Can I forgive myself for my daughters death?
James Bradley Publish date: 2024-01-06
Two years after his 13-year-old child died needlessly in hospital, a father reflects on life without her
It’s been two years since my daughter, Martha, died in hospital, just before her 14th birthday. I divide my life into before her death, and after: nothing is the same and the change is permanent. Alongside Merope, Martha’s mum, I’m grappling with how to live. Consciously or not, we adjust a little more each day to our new reality, wondering: can we manage to appear “normal”? Is it possible to keep being friends with families and not be flayed by envy?
If grief can be defined as learning to be in the world without a person you love, I have a lot of learning still to do. As things stand, my thoughts revolve around two questions – they dominate my days. The first is: can I forgive the doctors and the hospital who so badly let her down? (Martha’s was a preventable death.) And second, at the core of everything: can I forgive myself for failing to save her?
When you raise a child for 14 years, the line where you end and they begin gets blurred; the cliché is that they become part of you, with all your instincts and priorities transformed. From the time Martha was born in 2007, I saw myself, first and foremost, as a dad; from 2009, I was the father of two daughters and it gave me a huge sense of self-worth and fulfilment. I did what parents do everywhere – the bathtimes, the picture books on repeat, the school run. It felt right; it was a lot of fun.
For years, being Martha’s dad was mostly a job of care; gradually, it became a role in which I stood back and was impressed by what she could do. Music, maths, wry put-downs… too much to mention. She was a teen seeking freedom, but wasn’t old enough to break out of the early closeness of family. And in some ways, naturally, Martha remained a child. I think of her sleeping – she slept through anything, her rabbit soft toy pressed against her nose as she breathed him in.
My primal, existential role was to protect my child, to keep her alive – and I failed. Most bereaved parents know a version of this feeling. It’s one of the reasons losing a child can be different from other types of grief. Not only is such a death an inversion of the natural order. And not only was Martha denied anything that resembled a full life (“She had so many plans,” her sister, Lottie, said.) But I was responsible for her welfare during all of her short life. So when I went to see Martha’s body, post-autopsy, at the undertakers, what I howled was: “I’m sorry, I’m so sorry.”
I still replay the events of her last month in my mind, willing a different outcome, ambushed by the what ifs and should haves. Martha sustained an injury to her pancreas when she fell off her bike on a safe family trail in the summer of 2021. She was going slowly, but slipped on some sand. As she fell, the end of her handlebar hit her stomach, hard. How many times have I thought: “Why wasn’t I riding next to her, so I could have warned her, or prevented her fall?” Cycling just ahead, I had skidded a little myself: “Why didn’t I stop and tell the girls to get off their bikes?”
Such handlebar injuries are far from unknown and are tricky, but treatable. Martha ended up at King’s College Hospital, in London, which is one of three recognised centres in England for looking after children with pancreatic trauma. She had a bed on the well-funded Rays of Sunshine ward and was seen by consultants from the high-status paediatric liver team. As Merope, a senior editor at the Guardian, described in an article published a year ago, Martha died because her doctors failed to respond adequately when she developed sepsis. Many sepsis-related deaths are due to a delay in diagnosis, but the consultants at King’s knew Martha had severe sepsis six days before she died.
They kept her on the ward, rather than moving her to intensive care – though blood soaked her sheets, and even when, over the August bank holiday weekend, she had ongoing sepsis from an unknown source, very low blood pressure, a fever and a rapid heart rate. She then developed a rash. These were all clear signs of an emergency, but she stayed put. Despite her condition, no consultant checked back to look at her on Saturday afternoon or Sunday afternoon (they had gone home, on call). No doctor visited her overnight on Sunday when she was critically ill (the senior house officer considered her duties to be merely “clerical”). By the time the medics woke up to the situation, some time after Martha had a seizure on Monday morning, it was too late – she died of septic shock.
After a death in hospital, most families can say of the medical team: “Well, they did all they could.” It provides consolation as the years go by. But in Martha’s case, consultants failed to set eyes on her when she was deteriorating; her rash was misdiagnosed (we’ve been told the registrar “went down a rabbit hole”) and she was assigned inexperienced staff. “It was ingrained in the culture” of the liver consultants, investigators have said, that inviting an ICU doctor to look at Martha would have been “a sign of weakness”. These consultants had a “complete disregard” for junior colleagues in ICU, a case of arrogance and office politics.
A bed was available in ICU and the different treatment Martha would have received there has been spelled out to us. How am I supposed to respond to the fact that the duty consultant on Sunday made such bad decisions that no one looking into Martha’s death can account for his behaviour? Nurses had designated Martha “at risk” many days before her death, but weren’t listened to, such was the hierarchy on the ward. Merope and I had expressed anxiety about septic shock, but our concerns were dismissed. Before Martha’s death, sepsis training wasn’t compulsory at King’s and the Rays of Sunshine doctors, it seems, felt no need to attend. Investigators were told: “None of the liver team do this.”
Martha’s avoidable death was unusual in that the prime causes weren’t overwork or a lack of resources, but complacency, overconfidence and the culture on the ward. What upsets me most was that the consultants – a different one most days – took a punt that she was going to be OK over the weekend. No one assumed responsibility; they hoped for the best rather than playing safe. Was everything done for Martha that could have been done? Emphatically not. It’s very hard to live with this knowledge. But just as hard is the recognition that I, too, didn’t do enough.
On the ward, Merope and I spent alternate days by Martha’s bedside. After her deterioration, I had time to demand she be moved, or at least to insist that one doctor from paediatric ICU look at her. (We found out later that a national expert on sepsis was working there.) Why didn’t I know enough to ask for it? Merope texted me when the registrar maintained Martha’s rash wasn’t caused by sepsis. Why didn’t I drop what I was doing, rush to the hospital and find out what the hell was going on? The stakes could not have been higher.
Right to the end, I thought everything was going to be fine. I believed the doctors when they said Martha would “turn a corner” (they never once raised the subject of sepsis). I was in thrall to their status and expertise, and put my daughter’s fate entirely in the hands of others. I fantasise every day about swooping in on Sunday like the hero from a TV drama and coming, last-minute, to the rescue. Martha was so determined to get better, but in the end was left on the ward so long she sensed she was going to die.
The first months after her death was a time of shock, zombie numbness, constant flashbacks, very little sleep. I would have welcomed a nuclear apocalypse. The world seemed offensively crammed with people less deserving of life than Martha.
Because bereaved parents feel so shipwrecked and alone, they often seek each other out. We did within weeks. Group meetings of people who’ve lost kids are extraordinary experiences, intense and exhausting. Each story – of cancer, say, or suicide – capsizes you. People from all areas of life are there, but everyone has hit the limits of emotional endurance. It’s inscribed in their faces. You feel a desperate solidarity: they know.
After Martha disappeared so suddenly, I still had a compulsion to care for her – it was a 14-year habit. I felt the urgent need to “fight for her”, driven in part by my sense that I had failed to fight for her during her final days. One of the only ways in which I was able to do something for her was to find out all I could about how she was allowed to die.
So Merope and I began to send emails to King’s, requesting documents and asking questions. We were consulted as part of investigations and had a number of meetings, but some requests were denied, and it was an uphill struggle. It was only because we kept pressing that important details about Martha’s case were discovered.
I believed the doctors when they said Martha would soon ‘turn a corner’In the weeks after Merope wrote her article, which was widely read, she received an extraordinary number of responses from doctors, full of sympathy and concern. One GP put a picture of Martha on the wall of her surgery, as a reminder to listen to patients and those at their bedside. Dozens of medics expressed astonishment at what happened, but recognised the problems of arrogance and hierarchy in hospitals. Martha’s story, we were told, would be taught in medical schools: it could be used to prevent future deaths.
But we found a different attitude on the social media site Reddit, as part of a thread in which junior doctors talked among themselves, with anonymity, about Merope’s piece. The “us” and “them” attitude, while perhaps inevitable, was striking: many posts were compassionate, but others assumed that a layperson like Merope couldn’t possibly understand the situation, even suggesting she wasn’t telling the truth.
When the question of parents insisting on intensive care was raised, one comment was: “Thing is, I highly doubt most members of the public would be able to articulate on that level.” Another post read: “Patients’ degree of entitlement/inability to accept mistakes is just simply unsustainable, wholly incorrect and an enormous burden.” Merope was castigated as yet another relative who couldn’t control her emotions – “Grief isn’t an excuse to act out… pathetic.” It was “Sad for the parent, but beyond that people die and that’s life.”
Since then, an independent report – commissioned by King’s College Hospital – found there was “a departmental and Trust responsibility” for Martha’s death. We learned shocking new details, which the most senior figures at King’s found uncomfortable. Talking to us, the consultants who wrote the report used words like “horrific” and “indefensible”. They found a “litany of failures”. They also made clear the extent to which a doctor at the heart of the case had refused to accept her obvious errors (“We are both a little stunned”). Even more depressing was their reflection that only one of the many doctors they interviewed “spoke about Martha as a person”.
After two years, I’m able to function, but remain in denial. Looking at photos of Martha, it seems untenable that she’s not around. My mind constantly shuttles back and forth between our life now and the one we “should” be – she should be – living. And there’s the fantasy bargaining: of course I’d instantly give up my life in exchange for her just going through sixth form, or to university.
How has Martha’s death changed my view of the world? I feel more viscerally aligned with those who feel that the “system” or state doesn’t work in their interests. I’m more cynical than ever about how large institutions are run – protecting the brand by giving evasive, anodyne responses matters more than admitting the whole truth. I’m fed up with lazy uses of the word “trauma” – and more drawn to people who’ve genuinely suffered it. And I no longer have any fear of death (compared to Martha, I’ve had such a long life).
By now, people seem to expect a “coming to terms”; I should be making my way back and be trusted not to let untidy feelings break the surface of civility. Some tears are allowed, but not anger, which is off-putting, corrosive – even tiresome. Writing this kind of article, I feel another weight of expectation: that I have some kind of positive narrative or advice to give. This is how I pulled through! Here’s my new perspective on how to live! Lose yourself in nature, take up a craft, try ayahuasca, go cold-water swimming, find God… I’m willing to believe all might help.
I do think I understand better what I’m trying to achieve in my “grief work”. I need to nurture the feeling of having been lucky to spend 14 years with Martha – a sense of positivity that can sit alongside the pain. I have to resist the pull of nostalgia. I can feel delighted that a writing prize has been set up in her name. Above all, I’m so lucky to have her wonderful sister.
For the moment, though, everything is still too ragged and raw; it seems wrong to push aside the unpalatable truths about how Martha died. I simply can’t forgive myself for my passivity. And I miss her so much.
Martha’s bedroom remains as it was the day she died, though Lottie has rearranged her desk with some favourite things. The room has become a reliquary of sorts, with mundane objects taking on a heightened meaning – daft selfies of her and her friends; fragments of stories, plays and song lyrics she was writing; drawers left open with her jeans and hoodies spilling out.
There’s a line in a Nick Laird poem: “Impossible to grieve/and not know the vanity of grief.” Whatever we are going through, the thing that matters most is that Martha didn’t get to live. I see groups of girls coming to and from school, and imagine her among them, chatting about parties and playlists or scrolling TikTok. I think of the moments, lovely and quotidian, captured by one of her friends, from the weeks before she died:
“One of us brought hot chocolate in a flask and we couldn’t stop laughing because we were sipping the chocolate so slowly and we thought we looked like old grannies enjoying the train view with their tea.
“On the last day of Year 8 we had a water fight. Our friends had gone to fill up the water guns and me and Martha talked about the boys that we liked, though they had no idea we liked them.”
Just ordinary days and the promise of experience. Her friends are now older, taller, embracing a new phase. But Martha never got to start Year 9. And she had so many plans...
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