We go through the chart with a fine-tooth comb. Fraser arrived at A and 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 100.4 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 107.6 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 into my brain. It’s one of the deep fears of any doctor. But this . . . I don’t know. I haven’t seen a 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 a 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 Recuss. 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.