The surviving sepsis campaign made regular appearances in our weekly teaching sessions as junior doctors in Bristol. However, I didn’t exactly follow the book when I came across a septic 67 year old woman in a tiny village in the middle of the Altiplano last week. Her family had actually asked for the local priest to come as they were sure she wasn’t going to survive. As I happened to be passing I thought I should see what I could do before handing over to my clerical friend.
This lady had been ill for weeks, eating and drinking little, getting weaker and more unwell. Without wanting to put anyone off their lunch, there were some obvious sights and smells that told me that at the very least she had a serious Urinary Tract Infection. With a temperature pushing 40, Blood Pressure so low I could barely measure it, a pulse so fast I could barely count it and severe dehydration obvious, I really did need to do something about her situation.
I thought about what I SHOULD do. Intravenous fluids and antibiotics as per the “Surviving Sepsis Campaign” guidelines. Samples for culture analysis and sensitivity testing to modify the treatment. Imaging to investigate the source of infection. Close monitoring and continued care. Then I looked at my small medical bag and thought about what I COULD do. The two versions didn’t exactly match.
At that point I gave a small murmur of thanks to two people back in Bristol. The first, my previous clinical supervisor who had advised me to always make sure I had a couple of bottles of Ciprofloxacin and Gentamicin in my bag. The second, a nurse who had patiently taught me how to actually set up a drip (rather than just write on the fluid chart for the nurses to administer) and who didn’t laugh too much when I squirted half a bag of saline over a patient when I first tried to do it myself.
Their advice meant that I was able to rig up a drip, give all the fluids I had in my bag and give some broad spectrum antibiotics to my Bolivian patient. With a few more meds to bring her temperature down and aid her nausea I then realised that there wasn’t a great deal more I could do. Light was fading and there was no 999 service here to take her to hospital (which she wouldn’t be able to pay for even if she could get there).
I went back to her village the next day to top up fluids and antibiotics, and over the last week or so have been relieved to see a complete recovery. Although I can’t be absolutely sure of the initial problem, my delight at being able to help is clouded by my thoughts that this woman could easily have died from what most likely started as a UTI.