I drowned a man I never met

It was a busy shift, fighting fires, physically and psychologically tiring. I was dealing with two unwell patients in A&E when a house officer from the surgical ward called. He was worried about Mr X’s blood pressure. The numbers didn’t sound too worrisome to me, at least not compared to the patients in front of me. ‘Give him some fluids,’ I said, ‘I’ll be there when I can’. I thought but didn’t say ‘Not for several hours mate’. I continued seeing the patients in A&E. He called again. I tried to buy time with more fluids. Even in hindsight, I don’t know if on the basis of the information available I made the right prioritisation. The crash bleep went off, rudely monopolising attention and trivialising all previously-prioritised thoughts. I raced to the surgical ward, to find an ashen-faced Mr X, in the throes of CPR, and an equally ashen-faced house officer. Pink froth was bubbling from Mr X’s mouth. Pulmonary oedema. He had had too much fluids. The blood gas came back. Lactate above 7. Somebody produced a history of AF. ‘AF, abdo pain, raised lactate, shock = ischaemic bowel’. Obvious. He didn’t need fluids, he needed emergency surgery. The anaesthesist arrived. A very senior and unflappable registrar whom I liked. He tried to intubate Mr X but the pink froth from his dying lungs made it impossible. The anaesthetic consultant arrived. His first words were to his registrar - ‘what the fuck are you doing?’ He grabbed the equipment and intubated Mr X. We continued with desultory CPR until enough time had passed that we pronounced him dead. I scribbled something in the notes then returned to A&E to face a barrage of sick patients. 

I’m not sure that I killed him, but the odds seem pretty compelling. To those who accuse us of playing God, all I can say is, this doesn’t feel like play.

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