6 February 2006
Grief has peeled away the thick skin that used to protect me from the world.
So many things now have the potential to floor me: a patient being unexpectedly kind, a memory sparked by the smell of apple crumble in the canteen. It’s over six months since Mum died, but the emotional ups and downs are still way more dramatic than any I have induced pharmacologically.
‘OK, and bed four and six are stable?’
I nod at Debbie, the doctor who is taking over for the night shift. ‘Yeah, though after the day we’ve had, you might want to keep your fingers crossed at all times.’
Two patients have died today, one expected, one not. The latter was a guy in his fifties whose liver cancer had stripped away everything but his charm. I liked him a lot.
‘You look shattered, Tim.’
I shrug. We don’t show weakness on the ward. My childhood was the perfect training for this.
‘It’s been a long day but it’s nothing a pint won’t fix,’ I tell my colleague, though I rarely drink now because that releases my feelings in an unstoppable tide.
Outside, the darkness welcomes me after the unremitting brightness of the ward lights.
I check my phone and my heart sinks when I see four missed calls from Kerry. It was her last interview today. In her voicemail she sounds downhearted, and I have to steel myself to call her. I want to be supportive, but even in stable times, I am better at practicality than empathy.
And now is not a stable time.
‘Bad shift?’ she asks when she picks up.
‘Ah, same old. Busy. Sorry not to call sooner. How did it go?’ I cross the road, into the estate.
As she tells me about some old fart of a surgeon giving her the third degree about being married, it startles me. I can’t quite believe Kerry is my wife, though it’s one of the things patients and nurses always ask about. Being married seems to make me a little more attractive to the women I encounter.
Guilt makes me flinch. Must try harder.
‘What was his problem?’
‘Kids. He was implying that it’d be a waste of time training me because I’d only run off and have kids.’
I wait for her to scoff but she doesn’t. I’ve always assumed she thought the same way as me, that kids were for other people.
Except I’m not sure about that anymore. My first placement down here was in Paeds. Perhaps it was because Mum had been so sick, but it was a revelation to see how kids bounced back so fast. It was even more surprising to discover I liked spending time with them. That children are people too.
So much has changed since last July. I don’t know if I recognize myself.
Kerry is waiting for me to say something.
‘You don’t want to train at a school that endorses that level of outdated prejudice,’ I say, though in reality, dinosaurs exist in every hospital and she’ll probably have to face far worse.
‘I want to train somewhere. I’m running out of options.’
I make a soothing noise. ‘It’ll happen. You were born to be a doctor.’
She says nothing for a while.
‘You are coming home at the weekend, aren’t you, Tim? It’s lonely in the bungalow without you.’
Her vulnerability feels like another demand on my limited resources. ‘Of course. Look, we’ll find a way to sort this out between us, we always do.’
I say this more because I know it’s expected, than because I really believe it’s true.
When I reach my digs, my landlady is out, which is a relief. She talks too much. My room is the cheapest one I could find, coffin-sized and shared with a suspended skeleton. My landlady’s not a medic, and I haven’t dared to ask why she owns one in case the answer makes it even harder to sleep.
I open a cider – one of the local habits I’ve been happy to embrace – and wait for the alcohol to perfuse. But even after I’ve finished the bottle, I can’t shake an uneasiness that I can’t identify.
Is it because I’m worried about Kerry? She deserves a place at med school, but that doesn’t mean it’ll happen. The number of places on offer is finite and some people have to apply several times. Yet I fear she won’t apply again; the rejection will be too much for her.
Still, I’m unsettled. Why? The deaths on the ward shook me, but for once, I don’t feel like crying. I take out the notebook I use to reflect on my practice.
As I write, I go through my usual list of prompts. What did I do well, what could I improve upon? Most days, I can list half a dozen answers to the second question, but my errors are never serious or irreversible. Next, I ask myself, what would a good doctor have done? This question challenges me more. The pragmatist in me knows one day I might end up competent, but I can’t ever see myself being good.
Even as I put away the notebook, something still gnaws at me. But I’m too knackered to let it keep me awake . . .
I come to in an instant, my body knowing it’s very early before my brain does.
The bleep. Shit shit shit.
I leap out of bed expecting to feel smooth hospital lino under my feet, but instead it’s carpet followed by the rattle of bones as my ankle hits my landlady’s skeleton.
What the fuck am I doing at home? If it’s a crash call, I’ll never get there in time and—
My phone vibrates on the floor. It’s not the bleep, it’s someone ringing me.
I’m not on call, it’s OK.
Except it’s a private number which usually means the hospital, and it’s not even 6 a.m. and—
Just fucking answer it.
‘Hello. Dr Palmer speaking.’
‘Hi, Tim, listen, it’s Fred Dornan.’
My consultant is really sound. He hasn’t forgotten what it’s like to be a junior, though I’ve never heard him sound so stern.
‘I need you to come in before your shift, ideally now.’
I sit up. Is it a terrorist incident? The 7/7 attacks knocked everyone for six last summer, but I never thought something would happen down here in the sticks. ‘What’s happened, is it an accident or—’
He coughs. ‘No. It’s one of our patients. Mrs Lomas.’
I can’t picture her. ‘What’s wrong?’
‘She’s gone into anaphylactic shock and it looks like a prescribing error. We need to get your statement before you come on duty.’
I blink. Prescribing error. ‘Is she all right?’
A long, long pause during which I finally remember her: a woman in her late thirties, who’d had a cholecystectomy. Routine stuff. I can picture her children, too, being told off by the head nurse for running up and down the corridor.
‘Don’t panic, Tim. But I do need you to come in as soon as you can.’
This is real.
Mrs Lomas is allergic to the penicillin I prescribed for a wound infection at her operation site. I didn’t know about the allergy, but I didn’t check for it either. It would have been there, buried somewhere in her notes.
And because I didn’t check, she’s now in ICU and there is a significant risk she will never wake up.
I describe the steps I took and everything I can remember about her treatment. The human resources woman tapes my statement so there can be no comeback later.
There is a protocol for this.
Fred Dornan’s voice is calm again, but he won’t quite meet my eye, and I am asked if I am prepared to take today as leave. I then have five scheduled days off till I’m due on shift again next week.
By that time, we may have a clearer picture of what’s what.
The words sound as though they’re coming from a long way away.
I go to the mess and remove everything from my locker. Debbie comes in. I brace myself for an outburst because I know the other F1s will have to take up the slack while I’m away.
But instead, she puts her hand on the locker door. ‘Hey, I’m sure it’ll be all right.’
She knows already. They will all know by the end of today.
‘How can you be sure, Debbie? I don’t think anyone knows what’s going to happen to Mrs Lomas.’
She sighs. ‘It’s shit. But human beings make mistakes. Mostly they get picked up but this time you were unlucky.’
‘Not as unlucky as my patient.’
‘Look. They say every doctor will have one, a patient we’ll never forget. There but for the grace of God or whoever the patron saint of junior doctors is.’
There is no grace, no God. Somehow I’ve always known this moment would come and now it has; I am numb.
I manage a half-smile for Debbie’s sake, and I carry my box of stuff down in the lift and along the corridor and out the back, the same route I took on my way home eleven hours ago. At that exact moment, Mrs Lomas must have been receiving the drug her body would reject with an attack that could take out her own organs as collateral damage.
When I get back to my digs, it’s still not quite light and my landlady’s bedroom curtains are closed. I tiptoe into the flat and grab my bag, leaving a note for her, and take a taxi to the station.
I should call Kerry now. I take my phone out, ready to dial.
But I can’t do it.
I can’t bear to hear her voice when she realizes how badly I’ve screwed up this time.
The only consolation is that my mother will never find out.
As I board the train to Brighton, I send a text. The reply comes back immediately.
Come over. Whatever it is, it can be fixed xxx