The Little Girl Called Esme

I have recently obsessively begun watching the BBC Two Documentary, Hospital. In a recent episode, a 4-year-old little girl, Esme, was rushed to hospital with a case of sepsis. I watched her parents sit there, hand clasped tightly; nervous as their little child was put into an induced coma, her hands and feet turning a disconcerting purple/black colour. I could only imagine the fear that they would be going through.

The doctor in that episode, Dr Patrick Davies, explained to the camera what was happening to Esme:

“There is a level of sepsis called septic shock and that is when the body starts to divert blood to the most important organs, I mean brain hearts, lungs, kidney that kind of thing. The organs that a body cares about least are fingers and toes and that is why with some patients with extreme septic shock, they will shut down their blood supply to the hands and their feet. So it’s almost a bit of self-sacrifice when the body is in that much trouble.”1

I had heard of sepsis before watching the episode but was never quite sure what it actually was, so the purpose of my article today is to find out more about sepsis.

Sepsis, as defined by The UK Sepsis Trust, is the reaction to an infection in which the body attacks its own organs and tissues.2 It is sometimes confused with blood poisoning or septicaemia—which is what I thought it was—but there is a difference.

With blood poisoning and septicaemia, bacteria (the nasty ones) make their way into our bloodstream, wreaking havoc as they get transported throughout our bodies. However, sepsis is different, as the bacterial infection (as well as albeit less commonly, viral and fungal infections) can cause harm to multiple organs in our body even without entering the bloodstream via septicaemia or blood poisoning.

There is a helpful mnemonic on The UK sepsis trust website, which is used to remember the symptoms of sepsis:

Slurred speech or confusion

Extreme shivering or muscle pain

Passing no urine in a day

Severe breathlessness

It feels like you are going to die

Skin mottled or discoloured 2

Esme’s hands and feet had gone that purple/blackish colour because as Dr Patrick had said, the body had stopped supplying blood to her hands and feet, as it does not care about those organs as much as the vital others such as the brain, lungs, heart, kidney etc. On our symptoms list above, this would be an extreme version of the last S: Skin mottled r discoloured.

There were two main concerns with Esme:

  1. No one knew if her brain would be in a good enough condition. Whilst in the induced coma, there was obviously no way to judge whether she would wake up to be the same girl as before. Her brain could have been starved of oxygen, in which case her neurones would suffer, causing a substantial amount of brain damage.
  2. Some of her digits (fingers or toes) may have had to be amputated due to the lack of blood supply as the body was pushing the blood to her vital organs instead of the fingers and toes.

Later on in the episode, the medical team stabilises Esme and take her life out of danger, fortunately without the need to amputate any digits, but they still didn’t know the condition of her brain. There is not a brain test yet that would have been able to tell the medical team whether Esme would wake up the same girl as before, so the only way they could get a good idea of how her brain was doing, was by waking her up out of her induced coma.

I sat at the edge of my sofa as Dr Patrick gently woke Esme up from her sleep. ‘Oh God, please let her be okay’ I thought to myself, my feelings probably somewhat mirroring those of her parents. If Esme could communicate well, she would be fine. If not, then she would have to spend more time in hospital, 80 miles away from home, as she and her parents would be loaded with information and the emotional rollercoasters of what to do next.

Esme was brought out of her induced coma, and when Dr Patrick asks her

“How are you?”, she answers: quietly but sturdily:

“Good”. A flood of relief washes over Esme’s parents’ faces, and I relax back into the cushiony sofa.

“Are you tired?” the doctor asks, to which she feebly yet affirmatively nods.

“Are you hungry or thirsty?” he asks again

“Thirsty” she replies

“Would you like some food?

“No, thank you… I’m thirsty”

“What would you like to drink?”

“Blackcurrant juice”

The doctor leaves the family in peace, and the nurse comes in, gently lifting Esme and placing her in her mother’s arms, who cradles her like a new-born baby. The small family sit there, tears in their eyes; Esme resting peacefully with her eyes closed. I can only imagine what they might have been imagining. What they went through must have been a horrible experience.

But, it reminds me to be grateful for the wonderful organisation that is the NHS. In another episode of Hospital, a lady describes the NHS as ‘a privilege, not a right’, after her operation is cancelled for the second time, and that made me think: no matter how much we may scrutinise the NHS, they are absolutely incredible. We are lucky to have them.

Watching Hospital has allowed me the honour of witnessing the highs of being a doctor, but it has also shown me a glimpse of the stressful reality that lies ahead of me. To be completely honest, when I think that one day, I will have to make a decision which could change someone’s life (whilst running on sleep deprivation, lack of food and underfunding), it terrifies me, and I want to run in the opposite direction from medicine. But then I see that doctor getting a huge smile from their patient, or that child getting a huge hug from their parent, and I am reminded that yes, it will be tough, but it will all be worth it in the end.

After all, ‘diamonds are formed under pressure, but they are not formed overnight’.

By Muskaan Jonathan

References:

  1. https://www.nuh.nhs.uk/latest-news/four-year-old-esme-fights-sepsis-in-hospital-2637
  2. https://sepsistrust.org/what-is-sepsis/

Other sources:

  • https://www.nhs.uk/conditions/septic-shock/
  • https://www.nhs.uk/conditions/sepsis/
  • You can find out more about the documentary via this link: https://www.bbc.co.uk/programmes/b09xt5yv

 

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