Pulse

by Felix Francis

  The two patients were wheeled in on trolleys, each with a couple of paramedics in attendance together with a first-response doctor who had attended the scene. I took the female pillion passenger while Jeremy looked after the male driver. Both of them were in a bad way and close to death.

  For the next hour or so my team and I worked feverishly to stabilise the young woman’s condition.

  She had arrived in a coma, medically induced by the doctor at the roadside, so there was no chance of asking her where it hurt. But it really didn’t take any great medical skill to determine the extent of some of her injuries.

  From the unusual angle of her feet it was clear that both her legs were broken and she had numerous gashes in her leather suit that indicated severe lacerations beneath.

  But, in emergency medicine, the same mantra applies as in first aid: ABC – airway, breathing and circulation. Without respiration and circulation a patient will rapidly die and intervention elsewhere would be fruitless.

  So we initially concentrated on keeping her airway open, her lungs ventilated and her heart beating. Next we checked for signs of major bleeding, both external and internal, and in particular into the chest cavity. When we were confident that she wasn’t about to die on us in the scanner, we took her to CT for a full-body scan that revealed not only the multiple fractures to her lower legs but also several cracked vertebrae in her back, together with a bruise and small bleed into the brain.

  If the bruising caused any swelling to her brain then the pressure in her skull would need to be relieved. She would need dedicated specialist neurological treatment, something that was not available here at Cheltenham. If we hadn’t been so close to the accident she probably wouldn’t have come here in the first place.

  As soon as she was well enough, she would be transferred to the regional major trauma centre in Bristol, some forty miles away. A dedicated ambulance was already standing by.

  With her breathing and pulse finally stabilised, I had to be sure that she had an adequate blood supply to her lower limbs before she was moved. If the broken bones had punctured the tibial arteries through her calves, then her feet would start to die even before she made it to Bristol.

  I studied the CT scan closely. It showed that there was a little internal bleeding behind the knees but not as much as would be expected from an arterial tear. In addition, I could feel a slight but steady pulse on the top of each foot.

  ‘OK,’ I said. ‘She’s ready to go.’

  A fresh team of paramedics connected her to their portable monitoring equipment and then wheeled her gently out to the waiting ambulance.

  My whole team took a collective sigh.

  ‘Well done, everybody,’ I said. ‘Good job.’

  The young woman had been on the brink of death when she’d arrived but now there was every chance she’d survive. Only time would tell if her brain injury would be life-changing.

  So preoccupied had I been trying to save the patient in front of me that I had temporarily forgotten about the unconscious man I’d left in the other cubicle – that was until I saw the junior doctor, who was standing to one side waiting for a break in the action. I could tell from his expression that things were not good.

  ‘What is it?’ I asked.

  ‘He died,’ he said bluntly.

  ‘He what!’ I shrieked at him in anger. ‘How?’

  ‘Cardiac arrest,’ he said. ‘Just after you left. We’ve been trying to resuscitate him for most of the past hour.’ He looked up at the clock on the wall. ‘I declared him dead five minutes ago.’

  ‘Why didn’t you call me?’ I shouted.

  ‘You were busy,’ he said rather sheepishly. ‘And we received the results of his blood tests back from the lab.’

  ‘And?’ I demanded.

  ‘He’d taken a massive cocaine overdose. There was nothing anyone could have done to save him.’

  I felt the tingling reappear in my fingertips and my right leg again began to tremble.

  There must be worse places to have a full-blown panic attack than in the emergency department of a hospital. However, I was determined that none of my medical colleagues should be aware of it.

  Thankfully, after the departures of the female motorcyclist to Bristol and her male companion to the operating theatre to have a broken leg set, there was a brief respite of major activity. But I knew it was only the lull before the storm. That would occur later in the evening, when the pubs and bars closed, and the half-drunk, and worse, would turn up at our door with injuries caused by anything from vicious street brawls to simply falling over in the gutter. But our job wasn’t to police the public’s drinking habits, just to patch them up and send them on their wobbly way.

  The tingling migrated up through my hands and into my arms and I just about managed to tell Jeremy Cook to cover for me for a few minutes before sneaking off and locking myself into the department linen store.

  The shaking that had started in my right knee gradually spread all over my body and the tingling rolled right up my arms and into my throat.

  It’s OK, I said to myself as I crouched in the dark. Keep breathing. This will pass. Although it didn’t feel like it at the time.

  But this was not the first occasion.

  I had been a doctor now for over eighteen years and had been a specialist in emergency medicine for the past ten. Hence I believed I knew the workings and failings of the human body pretty thoroughly, but I had little idea what was happening to my own.

  About a year ago, I’d been to see a gynaecologist.

  ‘Onset of the menopause,’ he had said with a knowing nod.

  ‘Surely not,’ I’d replied, emitting a hollow laugh. ‘I’m only forty.’

  ‘Slightly early, I’ll admit, but that’s what it is. No doubt about it. But it’s nothing to worry about. Quite normal.’

  I had given him very low marks for patient sensitivity as he’d ushered me out the door of his consulting rooms. He was a busy man, he explained unapologetically. Lots of patients waiting.

  Menopause.

  I’d sat outside in my car and cried.

  I cried for my lost youth and also for the lost future my husband and I had been planning.

  We had twin boys, now aged fourteen, and we had recently been trying for another baby – maybe even the daughter that both of us so craved.

  My husband, Grant, had been a soldier when I’d met him, my eye caught initially by the uniform rather than the man inside it. We’d been at a wedding where my female cousin was marrying his male one. We had spent the whole evening together, and then the night too, sans uniform.

  He’d been a combat engineer and had remained in the army for the first twelve years of our marriage. Hence he’d had frequent postings to Iraq and Afghanistan when the boys were small and he’d missed out on many of the things most fathers would take for granted. He’d been on deployment, building bridges in Basra when the twins took their first steps. He’d also been away when they started school, for their nativity plays and concerts, and had been absent at too many sports days to remember.

  But now Grant was back in civvy street and working nine-to-five as head of the product-research team of a local aerospace-instrument company. He’d been looking forward to helping at bath time and reading bedtime stories, to being the hands-on dad he’d been unable to be with the twins.

  But I’d had trouble conceiving. I’d put it down to my age. But plenty of other women have babies after the age of forty. If Madonna and Meryl Streep could do it, why couldn’t I? That’s why I’d gone to see the gynaecologist in the first place.

  Menopause.

  How could it be? I wasn’t having hot flushes or night sweats. True, my periods were a bit erratic but they always had been. Everything else appeared normal. But the doctor had arranged for me to have a blood test, and he’d just given me the result.

  No oestrogen.

  No eggs.

  No fertility.

  No baby.

  Menopause.
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  I had sat in the car and cried for more than an hour.

  But here I was holed up in the linen store, twelve months down the line, and things were worse than I could possibly have imagined. Much worse. Not being able to have another baby was now the least of my problems.

  Initially, Grant had taken the news pretty well, but I felt that I’d let him down badly.

  I began to imagine that he would look elsewhere for a fertile woman to be the mother of his daughter and I became intensely and irrationally suspicious of his young unmarried secretary, all the more so when she started showing signs of being pregnant.

  I even confronted Grant and accused him of being the father.

  He just laughed and told me not to be so silly, but I couldn’t throw the thought from my head. So obsessed was I that I later went to see the secretary in the maternity wing after she’d given birth. I was convinced the child would look just like Grant.

  The secretary was there with her boyfriend, a large Afro-Caribbean man called Leroy, and the baby cradled in his arms had dark skin.

  I had almost cried out with joy.

  And I’d felt foolish.

  But, by that stage, feeling foolish was one of my lesser worries.

  Twelve months ago if you had given me a broken leg, a punctured lung or a ruptured spleen, I would have known exactly how to fix it, but a chemical imbalance in the brain and the impact it has on mental function had been a closed book to me.

  Not that I really knew any better now, in spite of some extensive research, with me acting as the guinea pig.

  During the year I had been referred to two different gynaecologists, an endocrinologist and, in desperation, a psychiatrist. I also had so many blood tests that the veins in my arms were like pincushions.

  Yet not one of those eminent physicians could point a finger and confidently say, ‘This is what is wrong with you.’ Each of them had their own opinion, and that seemed to vary with each successive set of blood results.

  ‘Ah, yes,’ my endocrinologist would say, studying one of the readouts. ‘Your thyroid hormone level is too low. We need to boost that.’

  So I would take a pill every night. However, the next test would show that the thyroxine was now too high but my testosterone was too low. So another medication would be prescribed.

  And so it would go on.

  I was now taking a nightly cocktail of a dozen pills, plus applying various patches and creams, and still I didn’t feel well.

  It had taken me quite a while to accept a diagnosis of depression.

  How could I be depressed? I had a loving husband whom I adored, two wonderful kids doing well at school, a nice house, roses in the garden, two cars in the driveway, a purposeful career and no financial worries. What did I have to be depressed about?

  ‘It’s not about what you have or don’t have,’ the psychiatrist told me. ‘John D. Rockefeller was the richest man there has ever been and he suffered from depression. Acute anxiety caused him to lose all the hair on his body.’

  Was that supposed to make me feel any better?

  It certainly had me scrutinising my hairbrush each morning to see if I was losing mine. I would lie awake for hours at night worrying about it. In fact, I had become a chronic worrier. I could worry for England about an entire range of things over which I had no control, nor any need to control. The whole process simply made me immensely tired and even more anxious.

  Some days my mood was so low that I had difficulty getting out of bed. All I wanted to do was curl up in a ball and wish the whole world would go away.

  But I had kids to get to school, a husband who liked his breakfast, and a job where people were relying on me to keep them alive. So curling up was not an option.

  But, all the while, I was trying to keep my condition a secret – a secret from my children, from my mother, and especially from my work – not an easy task when I was surrounded on a day-to-day basis by highly trained and observant doctors. Indeed, there had already been a few questions asked, questions that I had successfully sidestepped and left unanswered.

  ‘Why don’t you just tell them?’ Grant often asked. ‘I’m sure they would understand and be helpful.’

  Would they?

  According to the Mental Health Foundation, some form of mental illness affects about one in four of the UK population.

  So I was not as alone as I felt.

  However, there was a stigma surrounding it, with many imagining that those with a mental disorder were likely to be violent and dangerous.

  But perhaps the real reason I wanted to keep things a secret was because I believed that it would make me appear a failure and a liability, and I had a dread of being a disappointment.

  I feared that, even if I didn’t lose my job because of it, my colleagues would look at me in a new light, one that wasn’t supportive. They would begin to doubt my competency and fitness to practise. I would be written off and downgraded at a time when my work was the only normality in my life, the rock to which I was still clinging.

  Hence, here I was in the linen cupboard, hiding away while my mind played tricks with my body.

  Panic Attack had always seemed to me to be a bad term. I didn’t particularly feel that I had been panicking about anything. The symptoms simply appeared out of nowhere at times of stress. Perhaps Stress Attack would have been a better name.

  Either way, the effect on my physical well-being was pronounced. Apart from the shaking and the tingling, my heart was pounding in my chest and I was hyperventilating. Both those things tended to make me even more stressed, to the point where there was a positive-feedback loop with every new symptom reinforcing the problem and making the situation worse and worse. I felt I was spiralling down ever faster into a bottomless pit.

  I forced myself to breathe slowly – in through my nose and out through my mouth. I knew from experience that the attack would pass. Sometimes it would take just a few minutes, on other occasions it could last for hours.

  I didn’t have hours.

  I repeatedly told myself to get a grip, but telling someone with a mental illness to get a grip was a waste of time and even counterproductive.

  I couldn’t get a grip any more than someone with cancer could somehow get a grip and use their free will to initiate a cure.

  Depression is a disease, but one of the mind not the body. There is no fever, no bleeding, nothing that shows up on X-rays or scans, indeed there are no visible signs whatsoever. But it is a disease nevertheless. It is like a worm that gets inside your head and burrows through your brain, eating your self-respect and laughter, while leaving nothing but frustration, pain, loneliness and misery.

  It makes you feel worthless, ugly and a burden to those around you.

  And it spawns the belief that you would be better off dead.

  3

  I emerged from the linen store cupboard about ten to fifteen minutes later.

  Thankfully, it had been one of my shorter episodes and no one else in the department seemed to have been unduly concerned by my absence.

  ‘There’s a policeman looking for you,’ one of the staff said to me as she hurried past.

  It was PC Filippos and he found me at the nurses’ station.

  ‘Ah, Dr Rankin, there you are,’ he said with a slight trace of irritation in his voice. ‘I need to ask you some questions.’

  ‘I’m busy,’ I said.

  Answering questions was the last thing I wanted to do.

  He looked around at the surprisingly empty cubicles behind me. ‘It won’t take long.’

  ‘I’ll be needed if an emergency arrives.’

  ‘It won’t take long,’ he repeated. ‘Can we go somewhere private?’

  Something about his expression told me he wouldn’t give up so I went with him to the relatives’ room.

  ‘Coffee?’ he asked, standing by the machine in the corner.

  ‘No thanks.’ Caffeine was the last thing I needed in my present fragile state. He made himself one and then s
at down opposite me on the hospital-issue pink chairs.

  ‘I understand my patient died,’ he said.

  His patient, I thought. That was a new one.

  ‘Yes,’ I said. ‘He had a cardiac arrest and couldn’t be resuscitated.’

  He took out a black police notebook and wrote something down. ‘What caused the cardiac arrest?’

  ‘That will be up to the pathologist to determine and the coroner to confirm.’

  ‘You must have some idea, as the attending physician.’

  ‘I wasn’t attending him when he arrested,’ I said.

  If he was surprised, he didn’t show it. ‘And why was that exactly?’

  ‘I was called to attend another patient – a motorcycle pillion passenger arrived by ambulance with life-threatening injuries.’

  He nodded as if he had already known.

  ‘But my patient also had a life-threatening condition.’

  My stress level notched up a little.

  ‘As it turns out, yes, he did. But I didn’t believe it was as critical at the time.’

  He went back to writing in his notebook. He sipped his coffee.

  ‘Am I being accused of something?’ I asked, my stress levels now reaching the stratosphere with the tingling returning to my fingertips.

  ‘No, Dr Rankin, nothing like that.’ He smiled and the tingling abated. ‘I just have to get the sequence of events accurate for my report.’

  He wrote some more then looked up at me. ‘You must have some idea what killed him.’

  ‘As I said, that will be determined by a post-mortem examination.’

  ‘No ideas at all?’ He was persistent.

  ‘I understand that a blood test showed he had excessive cocaine in his system but I haven’t actually seen the results myself.’

  The policeman raised his eyebrows. ‘Cocaine?’

  ‘Yes. It seems that he had taken a massive overdose. One of my colleagues is of the opinion that no intervention by us could have saved him but the toxicology results will prove that one way or the other.’