Alex, twenty-five years old
Cause of death: Allergy
Cause of life: Music is the operating system for the soul
It was the most delicious bowl of cornflakes Alex had ever eaten. Sadly, they weren’t just cornflakes. Instead, the most allergic boy in Britain had eaten a large serving of cereal covered in tiny crunchy nuts. And then he died.
I first met Alex, unconscious and fighting for his life, shortly after I had returned from a book festival in Bali. There I had become vegetarian through writing my book One Medicine, which explores the extraordinary lives of animals. My protein sources changed overnight from chickens and cows to cashews and chestnuts. Nuts had become my friend but not for Alex, who had reacted dangerously to nuts, eggs and even peas since he was a baby. After spending months in London’s Great Ormond Street Hospital as a child, Alex returned home to a new, adapted life. In school, Alex sat on a dedicated table with just one ‘nut free’ friend. Before football matches, he needed inhalers to fight off asthma attacks that would flare up each biting British winter. And birthday parties never ended with a slice of cake. Following in the footsteps of his Welsh great-grandad Mansel Treharne Thomas, one of the most influential musicians of his generation, Alex played the euphonium despite it making his face go red alongside the eczema related to his allergies.
Alex’s parents, both in the police force, divorced when he was ten. Alex kept a strong relationship with both his mum and dad thanks to the time he spent with them at football matches, holidays abroad and long, lazy Sunday lunches with his sister at their Wiltshire childhood home. It was during one of these trips with his dad that Alex had a cardiac arrest after eating breakfast at a hotel in Cardiff.
Alex and his dad were visiting my home city of Cardiff to watch London-born singer-songwriter Freya Ridings. Her chilled-out piano music performed in Wales’s St David’s Hall was a perfect vibe for the cosy winter night with father and son. With last night’s songs still playing in his head, Alex wandered around the hotel breakfast buffet, avoiding the foods he knew would spell trouble. The cornflakes he chose were the nicest bowl of cereal Alex had ever eaten – probably because it was the first time he had ever eaten the unlabelled nut-based crunchy cereal. The trouble is they tasted too good. As Alex was about to return for a second helping, he felt terribly sick, rushing up the three flights of stairs to his room on the top floor of the hotel. Realising what had happened, Alex tried to make himself sick before swallowing a handful of his anti-allergy tablets then punching his EpiPen through his jeans into his left thigh. By the time his dad got back to the room, Alex was bright red and struggling to breathe. ‘It felt like Darth Vader had taken over my lungs,’ Alex told me when we were reunited three years later. Alex collapsed to the floor as the medical team arrived, whispering to his dad, ‘I think this is it.’
Chatting to Alex three years after he thought that was it, he showed me a blurred photo of his lifeless body lying on the hotel floor taken by his dad as the medical team saved his life. Alex was barely recognisable – his blotchy red skin replaced by a now pale, healthy complexion, a ripped T-shirt with defibrillator pads stuck to his skin replaced by a neat blue ironed fleece. Alex’s surroundings were radically different too – gone was the hotel floor scattered with medical equipment and blurred paramedics sweating doing CPR. Instead, Alex spoke to me from a calm, tidy room at his sister’s house with a black piano just visible in the background. Thankfully, public and commercial awareness of severe allergies has also moved on. Sadly, this came too late for 15-year-old Natasha Ednan-Laperouse, who tragically died in 2016 as she flew over the River Seine to Nice after eating an unlabelled sandwich containing sesame seeds.
The medical team who saved Alex needed to do three rounds of CPR, pumping in fluids, adrenaline and other drugs to put him safely on to a portable life support machine right there in the hotel room. Their next challenge was getting Alex to my hospital. Although only a few miles away horizontally, Alex was trapped in a cramped top-floor hotel room without a lift, the only escape through winding steps down narrow corridors. It took the fire service three hours to safely winch him from the top-floor window while still unconscious on a life support machine.
I met Alex after this tortuous journey in the resuscitation bay of the emergency department. It had already been a tough shift, too many patients with not enough beds. But as the emergency buzzer screeched out, the report came through of a young patient in cardiac arrest from a severe allergy. All the staff suddenly found an extra dose of energy from somewhere. After bursting through the doors, it was clear that the large bowl of cereal was still causing chaos inside Alex. Although our drugs were keeping him alive, the best action is always to fix the root cause in patients who are critically ill. So we sucked out as much of the congealed food as we could using tubes into Alex’s stomach. But the thick mush wouldn’t come up our pipes. So instead, we put down cameras like the ones used to unblock waterpipes and sucked up the remnants of the nutty cereal. We then put black charcoal into Alex’s stomach to bind any remaining peanut proteins.
We used a powerful drug called aminophylline to open up the constricted passages in his lungs. You probably drink a similar drug yourself most mornings: caffeine is a naturally occurring phosphodiesterase inhibitor acting in a similar way to aminophylline, which can be used in rural locations without medical facilities to help treat tight lungs caused by allergies like Alex’s or asthma. Chewing instant coffee may not be a pleasant experience but it can help save a life in people with severe asthma and no access to help. And all of this worked.
Over the next few hours, the amount of help Alex needed from our machines reduced, his face turned from Saturn red to salmon pink and his heart started squeezing once again. Within twelve hours, Alex was opening his eyes. Twelve hours later he was off the life support machine. And twelve hours later he was getting ready to go home. Just days after Alex died, he was back at work. And that is why I love caring for patients after cardiac arrests.
What’s your favourite magic trick? Or top-rated miracle? The best scientific breakthrough? I would say ‘to bring someone back from the dead’. Much of human history has been moulded by such extraordinary claims of resurrection yet every day, in every town, in every hospital, and in every ambulance, these so-called miracles occur. Not thanks to God but thanks to science. Thanks to our incremental acquisition of knowledge and thanks to everyday people like you doing something as simple as pressing on someone’s chest. It is not always the right thing to do of course. When someone’s heart stopping is simply the end result of another irreversible process, be it cancer or infection or heart disease, pressing on the heart won’t work and wouldn’t be right. But when a cardiac arrest happens suddenly for unknown or fixable reasons, CPR saves lives.
The week that Alex’s heart stopped, the hospital where I work was leading one of the world’s largest studies on caring for patients after a cardiac arrest. Studies like these are difficult to do, not least because patients are unable to give consent unlike other medical studies. After a cardiac arrest, people are often unconscious, many have brain injuries and although we could ask their family, these same people might have just done CPR on their son or daughter, mum or dad. These lifesavers are often unable to sleep, eat or drink afterwards yet alone synthesise the risks and benefits of a clinical trial on behalf of someone that they love who has just died.
Some say we just shouldn’t do research in these situations. That it is unfair, unethical or not right. That instead we should just keep doing what we have always done. Yet critically ill patients, especially those suffering from cardiac arrest, are the most vulnerable to medical harms, the most in need of better treatments and actually the ones most in need of high-quality medical research. Out of 100 people who have a cardiac arrest outside of hospital, only ten of them will get to hospital alive. And from these ten people, five will die and three will survive but with severe brain injury meaning life will never be the same again. Out of 100 people, just two will return to their second act like Alex. The 2 per cent club. And that is just not good enough. Thanks to large international trials like those co-ordinated by my colleagues, we are making progress in allowing more people to have a second act. We want more people like Alex.
But there are other ways to save a life. To save many lives. Five years ago, I was lying down on a hard table with my trousers around my ankles, with two strangers holding my testicles while making small talk. As a 40-year-old with 2.5 children (two daughters and a dog), what better gift for my birthday than a vasectomy? The gift that hopefully stops giving was planned months before I turned forty. I thought I would be embarrassed after finding out a medical school friend does all the vasectomies in my local area. We had previously shared drinks and songs and anatomy books. I hoped he had remembered the anatomy but forgotten the songs. Thankfully, the considered environment, the preparation and the people made the whole experience easy and not awkward. The nurse who assisted him chatted as my friend cut into my scrotum. The sedative I was given even made the walk around the small, picturesque village where the clinic was, searching for my lift home, almost relaxing despite my unusual gait. It was like a scene from a zombie movie with around ten similarly aged men limping around slightly disorientated in jogging bottoms.
The hard bit actually came sixteen weeks later when I needed to provide a sample. Although I understand why a semen sample had to be delivered within an hour of production, this was tricky. Especially as I live more than an hour away from the hospital. I faced a stark choice between speeding or getting caught in a compromising position in my own hospital office. Having navigated this first challenge (I’ll leave my modus operandi to your imagination), I proceeded to the sample drop-off area clutching my cargo with five minutes to spare. Given that even beer bottles are wrapped in brown paper, it seemed unfair that the giant sample packaging was made from the world’s most perfectly transparent material. What should have been a short walk down a corridor turned into a nightmare of bumping into colleagues like a wedding-greeting ceremony. Aware that the hour was nearly up, I had to lie and say I was delivering an important sample to the lab for a patient.
‘Oh, I’m going that way, I’ll take it for you,’ said a helpful colleague reaching out to take the bag. Perhaps they noticed the giant oversized red capital letters spelling ‘SEMEN’ on the side as they accepted my lame excuse and walked on. With just two minutes to go, I arrived at my destination only to see a queue of guilty looking men all with identical sample containers. Each would take it in turn to press the wall intercom that was answered in a booming voice, ‘SAMPLE DROP OFF?’
The oversized sign above the intercom read ‘Fertility Centre’ just to avoid any remaining uncertainty from the colleagues I had just met who now filed past me like slow buses. Finally, my turn came. With seconds to go, the door was opened and I handed my sample to the nurse. Or in my case, the hospital chaplain who had unfortunately been walking through the same door just ahead of the nurse.
This experience taught me a number of things. First, always check who you are handing your semen to. Second, despite having lovely, marvellous people in healthcare, we need to pay as much attention to the systems as the somebodies working within them. Complaints are often directed at people, yet the root causes are frequently found in poor systems or processes, not humans. I now appreciate the power of small changes. An opaque bag, a letterbox, a quieter intercom would not dilute the science but may make my next meeting with the hospital chaplain easier.
An email came out of the blue the evening after I was recovering from my vasectomy asking me to become an ambassador for the bereavement charity 2Wish. It was an invitation to attend their ‘Little Ball of Hope’. It was the only little ball of hope I had left after my vasectomy so I immediately said yes.
2Wish support the friends and families of young people who have died, providing rooms for bad news to be broken, memory boxes that allow handprints and hair cuttings, and counselling in the days, weeks, months and years that follow when someone you love has died.
I used to think I knew how to save a life. I’ve worked as a doctor for over twenty years, in intensive care as a consultant now for nearly ten. And the reason I chose that speciality wasn’t the fancy machines, or the expensive drugs and certainly not long night shifts. It was because of a patient. It was because of one patient. He was called Chris.
Chris was a 17-year-old student, his life at his feet. Chris loved travel and music. He loved life. When Chris went on a school trip to Kenya something worried his parents, who tied a small piece of red wool to the roof rack of their car as they drove Chris to the airport. His dad told him that they would only untie that red wool when Chris returned home safely.
He never would. Because shortly after climbing Mount Kenya, Chris developed a temperature. This turned into a chest infection needing Chris to go to the local hospital. He became critically ill with sepsis and six weeks later was flown to Cardiff still attached to a life support machine. That was when I met Chris and his family.
It was the day after his eighteenth birthday party, held in the ICU, the day after he struggled to blow out the candles on his cake, that we told Chris’ parents that he had died. We sat in the rubble with them. But there was nothing we could do. I remember everything about that day and visiting Chris’s parents a decade later, so did they. They remember the relatives’ room that was not fit for purpose, the peeling paint on the walls. They remember the specks of blood on the shoes of the staff. And they remember leaving the hospital with just a bag of Chris’s clothes and a box of half-melted birthday candles. The red wool is still on their car today.
And so it was because of Chris that I decided to do intensive care medicine. I wanted to be able to answer the questions his parents had asked that day. Questions that many people ask when someone dies.
‘Why did they die and yet others survive?’
‘What more could have been done to save them?’
I spent decades trying to answer those two questions. Trying to save Chris’s life again. I did research into sepsis, wrote books to explain things to the public. But I had forgotten about the third question that Chris’s parents had asked. Perhaps I hadn’t forgotten, perhaps I just didn’t want to think about it because it was too hard. The third question his parents asked as they left the hospital was simple:
‘What do we do now?’
And I had absolutely no idea. In my focus on saving Chris’s life, I had forgotten about the other lives left behind. And I realised this as I read the invitation to the Little Ball of Hope.
How can you save a life?
Well, you can’t save a life using machines, or expensive drugs, or doing night shifts like me. But you can save lives by being there for people left behind in the wake of loss. By saying the names of those who have died like my daughter’s friend’s mum, Charlotte. And by just reading this book you are helping. I have committed to giving 10 per cent of profits from this book directly to 2Wish so that even when I cannot save a young person’s life in ICU, those who remain can continue theirs. You are giving them practical support, a room where the paint is not peeling. You are giving them a memory box to take with them to remember those who have died that isn’t a box of melted candles or a carrier bag of clothes. And you are giving them psychological support immediately after sitting in the rubble and years later. And so now, when I break the worst news to families as I do every day in the Intensive Care Unit, I can at least answer one of Chris’s parents’ questions – ‘What do we do now?’ You ask for help from organisations like 2Wish.
And for that I thank you. Thank you all. Thank you for supporting this cause. And I say this not only on behalf of those left behind, which one day could be you or I, but I thank you on behalf of healthcare staff like me. We all have what can be called ‘those we carry’. Patients and families that we cannot forget even if we try. We see their shadows around corners on long night shifts, or at events like that Little Ball of Hope that I attended. That night, among the glittering ballgowns and manicured hair, I could see Chris sitting in my empty seat next to my wife as I spoke on stage. I saw others dotted around the room. And carrying these people can make you tired. But knowing that there is someone there to share that load, to offer them the support they need, makes the speech I gave not a sad one, but a happy one. Because those others I could see around the room had been supported by charities like 2Wish. I could see the people left behind who have had their lives saved, not by machines, or drugs, or doctors like me. But by others being there to support them.
At the end of that speech at the ball, I included words of wisdom from the Welsh language about these 4,000 weeks we have on Earth that we call life. I had asked an old childhood friend of mine for advice. Huw grew up in a busy, big, crazy household, always filled with music, people, family and his grandmother, or Mamgu as she was known in Welsh. Huw is a talented Welsh musician, poet and linguist. He first suggested ‘yf dy gawl cyn oero’, meaning ‘eat your soup before it gets cold’. It was a perfect sentiment but as I was speaking during starters, I was actively making the soup go cold. So he instead settled on something said by St David, the patron saint of Wales and whom the concert hall Alex had visited was named after. As he died, Dewi Sant whispered:
‘Gwnewch y pethau bychain mewn bywyd.’
‘Do the little things in life.’
He wasn’t talking about my vasectomy. He was talking about the little big things that really do matter. And who better to tell us about some of these little things than Huw’s Mamgu, who died at the age of ninety-nine. Huw told me about his ‘Mamgu’s lessons for a happy life’, which were:
Cook for people
Keep some things for best
Remember your friends’ birthdays
Write letters and cards to strangers
Visit those who can no longer visit you
Look through old cards, letters and photographs every year
Always keep a chair outside to enjoy the evening sun
Eat your soup before it gets cold
We return to Alex, whose body was back to normal but his mind was not.
‘It was a struggle,’ he told me. ‘I should have been so happy but I was not. I just kept asking why? Why me? Why did I survive? Why am I alive?’
Struggling when amazing, rare or fortunate things happen is seen in corner cases of life – extreme situations that are hard to anticipate in advance. This existential experience has been described by people who have also needed a type of life support machine to stay alive like Alex, only not due to disease. Instead, they need specialised equipment to supply oxygen when they enter not a hospital but outer space. But why on Earth should space travel make you question life? And what can the experiences of astronauts tell us about life and death? How can they help Alex explain how he felt?
When Yuri Gagarin became the first human to leave our atmosphere, as breathtaking as the journey was out into space, it was the return trip to our little blue dot we all call home that was life-changing. Although psychologists worried that he might develop ‘space madness’ while in orbit, they didn’t predict the so-called ‘overview effect’ that would be described twenty-five years later.
It was the experience of seeing Earth from the outside, hanging free against the vastness of space, that led to a fundamental change in a Gagarin worldview. He described this long before the term ‘overview effect’ was coined, saying, ‘Orbiting Earth in the spaceship, I saw how beautiful our planet is. Let us preserve and increase this beauty, not destroy it.’
The overview effect is a cognitive shift during spaceflight, often while viewing the Earth from outer space. This effect encompasses feelings of awe, a deep understanding of the interconnectedness of all life, and a renewed sense of responsibility for taking care of our planet. Their narratives often touch on themes of unity, scale and the fragility of life – elements that dramatically widen their perspective and, occasionally, alter their approach to life upon return.
But there is an astronaut even more famous than Gagarin who can explain the links between the overview effect and survivors of cardiac arrest like Alex. They can also give us hope that we can get through tough times in our own lives.
When I say a more famous astronaut, I have stretched the truth a little. Because even though William Shatner has gone into space many hundreds of times more than Gagarin, on board his fictional starship Enterprise, it was not until 2023, aged ninety, when Shatner did it for real. After stepping off Amazon founder Jeff Bezos’s commercial spaceship New Shepard, he said, ‘I was crying. I didn’t know what I was crying about. I had to go off some place and sit down and think, what’s the matter with me? And I realised I was in grief.’
Similarly, individuals like Alex, who experience near-death situations such as cardiac arrests, often face a comparable profound shift. A grief of sorts. Loss of his former self or worldview. Grateful to be alive. But unsure what this life is now all about or ever was. After his anaphylactic shock, Alex’s return from the brink was not just a physical recovery but also an intense psychological journey. Survivors often report feelings of disorientation, depression, or a deep existential searching akin to what astronauts like Shatner experienced after returning to Earth. This emotional turmoil is not the madness that worried space psychologists, but more a crisis of meaning and identity. In fact, it is the sanest feeling of all – what is this life really all about?
Like many people who survive the unsurvivable and arrive in a second act, rather than feeling ecstatic they can feel sad. Sad because they realise how precious life is, sad because suddenly they may look on their former life as lacking meaning, or sad because they see how cruel people can be on Earth despite the awe and beauty that surrounds us all.
Both astronauts and cardiac arrest survivors like Alex undergo a sudden expansion of perspective that forces a confrontation with existential realities. They face questions about purpose, the fragility of existence and their priorities in life. For Alex, his survival was not just a second chance at life but an invitation to re-evaluate what matters most. Just as astronauts may return with a new-found commitment to planetary stewardship or global unity, Alex found himself deeply contemplating how he wanted to use his regained life. He follows in a long tradition of our search for meaning.
So how do we combat this sense of nihilism, whether it is from space or from surviving death or just the everyday grind? Do we need to search for meaning in grand, worldly ways, big gestures and making an impact on the world?
For Alex, meaning eventually returned from deep down. Deep but different. Music had always been rooted in his heart but after his brass band folded, going back to the euphonium didn’t feel right. Like a well-crafted plot of a novel, Alex returned to the music that surrounded him near his death. Freya Ridings’ album that he listened to that winter night in Cardiff had been entirely written on piano. And as he returned to work, experienced the feelings of ‘what now?’, his old family piano called to him.
Tinkering on its keys led Alex from first learning to play his favourite songs to writing his own. And he loved it, partially because he was not good at it. Unlike his perfected brass tones, he would often hit a bum note or not hit a note at all. But that challenge, that exploration seemed to make it better. It also helped his hazy memory that he had struggled with since his heart stopped. Music is the operating system for the human soul.
Sometimes life feels like one long competition. And perhaps you have already made it. Perhaps you have already won. You were born, you survived. You may have been a top student in school, or did better than your friends in exams. You may have played sport at a high level, aced your musical grades, or performed on stage in lead roles. Even if getting into work or university was a struggle, you overcame that. You persevered. You fought. You held on. Many of us start and remain competitive by nature.
But even when we ‘make it’, arrive in a job we always wanted or a place in life we have strived to, we sometimes engineer our own competition. For me, I stepped into roles in academia; for others they join the management escalator. We look to titles, committees and the conference stages to find meaning. Some doctors find competition in illnesses where only a cure equals a win, although this is a ghost that can’t be held. This competitive nature isn’t all bad, of course. We need driven, dedicated individuals who strive for their best as well as what’s best for patients for those working in healthcare. But, just as we can’t all be chosen to be the school team captain, there may remain a residue of discontent when we’re left on the bench or playing for the third team.
So why not instead pour this competitiveness into something different, something pointless, or even something you’re terrible at? Many of us do a version of this already. We may try to beat our 5K time at parkrun or plan a marathon before our fortieth birthday. We think back to our old personal bests and begrudgingly hold on with gritted, aged teeth. We may even discharge our competitive spirit at the weekly pub quiz or on a Sunday with a crossword. But I had always thought that these activities should be things we were already good at, or at least in pursuits we could become good at.
In a Guardian article headlined ‘The joy of mediocrity’, Kerri Duncan encourages us to find joy in what we’re bad at. She writes, ‘When I focus too much on getting better at something, it creates room for failure. I don’t want to fail in my relaxation time.’ This is a blissful contrast to the necessitated perfection in healthcare. Having even one moment when we’re ‘bad’ at our job, by making what in other professions would be a very understandable and simple mistake, becomes a formal complaint or a patient’s life. So allowing or even running towards incompetence in other parts of our lives may be a welcome change.
It’s okay to join that choir even though you’re a terrible singer, to paint if you can’t paint, or to run if you can’t run. You may never be able to chase away your inherently competitive nature that got you where you are, but that’s okay as well. Perhaps after some time your voice will improve, your art will get better, or your 5K time will be shorter than your ward round. Pouring your competitive nature into something other than just your day job may allow mediocrity to improve your life, inside and outside your work, instead of only spelling failure.
And so, for Alex, if art was life, music was therapy. It shows that although this book encourages a YOLO (you only live once) approach to life, this doesn’t mean splurging your savings, or making bad choices that you regret the next morning, or making massive waves of meaning in the globalised world. It means finding meaning in the small things. The little things that matter as Dewi Sant has told us. It means being open to new experiences whether it is swimming in the cold sea or learning to paint or playing the kazoo. Go on. Go nuts.