My Toughest Case

I'm the resident doctor on BBC Radio 1's Surgery and a resident NHS general medicine doctor in London. At the time of this case I was a junior doctor working in acute medicine. I was working in A&E and I was asked to see a teenage boy who had come in complaining of a severe headache. He was in a low-lit cubicle as he could not face the light, and was very uncomfortable and quiet. It was unusual to see a teenager in this state and it was clear that it was not his normal character. We were currently looking into the possibility of a migraine.

I was starting to get increasingly concerned as the boy began deteriorating quickly. As a junior doctor I started questioning whether I could manage. He could not move his head and was tossing and turning trying to get comfortable. I decided he needed a CT scan to look for any infection or bleeding in the brain. By this time, however, it was 5pm and most of those in radiology department were heading home.

I could see that this boy's condition was getting serious and had to really emphasise how important it was that this young boy got a scan there and then. The scan came back showing no swelling or bleeding and so we began to suspect meningitis.

I conducted a lumbar puncture, in which we withdrew a sample of cerebrospinal fluid to confirm the diagnosis. This usually produces a perfectly clear liquid, but for the first time in my career I saw pus being removed. My heart was now seriously racing and I was scared for this boy. This showed a definite infection of septicaemia. We got him on fluids and antibiotics and contacted the ICU team so he could be treated in the intensive care unit.

By this time it was quite late. I was supposed to finish my shift at 6pm but it was one of those cases where I just couldn't stop thinking about how this boy was doing. I couldn't sleep all night. The next morning I came in and went straight up to see him in ICU and just couldn't believe that he was sat up in bed eating breakfast and chatting after the state he was in last night. This was after a night of just fluids and antibiotics – the effects were amazing. In this profession you often see people at the end of their lives but you rarely see such dramatic turnarounds as this.

More than anything, this particular case really taught me the importance of the team when working in the NHS. That night I worked closely with the nurses, the other doctors in A&E, the radiologists and the ICU team. And we were all linked too to Alexander Fleming whose 100-year-old discovery of antibiotics really saved this boy's life. Looking back, I'm so grateful to have had such as great team behind me and my biggest piece of advice to all junior doctors is to use that team and always ask for their help.

Interview by Samantha Herbert