I didn't do it

Mrs Crumbles is very, very ill. Her persistant cough and 'touch of the rheumatism' has turn out to be a very aggressive lung cancer spread all over the body and into her bones. She moans in pain, and covering her face in her hands, she weeps. She begins to talk about planes and fires and being in Cambodia. She doesn't have much longer.

The consultant on the ward round says to us, quietly, "Start the Liverpool pathway today, and get me the Yellow Form."

This is doctor-speak for "This patient is dying. Make sure she is comfortable in her last few days. If she dies, do not resuscitate."

I take the drug chart from him, and get out the Liverpool protocol. On the 'as required' side, I write in morphine tablets for pain, haloperidol injections for nausea, midazolam injections for agitation and anxiety.

The nurses are somber.

They wheel Mrs Crumbles into a sideroom where she can have peace and quiet. Mrs Crumbles begins to scream they do this. She retches loudly, vomits, then screams again.

The nurses grab the drug chart out of my hands. "She's agitated!", they cry out in unison. They begin drawing up the midazolam.

Fifteen minutes later, as I'm tending to another patient, Staff Nurse Blue walks up to me and whispers in my ear, "Mrs Crumbles has gone a little bit 'flat' and sleepy. Please have a look at her."

I walk into Mrs Crumbles room. Her eyes are shut and her face is serene. There is no sound in the room but the hissing of the oxygen mask. She takes in a big, heaving breath that is not a breath, but more like a gag. I put my hand on her wrist. No pulse. I put my hand on her neck. No pulse. She makes another last ditch effort to breathe. Then, there is nothing.

My mind collapses in a muddle.

Midazolam!
Injection!
Death!
No!
I've killed her!
No!
No!
Gotta do something!

My throat is suddenly very dry.

I croak at the nurses, "The midazolam! The midazolam!" and wave my arms in a windmill fashion. The nurses look at me with sad eyes. They've seen this many times before, the dying patient becoming the deceased patient, the junior doctor freaking out over the prescription charts, the junior doctor who hadn't realised that the patient had been knocking on death's door for a long time.

Nurse Blue puts her hand on my shoulder and says, "She was dying and it was her time."

And then I realise that she is right, and we couldn't have killed her with a subcutaneous injection of a meagre amount of sedating midazolam.

But for 30 seconds, I thought it was my fault.

I cried - mostly in relief.

Then I wiped my eyes, and steeled myself. There was doctor's work to be done. Her husband had arrived, and not in time to say goodbye.