"A mixed experience of NHS care for my infected lump"

About: Nottingham City PCT / Emergency GP out of hours service Queen's Medical Centre / Accident and emergency

(as the patient),

I had been suffering with a painful lump under my arm for a few weeks, and was starting to get really worried, being female, and eventually convinced myself that it was terrible, and I was adamant I had cancer. After a terrible weekend, and the lump nearly doubling in size and becoming very painful, I plucked up the courage and went to my doctors to see when I could make an appointment. They had nothing to offer me for a week, even after I explained my situation.

I decided when I got home from work on the Monday that I couldn’t put up with it any longer and off went me and my partner to the Walk In Centre in Nottingham. After about 5 minutes of being seated I was called up to reception to give them my details and one of the senior nurses had a quick look at my arm. She looked rather alarmed and asked me why I had not been to the doctor sooner. I explained the situation and advised I had now tried to get an appointment and noone could see me for a week.

She advised that if I had been in to them earlier in the day they would have referred me straight for surgery. She explained that she could prescribe some antibiotics, but she was not sure that they would totally eradicate the lump due to its severity. She made the call and referred me to an emergency doctor over at NEMS.

I was really impressed with the urgency in which they dealt with my situation, and the speed in which I was seen, bearing in mind the amount of pressure the walk in centre staff are under constantly.

I drove straight over to NEMS for an appointment with the emergency doctor at 8pm, and got seen practically the minute I walked through the door.

The DR was a little less concerned and had a quick look at my arm, but didn’t touch it or suggest what he thought it was. He asked me if it was sore, which I think he then realised when he tried to touch it, and saw the red inflamed lump, the size of a small golf ball under my arm, and the pain I was in when I was trying to move my arm.

He tested me for diabetes which confirmed I was not, and explained that I could either take a course of Flucloxacillin, double dosage to see if this reduced the lump and pain, or he could admit me to hospital so antibiotics could be administered intravenously. I didn’t really say anything to this as still wasn’t sure what it was or what it could possibly be. The doctor then advised me he thought a course of antibiotics would be the best and printed off a prescription.

I went off to get the antibiotics and started taking them immediately. The doctor informed me that he would expect them to work pretty much straight away and I should notice a considerable difference in the pain and inflammation I was currently suffering from the next day.

The next morning I woke up in incredible pain, to the point of tears and nothing seemed to have got any better. I plodded on to work and suffered for most of the day and felt really sorry for myself.

When I got home I took a picture of the lump and sent it to my mum for her to see what it was and see what she had to say. As soon as she received it she called me and told me I had to go to the hospital and see if they could sort anything out for me, or give me any inclination as to what it was that was causing the lumps, as since the lump inflamed under my right arm, I felt a small hard lump under my other arm.

We drove down to A and E and walked the miles from the car park and finally managed to find A and E which to be honest wasn’t very well signposted from the other side of the hospital where the only car park open was.

I gave all my details in at reception, and sat down for a nice cosy evening in A and E. I wasn’t complaining or fussed about the wait, as I have a lot of respect for the staff that work there, and saw quite a few funny drunken sights during my wait.

I was seen by the triage nurse within about 20 minutes of arriving. She was rude, obnoxious, had obviously had a hard day that reflected on her attitude and didn’t seem very interested in what I had to say. I was absolutely disgusted with her lack of empathy, for a 23 year old girl that was extremely concerned for a lump that had appeared under her arm.

She advised me that she did not look like anything could be drained from the lump and the doctor would probably just tell me to continue with the course of antibiotics, but after a long sigh she said she would put me down to be seen by the doctor anyway.

I was called through to another area of A and E approximately an hour and a half after I had been seen by the triage nurse and was moved to another waiting area, but was seen almost immediately after this.

The doctor took one look at my arm and explained to me that he thought it was probably a blocked sweat gland, and nothing major to worry about, but that it would need to be drained and investigated. He advised me that due to the location and amount of pain the draining would cause I would probably need to have a general anaesthetic for this to be done.

He said he would like a surgeon to take a look at the lump before they decided what to do for the best. The surgeon appeared very quickly and confirmed what the doctor had said. He said he would like to place me on the emergency surgery list, and return on Wednesday morning at 7:30a.m. and I would be seen and taken to theatre throughout the day depending on the other cases that were on the list and were seen during the evening.

I turned up to QMC bright and early on Wednesday morning, and looking forward to the relief of the lump being drained, but nervous about the surgery. I was taken onto the admissions ward, and all of the staff were lovely and very helpful. The anaesthetist came up and saw me and went though the paperwork, along with the nurse, and I was then taken down to theatre and told I was the first person on the list to be dealt with.

I presume the operation went well and wasn’t really sure how long I was in there, but ended up staying in recovery for 3 hours as I didn’t react well to the anaesthetic and was suffering with a lot of pain so was given pain relief regularly until they felt happy enough for me to be sent back up to a ward.

I was taken up to ward F22 and the nurses seemed very friendly and asked me if everything was alright and if I needed anything. I even got a lunch out of them.

I got some more pain relief and was advised that as long as I felt well enough I would be able to go home later in the afternoon.

My partner came to pick me up, and the nurse changed my dressing and packed the wound. It was terrible pain, and not something to look forward to for the foreseeable future, as I was advised it needed to be done daily until it had healed properly.

The nurse that discharged me went and got all of my medication, and advised me to go to my doctors surgery the next day and make daily appointments with the nurse so that the wound could be packed. She also gave me some bandages and packing as she advised that they may not have the stock and would need to order it in.

Late morning the next day I went over to my doctor's, Cotgrave surgery and tried to make an appointment to see the nurse. The receptionist advised me there were no appts for that day. I explained my situation and she advised I could go and see the nurse at Bingham surgery as they rotate between practices.

I went straight over to Bingham and saw the nurse. She did not seem very talkative, and didn’t react well when I expressed my discomfort. I was in tears walking out of the surgery due to the pain, obviously now the pain relief was wearing off. I asked the nurse if she knew roughly how long it would take to heal, and how long she expected me to need it packed for. Her reply to this was "well I don’t really know, my crystal ball isn’t working today."

I made the daily appointments and was disappointed that I had to see the same nurse again, but to give her her dues the more and more I saw her the more understanding she seemed and seemed to get more responsive to me each visit.

I then had to see another nurse when the regular nurse was not available. I unfortunately turned up 2 minutes late to my appointment and turned up apologising to the receptionist, whose rude answer to me was "well the nurse won’t see you now". I apologised for being no more than 2 minutes late and advised it was really important that I was seen. She said she would say that I had arrive but doubted that I would be seen. As soon as I had sat down the nurse called me and I was seen.

The nurse was unfamiliar with my case, and when she looked at the wound she asked me if I knew where the hole was that needed to be packed! This filled me with great confidence. She concluded the appointment that she could not see a hole significant enough to be packed and thought it was healed, and I just needed to continue to change the bandages and return in a week to see the nurse and make sure that it was ok.

I went home and my partner took a photo, and there was a clear hole that I, an untrained eye could see, and was really frustrated that this had not been done. I went back to see the original nurse, who couldn’t believe that it hadn’t been packed, and was concerned that the wound would not heal properly. She asked me to return if it got red or the lump started to re-appear.

A week down the line, the unwelcomed pain started to re-appear, and I know have a red raw armpit, that I can’t shave which I am deeply embarrassed about, and unbearable pain with a lump starting to appear. I made an appointment to see the doctor at my surgery. She looked at my arm, and I explained to her what had happened, and that the surgeon had explained to me that it could re-occur. She was quite happy to just print off another prescription for more antibiotics and not address the issue. I now need someone to do some investigation work and get to the root cause of the problem, as I don’t really want to be taking antibiotics for the rest of my life and suffering the pain I am suffering.

So I am now at work explaining my story, and will be off to the walk in centre again this evening to see if there is anything they can do.

It’s a shame that the NHS is let down by a certain few members of staff, when I received such welcome and caring within the hospital, apart from the triage nurse, and it has really let me down and I feel like I don’t know what to do next to try and get this problem sorted once and for all.

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