I’m in the corridor in the General Surgery emergency ward when the nurse calls to me, “Doctor, there’s an ER slip.” Shit. ER slips are patients who are admitted immediately because, well, they’re about to die.

I walk over, and then walk back. The patient is on a trolley in the corridor, there are no beds left. He fell from the first floor of a building. I look at the X-rays: he’s got a pelvic fracture and also one in the spine. The X-rays are from another medical college, they sent him away, they have no beds either. He was only admitted here because he was dying.

4.25 AM:
I yell for oxygen. I call to the staff nurse for injections, to help him breathe, to speed his heart, to boost his blood pressure. I’m thinking pelvic fractures can cause internal bleeding of up to two liters. He’s probably bled out into his pelvis. I’m not feeling at my best, I just woke up. I wish he’d fallen off his building at a more convenient time. I’m also pissed off, I wish the other medical college had admitted him. I wish Orthopedics had admitted him. I wish he had been admitted anywhere else, and then he’d be someone else’s problem. I start an IV line.

4.34 AM:
His pulse is at 40. I can’t find his blood pressure. I yell for more injections. I ask if any family is present. Thank God, these are people who work with him. I hate telling family about deaths. He must be what, thirty? All this time I’m trying to find the pulse at his wrist. His hands are cold. I should check his urethra for bleeding, but I have no time. He’s dying. Ah well, we are all bubbles, we only float along for so long.

4.38 AM:
I start CPR. I check the oxygen. It’s bubbling away, inappropriately cheerfully. This involves chest compressions; thank God I don’t have to do the mouth to mouth thing. Imagine getting Mono from a corpse. I almost laugh. Then I feel guilty. I wish I had time to call for a bag and mask for ventilation. Do we have a bag? Probably in pediatrics. Focus. Focus. Not important. I’m pressing on his chest with the heel of my hand. Keep the blood flowing. I wish I had time to call a senior. Heck, what would he do that I’m not already doing. I can’t believe I just said ‘Heck’. We are all leaves, we only stay on the tree so long.

4.46 AM: His heart is beating twenty times a minute. I wish I had time to start another IV line. Desperation time; I ask for adrenaline. I continue the CPR. Man, my shoulders are beginning to hurt. I hope I’m not breaking any of his ribs. Forget it, he’s got bigger problems. The nurse brings it. I find the appropriate place in his chest and push the needle into his heart and inject the drug. I know a doctor in this hospital who tried to commit suicide by pushing a needle into his heart and injecting air. He’s in a coma at Apollo, and his wife is pregnant. Man, stranger than fiction is right: you can’t make this stuff up. I continue CPR. Shit, this isn’t working. We are mayflies. We are rainbows. We are TV sitcoms.

4.50 AM: He’s not breathing. I check his eyes: pupils wide, staring. I touch his cornea with a wisp of cotton. No response. I listen for a heart beat. Wait! Is that a beat? No, it’s my fingers. I hold the stethoscope down with the palm of my hand. No use: I still hear phantom sounds, thuds, creaks, gasps: a factory closing down at the end of a workday that’s been busier than most. Is that a heart beat? Am I hearing my own? Oh shit, I can’t decide. I’ve called lots of deaths, and this happens every damn time. We are rainforests. We are perfect moments. We are election promises.

4.55 AM:
No peripheral pulses palpable. Blood pressure unrecordable. Pupils fixed and dilated. Corneal reflex absent. No heart sounds or breath sounds audible. I have examined the patient carefully and thoroughly, and I declare the patient to be clinically dead. It’s like a catechism, measured and bloodless. This is how you call a death. I call it. I tell the people who came with him. Someone covers his face with a sheet. I have to choke down a wild impulse to tear the sheet off and check for a heartbeat again. These people are okay. I’ve had people yell at me, or thank me for my effort. These do neither.

5.00 AM:
I do paperwork. I write everything I did, I write a bogus orthopedic referral, a bogus neurosurgery referral, the record of death. It takes me longer to do this than it took the man to die. I’m called away once in the middle to attend to another patient.

6.25 AM:
I’m back in the Junior doctor’s room. I stretch out on one of the beds. I look out. This is the first day of winter, so say the papers. Dawn has come and gone. Light hangs like silk in the air and photons lie thick as dust over everything.