I’ve been watching the new series of Junior Doctors, which has been on BBC 3 for the last month and this year is set in the Royal Liverpool. It’s a very surreal thing to watch – not like during Series 1, when I was a fourth year medical student and being a proper doctor was just far enough away that this was all a bit exciting, and, besides, that was in the hospitals that I had grown up around; and not at all like Series 2, which aired right through written finals and less than five months away from graduation and, well, I never worked up the nerve to actually watch it. Series 3 shows five doctors who started working on the same day that I did, and now I have these memories that run almost in parallel to the things I’m watching on TV. I find myself having flashbacks to things like wanting to vomit the whole way to work on my first day and trying not to giggle the first time I had to tell someone I was a doctor.
And so when Emily talked a few weeks ago about the death of one of her patients, I remembered being that doctor and that the first time I agreed it was time to stop was the single most heartbreaking thing I’ve done in the last six months.
It was a weekend, I think. Perhaps. The days all merge together in the end until one day you look up and it’s February. I had never attended an arrest before. Not really. I had been to never-mind-patient-just-fainted arrests and patient-drank-coffee-while-having-five-second-runs-of-asystole arrests and oops-thought-that-was-the-light-switch emergency buzzers. I had one day when the arrest pager went off five times and none of them were an arrest. I had done all of the adrenaline-racing pager-going-off-on-the-loo pounding-up-three-flights-of-stairs-in-dress-shoes… and then I had turned around and walked back down the stairs and back to my day job. It was a joyous state of affairs, but one that could hardly last forever.
On that day, I was drinking coffee and writing a discharge letter when my pager started in with rapid sequence of bleeps that mean “on your marks” and the fuzzy hiss of static that means “get set”. And, on that day, when I arrived on the ward with the rest of the team, I didn’t arrive to never-mind-patient-just-fainted or to oops-thought-that-was-the-light-switch. I arrived in Beirut.
I remember wondering what the other patients in the bay must have been thinking.
The noise hit me like a brick wall, muted through the pounding of my own blood in my ears.
For a split second, the only thought I had was, “Shit, this is for real.”
And then I waded in.
In the chaos around about, there were people putting up fluids and trying to get a better venflon in and looking for somewhere to take a blood gas and getting out the emergency drug box and leafing through medical notes. I think I ended up taking control of the airway.
He was a patient who I hadn’t known before. I don’t know why he was in hospital or what had happened to take him to that point. I think he was pre-op, or post-op, maybe, but I don’t know for what and I might even have just assumed that because of the ward he was on. I don’t know his name. I could describe him, perfectly, what his face was like in that moment, but he didn’t look like that before I met him and I don’t think he would have wanted people to remember him the way I do.
They asked if I could take over CPR. I nodded. It isn’t like the training. It’s a million miles away from the air conditioned room and the mannekin and Nellie The Elephant. My stethoscope and ID lanyard were on the floor, thrown there when they had started to get in the way. I thought, with my lungs burning (“watch it, Beth, there’s a sharp coming out near your leg”) and heart racing (“third round of adrenaline in”) and muscles screaming (“has the gas come back yet?”) and sweat starting to roll down my neck (“still in asystole, continue CPR”), that if this was it for him, this would be a horrible way to die, so please, I thought, please don’t, wake up and just stop being dead, stop it now. It doesn’t get more personal than this. “We aren’t letting you die,” I heard someone mutter. “You aren’t dying, not today. Don’t you dare.”
It felt as if we were there for hours and at the same time for no time at all.
And then the noise stops. At the beginning of an arrest, there are bloods to be taken and access to be got and drugs to be given and things to be found out and problems to be fixed. Later, all of the things that can be done have been and all of the things that can be fixed are being and the only noises left are the quiet occasional hiss of the ventilator bag deflating and the odd grunt from the person doing CPR.
The consultant took a breath in. “I think going on now won’t make any difference,” he said. “I think we’ve done everything that we can. Does everyone agree that we should stop? Does anyone object?”
We had done everything that we could. We had.
“Thank you,” he said.
Afterwards, I had picked up my stethoscope and ID from where they had landed and I had walked back down the stairs and was going back to my department to somehow get on with the rest of the day. The living don’t go away just because the dead are dead. On the way, the colleague I was walking with offered me a hug that I fell into, crying like I had managed not to upstairs, and I have seen some awful things in the six months that I’ve been doing this job and in the two years before that, but being in that room, with that man and on that day and at that time, that is the thing that I will never ever forget.