Day 51 – A Detective Story
Detectives: A. Allen, I. Clowes
Subject: Little Sam (or as it turns out – not so little)
Information to be found: What has happened to this girl?
Sam is a curious case who had caught our attention weeks ago when Aaliyah watched her pressure sores being dressed by the nurses whilst I’d been doing therapy on Women’s Ward. Since then, as I’ve previously written, I’ve been doing her therapy and been fighting to get her on the Long Trolley and that project had been a success. But our interest continued to crescendo as more questions began to be asked: why did she have so many surgical scars that made her hips look like a worn blanket? Why does she have a pressure sore that must be years old and yet looks fresh as if it arrived overnight? Why is she paraplegic when there’s no obvious trauma signs on her back? She was a bright, happy girl who seemed to have no idea about her history and after a phone call with my Mum who said we should pick it up as a case study, Aaliyah and I set about digging up every file and folder we could get our hands on that were labelled with her name…
We began with the physio notes. I mean, why not? They were the closest on hand and after dealing with them for the past 8 weeks, I felt I had the best chance to try and unpick any hidden information amongst the copy and paste SOAP notes they kept. At first glance it appears like any of the others: name, age (to be queried multiple times), contact number (not usually there, but we were lucky – not that it was relevant to our investigation), ID, diagnosis. There follows in each box the same complaints, exercises, analysis and plan every single day from her admission (?) to the present day. However, we also then took note of the days she had fever, was sick (no other info given) or absent due to operation – we further noted that therapy was missed.
Next, we headed down to the Nursing Station and easily pulled out the necessary files and began sorting and sifting through the most complicated paper trail I’d come across so far.
We had Doctor’s notes that began before her admission that told a very interesting story telling about referrals, advice given, attempted and possible analysis, medication given, possible diagnoses… To say it was endless would actually be better than not as it came up short to the present day pretty quickly and hadn’t provided much clarity to her condition.
Next, was an MDT Assessment booklet filled out the day she arrived – by this point the admission date was fairly consistent so we accepted it as true – which was lacking some information not as much as most but although it added more pieces to the puzzle, I felt like we now held more threads in a tangle of string. We added further things to our problem list and ?Diagnosis and possible operations or date of injury. Then we realised what we really needed as none of the notes were making sense and if they were, they probably contradicted with something else that appeared to be decisive and finalised. So, what was next? We moved onto the patient.
As we walked in, Aaliyah said ‘Right, we’re here to investigate a patient, not a friend.’ It sounded harsh but she only meant we couldn’t get distracted and had to stay on topic. Unfortunately we felt we had to disregard the information she gave as it didn’t correlate with anything else that we’d seen so far, she didn’t even know her own birthday, but we did hit a jackpot when she said she kept her X-Rays, MRIs and CT Scans just under her bed. Bingo, I thought.
The feeling didn’t last long as it wasn’t exactly our area of expertise being students and not hardwired to understand the findings, even my Mum – who is a GP – later said she only looked at summaries of the scans which we didn’t even have. We did, however, find a date that looked promisingly like a date of birth which had a surprising figure. After that, everything was queried. We went back to the day she had the surgery which supposedly caused the paralysis even though she’d suffered from a ‘burning sensation’ months prior to this and had only been given some meds though there’s no record of a Doctor’s admission. There were reports from urine samples, blood analysis, wound swabs, ABGs, everything under the sun from all over Bangladesh, I could only hope that she also hadn’t had to do the travelling between Chittagong, Cox’s Bazar and Dhaka.
By the end I had dates scrawled all over 3 sides of A4, chasing this little girl on her wild journey where she collected scars and lost her way only to end up at the CRP. We have yet to put it all into a comprehensive timeline and list but we’re currently working on a hypothesis of TB even though we’d found a negative test using a possible method not 100% accurate. The diagnoses we’d pulled together – scattered across flimsy bits of paper and sticky, coffee stained reports – include: Perthes disease of the left hip (incorrectly spelled several times), secondary OA following the disease, a right hip dislocation (it’s where and when still unknown), cellulitis of the left dorsum on the foot around one of the 7 pressure sores she’d accumulated, transverse myelitis had briefly been mentioned but the final and almost decisive diagnosis (?) was Pott’s disease. And when we finally discover it’s symptoms and idiopathy, we may have a conclusion that little Sam has TB Spondylitis.
After all this, we gave her the notes back and informed her she is 15 years old and even supplied a birth date so she could now celebrate her birthday