‘The cost of so nearly getting it wrong’
Highly commended in ‘The case that still gives me nightmares’ category, Dr Philippa Vincent recounts how a near miss with a remote consultation and oximeter readings in the pandemic still keeps her up at night
January 2021. Nine months into the nightmare that, even with the new vaccine, didn’t seem to be ending and, in fact, seemed to be ramping up again.
Bertie was on the ‘over 70 with a positive covid test result’ list. I called him late on a Monday afternoon. ‘Oh, I’m grand,’ he told me. ‘Just a bit of a cough. The wife’s worse. I’m already starting to feel better.’ We had a brief discussion and I gave him advice about worsening symptoms which I could feel sliding off him as I spoke.
Next call – to the pulse oximeter courier service. Replying from somewhere in London that I never discovered, the amazing volunteer took yet another postcode and house number from me.
I called back at 7.30pm but the pulse oximeter was still in transit on the back of a motorcycle somewhere.
I called again at eight the following morning. Yes, it had arrived. Yes, he was waiting for me to call. Yes, he was still feeling fine, again a bit better, again ‘just grand’.
‘OK Bertie,’ I said, relieved. ‘Let’s just get these numbers, shall we? Read them out to me.’
Bertie had them all ready. ’99, doc. And 88.’
‘Perfect!’ Such relief. ‘I’ll call again tomorrow then Bertie. And just call back if that 99 drops to less than 94, yes?’
And then I stopped. I had a sudden thought. A premonition? A spidey sense? A gift from God? Who knows?
“Bertie. Can we just check? There’s a percentage sign after one of the numbers and after the other one it says bpm. Which number is which?”
I could feel Bertie squinting at the oximeter down the phone line.
‘The 88 is before the percentage and the 99 is before the bpm.’
‘Really? Are you sure?’
He was sure.
Between us, we managed to get a video call up and running. He looked as well as he said he felt. Sitting comfortably, smiling, breathing normally, trying to reassure me all was well.
‘Show me those numbers, Bertie,’ I asked him.
A minute or two elapsed whilst he and his wife figured out how to get the oximeter in front of the screen.
And then – he was right. His saturations were clearly 88%, dipping to 87% and flickering back up. His pulse was 99bpm, now 100, now 98.
I took a breath.
‘Bertie, these numbers are not as good as I was hoping. Your oxygen levels are low. I know you feel fine but I’m afraid we need to get you to hospital.’
As Bertie protested, I could see the fear in his eyes – fear mixed with his certain knowledge that I was making a fuss about nothing.
I called the ambulance service. And then got on with my day.
Six weeks later, the discharge summary arrived in my inbox. I read it with rising disbelief. Within an hour of admission to hospital, Bertie had been on ITU being ventilated and had remained there for two weeks. He had just been discharged following another three weeks on the ward. Luckier than many, he had nonetheless been very sick indeed.
I’ve been a GP for years. I have learnt much and have much still left to learn. I have cared for many patients and have many more to care for. I have, no doubt, made mistakes. But the one case that still makes me wake up sweating and shaking is the one where I got it right but so nearly got it so wrong.
Dr Philippa Vincent is a GP partner in North London
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