Fiona says he’s had the flu, and he was fine when he arrived, just fine! She gave him fluids and Paracetamol and had clearly hoped that he’d go away after a while, having been convinced that it was, in fact, just the flu and nothing more.
By this point the patient is dying. His breathing is labored with the shallow pant of a body not coping with the basic requirements of taking in air. His skin has the gray pallor of someone whose bodily systems are shutting down, and his temperature is climbing higher and higher. There are now seven members of staff surrounding him. Matron is taking his temperature at two-minute intervals and announcing with barely disguised disbelief that it’s climbing this quickly. We strip him and surround him with ice and cold towels. I examine his entire body, looking for a wound, an insect bite, a shaving cut, a scratch. Anything that could be causing sepsis. There’s nothing. No rash, so meningitis is unlikely. By this point I’m starting to think he’s past the point of no return. There’s not a huge amount you can do once the organs start shutting down. We catheterize him, give him fluids and oxygen. We pump him full of massive amounts of antibiotics and antivirals to start fighting whatever it is that’s burning him up, we give him steroids for his breathing, we do everything we can. We take bloods to screen for infection, 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 and 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 the room, 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 pulverize 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., November 3, 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 learned from a consultant when I was training in Edinburgh. When you’ve lost a patient, you go through the chart right 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 realize 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.