No Clue At The Hospital

"I want to know why they let her go. Why did they let her walk out the door with penicillin when they didn't know what it [cause of daughter's ill-health symptoms] was?"
"I was screaming at them, 'You sent her home. Why did you send her home?' They just had no answers as to why they sent her home."
"It was a nightmare. I couldn't believe I was talking to her the day before and [then] she was lying there dead."
Roxsanna Mueller, Ottawa

Roxsanna Mueller holds photos of her daughter, Lilly. Tony Caldwell / OTTwp

"We extend our deepest sympathies to the family and have reached out to them in hopes of discussing the details when they are ready."
"We realize this must be a very difficult time."
Dr. Andrew Falconer, chief of staff, Queensway Carleton Hospital, Ottawa

It could happen to anyone. A rare occurrence of a rare disease. So rare that practised physicians failed to recognize the tell-tale symptoms of the disease. Irrelevant largely in the diagnosis of many types of health failures, but beyond critical in a failure of health that is so catastrophic that those who contract meningococcal meningitis have a narrow window within which the symptoms must be recognized and medical mediation be immediately applied. Best practise in diagnosis and response failed 23-year-old Lily Mueller, daughter of Roxsanna.

She was taken by her father to their closest local Ottawa hospital, arriving at the emergency department with some of the typical symptoms of meningitis. There, attending emergency room practitioners failed to recognize those symptoms. There was no real diagnosis, but there was the advice given that she return home, rest, and take the penicillin that was prescribed for her use. Less than 24 hours later this young woman was dead. Leaving the regional coroner's office to investigate.

And because meningitis is spread through saliva, when people share drinks, food, cigarettes or intimate bonding through kissing, anyone who may have come in contact with the young woman has been advised to contact medical authorities for appropriate treatment, if required.

Lily Mueller had a high fever and suffered from a stiff, painful neck. This, in a young, healthy woman conscious of maintaining good health and who, in fact, worked at a fitness club. On the night of June 25, when the young woman arrived home from work, she felt unwell, but went to bed for the night. At 4:00 a.m. she alerted her mother: "Something is wrong. I can't move my neck. I have a sore throat, my head hurts".

When Roxsanne checked her daughter's temperature it was alarmingly high at 105.3-F degrees. That was when her father took her to hospital and when doctors gauged her symptoms and thought she likely was suffering from Strep throat or mononucleosis. No need for her to remain for further observation -- hospitals are notoriously tight of beds; space, time and personnel at a premium. The prescription was filled but Lily was unable to use it.

She was seriously unwell, kept vomiting, her temperature hovering between 102 and 103, which led her mother to return her daughter to the hospital at 5:00 p.m. after her daughter began screaming in reaction to the neck pain she was suffering. This time on their arrival at the emergency department of the Queensway Carleton, Lily was rushed into a bed, her skin white, lips blue, difficulty in breathing.

Intravenous antibiotics and fluid and soon intubation to help her breathe followed in quick order as Lily was sedated, hooked up to those marvellously advanced machines that help to keep patients alive, while four or five doctors studiously did their utmost to fully understand what was happening. One of the doctors speaking to Roxsanne informed her that her daughter had a "very strong virus ... is it Strep? Is it Mono? We don't know".

She herself advanced the thought as to whether the symptoms could be those of meningitis, but the response was that her daughter's "were not the symptoms" of meningitis. Her daughter Lily had been placed on a broad spectrum of antibiotics to cover anything she could possibly have come down with. "This is a very highly infectious disease. We don't know what it is, but it looks like she is septic", another doctor advised the mother. And Lily died at around 3 a.m. that following morning.

"It is very rare. It is tragic when it occurs. Our job really is to make sure anybody who might have been exposed is followed up with", stated associate medical officer of health, Dr. Robin Taylor -- with Ottawa Public Health -- of this difficult-to-trace, rare disease. A headache, fever, sensitivity to light and a stiff and sore neck are classic signs of meningitis which tends to hit younger people spending time together, sharing food and drinks.

In today's public health scenario infants are routinely vaccinated against the disease, with a separate vaccine given in Grade 7, and in that scenario of immunization the risk of meningitis infection has been decreased, even while strains have altered since vaccination became more common. More than one kind of infectious meningitis exists: "a very rare and incredibly serious disease". Lily Mueller was not vaccinated.

Bacterial meningitis represents an extremely serious type of infection, so much so that even prompt medical treatment cannot always avoid death, with fatality rates ranging from five to 15 percent. Few cases are reported in Canada, though 21 cases were reported to Ottawa Public Health in 2017, an increase from the 17 reported in 2016, 16 in 2015, 10 in 2014 and fifteen in 2013. Severe headache, high temperature, vomiting, sensitivity to bright lights, neck stiffness, joint pains, drowsiness, confusion, tiny red-purple spots or bruises anywhere on the body are all symptoms.

Meningococcal meningitis is a rare but serious bacterial infection. It causes the membranes that cover the brain and spinal cord to become inflamed. Each year, approximately 1,000 people in the U.S. get meningococcal disease, which includes meningitis and septicemia (blood infection).
Meningococcal meningitis can be fatal or cause great harm without prompt treatment; as many as one out of five people who contract the infection have serious complications. According to the Centers for Disease Control, about 15% of those who survive are left with disabilities that include deafness, brain damage, and neurological problems.
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