Can I forgive myself for my daughter’s death?
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, lastminute, to the rescue. Martha was so