Reviews

Looking back . . .

It was an emergencynot life threatening, but something needed to be done. All the monitoring equipment was attached, and, with words like, "Don't worry, everything will be fine," we began. But everything was not fine, and it got worse, and after half an hour my patient was dead. At my hands.

Immediately after the event I was a wreck. I vaguely remember talking to the family; I don't know if I was much use to them. The best advice I was given was to write down as much as I could remember as soon as I could. Doing this made me realise how much was just a blur. I remembered impressions, images, emotions much more than a cool sequence of clinical events.

That night I got drunk. It was the only way I could sleep. A sensitive colleague came and sat with me. I didn't realise until later that this was to ensure that I didn't go and kill myself. By the next day I had reassured myself that it wasn't "my fault." It was a normal complication, and these things do happen. I even managed to go through a family conference, detailing what happened and why. With time, more details emerged from my memory.

Then the medical examiner rang. The necropsy did not absolve me from blame. Perhaps I might have been at fault. Perhaps my patient should be alive. Armed with the written report I visited the family. Patiently, I explained what went wrong and why. As understanding dawned so did anger. All I wanted to do was cry out, "It wasn't my faultI did the best I could." Instead I listened to the anger directed at me. It was probably justified. It was also the hardest thing I have ever done.

After that, contact with the family ceased. But life continued. I was able to see patients again, but not concentrate. I began to "enjoy" alcohol. It would have been easy to go down that route. My family was wonderfulI don't know how someone without a caring partner would have coped. Reactions from colleagues were mixed. One valued friend went through the whole event with mecarefully going over each step without passion. Slowly we made some sense of the events. I received lots of telephone calls. Some support was clumsy: someone asked me how I was getting on in the middle of a crowded room at a conference. Others simply offered useful supportsuch as locum assistance if I needed to get away. Others just ignored meas though I might taint them with my failure.

As the days stretched into weeks, people ceased to be interested. I realised that for them it was now old news, despite the fact that I still dreamt about it. It was time to move on. My thoughts about the incident changed with time. Regardless of the actual events, I realised that it was my fault. I could not avoid the fact that I was responsible for the patient's death. But did responsibility mean that I was negligent? Interestingly, suicide never entered my mind. If it had, however, would it have been an inappropriate response? I'm not sure. Surely there is a price for the responsibility we handle.

It was two months before the dreams stopped. It was three months before I spent a day and did not think about the events. It was six months before my heart stopped leaping at letters marked "private and confidential." I was over it. Life returned to normal. That is, of course, until my partner suggested that my behaviour was erratic and asked what the matter was. Within minutes I was in tears, hopelessly out of control. I realised then that "getting over it" was not the issueliving with it was.

So I adjusted, and gradually life did return to normal. On the first anniversary, I had several procedures booked. This was a mistake. Everything that could go wrong did go wrong, and I was a mess. But I and the patients survived. Interestingly, the day after, I coped with several extreme emergencies without anxiety. It was as though a milepost had been passed.

So where am I now? As I write this, the memory still makes my hands shake. The emotions are always there. But I am okay. I can function and be an effective doctor and spouse. I no longer need the forgiveness I craved at first. I can live with my fallibility. I continue to try to do my best for the patients. But now I truly understand the consequences of failure.

I do not presume this to be a blueprint of what to do in these circumstances. But I know that this will happen again to someone else, and they should know that they are not alone.

Footnotes

If you would like to submit a personal view please send no more than 850 words to the Editor, BMJ, BMA House, Tavistock Square, London WC1H 9JR or e-mail editor{at}bmj.com