Opening session: Sepsis undiagnosed, cancer unreported

We opened by reading together the tragic, tragic, tragic story of the death in Naas hospital on Christmas Day just gone of twenty-four-year-old Karen McEvoy from sepsis, only days after safely having had her third child, as reported by Kitty Holland in the Irish Times.

https://www.irishtimes.com/news/health/woman-24-who-died-a-week-after-giving-birth-had-sepsis-says-coroner-1.3776483

The overall sense that came across from the reading was one of incredulity: how could this have happened to this young, healthy mother; how was the sepsis missed; how could she have handled so much pain without the urgency of the situation becoming apparent to everyone?

We looked at the language of the reporting and at what Karen’s partner, Barry Kelly, has said since, as quoted by Holland:

“Nobody asked Karen anything about why she was on crutches… “I went into her and I was talking to her. I was like: ‘I love you. You can’t leave me. We have to build our house. We have to get married in 2025.’ I just kept calling her. I can still hear the sounds of the compression pump on her chest, and all I wanted was to hear the beep, but it was just a flatline… “I have to do this for Karen. Her shoes are my shoes. No matter what I do or say I can never bring Karen back.
“I have to get answers for my kids. They are not going to believe in fairies forever. I have to be able to tell them: ‘This is what happened to your mum’.”

We discussed some of the factors that may have fed into the disastrous dynamic that led to the tragedy: her background, her situation, the time of year, the healthcare resources.

I wondered might there be anything in simply the fact that Karen was a woman (aside from the postpartum aspect of the pathology). There was a discussion about the idea of women being taken less seriously than men when it comes to their reports of pain. I suggested we keep in mind the possibility of some women in some cultures (Ireland, for instance) being less likely to report pain in the first place for fear of being the focus of attention, of causing someone a problem, of ruffling feathers, of breaching the unwritten code of behaviour that says you’re not worthy of anything more than survival.

With that in mind we moved onto our second text: John McGahern’s The Barracks, particularly the story therein of Elizabeth, who develops breast cancer and is very slow to report her symptoms with tragic results.

She could not let herself collapse …

She tried to brush it off as nothing. With all her will she rose from the chair. She lifted off the boiling kettle, put on a saucepan.
  “It’s nothing at all,” she smiled casually with every muscle in her face. “It’s only to be sure.”


It’ll probably be just another iron tonic,” Elizabeth tried to close the conversation.

“Have you been aware of them for long?” he asked.
  He did not even ask to see them yet. She pretended to count back.
  “Last November,” she diminished. “I felt as well as usual. Christmas was coming. There seemed so many things I had to do. It went on the long finger and slipped from day to day.”

  “In the breast. There are cysts there. They may be malignant.…”
  “When did you notice them?”
  “A few weeks ago,” she lied.
  “You never told?” he reproached.
  “I thought that they were nothing,” she tried to excuse. “I didn’t want to cause you more trouble. I was feeling tired and didn’t know till he said.…”

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Medical student puts doctors centre stage

Madam, – [Re new children’s hospital debate] Dr Finbar Lennon writes “The vast majority of the children who will be served by this new hospital are not yet born” (October 19th).

Furthermore, many of the clinicians who will work in this new facility are yet to qualify. As a lowly student of medicine, I feel that the current debacle does nothing to motivate, encourage or inspire tomorrow’s doctors, nor does it bode well for the future of Ireland’s ailing health service. – Yours, etc,

FRED ENGLISH (Times) >>>

From Scope magazine: obstetric fistula

Eimear Vize writes: “Constantly in pain, leaking urine or faeces, bearing a heavy burden of sadness in discovering their child stillborn, outcasts because of their offensive smell; ashamed, these young women live on the periphery of their former existence, without friends and without hope….

The eradication of obstetric fistulas in Africa is decades away at least. But these doctors and nurses with MSF, and other humanitarian groups, are taking crucial first steps toward that goal.” (Scope) >>>

In the papers

1,200 patients in ‘outdated’ institutions to be moved >> Minister for State with responsibility for mental health John Moloney says he wants to close the remaining 14 Victorian-era institutions and provide new community-based facilities. >> Irish Times

Top consultant backs hospital protest > The consultant has already resigned from a steering group set up by the HSE to examine the ‘reconfiguration’ of acute hospital services across the south-east and is now backing a protest march due to take place at the end of the month. >> Indo

Group says obstetricians need to ‘regain trust’ over symphysiotomies > WOMEN who underwent symphysiotomies in this country have called upon obstetricians to concede the procedures should not have taken place over the past century. >> Irish Examiner

In the papers

A DOCTOR working in psychiatry who cheated in a postgraduate examination was yesterday found guilty of professional misconduct by the Irish Medical Council. >> The committee noted he had undertaken not to repeat his behaviour and had already been suspended from the medical register in the UK. The committee will recommend to a meeting of the full medical council that he be censured. >> http://www.irishtimes.com/newspaper/ireland/2010/0218/1224264715137.html

When I found a lump I thought I was too young >> I had my full mastectomy with diep flap reconstruction – in which tummy fat, tissue and blood vessels are removed and used to reconstruct the new breast – on October 24th last year, 10 days after my daughter’s first birthday. >> http://www.irishtimes.com/newspaper/health/2010/0216/1224264544086.html

In the papers

Doctor’s treatment ‘appalling’, mother tells court > When he put to Ms McGillin that the final decision on the medication was hers, she said: “Someone has to take responsibility for what happened to my daughter”. >> Independent

Surgeon with HIV seeking damages > Among claims in the case is that absence of mandatory screening of hospital patients for HIV exposed the surgeon to a risk of harm. >> Irish Times

Oscar the cat predicts 50 deaths in nursing home > Dr Dosa suggests that Oscar is able to detect chemical changes that accompany death >>Independent

Brain-injured patient’s thoughts ‘read’ by scanner > Dr Adrian Owen, assistant director of the Medical Research Council’s cognition and brain sciences unit at ­Cambridge University, believed that the patients who responded in the study were probably “perfectly consciously aware”, although he knew others would disagree >>Guardian

Today’s Literature & Medicine lecture

After today’s lecture, apologies to you all on three counts –

1. the confusion about your assignment: I am since informed that the assignment is actually a separate matter altogether from my lecture & that you will hear more about it this afternoon during another class

2. the fact that I didn’t have the handout with me: you can now download it in pdf format here >>>Lit and Med lecture handout 

3. the fact that I didn’t cover all the texts I had intended to & that therefore the lecture lacked the structure I had hoped: this was totally my fault (put it down to being off form), and I hope to make up for it here shortly by offering you some perspective on the issues that the extracts raise >>> check back next week

Thank you for your attention.