Christina Sweeney-Baird - The End of Men

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 back out to the ward. I tell Matron to ask all the patients in the department if they were in A&E two days previously. She just looks at me disapprovingly and I don’t have the time to have a discussion with her so I move on to the waiting room. I ask who was here two days ago and two men stand up. One man just raises his arm. He’s paler than the other two. I get him on a stretcher. My heart is starting to do the clenching thing it does when I’m getting a panic attack but there’s actually a reason for the panic. This has never happened before. It’s always been a panic attack because I was panicking about nothing, it’s not meant to be legitimate panic. I want to cry, slump down in one of the staff room chairs and leave someone else to deal with whatever this is.

They all have flu-like symptoms. Either they or their wives are concerned it’s something sinister like sepsis – there was a sepsis campaign put out by the Government in October. It’s saved around twenty lives in this hospital alone and has also single-handedly increased waiting times. Everyone and their mother are convinced they have sepsis.

I want to tell these men that actually I think this might be a lot worse than sepsis, ten times more terrifying than one of the nation’s biggest killers, but I don’t. I stay quiet and determined and outwardly calm. No one dares to question what I’m doing until I chuck everyone out of the Minor Injuries Unit and place the suspected infection patients in there. One of the nurses starts spluttering at me but I just tell her to go to Resus. I can’t explain things right now, there’s no time. Matron has done as I asked and found two patients who were in A&E two days ago and are now back. I have three from the waiting room. That makes five. Fraser McAlpine makes six. The man from the Isle of Bute makes seven. This isn’t a coincidence.