Coda

And a deeply, deeply weird sequel to the "woman who looked like a snow ghost" story.

Three sequels, actually.

The first is that there was a rumour that "they" found four pharmacy cards on her and a minature ziggurat of ibuprofen packets in her house, over four hundred tablets. I don't know who "they" were or why "they" were in her house, I don't know that this was true at all.

But it would explain how a twenty four year old Asian woman can get a bleeding ulcer the size of your fist in her stomach. And she had been in terrible pain for weeks, and pain makes you not eat, so if you're knocking back anti-inflammatories for weeks on an empty stomach, and treating the growing pain with more pain relief that is causing the growing pain, and then not going into hospital because they're going to find out about the four identities at four different pharmacies ....

I don't know. We, the hospital, are telling this story for a reason. But that doesn't mean it isn't true. And if it's true, that doesn't mean we should have treated her differently, it doesn't let us off any hook. But in the end we're telling the story, and I can't help but feel it's shifting the blame.

The second is that she was pregnant, and the fiance swore they hadn't had sex for six months, and they were going to get married in June, and maybe they still will. He'll never know, unless she tells him. Or unless she's still pregnant. I feel it is inconceivable that a four week pregnancy would survive what her body's been through, but, hey, I've been wrong before.

And the third weird sequel is there is no blame. I went into the ED today and spoke to my boss. He is an Irishman, loud booming voice, big hands, uber-confident, the man you call when your head has been ripped off because he's the one who'll save you. He was ebullient. Surgery were very pleased with what had been done, they said. The coroner (or whoever looks investigates cases of temporary deaths) would investigate, because a twenty four year old had had a cardiac arrest on the Xray table, but we were going to come out "luminous". His words, "luminous". Everything we did had earned praise. Our rapid response. The intravenous access, the swift transfusion of the approporiate fluids, the code green (summoning the appropriate specialists), the clear and complete assessment, our well-co-ordinated and eventually successful response to her cardiac arrest. Her death and our successful and permanent reversal of that event.

And my boss used the words "excellent", and "very good", and "entirely satisfactory". He said I was a very good registrar and would make a very good consultant. He pointed out that her heart started beating again because of my frenzied rhythymic shoving at her breastbone, that her heart pumped the blood I had poured into her, through the line I had put into her vein. And that she was talking and it looked like she would be walking, when a few days earlier her eyes were huge, silent and dark, as unresponsive as space, and her hands were clawing at nothing.

And if I, God forbid, were to have a cardiac arrest at age twenty four, would I rather not have it ten feet away from the resuscitation room, with lines in each arm and my veins pumped full of blood and six doctors and twelve nursing staff within thirty seconds of me?

And it wasn't me, it was the team, the nurses and the doctors and the support staff and the radiographer, from the triage sister who saw her out in the waiting room to the orderlies who wheeled her into the lift -

the tumult and the shouting dies,
the Captains and the Kings depart,

- all that kind of thing, and Dr Iskandar deserves more of the praise than me, and is probably at home flagellating himself. I should ring, but it's midnight.

I might ring. He'd want to know.

By God, that space cadet glow.

And when I went out, bemused, Doctor Benedict, the man who scored higher on his primary and fellowships exams than did anyone else his year, was drinking green tea and reading the rugby and looked casually up to me and said "Good save on Monday. Good work, I hear", and then went back to sneering at the Welsh. And in the ED several people came by and wished me well and said "Good resus".

Well.

Some other time I am going to expound on my theory of emergency departments as centres of optical perversity. They are like cosmic phenomena, places like black holes where the normal laws of perspective alter. I the ED that which seems a disaster is a triumph. You go home thinking you've done really well and three months later you open the paper and you're being named on Today Tonight. You stumble home mired with the blood of innocents and the survivors of your reign of blood write you thank you letters and give you boxes of chocolates. Drug addicts who don't have home-made tattoos, people you know are dead who come back to life, weeping girls who cling to their fiances and can't tell him this one thing.

None of this makes any sense. You remember that paper a year or so back that reckoned we might all be living in some virtual reality simulation? Tomorrow it's lie on the lawn and read superheor comics. It was a soap opera the last few days, but it's going to be a pastoral tomorrow.

John