They’ve always had that saying, “doctors are the worst patients”.  Even I’ve said it many times before, nervously dousing in a feathery laugh as I try to throw in a light-heartedly sarcastic joke, the attending doctor glaring round at me with an expressionless smile.  Truth is, medical students are too. Nurses.  HCAs.  Physiotherapists.  In fact, for those who live and breathe the world of medicine, we all are.  

I scurry down the length of the stuffy ward, my tight brogues clip-clopping quickly down the corridor, my feet rolling over to the outside ever so slightly as I grimace through the developing dull ache that is plantar fasciitis.  I’m tired, and achey. The nurses lean over the drugs trolleys, heavy backs hanging over as they give out sweetshops of medication to the geriatric patients.  Behind them a big sheet of creased red paper plasters the wall, numerous information leaflets and big red flags pinned on its face in various places.  As I near the end of my fortnight block on the respiratory ward, I am beginning to reflect on what I’ve learnt, what I’ve done well with patients, and what I need to work upon to improve for further practice beyond medical school.  Of all the specialties though, respiratory is perhaps the hardest rotation I can go about without impressively covering up the look of sheer hypocrisy on my face when I tell my patients to take their inhalers properly, asking whether they are truly compliant with taking them.  Because I’m certainly not.  Even after my 10th admission to Intensive Care, intubated.  Yesterday, I received quite possibly the best feedback yet on my placement, from the specialist asthma nurse in clinic, telling me my peak flow technique was faultless.  Why then, am I so terrible at recording my own peak flow readings each morning?  Why then, do I not stand up and pull my shoulders back as I take the biggest possible breath in?  Because medical students are the worst patients.  Doctors are the worst patients.  

The sad fact is, is that we often don’t take things too seriously until a significantly life-altering event hits us back in the face, causing us to change our actions, minds and insights quite considerably.  The ‘Big S’ is certainly one of those big, significant things.  And, going by the photograph embedded into this blog, you may well be thinking ‘Swimming’, ‘Snorkel’, ‘Scuba-diving’, or ‘Sea’, no?  Quite frankly, anything that associates me with a big body of water, glaringly hot sunshine and a very big life lesson.  Not quite.  

I finish off clerking my final patient of the morning, running over a few X-rays to identify how much exactly Bed 5’s pneumonia has cleared up, before waving goodbye to the staff nurse, her back still hanging heavily over the drugs trolley.  As I walk back up the length of the same corridor, I pass numerous patients, curled up in individual side-rooms, lights switched off. Cut off from the rest of the world, the smell of disinfected commode lids fizzing in my nostrils. They looked like prisoners. I hover past another big poster upon a pin board, on the adjacent wall.  This poster is also red in colour, with big multi-coloured letters, cut out shabbily and stuck on individually, reading ‘S – E – P – S – I – S’ followed by a big yellow question-mark in fancy bubble-writing.  i had begun seeing an increasing number of these big red posters dotted around the hospital corridors recently.  

I don’t fully remember the day of 10th August, 2018, but of what I’ve been told, it started off as another wonderful day.  I was out in Italy, holidaying with my two closest medic friends, my first ever ‘girl’s holiday’ away.  I had just finished FaceTiming my parents back at home, singing Happy Birthday to my Papa, who had turned 84 that day.  The day before we had been spending hours on end snorkelling in the azure blue sea, diving off the front of the little speedboat my Italian medic friend owned, and took us out on, visiting the many beautiful hillside towns down towards the seaside town of Lavagna.  Our hair had dried crisp, curling up into little golden wisps, like the crumbling golden stone that rolled down the cliffs of Portofino. Beach hair.  

A few days prior to the snorkelling trip, I had had an unlucky turn and ended up spending the night in ICU following a severe asthma attack.  But I turned around quickly and insisted that i get discharged, so not to miss out on too much more of my time-ticking holiday.  It was no big deal.  After all, this was my 9th ICU admission.  I felt fine now. I was told my white cell counts were up and that if I did choose to leave the hospital I’d have to buy myself a pack of amoxicillin antibiotics at a nearby pharmacy.  Yeah.  My white cell counts forever seemed to go up after an acute flare-up of my asthma.  it was surely just all the medications that had triggered this cascade, the steroids.  It was nothing new.  In all honestly, my mind was wandering elsewhere. I was utterly starving.  I had had nothing to eat in the hospital other than a paper plate splodged in a goo of brown mashed potato.  I certainly didn’t eat it.  I insisted we get driven straight to the bakery for a stodgy focaccia as soon as I escaped the hospital.  I quickly forgot about our little pharmacy pit-stop.  

My two friends and I had stopped off nearby to find an authentic place for lunch.  We were thinking ‘Italian’.  Italian all the way.  Pizza, gelato, and focaccia.  But despite the foodie I usually am, I wasn’t particularly hungry.  Yesterday’s focaccia was still lingering.  Whilst the girls ordered pistachio and raspberry gelato to cool them down in the bedraggling Mediterranean heat, I went on to order myself an Eggnog.  I was obliviously convinced that this was in fact a traditional Italian drink, local to its cuisine.  What arrived was a hot, but alcoholic, coffee, a golden egg-white pooled on top like a glistening honeyed jelly.

“Alexandra – you do realise that’s a drink you have at Christmas?” My friend giggled, as I half-heartedly sipped this hot beverage in the height of the Italian summer.  I giggled back.  I was a little chilly, but the Eggnog seemed to be warming me back up, regardless of what the by-standers must’ve been thinking of my strangely acquired tastes.  

I had admittedly gone rather quiet, whilst the girls babbled over giggles and gelato and what we were going to do next.  But I was just thinking.  “I’m relaxed”, I thought.  “I’m just being mindful, sitting here, leaning back in my chair and enjoying the views.  And the Egnnog”.  I had figured my slightly ‘off’ and hushed manner had bitten a lip in the conversation, so we soon decided to move on, down the cobbled street and back towards our seaside apartment.  But I still wanted food.  I wanted more focaccia.  Consequently, the girls agreed to stop by the local supermarket where I bought yet another paper bag of the beautifully greasy, cheesy bread.  I can remember there being a huge basket towering up from cold marble floor, in it containing humongous watermelons, their skins a flamboyantly spring-green.  I had to get a photo with this.  A watermelon selfie.  We erupted into shrieks of laughter as I went to go and heave up one of the watermelons from the basket.  But I simply couldn’t lift it.  It was astonishingly heavy, my limbs feeling weak and tired.  It must’ve been the heat.  It could’ve also been due to my myopathy, a muscle-wasting disorder.  It could’ve been the jet-lag.  I had flown back in from Hong Kong just 18 hours before setting back off again to Italy.  That surely didn’t help.  My embarrassing defeat with the giant watermelon could’ve been down to anything…

And that’s the last thing I can remember.  

4 hours after that watermelon selfie, 24 hours after that snorkelling photo in the sea, I was in Intensive Care, intubated.  I would remain intubated for 13 more days, my parents signing for a tracheostomy procedure, my extended family back at home in the UK being told to expect the very worst.  I wasn’t coming back.  Snorkelling?  Scuba-Diving?  Swimming?  The Sea?  Nah.  It was Sepsis.  The Big S in which its symptoms I obliviously ignored, unknowing to the warning signs, putting down everything I couldn’t otherwise do to a pre-existing condition or alternatively petty excuse.  Scary, huh?  An acute asthma attack, coupled with respiratory failure and pneumonia all stemmed from, or stemmed to, Sepsis. It was now an entirely different kind of ‘time-ticking holiday’.

Whilst intubated, I developed hallucinations like none other.  I was convinced I was involved in a major road traffic accident, seeing the debris and destruction of a vehicle shell, unsurvivable, over and over again in my mind.  I still see this now. I was hanging off the edge of the building, gripping onto the bedsheets for dear life, for days, and I would alternate between pointing, terrified, to the hospital ceiling, and then to my ribcage, where a death-drum rattled underneath, unable to communicate or talk, saying I was convinced something that shouldn’t be, was in my lungs.  Dysphonia and brain fog. I was then packed up into a tiny box, the exteriors in my view all turning a pale, foggy white, my body turning an icy-cold.  I heard sobs and the words “she’s gone”.  I couldn’t scoop out any energy to lift my rib-cage, inhaling and exhaling.  I was at my own funeral.  

Experiencing the Big S for myself was a mammoth life lesson learnt in 2018.  I didn’t so much ignore the symptoms, I just simply wasn’t aware of them.  Yet you never think for a second the things you hear in the media, the more unfortunate, unlucky cases, will ever end up happening to you, or to someone you know.  Being a medical student who only ever reluctantly drags herself to see a doctor if really needing to, it frightens me to think how many other people, members of our general public, who go the widths and lengths to avoid a visit to the doctor, end up facing the BIg S themselves, often when it’s too late to reverse.  

5 months on and I am now having to accept and deal with the more lasting effects of Sepsis, many of which can go unnoticed, invisible, when you look otherwise fine from the outside.  I am plagued with the inconvenience of memory loss, daily nightmares and poor sleep.  Daily activities feel so much harder now, getting tired more often and needing more breaks.  All because I just didn’t ‘feel right’ on that day I tried my first Eggnogg back in Italy.  I have been attending an incredibly helpful and kind-hearted support group for ex-ICU patients, ‘ICU Steps’, which has definitely opened up the coping mechanisms post-illness.  But I can only say that I was sincerely shocked to learn that Sepsis is in fact so awfully common, with the majority, if not all, the patients at the ICU Steps group I attend, experiencing Sepsis somewhere along the line during their admission.  It can happen, and has happened, to any of us.  

I hate to dwell on the past, so do excuse the repetition of events that I seem to transfer from the haunts of my own mind onto the haunts of this page.  But, as I walk past the fourth big red poster of my placement today, its big bubble-letters reading ‘S-E-P-S-I-S’, I can only be reminded of not only how lucky I am, but smile at the fact that awareness of the Big S is finally being spread, informing us all of what to keep our wits out and about to.  It’ll be a long while before I get back in the sea, to snorkel and scuba-Dive in the sun, but now that I’ve learned one very big lesson, it’ll be an even longer time, if not, hopefully forever, before Sepsis comes up on the radar again.  So, next time you’re walking down the hospital corridor and you hover by a big square poster, its creases crumpled in the corners of the big red sheet, bubble-letters spelling out the one big word in bright yellow, question-mark followed, stop.  Stop and read the signs, symptoms and what to do if you experience any of these.  Be taught the lesson beforehand, but don’t let yourself get to the point where you personally have to learn the lesson, like I did, because, truth is, you could be swimming in the big azure blue waters of the sea one moment, and the next, fighting for your life against the horrendous Big S.  The symptoms will swoop in far quicker than you think, regardless of how invincible you feel you are, regardless of whether you are a medical professional or not.  Sepsis takes no prisoners.