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In flagrante delicto?
  1. Rob Miller
  1. rmiller{at}

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It was 2 am and the young man lay on the “crash” trolley with blood pouring from his nose and mouth, and cardiopulmonary resuscitation was under way. The “crash” team—including myself, as a rather naive preregistration house physician—was doing badly. Two peripheral lines were in place and plasma expanders were being squeezed in. Despite this, his blood pressure was falling, and every attempt at intubation was met with a wall of blood—and we were all covered in it. The patient—from the casualty card record—had first presented to the casualty department the day before. Speaking little English (he’d arrived in United Kingdom only a few days previously in order to study English at a language college) he had described some chest pain, possibly retrosternal and also possibly related to food. The casualty officer had prescribed some antacids and, as the patient had not yet got a GP, he had also arranged an outpatient appointment with the gastroenterology team. The onset of haematemesis—or was it haemoptysis?—at 1 am, had prompted the patient to walk the half mile to hospital. On arrival in casualty he’d had a massive bleed and “arrested.” In spite of a prolonged attempt at resuscitation, an asystolic arrest was the agonal event.

A call to the coroner’s office later that morning confirmed that a post mortem was necessary. Thirty six hours later the coroner’s pathologist rang me. From the conversation (which was frosty, …

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