There’s a certain Slant of light,
Winter Afternoons –
That oppresses, like the Heft
Of Cathedral Tunes –

Heavenly Hurt, it gives us –
We can find no scar,
But internal difference –
Where the Meanings, are –

None may teach it – Any –
‘Tis the seal Despair –
An imperial affliction
Sent us of the Air –

There’s a certain Slant of light”
~Emily Dickinson~

The light oppressively blazed above me as the blood slowly drained away from my brain. It felt like I was dying. I had had a procedure to remove “gunk” from my liver bile ducts late the previous afternoon. This had been rapidly followed by dizziness and then constant voming. Dizzyness was usual for me for a short time post anaesthetic but I had never vomited before. The room spun, with the glare feeling more hellish than heavenly. My consciousness gave up to the inevitable as my surroundings proceeded to fade into oblivion. After a month of being unwell, dying certainly felt far easier than living. I felt no despair…only resignation to the seemingly inevitable.

But then chaos swiftly descended upon me as the emergency response button was urgently activated. My routine observations had showed a systolic blood pressure of 60 and within seconds I was surrounded by a dozen people with a crash cart, having a rapid infusion of IV fluids, an ECG, a 2nd IV line (a struggle with my small and shut down veins) and being told to try to keep my eyes open so they could tell that I was still alive. It took a while before I was sure I was going to stay alive….and not have to be further resuscitated with CPR to the rhythm of “Staying Alive”!

The nurses would later tell me that I had told them I was getting septic…and that I had been right. I had not been expecting THAT kind of septic however. I wondered if I was going to end up in ICU but my blood pressure rallied quickly with a litre bolus of IV fluids and within half an hour I was at least able to talk…if not to actually think…and everyone sighed with obvious relief.

The next couple of days passed in a blur of dizziness, nausea, and shortness of breath. My fluid resuscitation meant that I spent two nights propped upright unable to sleep, trying to drag air into my soggy lungs. I was so tired and sleep deprived that I actually had no idea what was happening to me. With oxygen sats of 98% and a normal ECG despite my central chest tightness I was not high on the list for an urgent clinical review. I was also way too unwell to make a fuss.

It was the morning after my first breathless and sleepless night that the registrar informed me that they were planning to transfer me back to my local hospital as I had now had the specialist investigation and procedure that I had been transferred for. I was so sick that I had no idea of what to do other than find someone else who could fight for me. Not only was I too unwell to fight, but I also had no trust in my own ability to fight as I had had a long past history of my descriptions of the severity of my systemic symptoms being ignored. What I needed was urgent help.

When I was admitted to hospital over two weeks before I had also struggled to have my septic symptoms treated seriously. I was seen in the Emergency Department by a young doctor who not only didn’t take a proper history, but then tried to bully me into a having a cannula in my cubital fossa where I have very small veins.

I was rescued by the emergency physician in charge of the department who expertly put in two ultrasound guided large bore cannulas with IV fluids going rapidly through one and IV antibiotics through the other. It was then it dawned on me that maybe I should have presented the day before, though it was only during the night that I had had recurrence of epigastric pain, along with sweats and chills.

What surprised me was how hard it was to get more IV fluids charted. The second bag went up at a paltry 125 mls per hour and I was still incredibly thirsty and had not yet passed urine. I asked my nurse to get the doctor to increase my rate to 500 mls per hour but it took more than two hours for this change to be made. By the end of this second bag I had at least passed urine.

Getting the third bag of fluids was a similar struggle. Before these were obtained I was seen by my surgeon who said I looked very unwell and suggested putting in a urinary catheter so they could better track my fluid balance. I was sick and a rarity for me, actually grumpy! I sarcastically said there was no use tracking my fluid balance accurately if nobody would chart me any fluids!! By the end of the third liter I was starting to feel slightly better and was now well enough to drink water to supplement them.

I was admitted under the surgical team as I was only two weeks post my gallbladder removal but it was quickly determined that my underlying sepsis was more medical than surgical. I was seen by the gastro reg who said the next best test was an endoscopic ultrasound at Tweed Valley Hospital which he would organise for later that week.

I spent two nights in the 23 hour ward of TVH, after having a stent placed in my common bile duct as no stones were found blocking it. This was complicated by airway instability, my oxygen saturations dropping into the 70s several times before they resorted to a more secure LMA airway. The plan was for three more days of IV antibiotics and removal of the stent in two months time.

Unfortunately this plan was thwarted by the fast recurrence of my systemic septic symptoms. Forty-eight hours later my dizziness and sweats returned. I was visited daily by the surgical team who listened to and documented my description of my ongoing symptoms but the only communication from the gastro team was passed onto me from what they had written in my notes.

On Monday they documented stopping my antibiotics since the planned 72 hours was now up, but the surgical team now sprang into action. They got me an infectious diseases review who recommended ongoing antibiotic therapy due to my ongoing systemic symptoms.

On Tuesday I had my second visit in nine days from the gastro reg where he asked me if my symptoms could all be due to my unstable myositis. Maybe it was a fair question, but it was more likely that he had read in one of my discharge summaries that the Multidisciplinary Team had decided that all of my lung abscess symptoms were due to my myositis, despite those symptoms including right lower pleuritic chest pain, a productive cough, and a positive lung biopsy for Aspergillus!!

This comment had precipitated my referral to an Infectious Diseases specialist in Brisbane who said I had Invasive Aspergillosis and needed to be treated more aggressively. I eventually had a wedge resection of my abscess and had been very well for 12 months, despite ongoing unstable myositis. I had yet to see the Gastroenterologist though I would later find put he was a locum and maybe felt under resourced to see a complicated doctor patient…

So…I sent a message to my non-treating gastroenterologist who had seen me during my last admission, enclosing a copy of my most recent test results. It felt like everyone was just expecting that I would get better, but unfortunately my body was insisting on getting worse. His blunt return message of “What the heck is going on?” at least validated my feelings of frustration.

What I didn’t know was that he was going to be doing procedures in the hospital the next day, and so was able to talk to my current treating team. By Thursday morning I was deteriorating rapidly with sweats, chills and difficulty eating. I insisted on talking to the gastro team so that they could see me in the flesh while I was really unwell and by that afternoon my transfer to the Gold Coast University Hospital had been organised for the next morning.

My non-treating gastroenterologist did message me saying he could see why the Gold Coast was reluctant to accept me as my test results didn’t really fit with the initial hypothesis of infected intrahepatic bile ducts. He hoped that they would keep an open mind.

It was only after my near death experience that things became dramatically clearer…sepsis that severe could only have come from an intrahepatic source. This resulted in a CRP of 150 and several days of a very increased WCC. It was during this time that the registrar suggested I be transferred back to my home hospital. I was a NSW resident taking up a bed in a Queensland hospital afterall. I was too unwell to explain to him cross border hospital politics and the official Memorandum of Understanding between our health districts.

So very stressed about being sent back to a lower resourced hospital with less access to specialised specialists I once again reached out to my long suffering gastroenterologist. Again he came through for me, ringing my GCUH gastroenterologist and selling my need to stay in a tertiary center. It is possible my admitting gastroenterologist had had no plans to discharge me, but I couldn’t take the risk. D then messaged me back saying that he would make sure that I didn’t fall through the cracks. This meant I could now focus on breathing and staying alive rather than stressing about who was going to keep me alive

It was only when I was seen by the cardiologist the same afternoon that I finally figured out why I had been so breathless overnight. My JVP was elevared to the angle of my jaw, an indication of severe fluid overload. The IV fluids that had been used to give me enough blood pressure to get blood flow to my brain had now redistributed into the interstitial spaces on my lungs, squashing my alveolar sacs and limiting the transfer of oxygen. This dramatically worsened on lying flat, resulting in my middle of the night struggling to breathe. After a second sleepless night I had a small dose of lasix to encourage my kidneys to get rid of the extra fluid and my breathlessness rapidly resolved.

As a doctor, when I am out of my depth while looking after an unstable or complicated patient the first thing I do is get assistance from a doctor more experienced or with a different skill set than mine. As a patient this often results me in grossly flaunting the typical doctor/patient boundaries. If I was not so unwell it would be easier to have patience but my fear rapidly overrides my stress of being seen as a difficult patient.

Over a month into my saga there are few answers but at least I am still alive…thanks in no small part to my non-treating home town gastroenterologist who was willing to go above and beyond the call of duty to fight for me, even though he had no idea what was really wrong. The one thing he did have was enough belief in me to know that if I said I was still very unwell, I was.

As a poor but heartfelt thanks I bought him a card that said: “What the f❤️ck would I do without you? Thanks for everything!” It still feels like he saved my life, even if he probably swore every time he saw an email from me in his inbox. I will be forever grateful.


When it comes, the Landscape listens –
Shadows – hold their breath –
When it goes, ’tis like the Distance
On the look of Death –

“There’s a certain Slant of light”
~Emily Dickinson~