Kai, thirty-eight years old
Cause of death: Too much life
Cause of life: More quit, less grit
The last time Kai’s chest hurt this much, he had been giving CPR for hours. Now he was the one receiving it. Kai is a forty-something intensive care doctor just like me. But unlike me, he briefly died while staying in a rural cottage during a weekend reunion with old friends. Kai lived because his wife saved his life by doing CPR as their young children watched. And after reading this chapter, I hope you too will be able to save a life.
Growing up near Cambridge during the ’80s, it was no surprise that Kai went into medicine. His mum was a nurse, his dad a leading equine vet, and his oldest sister a doctor. The small town of Newmarket was home to both his dad’s work and the family of six, which included Kai and his three older sisters. Kai was a clever kid, enjoying athletics and rugby, but still needed to work hard to get the grades needed for medical school. At university, he really found his feet, enjoying the science, the camaraderie, and made friends for life. Friends he would meet again decades later in that Old Flour Mill cottage in the Peak District where his life changed.
There was one experience during Kai’s second year as a doctor that made him want to pursue intensive care as a career. It was his first placement in the ICU and the start of a long run of night shifts. Within minutes of arriving at the evening handover, the emergency cardiac arrest alarm screamed out. For the next twelve hours it hardly stopped. It had been a very unusual night shift, far more cardiac arrests to manage than normal but the end of the shift was within sight. A colleague of mine often adapts the lyrics to the song ‘Far Away’ by the Levellers, saying, ‘There’s never been a night shift that lasts for ever.’ While this is true, that last twenty minutes waiting for the fresh, daytime reinforcements to arrive feels like an eternity. And it was exactly twenty minutes before the end of Kai’s night shift when the cardiac arrest alarm went off yet again.
It was the type of emergency that even the most skilled doctor dreads. After twenty years in medicine, it takes a lot to raise my resting heart rate but when the emergency buzzer’s speaker calls out ‘Cardiac arrest! Maternity suite!’, mine still shoots sky-high. Kai realised that not one but two lives would be in his hands.
It was a difficult, emotional and traumatic cardiac arrest. The obstetricians needed to do an emergency Caesarean section while Kai continued to do CPR on Mum. Getting out and saving the baby was also the best way of saving Mum in this rare circumstance. After just minutes that felt like hours, the reassuring cries of a newborn screamed above the sounds and clamour of emergency machines beeping and people counting out aloud the rhythm of the CPR still being done on Mum by Kai. Baby survived. Mum died. And Kai needed to come back the next night and the night after that.
He still remembers how he felt in the days that followed. Not only was it traumatic emotionally, but he was also physically destroyed. His back, chest and arms seizing up during the next night as if he had been fighting for his own life not someone else’s. ‘Those shifts were exhausting, tough and fascinating,’ he told me. ‘I knew by the end of those night shifts that I definitely wanted to do intensive care.’
Like when I cared for Chris, the young 18-year-old student who died of sepsis, Kai’s decision came soon after a tragic loss. There is something about the end, about death, that makes us strive to do more, to do better somehow. Walking towards difficulty is sometimes the easiest way to deal with it.
Admitting this is difficult. I’ve performed CPR hundreds of times and when I’m pressing on someone’s chest, I don’t think about the person beneath me, their life, or their death. I don’t think about their family or what I’ll say afterwards if they live, or if they die. I don’t even think about myself. Or my own family. Or my dog. Instead, I think about everything. Everyone. This whole thing. This life.
I’ve been a doctor for twenty years, been busy for twenty years. I’ve had little time to stop and think. I’ve grown up, had children, lost children, loved, been loved, cried, laughed, and not yet died. I’m now the age that I used to think was old yet feel young. Younger gets older the older I am. And as I press up and down on someone’s chest, these thoughts pour into my mind. Perhaps these two-minute cycles when I am doing CPR are the only times when I can truly reflect, be present.
And at the end of that pondering, another two minutes of my life and your life have passed. Another cycle of CPR will start, a colleague will take over from me and perhaps they too will stand there and wonder the same as I did. Perhaps, like me, they will eventually conclude that the meaning of life is less about finding answers, more about asking the question. Rather than ask, ‘What is the meaning of life?’, it is better to ask, ‘How to bring meaning to a life?’ Because meaning is not about being busy, or achieving everything, it’s not about an ‘inbox zero’ or a bank balance. Meaning is not only hidden in grand moments like those when I’m doing CPR, but in the simple, everyday acts we all do every day. The unremarkable passing of the short time we have to question why.
Life will never get easier. But you can get better at dealing with it. Working in the intensive care unit is to remain in a constant state of ‘permacrisis’. The extraordinary becomes routine, the unexpected a daily occurrence. The structure of the day is imposed on the chaos to contain it within something more manageable. But it can still change at any second. A stable patient can die within minutes, someone critically ill facing their end can be saved by a needle or a knife seconds later. I can never get comfortable in a chair, never sit back without one eye on the next moment. On top of this, every routine ‘day at the office’ for me is the most important day in someone else’s life. There are few jobs that demand this. Perhaps the vicar conducting yet another wedding feels the same pressure but doing a bad job wouldn’t result in death.
This environment demands not only expertise but also a profound resilience and adaptability as we navigate the relentless tide of life-and-death situations. In such a high-stakes setting, strategies are essential to manage the continuous stress and maintain effective patient care. But these tactics are not useful only in the white-washed world of ICU. I think they would help in your life too.
One of the frameworks I use are checklists. These are not mere administrative tools but vital instruments that ensure nothing is overlooked in the midst of chaos. Checklists guide procedures, confirm critical steps and ensure consistency in patient care. They help mitigate human error, providing a cognitive safety net that allows staff to focus on the nuances of patient care rather than the mechanics of routine tasks. This systematic approach ensures that even under immense pressure, the standard of care remains uncompromised. Although I use checklists to safely insert tracheostomy tubes into patients’ necks, I also use them to go on holiday. It makes that last-minute dash out of the door less stressful and has often prevented us from forgetting to turn off the heating or to bring a travel adapter. Checklists are for life, not just for tracheotomies.
Proactively planning and expecting disasters is another cornerstone of ICU preparedness. In an environment where rapid deterioration in a patient’s condition is just around every corner, forward planning is crucial. We don’t wait until the ventilator breaks or all power turns off to think about what to do next. These plans are meticulously developed, regularly updated, and rigorously drilled ahead of time. Simulations of cardiac arrests, multi-trauma admissions and other critical events prepare the team to act swiftly and cohesively. This anticipation and readiness for the worst-case scenarios fosters a culture of vigilance and proactive intervention, transforming potential crises into manageable situations. Life too has predictable disasters waiting for you. One day your car tyre will be flat, your only bank card will be declined, your parents will die. Doing some preparation, even if only cognitively, for these predictable surprises that will hit you on some idle Tuesday can really help.
Moreover, the emotional resilience developed in the ICU through continuous exposure to high-stress situations fosters in me a profound understanding of human fragility and strength. This perspective can cultivate empathy, patience and a deep appreciation for life’s fleeting moments. It teaches me to value health, relationships and the time we have, recognising that every moment is precious and worth safeguarding. It teaches me that everything is relative. After caring daily for people at the brink of death, it makes that flat tyre or that declined bank card less scary. If I start whingeing to myself while running 5K as it starts hailing, I will think about the patients with spinal injuries who would give anything to be running with me in the cold and wet.
Putting yourself outside the boundaries of your work and your life could bring a similar perspective. Volunteer with those less fortunate than you. Read books about what life was like for your own family just a generation ago. Think back to your own past when life was tough and remember how far you have come. Channel your inner Mark Twain who said, ‘I am an old man and have known a great many troubles, but most of them never happened.’
Ten years after Kai’s chest was sore from trying to save that mum’s life, doing CPR long enough to at least save her baby’s life, he was in the final weeks of training to become an intensive care consultant. It had been a brutal few years with Covid, difficult exams to pass and research projects to complete as Kai also balanced the demands of being a dad to three young children. But there was a bench at the end of his long path. With his final placement nearly over, Kai looked forward to a long overdue reunion with friends, which had been rescheduled multiple times during the pandemic.
Taking turns driving to the Peak District, Kai and his family finally arrived after dark following his last ever night as a resident doctor. Coffee and loud music had helped them over the final miles and a cold beer and lifelong friends welcomed them through the doors of the Old Flour Mill cottage where they were all staying.
Good conversation and catching up on shared experiences got in the way of home cooking, meaning it was nearly midnight when they finally sat down to eat. The children formed a self-governing crèche, entertaining themselves with only the occasional need for a parent to step in with an emergency wet wipe. After the babies had been carried to their cots and the dishes piled next to the sink, Kai and his wife went to sleep with their walking boots left next to the cottage door ready for the planned morning hike.
Kai’s youngest, three-month-old Dylan, woke for a feed just after 3 a.m. but was soon back asleep after Kai took on burping duties. As he held Dylan against his chest, Kai felt sweaty, sick and like he was about to die. He was.
After quickly handing the baby to his wife, Kai collapsed on the bed, fitted and hit his head on the thick wooden bedside table. It was thanks to what his wife did next that Kai’s life was saved. Would you know what to do? Could you save a life?
Despite our fancy machines and expensive drugs in ICU, the most powerful tools to save a life when someone has a cardiac arrest are not mine, or in the hospital. You have them. You can save a life.
We all have the potential for 3 billion heartbeats during our lifetime. We all die many times each day, in the pauses between these 3 billion heartbeats. But every year, 30,000 people in the UK will suddenly collapse to the ground having suffered a cardiac arrest before they get there. Their heart will either have stopped beating completely like Kai’s, started fibrillating (jittering) 200 times a minute, or will be unable to pump blood despite the electric circuits working correctly. Two out of ten of those people will survive, and one will have what we call a ‘good neurological outcome’. That person will get back to work, live normally with their loved ones, do the things they love doing. And that is phenomenal. It is one of the medical conditions that always astounds me, where people go from being dead to fully alive once again. It feels like magic.
But it is also tragic. Because if bystander CPR was always given, thousands more lives could be saved: thousands more husbands back to their wives, daughters back to their dads, friends to have coffee together again. If you did CPR on someone you saw having a cardiac arrest, they would be twice as likely to survive and return home. Why wouldn’t you?
Well, bystanders can feel scared, worrying they’ll get something wrong or cause more harm. But if someone is already dead, there is no harm you can do. The chances of surviving are doubled by prompt CPR (and defibrillation), and because around 80 per cent of cardiac arrests happen in the home or the workplace, there is often someone close by who might be able to help. That person one day could be you.
Doing CPR is not complicated, you don’t need to be a doctor or a nurse. I’m proud to say that my 11-year-old daughter Mimi learned how to do CPR at school because in Wales it’s part of the curriculum. It’s really one of the most important lessons schools can teach. Apart from simultaneous equations.
So, could you save a life? Yes. You need to make a choice whether this book will change not only your own future, but the life of someone else. Starting CPR early in cardiac arrest is critical to a good outcome. Even the fastest ambulance will not get to a patient and start CPR more quickly than you can. So let’s do this. Please switch your phone on to silent, close the door and put down your drink.
First, put the hard heel of your right hand in the middle of your chest, between your nipples. Now put your other hand on top. Next, get ready to sing. Press your hands up and down on your chest in time with the start of every word while repeatedly singing aloud the Bee Gees’ 1977 classic ‘Stayin’ Alive’:
‘Ah, ha, ha, ha, stayin’ alive, stayin’ alive Ah, ha, ha, ha, stayin’ alive.’
In fact, any song at around 100 beats per minute will work from ‘I Will Survive’ by Gloria Gaynor, Europe’s ‘The Final Countdown’, or even Taylor Swift’s ‘You’re Losing Me’.
Congratulations! You have just performed CPR in the correct position, pressing at just the right speed. Enrolling in a free CPR course will make you even better but from now on if you ever see an adult collapse, not breathing properly, and not showing any normal signs of life, you have the skills to help save them. Ensure the emergency services have been contacted, get down on your knees and simply do what we have learned. Keep your arms powerful and straight. Press down hard until you feel the chest move inwards. You cannot do more harm than good. You may save that person’s life. Not doing it carries a much bigger harm – certain death. If you ever do save someone’s life after reading this, please write and tell me. It will be the best letter I ever receive.
In the 1800s, death was not hidden away, rather it was even used as entertainment. The Paris morgue was known as the Theatre of Death, purposely located centrally on the banks of the Seine to collect people, help with identification and provide a spectacle with large viewing windows. It was the ‘only free theatre in Paris’. Despite using cold water that dripped from the ceiling, without refrigeration the people on display would last only a few days. So a wax cast of the deceased’s face would replace the body, allowing viewing and identification to continue.
One year, a girl around sixteen years old was found in the Seine, thought to have died by suicide. After a few days, as no one had claimed her body, her surprisingly calm smile was captured using a wax death mask. The viewing crowds that then gathered were so large that shops started selling souvenirs called ‘L’In-connue de la Seine’, ‘The unknown woman of the Seine’. Despite her celebrity status, the young girl was never identified.
Fast forward to the 1940s, Norwegian toymaker Asmund Laerdal’s son fell into a lake and nearly drowned. It was his dad’s quick actions that saved him and subsequently inspired his toy-making skills to be adapted into the production of life-sized CPR training dolls. Making the mannequin bodies was simple enough, but when it came to the face, Laerdal remembered a calm, smiling death-mask that had hung on the wall of his family’s home. It was L’Inconnue de la Seine. Using the newly developed post-war material called plastic, the unknown woman of the Seine became Laerdal’s ‘Resusci Anne’.
Anne has now been used to train more than 500 million people worldwide since 1960, including me, Kai and his wife, a GP. The Laerdal company estimates that more than 2 million lives have been saved thanks to the unknown woman as well as inspiring Michael Jackson’s lyrics ‘Annie, are you okay?’
As Kai lies dead on his bed in the Old Flour Mill cottage, his wife saves his life. While Dylan lay next to Kai, his wife pressed on his chest. Like the maternal cardiac arrest that Kai managed early in his career, the future lives of both mum and baby could radically change. And Kai’s chest hadn’t felt this sore since then either. The two older children peered around the door frame, asking, ‘Mummy, what are you doing?’
Dylan was placed on a single bed next to his dad, turned towards Kai’s wife Seren as she did CPR perfectly. She screamed for help and friends soon burst into the bedroom. There were frantic calls to 999, made more difficult due to the weak phone signal and long Wi-Fi password. By the time an ambulance arrived, miraculously Kai was conscious. He tried to sit up and joked to his friends, ‘If I did die, I can tell you now that there’s nothing back there!’
No one laughed apart from Kai and his friend who was a surgeon. Like Kai, he experienced both sides of life and death many times a day at work, where humour was often the only way to keep going. But as soon as the chuckles stopped, Kai felt like he was going to die once again.
Kai’s heart rate kept dropping to levels only seen in giant creatures like the 200-tonne blue whale. Although beating just six times a minute is okay for a whale’s heart, this is because so much blood is pumped out each time. Kai’s human-sized heart would never get enough oxygen to his brain at such a low speed.
Despite realising his wife had just done CPR after feeling his sore chest, Kai wasn’t afraid. He told me that the most scared he had ever been wasn’t in that moment, but rather while working as a doctor on the top floor of an old hospital in Christchurch, New Zealand, ten years earlier. On Tuesday 22 February 2011 at 12.51 p.m. Christchurch was badly damaged by a magnitude 6.3 earthquake, killing 185 people and injuring several thousand. The earthquake’s epicentre was just 6 miles south-east of Christchurch’s main hospital. The shaking that Kai had felt at the top of that old building gave him a raw, primitive feel in his soul. ‘I thought that was going to be it.’ This actual scrape with death, however, felt different. ‘I was dead, then I was alive again,’ he said.
‘It didn’t really happen to me, it was my family and friends who went through it. Being dead isn’t really that bad.’
Thinking about death can be hard. Like Kai, I’m not scared of being dead, but I am scared of dying. This is because death is a pain-free binary point in time just like the millions of years before you were alive. Dying is different, it is a process, non-binary, quantitative. You go through dying, you are there. We will all face both of those ‘D words’ at some point but many doctors, nurses, patients and families overdo a third ‘D word’ – denial.
In this longevity-obsessed world, we are becoming increasingly less able to countenance a natural death or to understand what truly matters in our final days. Instead, we channel our inner Dylan Thomas as we ‘Rage, rage against the dying of the light’. The Intensive Care Unit where I work is a technical marvel. We have machines to temporarily replace your lungs, heart and kidneys. We have powerful drugs that pause your immune system, change your blood pressure and erase memories. And most importantly, we have staff with the skills to use them and mindset to care. After all, beds don’t cure people, people cure people.
But for those who are already dying when they arrive in hospital, intensive care comes at a huge cost – both literally and figuratively. At a time when community and connection matter most, we too often default to high-tech but low touch. Moreover, misguided heroism on the part of medicine can mean whisking people away from those they love, from the homes and familiarity that they deserve. When the dying should be unencumbered, instead we insert more tubes than the average bagpipe. These well intentioned ‘medical assaults’ help all claim that we ‘fought hard’ and mean nobody is accused of ‘giving up’. The discrepancy between what so many people want at the end and what they may receive is something we should all be raging about.
When it comes to death, making the diagnosis is emotionally draining, but has been central to the doctor’s job for centuries. Surprisingly, British law does not provide an official definition of death. Instead, we rely on various guidelines, including one from the Academy of Medical Royal Colleges, which states:
Death entails the irreversible loss of those essential characteristics which are necessary to the existence of a living human person and, thus, the definition of death should be regarded as the irreversible loss of the capacity for consciousness, combined with irreversible loss of the capacity to breathe.
When I am called to confirm death, I perform the same ritual each time. First, I talk to the dead. In intensive care, patients often have their eyes closed, either from sedation or illness. But I still talk to them, explaining my actions. We are often surprised when recovering patients recall fragments of their unconscious time. And so, for me, communication remains crucial even when extended beyond death, even when no response is expected.
I begin by saying hello and introducing myself. ‘I’m feeling for your pulse,’ I say. Placing my index and middle fingers on their neck, I feel for the characteristic tapping of the carotid artery. Simultaneously, I position my stethoscope on their chest, listening for the lub-dub sound of the heart valves. Then I wait – a long, silent, slow five minutes. I listen for silence, feeling for the presence of absence. No sound is heard, and no pulse is felt. This confirmation can be chilling. Your mind plays tricks as you feel your own pulse and hear your own heartbeat.
Next, I open the patient’s eyes and shine my pen torch into the depths of their pupils, the black space between the front and back of the eyes. We all have this crack in our eyes, that’s how the light gets in. In life, the pupils would constrict to a tiny speck of black, but in death, they remain large and dark, like windows no longer looking out. Finally, I press firmly on the bony ridge above the eye, saying softly, ‘I’m sorry.’ Nothing happens. The patient is dead.
Talking about death is much harder than its confirmation. I have around 200 difficult conversations every year, telling people that their husband, wife, brother, mother, dad, sister, friend, lover has died or will never be the same again. Each conversation, saying sorry, watching other people cry with hope and fear, takes a tiny piece of flint away from my core. All in the knowledge that one day that will be you. The timing is just as cruel. I’ve confirmed death on people’s birthdays, wedding days, children’s first birthdays. Days they are due to watch their favourite band, go on that big trip, ask someone to marry them.
The reactions of a family to bad news are equally as broad as the tragedies involved. People cry, scream, laugh, run away, thank us, understand, hit the wall and hit themselves, hit others. They beg us to be wrong, they deny death is actually possible, and even the atheist can plead to God for a miracle. These reactions are not right or wrong, they are just part of human grief and the sacrifice needed to make love possible.
Modern medicine is a marvel, but can be a curse, especially for frail, older people, and particularly those with terminal disease. Honest, direct, careful communication helps everyone understand that an end is approaching and is likely unavoidable. Being the doctor who is called in at the eleventh hour, there has often been a lot of obfuscation in the lead up. Communication has always been the most important procedure in medicine. I’ve moved beyond euphemisms and instead prescribe compassionate candour. Now clarity is important. I’ve borrowed a phrase from palliative care physician Dr Kathryn Mannix and often simply say, ‘They are sick enough to die.’
Just as language surrounding the end is key, so too are the words when a patient has actually died. The power of disbelief grows in grief, making families interpret words in a way that is least painful. ‘I’m afraid we have lost your mum’, or ‘Your dad is no longer with us’, or ‘Your son has gone to a better place’ will be interpreted literally. ‘Where have they gone?’ comes the reply. Instead, I confront reality and say, ‘I’m very sorry, but they have died.’
Not only are too many patients not getting what they deserve, it’s also not happening where they want. For example, once upon a time, humans died at home, surrounded by family, friends, neighbours and pets. As the mortician Caitlin Doughty explains, ‘Home was where the death was.’ The wider community came together and spent the time – whether hours, days or weeks – making sense, finding courage, teaching and learning. Hands were held, tea was poured, cakes were baked and dogs were petted. Nowadays, dying hides in plain sight. It is institutionalised, technologically mediated, and obscured by monitors and Latin words. In hospitals, the tea, cake and pets are frequently banned, and family visitation is policed. I can still claim expertise because we know the pills and machines. But I’m happy to admit my amateur status when it comes to helping families make sense, connections and meaning. Dying should be nurtured by society, instead it has been hijacked by ‘big medicine’ or ‘big death’.
The change was inevitable. In 1950, a forefather of critical care warned, ‘At the beginning of ICU it is a problem to keep the patient alive, eventually it will be a problem to let them die.’ It has taken courage to grow intensive care into a specialty that has saved countless lives. It will take the same candour to mature into a specialty that saves as many deaths.
For balance, it is important to understand that we have also institutionalised death because it can be traumatic when it happens at home. This is why more resource should be allocated to palliative care, keeping people in their communities and alongside friends. And despite his initial protestations, even Dylan Thomas came to realise this. In his poem ‘Do Not Go Gentle into That Good Night’, the early denial of his dad’s death may have inspired ‘rage’, but even this firebrand eventually admits that ‘wise men at their end know dark is right’. The trouble is that wise men and women may not be the ones doing the resuscitation – they may be the ones forced to receive it.
In her job as a GP caring for elderly, frail people in care homes, Seren would regularly have conversations about CPR. But after we have learned about these marvellous resuscitation techniques, one might wonder why doctors shouldn’t try to save the lives of everyone having a cardiac arrest. How could a DNACPR (Do not attempt cardiopulmonary resuscitation) order ever be a moral choice?
There are two distinct scenarios in which cardiac arrest occurs. The first involves a patient who develops a primary problem with the heart or other organs, resulting in an unexpected cardiac arrest. This could be caused by a sudden heart attack, a clot in the lungs, or significant trauma. In these cases, we do everything humanly possible to ‘fix’ the underlying problem while performing CPR to buy us time. The lengths we will go to may even involve performing life-saving open-heart surgery at the side of the road, as one of my medical school colleagues in the Welsh air ambulance service did in 2017.
The second scenario is when a cardiac arrest occurs in a patient with a severe underlying disease that has reached its end stage. Patients with chronic heart disease, lung disease or terminal cancer will all die with a cardiac arrest. They do not die from a cardiac arrest; they die from their original disease. We all eventually die the same way: our heart stops. In these circumstances, the cardiac arrest signals that the underlying disease cannot be fixed. Pressing on the heart will only result in the loss of dignity for the patient and emotional distress for the medical team. There is nothing to fix, so any extra time CPR gives simply prolongs death rather than life.
Put in these terms, it’s hard to understand why anyone would insist on having CPR during the twilight of their life. If asked, most people don’t. But having that conversation before the end arrives is hard. And this is why, as intensive care professionals, we sometimes need to lead the way and ask people for their views on these topics in a non-confrontational, open manner. A heartbreaking, difficult two-week stay in intensive care, treating futility, is no substitute for an honest conversation with a patient who has the right to express their wishes about their life and death. Perhaps if we spoke more about our own deaths, it might make the end of our lives a little bit better.
And so, for Seren, if the heart of a frail, elderly nursing home resident stopped beating, this was not because of a new problem that could easily be fixed. It was part of a natural chain of predictable events. The cause of death would be a long life. In these cases, CPR would not prolong life, only extend death. She was brilliant at her job; the residents loved her.
Yet with Kai it was completely different. Kai was not that frail, wise old man in Dylan Thomas’s poem. He was a young man and in great health. Until he died. There had been a new problem, something that could be fixed. So CPR was exactly the right thing to do.
After arriving at hospital by ambulance, doctors carried out hundreds of tests to find out what had happened to Kai. The blood supply to his heart was fine – no heart attack. The electrical circuits that carry impulses were working normally too. There were no blood clots in his lungs, no bleeds on his brain. Instead, the cause of Kai’s death was also life – a busy life. Trying to do everything, for everyone, all of the time. He had travelled to the Old Flour Mill cottage after a busy night shift, drank coffee to get him through the day, not eaten much, not drunk much, played with the kids, carried the cases, caught up with his friends. Even in the weeks before, Kai had juggled endless projects at work, visited his parents, done renovation projects at home. In the months before, there had been Covid, work, more work, and a busy family life. Like many doctors, especially intensive care doctors, Kai was also a perfectionist. Not for himself, but for others. He didn’t want to let people down, took on more than his arms could carry, and when he dropped something, he would figure out a way to pick it back up, balancing it on top of the pile.
After all that, no wonder Kai ended up falling off.
Good advice can come from unexpected places. When the retired former world number one tennis player Roger Federer stepped on to the stage at Dartmouth college in New Hampshire, the audience of recent graduates from the Ivy League establishment didn’t know what to expect. Yet despite it being only the second time Federer had ever been on a college campus after leaving school at sixteen, he gave world number one advice. His message was just what Kai needed to hear.
Federer looked perfect on the sunny, green New Hampshire day – luminous white collar around his neck on top of a velvet black robe. Every hair in place, with shiny skin, white teeth and a wide smile. But Federer’s message was the opposite – there is no such thing as perfection. Perfection does not exist.
Drawing on data and not just feelings, Federer explained how, although he won 80 per cent of matches during his 28-year professional career, he actually lost 46 per cent of all points. And more importantly, after losing these points, he just had to move on. Not dwell. If professional tennis players ruminated on every point that they lose, they would lose the whole game and then the match. A point is just a point. When faced with challenges in life, do confront them with your whole best. But when that point is over, it is over. Move on. And give your best to the next, and then the next after that.
‘When you’re playing a point, it is the most important thing in the world,’ he explained. ‘But the truth is, whatever game you play in life, sometimes you’re going to lose. A point, a match, a season, a job: it’s a roller coaster, with many ups and downs.’
The speech was covered by the world’s media, but they failed to recognise the thick, textured brown tree stump that Federer was standing behind. This was a memorial to the ‘Lone Pine’ tree, a gathering place for graduates in Dartmouth since 1829 until the original tree was struck by lightning in 1895. The stump on which Federer placed his hands allows us to remember what was there before. The stump is strong and stable, yet it has no roots. The original couldn’t be fixed after the lightning strike. So it is now far from perfect. But it was perfect to speak behind. It is instead held in place by its own weight pressing on the ground below. Like trees, humans are gardens to tend, not machines to fix.
And so the cause of Kai’s death was eventually put down to not one thing but many. Life is rarely as simple as A goes to B. His lack of sleep, working hard, being dehydrated, some wine, lots of coffee, eating late and Kai’s already slow resting heart rate led to what could have been his end. Instead, it was a new beginning. Sometimes, you are not stressed only because you are doing too much; you are stressed because you are doing too little of what makes you feel alive.
Kai couldn’t drive for six months, something that had a profound impact on his life and family. Everyday tasks like shopping, school drop-offs and commuting to work became major challenges, requiring him to rely on the kindness of colleagues and friends. The overwhelming support from family, friends and even strangers left Kai and his wife deeply moved. The nurses at work even pooled money to gift his family a weekend getaway, highlighting just how much this experience impacted them all, both in struggles and in the kindness they received.
Kai originally told me I should be speaking with Seren not him. He almost felt like an imposter in his own death. He felt his story shouldn’t feature because he was not that different. But during our conversation I think a realisation came over him: ‘My family do say I’m different.’
Kai 2.0 is no longer travelling at 120mph. Although he is still at 100mph, that is still a big difference. He balances fewer things on the pile held in his arms. When things drop, he often leaves them on the floor. In the three months it took Kai to get back to work, he lent on others around him more. Friends sent food and best wishes; he made some time for himself without feeling guilty. As a family they made some big decisions. They packed up a city life and moved to the coast even though their new home was over two hours from Kai’s work. They went anyway; they made it work. And when Kai did return to his ICU, he quit some roles to make room for another.
Kai now organises gatherings of healthcare professionals – from senior consultants to junior nurses – to learn from patients who have died or had a difficult healthcare journey. We call these ‘Morbidity and mortality’ (M&M) meetings, where each case is presented as a story with people bringing their own insights and experiences. Beyond practical learning, M&M meetings provide a space for emotional processing, fostering a culture of continuous improvement and transparency. That is why Kai started calling them M&M&M – morbidity, mortality and merit – the final ‘M’ recognising what was done well, be it saving a life or helping the family of a dying relative. Even when immediate improvements are not evident, sharing and reflecting can be therapeutic. It helps professionals process the emotional weight of their work, acknowledge their humanity, and find solace in shared experiences. M&M meetings thus enhance patient safety and nurture the resilience and growth of caregivers, blending practical improvement with emotional support. Subconscious or not, Kai is now leading something that he has gone through, to help others.
And the lessons that come from M&M meetings are often not about doing more and more. They are often about doing less and less, but better. I like to say to students struggling with what to do next with a complex patient, ‘Don’t just do something, stand there!’ Just as Kai made significant changes in his life, Eddie Cantor, a Broadway performer, humanitarian and founder of the March of Dimes, an organisation that helped defeat polio through vaccination, once said, ‘Slow down and enjoy life. It’s not only the scenery you miss by going too fast – you also miss the sense of where you are going and why.’ This is not about having less or doing less. It’s about making room for more of what matters. Quitting is the best way of succeeding. Or as Federer has shown us, winners are just people who know how to lose better.
Sundays used to be a drag in our house. They would start with an argument with my daughter to practise the piano, starting with mild threats of technology removal and ending with bribes. After a few minutes of hearing major notes that should have been minor, she would inevitably ask, ‘Can I quit?’ Given the time and money already invested in her lessons and books, my response was always a firm, ‘No!’ I believed she just needed more persistence. More grit.
On Monday morning at work, like Kai I’d channel this persistence. I would keep doing the projects I’ve been postponing, act in roles I’d outgrown. Some of us do entire jobs that merely fill time. We don’t quit. We endure. Because quitting carries a stigma. We focus on the time already invested, the progress made, and the commitments we’ve made.
One Sunday, I cracked. ‘Fine, quit then!’ I said to my daughter, throwing the piano books to the ground. I expected her to relent, but she didn’t. She knew better than me. She instead redirected her time to something she genuinely enjoyed and excelled at – dancing. Now, Sundays are filled with joy. She loves dancing, she’s good at it, and it makes her feel more like herself. The girl who took over her spot at the oversubscribed piano class is happier too. Sometimes the solution is not persistence but knowing when to quit.
As leaders, we’re often taught that quitting equals failure. Yet, true leadership involves helping others thrive. Good leaders should know when to lead and, more importantly, when to shut up and listen. Those we lead need opportunities to grow, spaces to fill. What if you are occupying one of those spaces? In Tim Harford’s podcast Cautionary Tales, he explores how Nobel Prize winners, known for their perseverance, often have a wider array of superficial interests than their peers. They move in and out of different pursuits, quitting more frequently.
Persistence has its place, of course. It’s vital at times. The key is to use it wisely. Focus on what you love, what you’re good at, or what makes you feel more like you. Dance if you’re a dancer, not a pianist. Simultaneously, let go of projects you know you’ll never finish. Quit roles that have grown stale, allowing others to take them on with fresh energy. Consider the opportunities missed by clinging to things you don’t truly want, rather than the time already spent on them. Embrace the joy of missing out (JOMO), let go of the fear of missing out (FOMO). I also advocate for the joy of walking out (JOWO). Embrace quitting. You’re never too old to learn the piano, but you’re also never too old to find joy in walking away from what no longer serves you. Less grit, more quit.
Despite the changes in Kai’s life, the biggest adjustment since that day in the Old Flour Mill cottage wasn’t for him, it was for others. But this too is an essential lesson – realise what a massive impact you have on others. Living our life is not just about living our life. Others live through you, and your words and your deeds change other lives as much, if not more than your own.
Realising the impact the events had had on their family and friends, when Kai’s family next went away, they spotted an old phone box transformed into a place to house a defibrillator by Community HeartBeat Trust, a charity dedicated to increasing the number of public access defibrillators in rural parts of the UK. These famous red ‘Jubilee kiosk’ phone boxes were launched in 1936 to celebrate King George V’s Silver Jubilee. By the ’60s almost 70,000 kiosks could be found across the countryside. The charity is changing these into life-saving devices.
The transformation of phone boxes to house defibrillators is a powerful metaphor for how we can change and improve our own lives. Just as technology evolves to meet new needs, we too can repurpose our skills, habits and perspectives to create a more fulfilling and impactful existence. Embracing change rather than resisting it allows us to discover new opportunities. Recognise and leverage your unique strengths and experiences, even those that seem outdated or irrelevant. These can be the foundation for new, innovative paths that give your life meaning and direction, especially when they impact on the lives of others. But to do this we all need to regularly think about our skills, habits and experiences. Death is the ultimate way to do this, but you don’t have to die. In fact, it is best not to.
The selfie that Kai’s growing family of five took outside that transformed phone box was sent to everyone who had been on that memorable reunion trip. By the time the family arrived home a few days later, there was a single postcard on the doormat. It was addressed to ‘Dr D Fib’, with the selfie as the main photo with large capital letters spelling the word ‘CLEAR’ on the other side. It had been sent by the surgeon who had laughed at Kai’s joke, ‘If I did die, I can tell you now that there’s nothing back there!’
Kai had been wrong, there is something after death – the people you leave behind whose roots you have helped nurture. Life after death is all about living on in the memories of those who knew you. So, live a life worth remembering and make sure to leave behind stories that are too good to forget.