and if he can at least survive until we get those back, we can tailor the antibiotics or antivirals we’re giving him but now his kidneys are shutting down. There’s zero urine output – the bag under the bed from the catheter is flapping in the air, depressingly empty. I often tell my friends when they half-jokingly ask me if they’re dying, if you still need to pee, you’re fine.
As I stand back and watch the scene unfolding in front of me, I keep my face arranged in an expression of grave calm. He’s a handsome lad. Dark hair, stubble across his chin, he looks kind. His wife keeps getting in the way, crying and crying, inconsolable. She can see the writing on the wall. We all can. She occasionally shouts at us to do more but there’s nothing more we can do but wait and hope that by some miracle his body will turn itself around. Three hours after he arrived in A&E, the machine we’ve all been waiting for begins its long shriek. His heart has stopped. In an odd way it’s a relief. The tension in the room has dissipated. Finally, we can all do something. Matron starts with compressions. I order for the epinephrine to be given. We shock him once, twice, three times. A nurse has his wife, mute now with shock, in the corner of Resus keeping her upright and away from the bed. The violence of an electric shock is not something a loved one should see if it can be helped. In the effort to bring someone back from death we pulverise them, shock them, try to fight their hearts back into a grudging rhythm.
It’s not working but we all knew this would be the outcome. This is a man whose body has been ravaged by something, but we don’t know what yet. Our arms tire. Matron looks at me questioningly with the paddles in her hands. I shake my head. We have done everything we can and should. To keep going now would be to inflict unnecessary torture on the body of a dead man. After fifty-two minutes I make the order. ‘Everybody stop. Enough.’
‘Time of death, 12.34 p.m., 3 November 2025.’ I leave one of my senior registrars to complete the admin that comes with death and comfort this poor man’s grieving widow. Only a matter of minutes ago she was a wife.
Fiona, my panicking junior doctor, is distraught. It’s the first young patient she’s lost in the department and it’s different when they’re young. It’s never easy to lose a patient but when someone’s eighty-five and they’ve had a long life and suffered a stroke or a massive heart attack, you’re sad but there’s a sense that this is part of life. Death comes for us all and you’ve had a good innings. Godspeed and see you on the other side.
But when someone young dies it’s because something has gone seriously wrong and we have been unable to fix it. The patient was called Fraser McAlpine. His wife is sobbing over and over again that it was just the flu.
I take Fraser’s chart and lead Fiona to the staff room. I sit her down so she can recover from the stress and go over what happened and why. It’s a technique I learnt from a consultant when I was training in Edinburgh. When you’ve lost a patient, you go through the chart straight away from start to finish, step by step. What did you do, when did you do it, why did you do it, how did you do it? Normally it makes the junior doctor realise that they did everything right and it was completely beyond their control. And if they did something wrong, it provides a learning experience. It’s a win-win.
We go through the chart with a fine-tooth comb. Fraser arrived at A&E at 8.39 a.m., so far so normal. He was seen by a triage nurse at 9.02 a.m. who deemed him to be low-urgency based on him appearing to have the flu. He only had a slightly elevated temperature and was breathing normally. He complained of feeling lethargic and having a headache. He saw Fiona at 10.15 a.m. who put him on fluids and gave him paracetamol. She offered to run a blood test to see if he had a bacterial infection or a virus, and to treat him accordingly. He was put on the list for the nurse to take blood. His temperature at 10.15 a.m. was 38.8 degrees. That’s barely elevated. Even a new parent with a six-week-old baby wouldn’t lose sleep over that.
Thirty minutes later, at 10.45 a.m., three quarters of an hour before his heart stopped, his temperature was 42 degrees. At that point you’re basically dead. That’s when Fiona came to get me. My blood runs cold. His body went from being normal to near dead in under an hour.
I can see Fiona relaxing as we review his notes. I haven’t mentioned a mistake she made and I’m clearly unnerved. This is not a simple case of junior doctor error. This is horrifying. This wasn’t flu and it doesn’t appear to be sepsis. He was a healthy young man. People drop dead sometimes, even young healthy people. But normally it’s clear what has gone wrong.
Then I see something that causes a wave of nausea to roll through my stomach. He was in the hospital two days ago. My immediate thought is that we must have missed something. One of my team, my doctors or nurses, must have missed something that caused this man to lose his life. I read the notes – he was in with a sprained ankle after a rugby match.
Death is not a side effect of X-raying and icing a sprained ankle.
Then the thought of MRSA pings itself in to my brain. It’s one of the deep fears of any doctor. But this … I don’t know. I haven’t seen an MRSA case before, thank God. But this doesn’t match up.
I’m poring over the notes, trying to find something, anything that would explain what happened. There’s a jagged edge to a memory. Something is nagging at me but I can’t quite bring it to the front of my mind. What is it? It’s not from yesterday. Maybe the day before? It dawns on me. A patient I treated two days ago. An older man, sixty-two, who was flown down from the Isle of Bute. He was gravely ill when he arrived. They’d intubated him on the helicopter. Kidneys had packed up. I wasn’t entirely sure why they had bothered moving him but the paramedic seemed pretty flustered and said, ‘He wasn’t this bad when we picked him up. His temperature has shot up.’ I didn’t think much of it at the time. Sick person’s temperature goes up. It’s not a huge surprise.
He had died about quarter of an hour after arriving. We had done the same thing as we did with Fraser McAlpine – we took bloods to identify what bacteria or virus was attacking the patient. We never followed up on the results though because he died. That was something for the morgue to look at. I check the bed numbers. They weren’t even close. Patients with sprained ankles don’t go into Resus. Then I check the staff who treated the man from Bute. I was the consultant who treated him along with a junior, Ross. One of the nurses, though, was the same. Kirsty treated the man from Bute and Fraser McAlpine.
Please God let Kirsty be a murderer because that would be so much less stressful than this being a contagious infection or a hygiene problem. No, what am I thinking? Murders involve a lot of paperwork.
I can feel the anxiety rising. It’s not the deaths – I’m used to those. It’s the uncertainty. The thing I like most about medicine is the certainty. There are plans and systems, lists and protocols. There are autopsies and inquests. No question is left unanswered. I try to remember how bad things were in my third year at university after Mum died. It’s like exposure therapy I do in my brain. I survived that so I can survive this. I survived panic attacks so if I have one now, I will survive it. I thought I was going to die then but I didn’t. Just because I think I might die now doesn’t mean I will. I didn’t know if I could be a doctor then but I am a doctor now. Be wary of that little voice that tries to twist one scary thing into a spiral of despair.
Do not panic, Amanda. This is just my anxiety talking. Two patients are not an outbreak of an antibiotic-resistant infection. Two patients are not a pandemic. Two patients don’t even comprise a pattern.
Fiona says she has to go. I stare at her blankly, unsure how long we’ve been sitting here. It’s OK, you can take a few minutes, I reassure her. Losing a patient is a lot to deal with. She says that she can’t, because someone’s called in sick. ‘Ross isn’t feeling well so we’re down a doctor.’
In a split second I do something that’s completely insane. If my husband was there, he would say that I need to book in to see my psychotherapist and that my anxiety has gotten completely out of control. But he’s not and I don’t because what if? My mum always told me to trust my gut and my gut is telling me this is a fucking disaster. I can feel the weight of the knowledge on my chest. I need to tell other people. I need to do things and not just worry in silence.
I go