And her life drained away..right there on the kitchen floor
Not long before taking up my first consultant job I was working a particularly brutal roster as a senior trainee physician in a busy city hospital. This place was mere yards from the most violent parts of town and we were no strangers to dealing with armed cops guarding the chained up patients we were supposed to be treating.
As a physician I generally had little interest in what these characters, male or female, had, had not, or were supposed to have done. Mostly this never came up in their clinical history- unless they had ingested or inserted something, or been somewhere they really should not have. My concern was just dealing with whatever we diagnosed and getting them safely off the premises.
Inevitably there were tensions. On one occasion a restraining order was placed on a patient’s son, a well known local gangster, keeping him at safe distance following threats, and with means to kill if I did not accede to demands to discharge his acutely unwell mother into his less than competent care. I did not and he was unceremoniously banished. For the next few weeks I was escorted to the boundary by security guards who watched edgily until I made good my escape, straining to see any would-be assassins in my rearview as I headed into the night.
On another occasion a local villain had to be directly restrained by security when I (erroneously) advised him he may have a gonorrhoea infection in his knee joint. It turned out to be something equally rare (but very similar) and I later apologised. His illness did not however prevent him from trying to visit a violent retribution on his hapless partner. Everyone survived and he left hospital with hasty promises of marriage to placate his intended. I often wonder whether this relationship endured beyond the doors of the hospital: probably not.
Some instances were more amusing. Two fraudulent brothers were caught attempting to ‘borrow’ their mother for an afternoon from a long stay unit. A large removals truck was backed up to the rear of the ward and they were caught red-handed trying to push her aboard complete with hospital bed. She suffered with profound dementia, and they hoped to convince investigators they had cared for her in their house for the preceding decade to justify the sizeable state-funded benefits they had been claiming while we took care of her and they rented her house to others. They did not succeed In their enterprise and instead were arrested for plotting to kidnap.
More extraordinary was the uncomfortable looking man who showed up in the Emergency Department requesting treatment for constipation. A quick assessment revealed multiple masses in his abdomen which he quickly confessed were due to dozens of cocaine packed condoms. A roster of policemen was duly parked by his bed to count his emerging cargo as it was gingerly offloaded with the aid of laxatives. I’m not sure that either patient or police enjoyed the next two days being handcuffed together until all was safely delivered into the hands of the law.
But one of my more graphic and heart rending experiences came in the middle of the night a few days before the end of my tenure. I was urgently summoned by a colleague to the emergency department to help with a resuscitation. What greeted me was not pleasant.
The team were already hard at work on an attractive young woman in her early thirties. I could see from the flat lining heart monitor, endotracheal tube attached to a bag and oxygen supply to support manual ventilation and chest tubes inserted into both sides of her chest that things looked very bad.
As I took this in I was struck by the fact that whatever fluid appeared to be going into her veins appeared to be emerging from the chest tubes at the same speed. The patient was translucent.
“Where’s all the blood gone?” I asked looking around at my colleagues and the sterile disturbingly bloodless surroundings.
A paramedic to my left said grimly:
“Pretty much all of it, best we could tell, is on her kitchen floor and covering her two kids who had to sit and watch her bleed to death.”
“What happened?” I said, scanning the exposed torso for wounds and finally spotting a single narrow slit just below her left collar bone, also pumping the same clear fluid as a nurse pummelled her chest trying and failing to achieve a meaningful cardiac output.
“Boyfriend thought she was having it away with his best mate so thought he would reorganise her internals with a carving knife..” he motioned a downward stabbing motion for dramatic effect.
“Where are we up to?” I asked my colleagues, thinking to myself that this lady looked very dead and long gone. There were five of us around her, three medics and two nurses. One of the medics, an anaesthetist, was running things and was, like me at the end of training, waiting to take up a more senior and hopefully less onerous job (little did we know in retrospect..)
“She got here about 15 minutes ago. Single stab wound to left subclavicular, massive haemorrhage at scene, asystole on arrival, down time unknown but we think over 45 minutes. Pupils fixed and dilated when she got here, no respiratory effort. Multiple cycles of CPR, atropine, adrenaline gone in, three, no wait four litres of volume replacement, chest tubes in, drained fresh blood then that..” pointing down at the chest tubes. “Oh-neg and platelets on the way. Baseline electrolytes normal, haemoglobin in her boots, acidotic and hypoxic on entry gases”.
”Right..”. You called your boss? I enquired.
“Rang the duty consultant surgeon, locum, to ask about coming in and opening her chest. Lazy bastard told me he was in bed, said she was fucked so why was I ringing him..?” She looked towards me and raised eyes skywards. “So I rang the surgical reg who turns out to be a cardiothoracic..then I rang you”.
“You want to crack the chest?” We looked at each other knowing that anything we did would probably not work but what did we have to lose apart from an argument about over-ruling the lazy bastard at home who probably didn’t give a shit anyway”
“May as well- tried everything else.” She shrugged. “Your call ‘cos way I see it you are the most senior person on site..”
These days a case like this would be jumped on by a fully equipped trauma team, scanned and in the operating theatre with skilled surgeons of all types elbowing for room to work before you could blink. But this was over twenty years ago and we were on our own, unfettered by rules, protocols and pesky bosses who gave a shit
“Ok”. This wasn’t new territory to me as I’d done this a couple of times before and assisted at a few planned thoracotomies in my dim and distant past. And anyway- you can only improve on dead so what the fuck.
The surgical registrar raced in just as we were talking: “Sorry guys- had to divert to the ward to stop the house dog killing one of my post ops. What the fuck happened to her?”
I gave the resume and plan in 30 seconds as he looked down nodding. “ Right- We’ll do it here“ turning to the sink to being scrubbing while barking orders for equipment. I fell in along side doing the same as we continued exchanging thoughts and information.
When you put your mind to it, opening a chest doesn’t take too long but my colleague was, despite his young face, was already skilled and artful as he sliced down, talking and documenting as he went, identifying anatomy, the paucity of blood making visualising easier but careful not to slice anything vital along the way. This last bit as it turned out was more important than I considered at the time.
Within minutes we were all staring into this poor woman’s chest, heart not beating, lungs inflating under our fingers directly in response to the nurse pushing oxygen down her ET tube. And as my colleague continued to carefully probe and identify structures I pointed at the root of the aorta, the main trunk artery as it rose in an arc out of her heart, cleanly sliced through and gaping open.
“Fuck me” the surgeon muttered, “her aorta is almost clean off- must have been a very long sharp blade he used..” he looked at me, hands withdrawing from the scene slightly, shoulders dropping “I can’t fix this..I don’t think anyone could” he looked, and we all felt useless.
“I think we call this” the anaesthetist glanced over at me “we did our best.”
“Yes” I said glancing up at a clock on the wall “time of death 0234.”
Some months passed before I was interviewed again by the police but I recalled everything that we had said and done that night perfectly. In any case we had all written our own notes and had provided police statements soon afterwards. I had made the transition to my new job, was already overwhelmed with work and glad the Inspector had agreed to travel 200 miles to re-interview me. He looked around my dingy office with disinterest.
“Its going to trial and you may be called” he started, “the boyfriend has entered a plea of not guilty and says she was alive when he left. Says it was an accident and she fell over carrying a knife..”
His face gave way to irritation, “Load of bollocks..doesn’t really explain why he made her 9 year old daughter sit and watch her mum bleed to death, then fucked off without calling an ambulance.. it was her daughter who called emergency services, once she realised hermum was dead.. Kid is now our key witness..”
“Right..” I said, not sure where this was leading.
The inspector shifted uneasily in his chair. “ Thing is his defence lawyer says it was you guys who cut her aorta open..and so killed her..”
“What?” I was dumbfounded. “We only opened her up because she was already dead..and anyway she arrived with no blood in her..ambulance guys said scene and kids were covered..”
“It’s OK” He said defensively, putting his hands up “ we believe you, post mortem doesn’t support his version and there are far too many witnesses. He’s going to go to jail.
Disconcerted as I was by this, I could not rest easy until some months later when the police got in touch to inform me that they boyfriend have caved in the face of overwhelming evidence and changed his plea to guilty. He was sentenced to life and as far as I know he is still in jail.
The one thing that continues to play on my mind was what happened to the kids, I presume now adults, when the lights went out on their mother?
The Secret Doctor 