Sepsis almost killed me – and my private clinic didn’t want to know

Photograph by Antonio Zazueta Olmos for The Observer

One winter morning a couple of years ago I found myself shaking uncontrollably. My temperature was 38.4C and rising, and my pulse, at 112bpm, was almost double its normal rate. I didn’t realise it at the time, but I was in the early stages of sepsis.

A fast-moving condition in which the body’s immune system overreacts to infection, sepsis is not well understood. Exactly why the overreaction occurs remains unclear, and many of the signs – high temperature and pulse rate – are often mistaken for other complaints, such as flu. But a delay in diagnosis can lead to septic shock and irreversible organ failure.

There have been several cases in recent years that highlight just how swift and devastating sepsis can be. In 2021, 13-year-old Martha Mills suffered a bicycle accident and was taken to hospital. When she developed an infection, doctors failed to spot the signs of sepsis. Her avoidable death led her parents, the journalists Merope Mills and Paul Laity, to campaign successfully for Martha’s rule, which makes it easier for parents to seek a second medical opinion.

In 2023 Craig Mackinlay, then a Tory MP, fell ill and within 12 hours both his hands and feet were amputated. He was given a 5% chance of survival.

Each year about 245,000 people in the UK contend with sepsis, according to an estimate from the US-based Institute for Health Metrics and Evaluation (IMHE), which produces the Global Burden of Disease report. The IHME also estimates that in about 48,000 of those cases the outcome is death. That’s almost the same number that die from the two biggest cancer killers – lung and bowel – combined. But whereas cancer has oncology, and heart disease has cardiology, sepsis is an illness that crosses all medical departments without being the preserve of any. “No one owns sepsis,” says Ron Daniels, the founder and chief medical officer of the UK Sepsis Trust (UKST). For the majority of patients, says Daniels, “we’ve got something like six hours or so to make a decision about which antibiotic to mitigate the deterioration”.

And the clock was ticking for me.

Seventeen days before the shaking began, I underwent a “procedure” at a private clinic. About one in 10 elective surgeries takes place privately, easing the surgical burden placed on the NHS. But it isn’t an unequivocal benefit to public healthcare, which often has to deal with any complications that stem from private treatment.

My varicose vein surgery was not quite varicose vain, but it was in that grey area that borders on cosmetic. Each summer, for 20 years, I’d put up with a swollen, empurpled limb that was flaky with eczema and so itchy that I would scratch it until it bled. Sometimes it became infected. Today the most popular treatment is laser ablation, which collapses and seals the veins. It’s guided by an ultrasound scanner and takes less than 45 minutes with a local anaesthetic.

Only the most debilitating cases qualify for NHS treatment, but I was offered the opportunity by another publication to write about vascular surgery and have the veins ablated for free by a private clinic.

In the spacious consulting room, my surgeon looked like he’d walked out of a daytime American TV drama.

Normal healthy veins are about 3mm in diameter, he explained. My great saphenous vein came in at 12.5mm. He outlined the notional risks of the operation, of which infection was by far the most negligible. “While you could never say never,” he said, “it’s not something that we see.”

The surgery took place in the basement of a “hospital” that was really a town house with some basic surgical facilities. But the procedure was mercifully quick, and within 90 minutes or so I was bandaged up and able to walk to the car.

After three days the bandages came off, a compression stocking went on, and I was advised to walk as much as possible to get the blood pumping. When the post-operative pain increased dramatically after a couple of weeks, I called the clinic. The duty nurse told me it was all quite normal, just scar tissue that would calm down.

When the pain became more acute I called the clinic again; the nurse said I was doing too much exercise. There was still no cause for concern, she said, but she would consult the surgeon to double-check. She never did.

The probable reason for her complacency was that infection is freakishly rare in endovenous laser treatment.

When I began shivering and shaking I called the clinic again; no answer. I left a message, then retreated beneath two thick duvets. I was freezing and my face was burning. I just wanted to sleep. All I wanted to do was sleep.

Fortunately my wife happened to be home that day, and I reluctantly agreed to be driven to a nearby urgent care centre. There, the nurse explained that the care I required was too urgent for urgent care. I’d have to go to the hospital.

The private clinic that had performed my laser surgery stated in my discharge notes that any hospital admissions necessary after the procedure would be arranged by its “on call medical professional”.

I called them again. No answer. As I arrived at the A&E department, a different nurse from the clinic finally called back. She told me there was nothing the clinic could do to help. My admission would not be arranged.

According to David Rowland, director of the thinktank Centre for Health and the Public Interest (CHPI), the false claim of arranged hospital admissions is common in private healthcare. “In a number of cases that we’ve looked at, it turns out that those arrangements either don’t exist or the protocols are not clear,” he says. “And that’s contributed to a number of patient deaths.”

The NHS is private healthcare’s free safety net. A recent survey by the CHPI found that in one year about 6,000 patients were transferred from private hospitals to NHS hospitals following complications.

“All of that was completely unremunerated,” says Rowland.

In one report the CHPI found that transfers from private to public hospitals cost the NHS £250m a year. That figure did not take into account cases like mine or the medical tourism that goes wrong and is treated back in the UK. Since the report the market in private surgery has grown significantly.

“If you have this situation where the NHS picks up the pieces,” says Rowland, “where’s your incentive to stop things going wrong?”

By the time I arrived at A&E, I was on the point of collapse. One of the identifying symptoms the UKST lists for sepsis is “it feels like you’re going to die” and that is precisely how I felt. After almost four hours I received a broad antibiotic to combat the infection before blood tests could identify the most effective antibiotic. By this time my temperature was 39.6C.

Daniels set up the UKST after watching a young man with two children die from sepsis that resulted from an operation wound like mine. “It was obvious that opportunities to save him had not been taken,” he said.

It’s common for sepsis cases to be held in the emergency ward for 24 hours because there’s no one to take them. “You contrast that with someone who’s had a heart attack or a stroke,” says Daniels. “They go straight to the relevant unit to be treated by the relevant specialists.”

I was held for more than 24 hours in the emergency ward, but in my case because there wasn’t a free bed in the vascular ward. I was lucky, however, that the hospital had a first-rate microbiology unit to examine my blood. Daniels says that, unlike with a heart attack or a pulmonary embolism, blood tests for sepsis cases are not fast-tracked within laboratories.

During that first night, I was so cold that I pleaded with the emergency staff for blankets to put over the thin sheet on my bed. They refused because my temperature was dangerously high.

By the following morning, a rampant staphylococcus aureus infection in my bloodstream had been identified. “Staph” is a common bacteria, often found on the skin. It’s usually not a problem, unless it gets into the bloodstream, when it presents about a 20% fatality risk.

I was switched to intravenous flucloxacillin, which targets Staph. The infection was soon under control, and my heartbeat and temperature were closer to normal.

Here was an example of the NHS doing what it does best: saving lives in emergencies.

I had no communication from the private clinic that had landed me there, but the surgeon did phone me. The CHPI believes this arrangement creates a confusion of responsibility that can hamper compensation claims. The surgeon was concerned and apologetic but genuinely mystified by the infection.

The next morning a consultant I hadn’t seen before did the rounds with half a dozen or so medical students. He spoke to me and then announced that I could go. I just needed oral antibiotics. My elation was short-lived. An hour later the microbiology team arrived and reiterated that I required intravenous antibiotics and I’d be staying for another three weeks. Surely, I inquired, there must be some alternative?

They told me that there was an option of changing to a twice-a-day intravenous antibiotic administered by a district nurse. It’s estimated that an NHS bed costs £562 a day. A district nurse costs £57 a visit, and I would require two visits a day – so £114 a day. Over three weeks that would make a saving to the public coffers of £9,408.

Yet simple maths don’t necessarily apply in our disjointed health system because the district nurse came out of the budget of the local authority, not the NHS, and the overstretched council reserved district nurses for the disabled. The only option was that I or my wife learn to administer the antibiotics.

I was too weary to read a newspaper, let alone master those complex mechanics. Louise volunteered. Twice a day, an hour each time for three weeks, she followed a demanding 62-point protocol. Once a week I went along to the super-efficient microbiology outpatient unit. Three weeks later my cannula was removed and I was put on oral antibiotics for another fortnight.

It took three months until I was fit enough to return to work. As a freelancer, that was three months’ money lost. Given that the private clinic had played down my repeated complaints I explored suing for medical negligence.

None of the no-win, no-fee legal firms would take the case on because there wasn’t enough money in it. An angry letter I sent to the clinic received no reply. But a more temperate correspondence eventually led to an agreement in which the clinic compensated me, without liability, for three months’ lost earnings.

In discussions with the clinic’s chief medical officer, who said it had improved its protocols as a result of my case and made reference to a surgeon standard, I accused the private sector of abusing the NHS by relying on it to deal with its malpractice and negligence. He disagreed, arguing that the whole point of the NHS was that it didn’t judge the circumstances behind injury. “Are you going to start turning people away for treatment because they smoke?” he asked. It seemed like a well-rehearsed line.

Two years on the word “sepsis” jumps out like a ghost each time I hear or read it. Yet the word was nowhere to be seen on my discharge notes from the vascular ward.

Davies says that on death certificates sepsis is often not mentioned, “even if it’s bloody obvious it was sepsis”.

In one study sepsis was cited in only 40% of death certificates in cases where experts had agreed on its active role. That’s partly because other causes of death may have been prioritised but also, Davies says, because “outside of the intensive care unit setting, sepsis still isn’t reliably understood”.

He would like to see investment in specialist staff, prioritisation in diagnostics, dedicated care areas for people who are not sick enough to require intensive care, and a more joined-up approach.

There is somewhere from which funding could come: the £15bn-strong private health sector. If it were compelled to contribute towards the NHS workload it creates, that would surely benefit all.

I never did write the piece about varicose vein removal. For the record, there’s no longer a linguini of bulbous veins disfiguring my right calf. But on balance, I’m not sure it was worth the drama.