‘In a few hours I lost my precious daughter and there are no answers’

Olivia O'Callaghan and Ella Martin

“She’s never going to know her sister, that’s what gets me the most. And the fact now that there’s no answers, it makes it 100 times worse.”

“She’s never going to know her sister, that’s what gets me the most. And the fact now that there’s no answers, it makes it 100 times worse.”

This was the heartbroken response of Olivia O’Callaghan, mother of three-year-old Ella Martin, after an open verdict was returned at an inquest into the cause of her death.

Even though Ella’s case had been “contemplated and discussed by multiple paediatric experts”, the cause of death could not be established, assistant state pathologist Dr Margaret Bolster said.

Her own autopsy report recorded “sudden and unexpected death of a previously healthy three-year-old girl following a brief illness” for which there was “no anatomic cause”.

While doctors who treated Ella at Cork University Hospital (CUH) on the day she died felt her symptoms were suggestive of sepsis — a potentially life-threatening complication of an infection — Dr Bolster said the inflammatory response you would expect to see in the body of a sepsis patient was not found.

‘In a few hours I lost my precious daughter and there are no answers’

“Whatever this is, if it is sepsis, it’s been very rapid, with no chance for the tissue to respond,” she said.

“But I have had very rare cases when sepsis seems the most likely cause but no cause is found at autopsy.”

Ella, a healthy child, who had suffered no significant serious illness up to the point of her death on September 14, 2015, was buried on her mother’s 23rd birthday.

Recalling the hours leading up to her death at yesterday’s inquest in Cork, Olivia described how she had picked her daughter up from her uncle’s house in the evening to travel to Mahon Point where they’d arranged to meet her father Paul. Ella seemed tired and fell asleep in the car. When they arrived, she projectile vomited, Olivia said.

Later that evening, she appeared in good form, laughing when her mum tickled her feet and happy to sleep in her own bed.

Olivia went to work the next morning leaving Ella with her grandmother, Christine, and rang home at noon to see how Ella was doing. She had not been sick and she had eaten, although her urine was strong-smelling. Olivia was reassured.

However, by 12.15pm Ella was complaining of pain and Christine gave her Calpol. By 1.30pm, she was crying with pain and Christine took her to their GP.

He felt she may have appendicitis,” Olivia said, and Ella was referred to CUH, where she arrived at 2.41pm. Olivia travelled to CUH from work and arrived at the same time as Paul.

She described Ella as “lying on the bed, completely lifeless, like a ragdoll”.

She said that over the course of the next few hours “we watched our little girl’s condition deteriorate. I feel she was struggling for breath and blue around her mouth”.

“At 5.12pm, Paul and I were alone with Ella when she went into cardiac arrest. Ella started gasping for air. The alarm sounded on the machine monitors and we called out to the nearby nurses for assistance. From 5.15pm the doctors tried to resuscitate Ella while Paul and I watched on.”

At 6.05pm, Ella was pronounced dead.

In a couple of hours, my whole world had collapsed and I had lost my precious daughter.

“The loss of a child is every parent’s worst nightmare and the loss is so much harder to comprehend when we have no answers to why she died, Olivia said.

Prof Conor Deasy, consultant in emergency medicine at CUH, described how when Ella arrived at the emergency department (ED) at CUH, her GP’s notes indicated he had checked for meningitis. She was seen by a triage nurse and was deemed triage category 2 “effectively the highest triage for people who are living”, Prof Deasy said (category 1 is cardiac arrest).

She did not have a fever, her temperature was 36.5C.

He said Ella was “considered very urgent” and seen by Dr Jason Vandervelde, an experienced critical care and emergency medicine doctor.

“Clinically, he felt she had sepsis,” Prof Deasy said. Blood tests pointed to severe septic shock. Prof Deasy said the blood picture “is not, however, unique to sepsis, but is strongly suggestive”.

He outlined how Ella seemed to improve initially after receiving antibiotics. However, at 5.20pm she went into cardiac arrest. Although every effort was made to resuscitate her, she died.

Prof Deasy said the “working diagnosis for Ella” at the time she arrived at the ED was sepsis, but that others were considered, including if it was a “rare presentation of diabetic ketoacidosis” an emergency presentation of diabetes where the blood becomes very acidic.

However Dr Deasy felt it would be “a very strange case” of diabetic ketoacidosis because while her blood sugar was elevated, it was not extra high.

Representing the family, Karen Bohane, of Cantillons Solicitors, asked what was the significance of Ella having symptoms suggestive of sepsis, but no fever.

“Sometimes a patient can have a low temperature in sepsis,” he said. However “one piece” of the jigsaw that did not fit with sepsis was her blood pressure, which was high, because in severe septic shock, blood pressure becomes lowered, the inquest heard.

Asked what he felt the cause of death was, Prof Deasy said: “To be honest with you, I expected it to be sepsis.”

Dr Bolster says six experts had tried to determine the cause of death, to no avail. She said no meningitis was seen or encephalitis (inflammation of the brain). She said there were no congenital abnormalities or evidence of a metabolic disorder.

She said usually in septic shock, it’s “very obvious at autopsy”, but ”whatever this is, there’s been no reaction in the body”.

She said she had seen a similar case recently in an older person where there was “no evidence” of sepsis, and this was “extremely rare”.

Coroner Philip Comyn said the suspicion he had was that sepsis was the cause of death. “However it is a suspicion and an autopsy that generally tells us an awful lot about cause of death is unable to assist here.”

He said it was “one of those rare and tragic cases that happen from time to time”, and in the circumstances “the only verdict that is open to me, is an open verdict”.

After the inquest, Ella’s grandmother, Christine O’Callaghan, said: “we were hoping today that we would get some kind of closure, but unfortunately that hasn’t happened.

“We are very very disappointed, heartbroken, that after three years, we still have no answers as to the cause of Ella’s death.”

Olivia said she will always be concerned for the health of her 11-month-old daughter, Maya, because of never knowing what caused Ella’s death.

“I just wanted an answer really. And now that there is no answer, I am going to to get a death certificate with “unknown”, and that’s all I’m going to have for the rest of my life, when I thought I was going to have the rest of my life with my daughter.”

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