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A Christmas Fairytale

It was Christmas Eve babe, in the drunk tank

An old man said to me, ‘Won’t see another one…’

The Fairytale of New York — The Pogues and Kirsty McColl, 1987

A miracle of Christmas in the Emergency Department. It’s shortly after midnight, and the cubicles are largely clear. A motley cohort of drunken misadventures, grizzly feverish kids and crumpled old ladies with broken hips have been dispensed with in multiple directions, and the harried staff take a moment’s repose as we saunter down from the operating theatre, dropping the keys off at triage. After two fractures, an appendix and a Caesar filled our evening in theatre, it’s a relief to head out the doors into the ambulance bay, and look out at the town’s lights shimmering in the warm still air below.

Like many country base hospitals around the country, the region’s health centre is a raggedy bunch of outbuildings dotted around a glorious (but entirely unfit for purpose) Victorian-era edifice at the top of the hill. Below, the pubs spew the last of their merry punters onto the streets and a couple of divvy vans crawl about, looking for the stray drink-drivers in the backstreets, or the scuffles outside the chips-n-gravy van.

Yet again I’ll miss Christmas with the family this year, the result of being the most junior on the anaesthetic registrar roster at a workplace that changes every six months or so. Now, far from the raucous family barbecue at home on the coast, it’s a quiet exchange of season’s greetings with the nurses, a farewell from Jonesy the orderly, and out into the night toward the doctors’ flats. A round of the kids’ ward complete, beard down, a sweaty Santa is joining a copper and two ambos in a quiet durrie by the back of the ambulance.

“Happy Christmas mate,” Santa grunts as I wander by.

“Hope Santa comes,” I smile back.

“Me too mate!” he coughs, as the copper and ambos chortle and snigger like schoolboys.

Across the lawn and into the flat. Mine has the green door that in no way matches the mustard yellow of the others. It’s a seventies abomination of course, low, rubble-covered ceiling and a slow, Apocalypse Now — style spinning fan. A new set of scrubs to sleep in, already damp with sweat. An air conditioner that gave up the ghost in November, and a hospital engineering department that couldn’t give a shit. Why is there no breeze in this bloody town? Supine on the bed, I’m just willing this fucking year to be over. 1997 started out perfectly: a first-year anaesthetic registrar position at one of the ivory towers in Sydney, gorgeous girlfriend, and a cool Paddington terrace to live in. I sigh, as on the CD player Johnny Greenwood rips Radiohead’s Paranoid Android into a distorted new direction. Merry fucking Christmas.

Ten brutal months later I’m alone, sweating it out in this godforsaken patch of scorched earth, not sure if I should be worried about the past or the future. Nine months at the “centre of excellence” has had me standing around like a stale fart in cardiac and neurosurgery theatres, essentially weighing up which group have the most sociopathic psychopaths (or vice versa.) In the end an abusive meat-balloon masquerading as a cardiac surgeon won that little challenge. I’ve chased results, trouble-shot epidurals, put a few lines and tubes in, and learnt, let’s face it, bugger-all. Home each day to pile of textbooks. West, Miller, Stoelting and their hardcover friends mocked me with a never-ending world of compliance, tolerance and peak flows. Come the exam, there was little of that. I started out badly and then things got worse. Twenty minutes of interrogation later, I’d sweated through a borrowed suit, and knew an invitation to return next year was a best-case-scenario. My long-suffering girlfriend Sarah, had, to be completely fair, been a rock throughout the year. But after I received the college letter with the inevitable bad news, she decided her support had gone on long enough. Generously, she agreed I could share the flat (spare room) until I left for the rural rotation. Less generously, she let that dickhead Colin from her work start popping around to do coffee and “helpful jobs.”

So here I am on a three-month stint in the country, a rotation sneered at by all those in the “ivory tower” department. Summer out west and it’s barely rained in weeks. But honestly, I’m drowning. Everyone I work with, including the local “unaccredited” country registrars, runs rings around me. I’m stuffing up drips, tubes, lines, the lot. And what’s more worrying is: I think I’m getting worse.

My hands shake with procedures, and I can barely speak to the specialists here. They’re friendly, easy-going, but they’re so bloody adept at everything. I can’t ever see myself in that way, confidently nailing procedures and diagnoses, a smile and laugh with the team, quick-witted slight to the surgeons, beer garden after work on a Friday. I’m just waiting for the final blow that knocks down the house of cards that is my so-called career.

I could have been someone — well so could anyone

You took my dreams from me when I first found you

The Fairytale of New York — The Pogues and Kirsty McColl, 1987

I’m finally on the brink of an exhausted sleep as Thom York soothes me with the promise of no alarms and no surprises… and it happens:

The piercing scream of the pager:

* * * C O D E B L U E C H I L D R E N S W A R D * * *

A moment of complete disorientation, and the nauseating period of dread as I’m pulling on shoes, running across the lawn, hitting the open button on the ambulance door, running up the stairs to the second floor. Let it be a false alarm, let it be a false alarm, let it be a…

It’s not a false alarm. The normally jolly night matron, Meryl, is ashen grey as she points me to the single room down at the corner.

There’s an assortment of bodies standing in the room as I arrive, and as one they look at me, all asking, pleading, “Can you do something?” In the centre is the focus of their concerns. A small, wizened boy stares ahead at the ceiling, coated in bright red blood.

I’m stuck, fixed to the spot, not sure if I’m about to have an arrhythmia or if I’m going to wet myself. I’m almost certainly about to vomit. But, continuing my pattern of the past few months, I can’t even make a first move in the process of disgracing myself. As if to fill in the dead air, the intern speaks up.

“This is Daniel. He’s fifteen, past history cystic fibrosis with multiple acute exacerbations of bronchiectasis.” I’m processing this, but can’t quite understand. Fifteen? He looks more like a ten year old. And bronchiectasis? This is a fucking crime scene, I never knew-

Christmas, and here I am about to preside over the death of a young boy. An infection eroding into the blood vessels in his lungs. And me: after a year spent doing next to bugger-all, now I’ve been dropped into this, a game for which I’m drastically underprepared.

In the far corner a man and woman grip each other tightly both with tears streaming. They’ve looked away from Daniel, and now they’re piercing me with their stare. “Please save my child, our little boy, it’s Christmas!” they seem to say. But I’m dumbstruck, frozen. I step toward the head of the bed, because I think if I don’t move my feet I’m going to faint right here, right now. the crowd moves aside. “That’s it,” they’re saying in my mind, “he’s moving to the head of the bed. Great. He’s the one in charge now…” But I’m not, am I. The iceberg has already been struck, and I’ve merely assumed the sinking captain’s seat.

With every cough, a new geyser of bright blood issues forth, initially into the air, then rolling down Daniel’s chin, neck and chest.

That’s when I feel it, a warm touch on my elbow. So warm against the goosebumps. Why am I so cold?

“Hiya, I’m Clare, senior anaesthetic reg, can I give you a hand here?”

Her hand is still on my elbow, warm to the touch, and she fixes me with her big green eyes. In my three and a half weeks here, I’ve never met Clare, senior anaesthetic reg, but I’m impressed with her timing. In fact, in the ten seconds I’ve seen her, I’m impressed with almost everything about Clare. Her Irish lilt, the confident glint in her eye, and that big-arse eighties hairdo she’s got her black tresses done up in.

“Why don’t we get the wee fella down to theatre,” she whispers to me. I look back, nod, and confidently issue the order.

“Let’s take him to theatre!” I command, with a positivity that is in no way justified by my internal terror. Meryl scurries off with her keys to open the theatre suite and call in staff.

Clare leans in and suggests, “Might be worth getting Mac in for this one.” Mac is the consultant on call tonight. A lanky, usually hilarious Glaswegian, he’s the perfect one to rescue this. Basically a legend in these parts. He is however, at this hour I’m sure, happily asleep on his cattle farm twenty-five minutes out of town. Shit.

“Can someone call Mac in, please?” I ask, hoping there’s some way he can defy physics and be here now.

We’re in theatre now, procession in tow. No theatre nurses yet, but the ward nurses hook Daniel up to our monitors. I look at Daniel, who seems to be looking almost back through me, a distant stare in his glazed eyes. The vital signs only confirm what it seems is about to be an inevitable outcome. My heart is making a sickening thump against my chest wall again. Again Clare puts her hand on my forearm, and this time I feel her soft, warm breath on my ear as she whispers, “How about some blood?”

“Yes, thanks, um, Jonesy, can you get me the four units of O-neg from the emergency fridge?”

The orderly tears away, glad of a job that doesn’t involve standing around waiting for a child to die. He’s back in no time. I’m sliding in a cannula as Jonesy arrives with the blood. Straight in, first go! Been a while since that happened!

Clare has the blood running through the line the moment I’ve checked it off. She smiles at me, and says, “Great, let’s get him off to sleep and stop this bleeding.”

“Pop down a double-lumen,” she says conspiratorially, “and we’ll block off the bleeding lung. Can you do that?” I shake my head. “I’ll talk you through it, you’re doin’ great so far.”

I turn to the airway trolley and she’s got everything out. It’s like I’m watching a movie. Exciting, confusing, and at a pace which I can scarcely believe. Before I’m ready, Clare has slipped a tiny dose of Thio and Sux into Daniel’s drip and he’s asleep. There’s blood absolutely everywhere. In his eye sockets, out his nose, everywhere. I’m sucking as I go but the blood keeps coming. More and more, and my hand begins to shake. The oxygen saturations keep dropping, from a beep, beep to a boop, boop, and now a sickening, pre-mortem borp, borp, borp. It’s then that the sucker clogs. Fuck!

“Settle now, just slip the sucker off and put the hose in,” Clare is behind me, warm hand on my shoulder as she watches. Sure enough, the hose sits in the back of the throat, starts gurgling again, and the red tide begins to recede. Laryngoscope into my tremulous left hand. For a moment, I spot the vocal cords and the airway I’m longing to see. “There ye go!” She cheers behind me and the big double lumen tube slides in. It holds up for a second, then with a twist descends into the left lung. I inflate the balloons, and the left tube jets blood out the top. Within a second, Clare has leaned in and clamped it off. “Clear out the right lung first,” she suggests, and with a sucked I clear the bloody remnants from the rest of the airways, then begin to squeeze the bag and re-oxygenate Daniel. Bleeding staunched in one lung, oxygen now into the other. His pale blue returns to a pale pink. Maybe we’re going to be OK here?…

The monitor alarms stop their screaming, and in the corner Daniel’s mother lets her tension release with a groan and a torrent of huge, lumpy, laugh-sobs.

Mac arrives soon after the intensive care team, who are now swirling around, tidying, finessing things. He surveys the carnage, nods, slaps me on the back and says, “Gaun yerself pal, have a wee rest, ah’ve got it fae here.” In his barely decipherable style, I think he’s saying, just maybe, we’ve done a good job. I allow myself a smile as the blood rushes to my face. My hands are still trembling and for a second I think my knees might give way, but I steady myself. Clare raises her eyebrows at me — see, you could do it!

Out on the balcony abutting the theatre tea-room, we stare up at the stars that in these parts are just ridiculously bright. “They don’t come much worse than that,” she starts. “When you can handle that sort of thing like you did, the rest isn’t too bad.”

“I would have fucked that up for sure if you weren’t there to help though,” I replied. “I’ve kinda set a pattern for that this year. I’m not sure I’m really cut out for this game, Clare.”

“That’s bullshit, it is. You’d have been out long ago if you weren’t up to it, and now here y’are, look atcha, savin’ a kid’s life on Christmas Eve.” She gives me a happy wink. “I agree with ye though, it’s not quite the dream job they sold ye is it?”

You’ve got that right. I nod.

“J’ever listen to that Christmas song, Fairytale o’ New York? I like that one.”

“The Pogues, yeah, course. One of the very few non-crap Christmas songs in existence.”

“Y’know, they’re happy heading off to New York with their big dreams and it doesn’t really turn out as they hoped, yeah? Well, it’s a feckin’ shambles to be honest isn’t it? Happy Christmas your arse, I pray god it’s our last… He’s in the drunk tank, she’s a junkie.” Clare bites her lip and stares our at the sky. “But in the end you know, ye kinda get to thinking it might just be alright. You know, like they’re reconciled with the situation and somehow they’ll work it out together. I like that. It’s not cheesy, but it’s kinda uplifting in a real way.”

“It’s not a fairytale, ye know. But some days ye just keep puttin’ one foot in front of another, have a wee win now and then. You know, one day, ye look back, and it’s not so bad ye know? Ye look at it one day and you’ve had a lot more wins than losses. And if ye think about it, every now and then, ye make a real difference in someone’s life.”

“Thank you.” I’m staring at those eyes, the massive explosion of black hair and her ivory cheeks, flecked with the tiniest specks of blood. “I hope we can work together again.”

Clare smiles back at me, this time tinged with melancholy. “You don’t need me to help,” she says, “I’m certainly not perfect.” But here, under a ceiling of piercing starlight, on Christmas 1997, after the most fucked-up year of my life, she is indeed close to perfect. Clare leans over, puts her hand on mine, then looks out toward the slight glow to the east. My chest thumps, as for a few long seconds the moment hangs. “Why don’t you go see if Mac needs a hand?”

And like that, it’s back to business. I leave Clare gazing sadly out to the Christmas sunrise, and head in to tidy up Daniel with Mac.

A couple of hours later a helicopter leaves the pad, Daniel aboard, winging his way into the sunrise and to definitive treatment in Sydney. Daniel’s mother and father embrace me as they leave for the long drive, and the next long chapter in the sickly child’s life. But today, this Christmas, they’ve still got him.

Mac walks with me back to the intensive care office, shows me a seat. “That was a good save, pal. Don’t know I would have had the wherewithal to go straight to a double-lumen tube maself.” He reaches into a filing cabinet and comes out with a bottled two tumblers. Aberlour 21 year old. Pours a couple of fingers into each. “You’ve kept that skill and knowledge hidden so far.”

“Well, Mac,” I explain, “Clare helped, she was the one leading the show.”

“What?”

“Clare was there, you saw her, she was pretty much telling me what to do. Clare’s the one you should be praising.”

“Are you takin the piss, son?” Mac does not look happy now.

“No, why, um,” I stammer, “She helped me, told me what to do, give blood, how to tube, not to panic…”

“Just what the fuck are you talkin’ aboot son?” He’s winding up, and I’ve got no idea why.

“The Irish girl, senior reg, she was there, I…” I should probably stop talking now.

“I know who ye fucken mean pal, I just don’t…” tears welling up.

“What?” I ask, no idea where this is going.

“Clare’s been deid ten years!” Mac is beside himself, tears and snot cascading down.

“Mac…” I’m struggling to compute this, “what do you mean dead?”

“Christmas, 1987. She was here as a senior anaesthetic registrar. Such a great girl, wonderful doctor. Funny, smart.” Mac opens a lower drawer in his desk, retrieves an envelope, opens it. Inside, a yellowing cutting from the Sydney Morning Herald. December 28, 1987. And a black and white picture of Clare, looking just as she did tonight. Staring back at me is the beaming face, the wonderful curls of black, and those funny, sad eyes. It’s her, but how can it be?

An obituary for Dr Clare Ahern, born County Clare, Ireland, September 13 1959, died New South Wales, December 25 1987. A life well lived, travel, family, devotion to medicine etc, and a sad death due to a “medication mixup”. Medication mixup? Strange way for a doctor to go…

I look again. It’s definitely Clare, but she was definitely here, tonight, no?

“She killed herself, Christmas morning.” Mac puts it plainly. “Struggling for six months, every case making her more and more anxious. Then it happens, kiddie dies on the table. Ruptured spleen, arrests as she induces him, cannae get him back. Terrible. Not her fault, should have told her.” He sniffs. “Should have told her all along. We kinna knew she was hurting, struggling, and you know what we did? Fuck all!”

He sobs, wipes his nose. “Christmas Eve, she gets called for an epidural in labour. Disnae come. Disnae matter, they call Jim who’s consultant on. He just does it, figures she could do with the sleep, check on her Christmas morning. When they finally twig something must be wrong they go to her flat, see in the windae, she slumped on the floor. Big Jonesy fair knocks the door off the hinges, but she’s gone. Big drip, she filled it with everything. You can imagine, the works. Broon breid, she was, absolutely nothin’ we could do.” Wipes a tear, catches his breath.

“And me, ah saw it, long before, and ah did nothin’. I. Did. Nothing.”

He’s spent now, looking at the desk.

“How did you know about Clare?” Mac looks up.

“Mac…”

I put the paper clipping back on the desk. It’s impossible to piece this together. Dr Clare Ahern, dead ten years, back here tonight to rescue…us?

“She told me this Mac, and I’ve no idea how or what the hell happened tonight. But I saw Clare somehow, and she was saying…” This is mad. She was saying? What on earth happened? “She says it’s all about a body of work. In the end, if we keep it up, we’ll win a lot more than we lose. And you’ve done it, Mac. We all think you’re a legend. Everyone. The things you teach us. The people you help every day. The lives you save. It’s a body of work, Mac. You’ve made it. Not perfect, but amazing nonetheless.” I nod at his glass and he nods back at me.

“Happy Christmas your arse,” he smiles, and we down the whisky.

Can’t make it all alone,

I’ve built my dreams around you…

The Fairytale of New York — The Pogues and Kirsty McColl, 1987

If this tale struck a chord, I’d really appreciate you sharing it with someone who may find it interesting. There’s some really interesting info on the #MH4Docs hashtag on Twitter.

Struggling, or know someone who is? Beyond your own GP, The Doctors’ Health Services, or ‘drs4drs’, are designed to offer confidential health-related triage, advice and referral services; follow-up services, including support and advocacy in returning to work; education, awareness-raising and advice; training to support doctors to treat other doctors; and facilitation of support groups.

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Dr Craig Mitchell

MBBS, FANZCA, PGDipEcho

craig@agb.com.au

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