedside to say goodbye after she became critically ill following a missed sepsis infection.
Fortunately the woman, whom the Otago Daily Times has agreed not to name, and her baby survived the ordeal.
Ms A said she had seen media coverage of missed sepsis cases at other New Zealand hospitals and wanted to make southerners aware there had been incidents at Dunedin Hospital as well.
"The main thing to put across is to identify the state that our hospitals are in at the moment," she said.
"Why are we wasting money changing the names and not hiring staff who are confident and competent to do what they have to do?"
Ms A was 36 weeks’ pregnant when she was admitted to Dunedin Hospital two months ago.
Due to severe morning sickness and other complications, she had an intravenous line inserted, but the lumen (the device through which medicines are delivered) had snapped and she needed another inserted.
She was sent home for 24 hours with a redone dressing as no operating theatre was immediately available, but was back at the emergency department at 6.30am with swelling in her neck and in severe pain.
"When I went in I was vomiting blood ... They put me out the back and didn’t take any observations or my temperature."
Ms A called for a nurse three times and pleaded to see an obstetrician or doctor — "I was starting to get very grumpy and stressed out" — as she was sure she had started going in to labour.
"I felt something was wrong, I didn’t feel well, but nobody came to see me."
At 10am she was sent for a pre-arranged scan, but when she returned to ED she was forced to wait in the hallway in a wheelchair.
A nurse who Ms A knew saw her languishing in the corridor and recognised immediately there was a problem.
"I pretty much think that she saved my life."
The nurse organised a neck X-ray, which spotted the intravenous line had relocated, and recommended Ms A receive urgent care.
However, Ms A’s hospital notes say at this point it was decided it was not appropriate for her to see a doctor, and that ED staff should carry on with their plan of care.
At this point Ms A "lost the plot and burst into tears" and begged for help.
In response a doctor was called, who told Ms A that her birth was not going to be induced and said she was concerned about her mental health.
Ms A is adamant she does not have any mental health issues, but said it was fair to say she was probably not coping at this point.
"I said ‘I’m not going to lie, I do want the baby out, but I feel horrendous and something is wrong. I feel very, very unwell’."
Ms A agreed to stay in hospital overnight and review the situation, but before then the still-undetected sepsis infection started to take hold.
"For the first time they took my temperature, which was 39.7degC," she said.
"My heart rate was through the roof, I was sweating but feeling really cold, and had really bad swelling."
Ms A passed out, went into labour, and the emergency medical team was called.
"They found my phone and rang my partner to tell him that he had to get in now because they thought that they were going to lose me and the baby."
Despite frantic efforts, clinicians could not control Ms A’s blood pressure and heart rate.
"They then rang my partner again to say that ‘you need to get in yesterday because she is in a really bad way’."
"They said ‘we have to do a CT scan as we are worried there is a blood clot in her brain and we don’t know if she will come out of the scanner alive,’ at which point he put his foot down really quickly."
Fortunately Ms A did survive, but was admitted to intensive care and monitored constantly for 12 hours; her survival was still touch and go, and Ms A’s mother was also called in case she did not live.
"They told my partner that they did not want to operate then, and they told me that because they had a skeleton staff on, if I could get through to the morning then we would both have [a] better chance of surviving."
After an apprehensive and anguishing night, surgeons operated the next day to deliver Ms A’s baby, who was immediately transferred to neo-natal intensive care while her mother recovered.
Ms A was in intensive care for a further two days, and then in hospital for another week recovering.
"We’re good now, but it has all been a blur and I have suffered from some of the after-effects of some of the drugs, but now we are home and we’re healthy."
She said part of her recovery was having to process the experience she had gone through, and the fact that hospital staff had both failed her but also saved the lives of her and her baby.
"I’m not angry at a certain person or pissed off that it was missed, but I’m still in shock that, with hindsight, the basics that could possibly have potentially have prevented this were missed.
"If they had taken observations when I first arrived they could have noticed my temperature was high and detected sepsis ... but then they saved me, and if I hadn’t been there in hospital, I would be dead.
"I am so grateful that we are here and our daughter is perfect."
Ms A has laid a complaint with the Health and Disability Commissioner about her treatment.
Te Whatu Ora Health New Zealand Southern chief medical officer David Gow said the hospital had an adverse events committee, which reviewed and monitored rates of adverse events and themes.
"We monitor rates of events looking for trends and where specific mitigation is required."
