The Queueing Chronicles

I stepped into the delivery suite at StThomas to watch the fetal monitors trace as the babys heart raced through labour. The little ones cardiogram was perfectly normal. I stared at the snaking line across the screen and remembered the night the midwife, Nurse Margaret, had sent a severely ill newborn home, insisting the parents could manage. Now I had to arrange cover with another obstetric nurse, Sophie, to keep the reception ward running.

Is everything all right? the anxious expectant mother asked, her eyes locked on mine. Something wrong on the monitor? You look so focused.

The hardest part of being a doctor is learning to keep a stiff upper lip. All our conscious lives are spent stitching together fragmentspartial clues that eventually form a whole picture. We learn to observe, to wait patiently, to intervene only when necessary, and to make instant, correct decisions. Acting is never taught to us.

After a grueling operation, in the dead of night, my eyes raw from icecold water, I have to wipe away the blood that has seeped through the cuff of my gloves, descend to the waiting ward, and meet the next patient with a calm, sincere smile. That smile must reassure the frightened, bewildered person who has just been rushed in by the ambulance that they are safe, that we are happy to see them, and that help is at hand.

No one ever taught us that a sick person is terrified. No matter how skilled we become, however we cope with the toughest crises, we must always keep our face. Fear distorts realityboth yours and theirs.

Outside the hospital doors, your parents are ill, children have lost their keys and sit on the stairs waiting for someone, the intensive care unit cant stabilise a pregnant woman with a nonviable fetus, and the operating theatre nurse is battling a hypertensive crisis. All of this churns in your head, yet somewhere above the furrowed brow

Holding your face together is incredibly difficult, especially when you realise you are merely fifteen minutes from disaster. You must conquer your own terror, issue clear orders, calmly explain to the patient why we are rushing, soothe her and her relatives, obtain consent for surgery, and race toward the trolleystripping off your coat on the way, still keeping that mask of composure.

Then, after the curtain falls, you slip not back onto the stage but into the wings.

The hardest moment comes when the catastrophe has already unfolded. Even then you must maintain your façade, ignoring the cold hammering at your heart, talking, talking, talking to patients, to families, to strangers, to yourself, to God, to your own tangled thoughts, to senior staff, again to families, again to yourselfuntil the aching pressure finally eases and you can take a full breath, aware that the nightshift scar on your heart has hardened.

An hour later, descending to a new consultation, you keep your face, grip it with all you have, smoothing the skin beneath your left clavicle as if nothing had happened.

Because doctors err. Every single one. Even those who seem sent from above. Theyre human; only those who never work are flawless. Even the most precise equipment fails, for it is built by hands that make mistakes.

The most frightening realization is knowing exactly when youve slipped. Your mind replayes the moment you could have acted differently, and you never get the answerwhat would the outcome have been? It remains forever unknown.

Did you stare at a perfectly normal cardiogram with eyes clouded by exhaustion? Your sight has grown accustomed to fatigue over years. Did you overlook an entirely normal lab result that no one else would have noticed? Did you dose medication exactly as the protocol dictated? Did you arrive a minute too lateor too early? Did you study an Xray and miss something, or see something that wasnt there? Your vision was the same yesterday, a month ago, a year ago.

Did a tremor of your hand let a clamp slip from a vessel? Why didnt it slip yesterday, the day before, a year ago? Perhaps six night shifts in two weeks is too manywhile your mother lies at home recovering from a stroke. Youve learned that in medicine time is relative, while loved ones have long occupied the honorary seat at the end of the table.

The worst is not understanding what you did wrong, because then the mistake can repeat. How many more textbooks must you read, how many more drills endure, how many sleepless nights must you survive to ensure it doesnt? No one can answer that.

And how do you banish the thought that statistics are on your side? The cold, soulless numbers say that out of a thousand births, surgeries, procedures, there will be three, five, ten complications worldwideevery day, every month, every year. Someones life, someones health, someones tragedy.

So the tragedy belongs to someone.

What does a doctor do when he becomes part of that statistic? He stands before grieving families and says, Here I am. Your murderer. Can anyone truly imagine being in that spot, surrounded by countless sorrowful souls, when you are the only cause of their unbearable grief?

I am the one, you whisper. Destroy.

And why, when a doctor errs once, are the countless times he was right swept under the carpet? Doctors err because they are human. Gods do not err. Their world, their creation, their statistics remain untouched.

The more I work, the more I realise that only the chosen can ever grasp that design. We are not chosen. We are ordinary. Ordinary people. Ordinary doctors.