Siobhan’s Story – Ordinary People with Extraordinary lives Series, Meningitis World Day Special

When ‘Meningitis: Keep Watching Ireland’ asked me to get involved in their campaign today, in honour of World Meningitis Day, I happily agreed. As a mother of two small children, the mere appearance of a rash and I’m running to the kitchen for a glass, grabbing the Meningitis Fact sheet I have hanging on my fridge door as I go. Sound familiar?

Thankfully in the main when a rash appears it’s nothing sinister. Babies get rashes all the time to keep us on our toes! However, when our little boy Nate was 5 weeks old he became very ill. A rash appeared followed quickly by a high temperature so Roger and I drove at breakneck speeds to our GP who quickly had Nate admitted to Wexford Hospital. Nate was terribly ill and in a lot of pain. The slightest touch in those first few days was too painful for Nate to bear, so we were told we shouldn’t hold him. I will never forget the physical ache I felt, watching my beautiful little boy so ill and not being able to comfort him in any way other than to sit in vigil beside his little cot. When a nurse gave us a leaflet on meningitis with a consent form to sign so they could do the lumbar puncture test, our greatest fears were realised. She said that we must prepare ourselves for a decision. Up to that point the word Meningitis hadn’t actually been spoken. Roger and I feared it, but to hear it said out loud terrified us. We were lucky though, as Nate didn’t have meningitis, he had Sepsis, which was still serious, but once the diagnosis was made and the correct antibiotics were given to him, he began to improve daily and we were home a week later.

For others they are not so lucky, as the cold facts show that bacterial meningitis and septicemia kill more children under five than any other infectious disease in Ireland, with babies most at risk. Just typing that sentence has given me chills again and I will never stop thanking God that my son was not part of that statistic. Here’s another fact that will leave you cold, the leading cause of bacterial meningitis is meningococcal disease. Ireland has the highest incidence of meningococcal disease in Europe, with over twice the average disease rate. As our Children aren’t protected against all forms of meningitis parents should therefore remain vigilant for the signs and symptoms.

So today on World Meningitis Day I have decided to continue my series on Ordinary People with Extraordinary Lives and I thought who better to pay tribute to today but one of Ireland’s dedicated and talented Paediatric doctors – Dr Siobhan Connor, who currently works in Crumlin Hospital and who has first hand experience of treating meningitis patients.

Siobhan, it is World Meningitis Day, can you give us some advice on when to worry about the symptoms associated with Meningitis?

Meningitis is inflammation/swelling of the lining around the brain and spinal cord. Septicemia is when the infection causing the inflammation enters the blood stream. They can occur together or separately. Children with either meningitis and/or septicemia can get very sick very quickly and therefore as a parent it is so important to know what to look out for.

Children get temperatures, vomiting, diarrhea, and rashes and can be ‘off form’ very often but when a child becomes unwell with meningitis/septicemia there are a few different signs and symptoms to look for.

In a young child

– fever

– not waking for feeds/feeding less

– vomiting

– irritability/not wanting to be held

– pale/mottled skin

– cold hands/feet

– high pitched cry/moaning

– non blanching rash

– seizure activity

In an older child

– fever

– vomiting

– headache

– dislike of bright lights

– stiff neck/neck pain

– non blanching rash

– confusion/disorientation

– seizure activity

A non-blanching rash is a rash that does not disappear when a glass is pressed on the skin. This is known as the ‘tumbler test’. Unfortunately every child is different and some children can have only one or two symptoms. This makes the diagnosis very difficult. As doctors we have a very low threshold to investigate and treat for suspected meningitis and thankfully don’t diagnose it too often. Generally the earlier the diagnosis, the quicker treatment is started, the better the outcome.

We always advise if a parent is worried about their child, no matter what symptoms they have, day or night, get them checked out. You know your children the best, if there’s something just not right, you’re probably right.

Have you dealt with meningitis patients yourself?

Yes, as a Paediatric doctor working in a busy Dublin hospital unfortunately I have seen a number of cases of meningitis.

Siobhan can you help paint a picture for us of what an average day looks like for you?

My day usually starts at 8 am with a handover of patients who have been admitted overnight through the emergency department or children who have been transferred from other hospital.

We then do team ward rounds, where we review all our inpatients and make decisions on investigations, treatment and further management for the day.

Then it’s usually off to start the outpatient clinics. During the day there can be new patients for review in the intensive care unit or in the emergency department. In between you are chasing results of blood tests and radiology, and by the end of the day, some children may need to be reviewed again and handed over to the on call doctor for review over-night.

We’ve all heard the horror stories about the long hour’s doctors put in, how long is your average day and what has been the longest you have ever worked?

Ah don’t get me started about the hours! My average day would be from 8am to 6pm; well that’s a good day! You just never know when a child will become unwell on the ward, or you could be referred a child from the emergency department when you’re about to put your coat on! That’s the way Paediatrics goes! As a rule I never make a plan to do anything before 8pm in the evening, it’s a wonder I’ve friends left I’m late for everything and never make the midweek family dinners!

In the hospital I’m working in at the moment (we usually change specialties/hospitals every 6 months) we do on call nights about once a week, on top of normal Monday to Friday hours.

If you’re on call on a weekday it’s an extra 15 hours but if it’s a weekend it’s an extra 24 hours. So that can add up to around 80 hours a week.

I frequently worked 24-30 hour shifts as an intern in adult medicine and in peripheral pediatric departments on call is much more frequent. In Paediatrics the nights are so busy, many nights you don’t get to bed so every effort is made by your team to get you out at a reasonable time the following day. Of course it depends on the hospital and the specialty. We don’t have enough doctors to provide a cross cover service so when you do get the chance to go home after your 24 hours, you’re very aware one of your colleagues is now doing double the work.

I truly believe that both Doctors and Nurses are walking angels. Especially those that work with children. When did you first know you would like to be a Doctor?

I never thought about anything else really.

There are young children who aspire to be a doctor themselves one day. In our house, Amelia my 3 year old already has declared that when she grows up she wants to be a doctor. Can you share with us about the training you have done?

I went on to do medicine in RCSI after a science degree in UCD. Known as the eternal student, I loved college! I did my intern year in Beaumont hospital and then started Paediatrics as a Senior House Officer (SHO). As an SHO I worked in the Rotunda hospital, Our Lady of Lourdes in Drogheda and Temple Street.

I enjoyed Temple Street so much I stayed there as a registrar for two and a half years and I’m now working in Crumlin. I will be starting the specialist registrar (SpR) training scheme in July. This is a five year scheme during which I plan to do a fellowship abroad for 2-3 years. After all that, I will be ‘trained’ and eligible to apply for a pediatric consultant position, which are few and far between! It’s so depressing to think that far ahead and unfortunately that is the reason, along with the hours, that Irish doctors are choosing to work abroad.

What area are you going to specialise in Siobhan?

Paediatric respiratory medicine

I’m sure there have been many highlights in your career to date but if you had to pick one what would that be?

That’s a hard question! I couldn’t possibly pick one thing. Passing exams and getting on training schemes keeps your career going in the right direction, but it’s seeing the really sick kids get better that makes it all worthwhile.

Siobhan, I cannot imagine how hard it is for you when a patient is seriously ill and there is nothing that you can do. How do you cope with this aspect of the job?

Sometimes the best treatment doesn’t work, sometimes you have to accept that you can’t cure an illness, but I believe there’s always something you can do. Keeping the child comfortable and supporting the family is just as important with seriously ill children. Support from other colleagues is invaluable. There’s always someone you can get help and advice from. Paediatrics is a relatively small specialty; we work closely and are a great support for each other.

What has been the most difficult moment you have had to face?

Breaking bad news is the hardest thing, and it doesn’t get easier no matter how many times you do it.

I have asked all of my extraordinary interviewees this question Siobhan. If you could stand in front of Enda Kenny and ask for anything what would it be?

Build the children of Ireland the Paediatric hospital they so desperately need and deserve.

Now just for a little bit of fun, I’m always curious if medical students and doctors watch Greys Anatomy? Do you watch it or any of the medical dramas and if yes, how realistic is it?

I used to watch them when I was a medical student! Maybe if I had more time on my hands then! But no, they’re not realistic, and doctors are definitely not that good looking!

I have to admit I have yet to come across any Dr. McDreamy’s on my visits to hospital! Just as well or half the Mammy’s of Ireland would be looking for a consultation! But seriously Siobhan, with the long hours you work, your free time must be very precious! What do you like to do on your time off?

Catching up on sleep is definitely number one! After that it’s fitting in family and friends and of course spending time with my poor deserted non-medic boyfriend!

I love travelling, and having the next holiday booked makes all the hours worthwhile!

Siobhan, I would like to thank you for your lovely, warm and helpful interview. You have given us all a great insight into what it is like to be a young (and can I say, beautiful) Doctor in Ireland. I am in awe of the work that you and other doctors do every day. While you dedicate your lives to the care of others, you make such huge personal sacrifices with the long hours you work, often without a break. Doctors like you change people’s lives with your personal care and dedication. Thank you.

That is the end of my latest installment in the Extraordinary series. Thank you as always for stopping by and reading Siobhan’s story. Before I go I would like to ask you all this one favour. Please share this blog post with every parent you know. It is vital that information about the very real threat of meningitis is spread to other Irish parents.

Meningitis Research Foundation Ireland with support from Novartis Vaccines and Diagnostics Limited are encouraging parents to remain vigilant for the signs and symptoms of the disease.

Go to the Meningitis: Keep Watching Ireland Facebook page at www.meningitiskeepwatching.ie and watch this film: http://www.youtube.com/watch?v=MV_1hvl7iPY

For further information on meningitis as well as a number of educational resources, please visit Meningitis Research Foundation website: www.meningitis.org