Five years ago. It’s 3am and there’s a stack of notes at the end of the long, curving nurses’ station. Only around five or six, now. When I started five hours ago I could’ve sworn it was never going to drop below twenty. I pick the next set and start reading about the patient I’m about to meet in cubicle six.
In ED I never read these charts from front to back, I start by skipping to the patient’s vital signs: temperature; heart rate; respiratory rate; blood pressure; Glasgow coma score. Then I look at their age and sex, to see whether those numbers fit. I want to know if my patient is sick, because I want to know whether I need to do something right now, or if I have time. Emergency medicine is all about time. Then I read their ‘presenting complaint’, a brief nurse’s summary of what’s brought the patient into hospital at this time in the morning. In this instance, the twenty-one year old I’m about to meet is ‘acute alcohol intoxication’. The mates who dropped him off are nowhere to be found, but an elderly lady in the waiting room told one of the nurses that she thinks his friends had been talking about him having fallen over. I briefly think back to medical school and some of the apocryphal stories our seniors used to tell about doctors, forty years ago, scribbling ‘PFO’ in patients’ notes. PFO, meaning ‘patent foramen ovale’, or, ‘pissed, fell over’. I think about suggesting to my consultant that the med school consider making a love of acronyms part of their selection criteria for future doctors. Then I think I won’t. We don’t use acronyms like pissed fell over anymore. To be honest, I’m not sure anyone ever really did: probably just a story to make the students laugh. The last thing I do, as I enter the room, is read his name; Guy.
There have been a lot of celebrity deaths recently, and, ordinarily, I probably wouldn’t have given most of them much thought, other than a cursory mental ‘that’s sad’, were it not for two things happening. Firstly, my girlfriend cried after David Bowie died. Now, to put that in context, you need to know that she’s not a crier. She’s an intensive care nurse. I would average that she sees more sadness in a month than most people do in their entire adult lives. And whilst she’s not made of stone, that kind of thing has a way of making someone pretty emotionally robust. Furthermore, she’s the kind of person who recently cleared out her childhood bedroom with less emotional toing and froing than I suffer tidying out the fridge. She’s not the kind of person who scores worryingly highly on one of those online psychopath tests, but she’s also not someone who would typically shed a tear over the death of an artist I don’t think I’ve ever found her listening to. So when she’d told me she’d cried I didn’t know quite how to react, other than to ask what, retrospectively, strikes me as a slightly cold and callous question; ‘why?’
Her answer reminded me why I’m marrying her. She’d had a tough run of shifts, the kind of barrage that comes along every now and again, where you seem to be working perpetual nights, and, to make it worse, every single patient you care for has a particularly heartbreaking story. And she’d cried, not because David Bowie was dead, but because the public reaction, the non-stop coverage and the open mourning of people who’d never known him, on television; Twitter; Facebook; and news sites, had only served to remind her of all those people she’d ever met, and cared for, who had died, quietly, with few, if any, hearts to break, and little, if any, outpouring of grief. Compared to the fairly muted event that is the end of most lives, this open flood of heartbreak struck an off-note. But she’s wise, my girlfriend, and, later, when she wasn’t so exhausted, she wondered whether celebrity deaths are sometimes a catalyst, for people to think about their own lives.
And then, yesterday, Harper Lee died, and I was a little grief-stricken. When I was young I wanted to be a Ghostbuster; until I realised that there weren’t that many ghosts, and, after that, I wanted to be an astronaut; until I realised I wasn’t American. Then a policeman, then a lawyer, and finally, a doctor. And, somewhat oddly given how many lawyers say they were inspired to their career by Atticus Finch in ‘Lee’s To Kill a Mockingbird’, that final change of heart was inspired by a line in a book, written by a woman I will never meet. It managed to capture the kind of idea that, as a teenager trying to figure out their life’s philosophy, you half-form but haven’t quite managed to articulate. I still remember reading Atticus telling his daughter, Scout, how to try to understand someone: “climb into his skin and walk around in it”. So visceral, so straight. Much more affecting than the ‘do unto others…’ I’d learned in Sunday school when I was little. It was real and immediate. Medicine seemed like the kind of career where climbing into someones skin was necessary on a daily basis.
So it’s five years ago. It’s three in the morning and I’m tired, hungry, and not going to get a break anytime soon. In cubicle six, Guy’s apparently come round enough to let me examine him, and to establish that he’s fallen and twisted his ankle, not struck his head. He’s avoided a CT scan. By this point in ED I’ve seen people drink until they’re so comatose they will choke on their own vomit, or until their liver has worked so hard breaking down the ethanol that their blood sugar hits the floor, their brain stalls, and they fit. Guy’s not that unwell. But he’s not going anywhere anytime soon. He’s hardly ambulant, and there’s no one to look after him. He has fluids running through a cannula and he’ll be observed. Guy’s the kind of patient it’d be easy to get internally annoyed at. After all, the press are always talking about how much money this sort of behaviour costs the NHS. And I have three other patients in my care right now, including a child who’s struggling to breathe and a forty-something who’s had a heart attack, as well as more people who need seeing.
When I go back later, to ask Guy a short series of questions to screen for alcoholism, we get talking. The department’s quietened down. Its four or five, I don’t know, and one of the nurses has stuck of pot of tea in the Sister’s office. Staff are gathering like villagers around a well, but I don’t go. Guy is telling me about his life and how he ended up getting so drunk. This time last year his sister died of lymphoma. They were close. It sounds like, recently, he’s been exhibiting more and more signs of depression. He’s been increasingly withdrawn and his mates, in an effort to help, took him out. But Guy just wanted to drink. He needs some help beyond some IV fluids and we start talking about it.
Harper Lee’s line about climbing into a person’s skin wasn’t the line that inspired me to go into medicine. That was a different line. Atticus is a lawyer trying to save an innocent man, and, central to the novel, is the way a child comes to understand this. At one point, a character called Miss Maudie explains to Atticus’ daughter, Scout, why shooting a mockingbird is the only one thing their father has ever told his children is a ‘sin’:
“they don’t eat up people’s gardens, don’t nest in corncribs, they don’t do one thing but sing their hearts out for us. That’s why it’s a sin to kill a mockingbird.”
If you can keep your head in the hospital you soon realise that every patient is a mockingbird, really. Their name might be the last thing you check, but knowing who they are is the most important thing you’ll learn. Even in the twenty-first century, with increasingly sophisticated investigations, a diagnosis is mostly made on a patient’s story, their ‘history’.
She was right, my girlfriend: celebrity deaths are sometimes just a catalyst.