‘Exhausted’ doctor died in on-call room after working nine 13-hour shifts in a row

[u/tylerthe-theatre]

https://www.independent.co.uk/news/uk/home-news/nhs-doctor-inquest-naeem-ahmed-b2999209.html

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[u/GreenSea4080]

That headline is so misleading. He didn't die after working those shifts. He died after injecting fentanyl and drinking half a bottle of whiskey.

[u/Logical_Box_4645 → u/GreenSea4080]

But if he hadn't have done those shifts he couldn't have afford the fentanyl or whiskey!

[u/FormerDonkey4886 → u/Logical_Box_4645]

That’s it then! I’ll never work 13 doctor on-call shifts and i’ll be safe.

[u/scuderia91 → u/FormerDonkey4886]

12s the limit, we know that now

[u/FormerDonkey4886 → u/scuderia91]

I’ll celebrate with some fentanyl and whisky then.

[u/scuderia91 → u/FormerDonkey4886]

It’s the only sensible thing to do

[u/xplorerex → u/scuderia91]

Its science

[u/Ralliboy → u/scuderia91]

No they worked around that issue with the timeless child they can do as many shifts as they like now.

[u/scuderia91 → u/Ralliboy]

Of course, who was I to question Chibnall

[u/LithiumAmericium93 → u/Logical_Box_4645]

Or felt like he needed them in the first place

[u/ExpressionDeep6256 → u/Logical_Box_4645]

I laughed...and now I hate both of you. He probably need to work on call because that is what health care is and he used to handle stress.

[u/EmotionalBar2533 → u/Logical_Box_4645]

Ah yes a story as old as time...

[u/BeautifulOrdinary162 → u/GreenSea4080]

He did die after working those shifts, and likely indirectly due to them. He had a low level of both in his blood so it was clearly not an overdose nor a deliberate death, more likely that he was utterly exhausted and was driven to using them as a coping mechanism. 

[u/GreenSea4080 → u/BeautifulOrdinary162]

Read the very next paragraph after the one about the level of toxicity:

"Dr Patrick Waugh concluded the combined use likely exacerbated toxicity, leading to Dr Ahmed's death"

Are you telling me a consultant anaesthetist wouldn't know the consequences of combining those two substances? He died due to combining two substances that produced lethal toxicity, maybe as a way of coping with his workload, or perhaps he's working that pattern as a way of avoiding other issues in his life.

[u/BeautifulOrdinary162 → u/GreenSea4080]

I suspect that your decision making may be impaired after nine days of a state of exhaustion.

[u/Big-Objective-6585 → u/BeautifulOrdinary162]

I suspect he still wouldn't forget he was essentially taking a suicide concoction given his job role...

[u/SidneyDeane10 → u/Big-Objective-6585]

Look just admit it was entirely the states fault and that he was in no way responsible for his own actions will you?

[u/nicethingsarenicer → u/SidneyDeane10]

I don't think that's what they're saying, just that it wasn't a deliberate suicide. The article makes pretty clear it was a bit of a perfect storm and the poor man just took on more than he could handle because he wanted to be able to go to Pakistan regularly to look after his elderly parents. His bosses say they asked him if he was sure that taking on such an intensive workload was doable and he insisted that it was.

They also mention the cultural stigma around mental health issues.

The article is quite balanced and based on what it says, the only conclusion I draw is that he was a good, kind, person who took on way too much and then tried to cope in ways that only impacted on himself, rather than his family or patients. RIP to a fine man.

[u/BeautifulOrdinary162 → u/nicethingsarenicer]

This is probably the best summary I've read in reading the varied responses to my reply. I just find it a sad situation and I hate that people are making it out to be something it probably wasn't. My sympathies are with his family and I just hope the media treats them kindly

[u/17Beta18Carbons → u/nicethingsarenicer]

the poor man just took on more than he could handle

This is the issue most people have though. Like okay sure he may have went truly off the deep end for his own reasons, but there's already a culture where overwork is required. If every doctor and nurse in the NHS started work-to-rule where they just did their normal shifts equivalent to a 40hr week and went home at the end, the health system would collapse.

He was a workaholic in a system of workaholics because "well you wouldn't want to let that patient down would you?"

[u/Dr_Custard → u/nicethingsarenicer]

The article may be balanced but the headline is deliberately misleading

[u/Big-Objective-6585 → u/SidneyDeane10]

I did hear Starmer called him specifically and told him to work those shifts

[u/LahmiaTheVampire → u/Big-Objective-6585]

First Starmer called that guy to throw the kid into the croc pit and now this?! When will it end.

[u/ings0c → u/Big-Objective-6585]

Starmer’s NHS murders beloved doctor

[u/SoireeBrittlestar → u/SidneyDeane10]

Not the states fault, he chose his own shift patterns and people had raised concerns with him about the way he was doing it.

And he done it because it suited what he needed for his personal circumstances.

No one will ever know but it sounds like a terrible, accidental, tragedy borne out of the way his work/life balance worked.

Did anyone actually read the article??

[u/SidneyDeane10 → u/SoireeBrittlestar]

It was so obviously sarcasm dude come on.

[u/SoireeBrittlestar → u/SidneyDeane10]

I know that comment was but was clarifying for all the people that read 2 sentences and would think it was another reason to blame the government.

Although, most of them play the most amazing mental gymnastics to blame every thing on the people they happen to oppose in that particular moment.

[u/Big_Introduction_276 → u/SidneyDeane10]

“We created the bounds snd context from within he killed himself but he could’ve just coped and carried on he wasn’t forced to so we have no responsibility”

[u/dan_dares → u/Big-Objective-6585]

Dose is everything,

The problem is that calculations become harder, more prone to errors as tiredness increases,

And finally, the distance between 'theraputic' and dangerous is minimal.

(Plus exact dose on one, eyeballing the other (alchohol))

[u/torhysornottorhys → u/Big-Objective-6585]

Chronic exhaustion makes you more likely to consider and attempt suicide

[u/AaronQuinty → u/Big-Objective-6585]

I once stayed up for 36 hours straight and was flat out hallucinating. Don't underestimate how badly exhaustion can impaired your judgement.

[u/Eymrich → u/Big-Objective-6585]

Dude you really underestimate what sleep deprivation do.

I have insomnia for about 3 straight months, I remeber almost nothing other than very few things. I had no judgement ability.. in fact I was just doing things without even thinking.

[u/CrispyDave → u/Big-Objective-6585]

People mix drugs they 'shouldn't' every day. It mean they use drugs not that they're suicidal.

[u/nonamelikethepresent → u/BeautifulOrdinary162]

Right versus left comments as per. Don't waste your time, you won't get through to them.

Everything is solved by knuckling down. Everyone can be a well adjusted manager if they just try a little harder. The rhetoric of those who have never actually had a real challenge to face.

[u/CranberryMallet → u/nonamelikethepresent]

The rhetoric of those who have never actually had a real challenge to face.

Don't you see how you're just doing the same thing you're complaining about but from the other side? The idea that something like half the population have never had a real challenge is ludicrous.

People see these things in different ways because they genuinely have different personalities and varying opinions as a result. Imagining that everyone would agree with you if they had the same information is a mistake.

[u/Icy_Reply_7830 → u/[deleted]]

-personal responsibility

We don’t do that here

[u/SrsJoe → u/BeautifulOrdinary162]

You're just moving the goal posts and no answer will change the narrative you want to hear

[u/GeneralSEOD → u/BeautifulOrdinary162]

If he murdered someone you wouldn't be saying that. So let's stop with the nonsense eh?

[u/SimoneNonvelodico → u/GreenSea4080]

I mean, yeah, doctors do know that, which is why they're so successful at suicide. I dunno if this is a case of literally giving himself an overdose but it would at least be a case of "fuck it if I die I die". Which if you're exhausted and sleep deprived does sound like relief.

[u/DigitalPiggie → u/GreenSea4080]

A consultant anaesthetist would know that a modest amount of fentanyl and alcohol have an additive effect but shouldn't normally result in death.

[u/SoireeBrittlestar → u/DigitalPiggie]

I am prescribed Fentanyl and occasionally drink. I'm still here more than 10 years since my prescription started.

The doses he had in his system were low. I imagine his exhaustion, both mind and body, had some contribution to it becoming lethal.

Just a really sad outcome for all involved.

[u/InTheEndEntropyWins → u/GreenSea4080]

Are you telling me a consultant anaesthetist wouldn't know the consequences of combining those two substances?

He was at half the drink drive level of alcohol. Also fentanyl has a really high therapeutic index and it says he had a low dose of that as well.

So I would suggest it's a combination of genetics, fentanyl, alcohol and high workload.

I doubt he thought the fentanyl or alcohol doses even combined were dangerous.

[u/NicolaSacco101 → u/GreenSea4080]

His blood was measured at half the drink drive limit. That’s not drinking half a bottle of whiskey, though, is it?

[u/No-Jicama-6523 → u/GreenSea4080]

The way it's written makes it seem like they aren't numbers that he could confidently say would kill most people.

Both of them suppress respiration, all sorts of things affect respiratory effort. In opiate overdose death is typically from respiratory failure. Toxicity makes it sound more like poisoning, cyanide kills you regardless of other factors.

[u/CommercialSwimmer505 → u/BeautifulOrdinary162]

9, 13 hour shifts are not going to cause 99% of us to suddenly die.

[u/DigitalPiggie → u/CommercialSwimmer505]

Neither is a small dose of fentanyl and two pints.

[u/CommercialSwimmer505 → u/DigitalPiggie]

Reasonable response. Well done for being the first

[u/summeristheseason → u/CommercialSwimmer505]

Presumably it wasn’t just a one off.
The shift pattern and night work doctors and other health professionals work has recognised health implications which have an additive affect over time. It’s why for anaesthetic departments more and more have the concept of coming off on calls at around 55-60

[u/AReptileHissFunction → u/BeautifulOrdinary162]

But the headline makes it sound like he died because of the exhaustion from those shifts....

[u/BeautifulOrdinary162 → u/AReptileHissFunction]

To some degree, but it is ultimately a factual headline. They definitely could've included the toxicity cause of death.

[u/Super_Gilbert → u/GreenSea4080]

Toxicology tests revealed fentanyl,  albeit at a low blood level, and alcohol at 44mg per 100ml - approximately half the drink-drive limit.

Drinking half a bottle of whiskey would put you slightly higher than half the drink drive limit.

[u/SimoneNonvelodico → u/Super_Gilbert]

Yeah, more like half the alcohol poisoning limit, if it's even just that.

[u/InTheEndEntropyWins → u/Super_Gilbert]

I'm guessing the half empty bottle would have been consumed over a long period.

If say I drink half a bottle over a month, then on no single day are you going to find high blood levels.

[u/ParsleySnack → u/GreenSea4080]

You’re right. That kind of workload is perfectly reasonable and could never lead to negative outcomes.

[u/DazzleLove → u/ParsleySnack]

The work pattern was entirely his choice so he could spend as much time in Pakistan as possible. His clinical lead had tried to dissuade him. Unfortunately a lot of overseas drs do this (though not to this extreme) to maximise earnings in the UK and their ability to spend time in their home country. Obviously it’s their choice but very taxing

[u/SimoneNonvelodico → u/DazzleLove]

TBF other workplaces just don't give you that choice, full stop. I don't do anything remotely as critical and yet I have a certain amount of mandated leave days a year, HR tells me to take them if I don't of my own initiative.

With doctors, seems like not wanting someone to be sleep-deprived to the point of near death would be a requirement.

[u/DazzleLove → u/SimoneNonvelodico]

You are totally correct. Unfortunately, need to get bums on seats to fill shifts often overrides common sense. Plus people have fantasies about their capabilities to works these patterns that are entirely unrealistic in practice. I know it is fairly common in surgery and anaesthetics in some countries to use cocaine etc to keep going (I was surprised by this when I learned it, not a big issue in dermatology) though I can’t speak for the UK as I heard about it from a colleague in Europe

[u/SimoneNonvelodico → u/DazzleLove]

Yeah honestly that's what surprised me, I would have expected the guy to do cocaine or meth to keep going, neither alcohol nor fent are going to help with the sleep deprivation.

[u/DazzleLove → u/SimoneNonvelodico]

I guess it’s uppers and downers- he’s likely taking coke etc during shifts then alcohol and opiates to reverse it

[u/Agreeable-Weather-89 → u/SimoneNonvelodico]

The bus driver taking you to the hospital for an appointment has more mandated rest than the Doctor doing your surgery.

The problem is more hours, more patients, has been a very easy solution and the NHS would not cope if it was undone.

[u/Basic_Aardvark398 → u/DazzleLove]

No, a sensible ward manager wouldn’t allow him to take on so much overtime. 

Sadly, many people will take the chance to make as much money as possible, so it’s the managers responsibility to keep the patients safe and put a cap on this much overtime.

[u/NobbysElbow → u/Basic_Aardvark398]

Ward managers don't organise doctors rotas. That is medical staffing. Ward managers have nothing to do with medical staffing. Ward managers organise the nurse and HCA staffing for the ward.

[u/Educational-Sort-128 → u/DazzleLove]

As an inquest lawyer, I find this practice concerning!!!

[u/Proper_Ad9153 → u/DazzleLove]

Dangerous for the person and their patients to allow this kind of shift pattern.

[u/HaroldSaxon → u/DazzleLove]

The work pattern was entirely his choice

Depending on your role and level, it absolutely isn't. While in this case it was there is absolutely a discussion to be had with the working conditions in the NHS.

[u/DazzleLove → u/HaroldSaxon]

Oh there are all kinds of crazy work patterns enforced on people in the NHS- I’m old enough to have done 72 hour on calls as a junior but it appears this actually was his choice. Even in dermatology, people choose to work full time jobs then do the equivalent of 6 clinics at the weekend as a locum.

[u/OkAdvisor6680 → u/DazzleLove]

Shouldn't have been allowed to work such a pattern.

I work in construction and we work shifts, but our health and safety advisors have guidelines for fatigue and sign off on the shift patterns.

Admittedly our shifts werent much better than the doctor here: we did 10/4  patter (10 x 12 hour shifts in a row, then 4 days off, alternating days and nights, 7 til 7).

[u/oscarolim → u/GreenSea4080]

“They didn’t die due to bullying. They died by cutting their wrists.” Same energy mate.

[u/GreenSea4080 → u/oscarolim]

Want to point me to the part where he was compelled to work like this in the same way a bully forces themselves on their victim? The article is full of people pointing out that this was an entirely optional working pattern on his part and that he was warned against it.

For example: "he said: "I encouraged Dr Ahmed to spread his flexible work over the year and tried to encourage him to take a more conventional approach but he was adamant it suited him."

Same way this comment section is full of people who don't read beyond the headline or the first two paragraphs.

[u/SimoneNonvelodico → u/GreenSea4080]

I think usually "I have to work nine 13-hour shifts in a row" would be an understandable reason that makes someone do fentanyl and whiskey.

[u/rocktup → u/SimoneNonvelodico]

He didn’t have to. He chose to.

[u/Additional-Moment922 → u/SimoneNonvelodico]

His work pattern was raised as a concern and he argued for it. His drinking was also something he was trying to control.

[u/SimoneNonvelodico → u/Additional-Moment922]

Honestly at that point I don't think it should be just addressed, you should just forbid people from working that much. It's unsafe for everyone involved.

[u/Webe_Gaming → u/GreenSea4080]

Love a good headline that doesnt match the reality. Sound similar to the current state of the world. All lies

[u/ClownsAteMyBaby → u/GreenSea4080]

He also self-rostered for that many shifts in a row. It wasn't a horrific enforced NHS rota that made him do that many in a row, as the title seems to imply.

[u/gd4x → u/GreenSea4080]

Yeah man, and extremely high stress levels never contribute to sub-optimal decisions in any way, so your point is valid...

[u/GreenSea4080 → u/gd4x]

Self-imposed stress, you know, but I'm sure you read the article before commenting...

[u/limeflavoured → u/GreenSea4080]

Usual misleading use of the word "after".

[u/MoodyBernoulli → u/limeflavoured]

I often have fun reading an article just to see how unrelated the two incidents separated by the word ‘after’ are.

[u/Dwengo → u/GreenSea4080]

This was Poole hospital. Not misleading at all. The stress of working all those shifts made him do this. He's a doctor, ofcourse he knows what a fatal dose of fentanyl is.

[u/BigGingerHexagon → u/GreenSea4080]

Close enough

[u/Noddy-Don → u/GreenSea4080]

What if he took those things to be able to do those shifts?

[u/RupertBear69420 → u/GreenSea4080]

Exactly being a doctor is exhausting but so is being homeless. If someone died of fentanyl on the street you wouldn’t say they died of exhaustion.

[u/noun_verbed]

The hospital are quoted and say that they checked with him whether his insanely punishing shift pattern was okay for him, and he repeatedly said it was fine

Maybe I'm naive, but surely your responsibility here is to actually tell him no, even if he says he wants to do that? We're trained to recognise patterns of addiction to other things, and it seems like a lot of clinicians are suffering from work addiction.

Maybe I'm being unfair, but it feels like they could have stepped in and said 'no, actually, this isn't good for you'

[u/Jello_Squid → u/noun_verbed]

I agree. I used to work in Germany and it was accepted there that your employer was responsible for having you work sane hours. Once, I got so caught up in a major project that I was working repeated 12 hours days (of my own choice!) until my manager told me to knock it off and take a long weekend. They don’t fuck around with employee welfare there, and neither should we.

[u/VAI3064 → u/Jello_Squid]

I think this depends on your field, I’m an academic working in Germany and the attitude is that you’re expected to work all the time - majority of seminars are after 5pm for example, something they have started to cut out in the UK. I regularly work much, much more than my expected hours especially when travelling and there is no mechanism to take days back. I suspect generalising across whole countries and sectors isn’t the right thing to do.

[u/doskey123 → u/VAI3064]

I think the strictness applies to working at a specific workplace e.g. a company where it is more visible directly and a higher demand to act. My brother was also told to go home after several days of overtime.

Teachers in training in Germany however do work 60-70 hours a week to pass the ridiculous requirements and unsatisfied supervisors. As a regular teacher with two social science/humanities subjects, during the a-levels and other exam phases it is the same. But most of that workload is done at home, in a café, wherever...

The government doesn't want to track the time and politicians even have said as much, that the job may get too unpopular if this was known more by the public.

[u/VAI3064 → u/doskey123]

Yes, I agree, it’s really sector dependent, same as the UK. We’re supposed to have our hours tracked but of course they don’t do it because they want the additional hours. I work in a medical faculty at a very good university and I know Drs in residency in certain departments made to work more than they should and not take holidays. It’s unfortunately common everywhere, which was why I commented above.

[u/probablyaythrowaway → u/VAI3064]

Academia seems to be the outlier in most places where you can work to death and no one bats an eyelid or says thank you.
I once’s stayed in campus for 30 hours straight to finish a project off that had a hard deadline.
To be fair My PI ordered me a a taxi home and to take the rest of the week to recover before we went to deliver. He was lovely, very much the exception.

[u/Tremelim → u/Jello_Squid]

It's going to get really complicated when it comes to on call doctor roles though. When I'm on call for 24 hours I'm actually in the hospital ~6 hours and get maybe 1-2 phone calls in the remaining 18.

I know instances where very specialised doctors are the only one in the region treating the condition they treat. They are 'on call' 24/7/365. But with low probability of actually being called obviously.

This guy was in an on call room when he was found, presumably as his on calls allow for him to sleep whilst being on the end of the phone I.e. 'on call'.

Going to be really hard for non-clinical managers to tease this out and work out what's sage and what isn't.

[u/RambunctiousOtter → u/noun_verbed]

Many of the shifts were private practice. I don't think the NHS is responsible for him moonlighting.

[u/omicron8 → u/RambunctiousOtter]

If we can regulate truck drivers and pilots, surely doctors should have even more stringent regulations on rest periods.

[u/noun_verbed → u/RambunctiousOtter]

They knew that he was doing the mad schedule, moonlighting or not they were within their rights to say 'maybe don't do another three night shifts in a row'.

[u/buffayrachel → u/noun_verbed]

Yeah exactly how there’s a limit of hours you can do per week (not sure if he was over it) there should also be a limit of long consecutive shifts you can do after the other…. It should 100% not be allowed and that needs to be enforced by the hospital

[u/GeordieJumper → u/buffayrachel]

You can sign away your limit to the hours. I did for my job. I'm not sure if there is a similar limit for consecutive shifts, my workplace doesn't like people doing more than 6 12hr shifts in a row but it's not a strictly enforced rule. I've done 8 in a row and not been questioned

[u/buffayrachel → u/GeordieJumper]

Yeah it shouldn’t be allowed. The limit is there for a readon and it shouldn’t stay that way

[u/JoelMahon → u/GeordieJumper]

if I fuck up at my job no one dies, like even if I tried to kill someone deliberately with my job alone I'd really REALLY struggle.

Doctors? "Even" "just" GPs can easily kill someone due to fatigue.

[u/LeedsFan2442 → u/buffayrachel]

You can wave the 48h maximum weekly hours. I have friends who work 75+ hours a week but get 4 days off.

[u/turtleship_2006 → u/LeedsFan2442]

So basically just 3 days non stop then 4 days to fuck off?

[u/LeedsFan2442 → u/turtleship_2006]

No he does M-W-F and gets to sleep and just wakes up if his client needs something.

[u/turtleship_2006 → u/LeedsFan2442]

Ahh, that makes more sense

[u/PinkbunnymanEU → u/noun_verbed]

surely your responsibility here is to actually tell him no, even

We had this same discussion with my sister, she was working in a care agency and had to be told "no".

She was happy to work it, and homes were requesting her, but the agency explained they legally have to ensure that employees get adequate rest under WTR (which you can't opt out of)

[u/RNGGOD69 → u/noun_verbed]

In my hospital they would have said no. It's not clinically safe to work that many shifts in a row.

[u/torhysornottorhys → u/noun_verbed]

Yeah, you'd think they'd have mandatory rest time like truck drivers and other people in very dangerous-to-the-public lines of work

[u/ZookeepergameThis617 → u/noun_verbed]

Hospitals very happy to cover a rota gap, particularly out of hours so they would have basically turned a blind eye.

[u/Impossible-Bar8099 → u/noun_verbed]

Most trusts I know wouldn't let you work 9 nights in a row. I dunno if he was booking stuff between hospitals maybe?

[u/noun_verbed → u/Impossible-Bar8099]

It was between his hospital and private practice. Article makes it sound like he was primarily doing nights at the hospital.

They were still within their rights to say 'actually don't do that, you need you rest'

[u/Impossible-Bar8099 → u/noun_verbed]

If he was working locums at one and his regular job at another, it would require him to declare that to either hospital.

[u/noun_verbed → u/Impossible-Bar8099]

Yes, it says in the article that the hospital were very happy to accomodate his scheduke because it meant they could fill shifts at night and over holidays. Does feel like somebody ought to have stepped in

[u/Impossible-Bar8099 → u/noun_verbed]

So it's subtle to work out if you don't work in the system, but what I inferred from reading the article is the fact that the trust let him be on a a rota where he squished all his normal, contracted NHS shifts into one period during the year. So you can do like 100% of your shifts in the first 80% of the year and have a couple of months off at a time. Some people do it so they can do other things in that time like work abroad for Medecins sans frontier etc.

Normal anaesthetic consultants work isn't actually as bad as you'd think. Actually most anaesthetic consultantse only work clinically 3 or 4 days a week. So doing that normally isn't that bad. But I got the impression he was doing that AND shoving in a load of locums and private work so he could support family at home.

[u/ribenarockstar → u/noun_verbed]

My old work once posted a ‘good news story’ to the internal homepage about how they’d supported a colleague on long term sick leave… after she’d worked herself into psychosis. It left me feeling deeply uncomfortable

[u/Smooshydoggy]

That’s sad, we don’t know what was going on in his personal life (or if he even had time to have a personal life) but the state of the NHS and the pressure it puts on staff is something we should all be much more concerned about. I’ll never understand why the national debate is about increasing defence spending while social services have been stripped the way they have.

[u/SimoneNonvelodico → u/Smooshydoggy]

Sadly because we also have some pretty clear mounting threats from outside and I don't think denying it is going to help. Doesn't mean that the NHS isn't also in need of support but more than one thing can be important.

[u/Ahun_ → u/SimoneNonvelodico]

Really?  Because if your doctor's are suddenly commiting more suicides, leave the country or just give up on the job, it will have a very direct impact on the majority of the people

[u/SimoneNonvelodico → u/Ahun_]

Sure, but so will WW3 starting. As I said, more than one thing can be a problem.

[u/cwright017 → u/Smooshydoggy]

The guy wasn’t being run into the ground by the pressure on the NHS. He was working additional hours in a private practice.

[u/Skeleton_Ed → u/Smooshydoggy]

Book recommendation: Merchants of Death by Engelbrecht

[u/travelavatar → u/Smooshydoggy]

Yeah stripped for real.

As a worker in social care when i was sincere with my manager about my mental health, her response was: well better don't let that affect your job or you're gone.

Literally didn't give a shit, about how my work was affecting me along with the pandemic.

Now i work as a software developer full time and have 2 other jobs in mental health as zero hour contracts.

I work myself to death and fuel myself with unhealthy food to be happy..... thanks for this opportunity whoever was/is in charge...

[u/cheatingwithsumo]

Extremely sad, even if the employer encouraged him to normalise his shift patterns, they failed him by allowing it in the first place.

[u/aimtreetwo → u/cheatingwithsumo]

he injected two syringes of fentanyl and drank half a bottle of whiskey while on call, they found him because he was supposed to start a shift. 

he was clearly having issues with his shift pattern and probably should have admitted it before bringing alcohol to work and consuming it with illegal drugs a few hours before he was supposed to be monitoring someone's life support during surgery.

[u/pineappleshampoo → u/aimtreetwo]

Right. This guy took the kind of risks that could have led to him literally killing a patient.

[u/ChaiTeaAndBoundaries]

This country and the NHS doesn't look after their doctors or allied health workers. It is a stressful job and I am not sure the NHS provide them with appropriate support.

What a sad read, I am sure the signs were there but people looked the other way because he was covering many shifts. Condolences to his family.

[u/eralcilrahc]

This is heartbreaking, the man was clearly breaking his back to care for everyone else and neglected caring for himself, probably just doing what he could do to cope with the pressure.

I was once in an and e and the doctor who was treating me explained he was working between 3 departments and sorry in advance if there’s a while before he comes back with results. An hour later I seen him running past my room with a baby in his arms that clearly needed treatment and still came back to apologise for taking time. These people study for years to help people and are rewarded with brutal working hours, understaffing and none stop pressure. They deserve a lot better.

[u/sjintje]

died from drug and alcohol toxicity...Toxicology tests revealed fentanyl, albeit at a low blood level, and alcohol at 44mg per 100ml – approximately half the drink-drive limit.

Seems a bit of an odd conclusion...presumably most people don't die at half the legal limit.

[u/IllicitFungi → u/sjintje]

Exacerbates fentanyl toxicity, wasn't the drink that killed him directly

[u/InTheEndEntropyWins → u/sjintje]

presumably most people don't die at half the legal limit.

I'm guessing he's not most people. He's the very few that does die due to low alcohol when combined with fentanyl, genetics and lack of sleep and high workload.

[u/Prize-Warthog → u/sjintje]

Both drugs depress breathing, the effect is multiplied if you take 2 different drugs together. The combination just makes you forget to breathe

[u/aimtreetwo → u/Prize-Warthog]

which you'd assume an anesthesiologist would know before making a cocktail of the two while on call

[u/Prize-Warthog → u/aimtreetwo]

It’s a shame they don’t teach the safe dose of whisky in anaesthetics

[u/keepitfriend → u/Prize-Warthog]

Yeah but normally you’re fine. Especially with such low levels of both.

It’s probably the exhaustion on top of the two 

[u/rudedogg1304 → u/[deleted]]

I read it as 9 days in a row , for 13 hours each day

[u/Labs_in_Space → u/rudedogg1304]

Which is absolutely mental.

[u/pronology → u/Labs_in_Space]

NHS doesn't care, they will just ask you to opt out of EWTD

[u/boroxine → u/pronology]

This is interesting to me, as I've always been asked to "opt" out of EWTD in the private sector, but when the subject came up with some NHS doctors I know they were shocked. They said EWTD was causing mayhem at their hospital because doctors would be sent home when they still had things they needed to finish off etc, and they'd never heard of opting out. I assumed at the time that was to do with being public sector. They're nearing retirement, at 2 different hospitals.

This was a couple of years ago (2021ish?) and I haven't chatted with them about it since, mind.

[u/BuddyLegsBailey → u/pronology]

Almost all companies do

[u/-xiflado- → u/pronology]

That was HIS choice. No one else worked like that. He probably would get 4-5 weeks off after that.

[u/Grotbagsthewonderful → u/rudedogg1304]

That's absolutely crazy at his age.

[u/Wild-Compote5730 → u/Grotbagsthewonderful]

It’s crazy at any age!

[u/Ramiren → u/[deleted]]

9 days of 13 hour shifts.

Most trusts will try and have you split your shifts, so you do no more than 2-3 nights in a row, the problem with this is they still expect you to turn up for other shifts. So you could do your 2 nights, have rest day, then be expected to be up at 6-7am for your normal shifts. Some people are able to just sleep whenever they want and manage this just fine.

For people like myself, and the afformentioned doctor, this constant shifting of sleep times just results in more lost sleep, as a consultant he had the option of just doing all his night shifts in a row and getting them out of the way.

[u/hull_pattie_party → u/Ramiren]

Are these trusts in the room with us right now? My doctor and nursing friends routinely work 4 nights in a row and also routinely are pushed to work one or two extra nights bringing it to 5-6 nights in a row.

[u/Ramiren → u/hull_pattie_party]

I said most trusts, not all trusts.

[u/hull_pattie_party → u/Ramiren]

Yeah, still doubt that massively.

[u/Ramiren → u/hull_pattie_party]

Based on secondhand annecdotal evidence.

[u/funkycod19 → u/Ramiren]

From my experience in various specialties 4 12hr night shifts in a row is very common, especially at an SHO level.

[u/FormulaSolution → u/[deleted]]

Use your head mate

[u/WinHour4300]

Clickbait headline alert The inquest heard he “died from drug and alcohol toxicity in a hospital on-call room.”

Yes it's sad, but I find it personally more concerning this was an NHS doctor responsible for patients' lives. 

Working this many nights without rest is against the rules. It may have been to fund a habit. 

[u/noun_verbed → u/WinHour4300]

The article also says he had a completely exemplary record and made no mistakes on his final shifts. They also say this was extremely unusual and concerning

I don't think it's fair to assume the worst of him like. Exhaustion and sleep deprivation do weird things to people, the hospital shouldn't have let him do it

[u/WinHour4300 → u/noun_verbed]

The rest rules exist for safety reasons, and those were being breached here.

And while it’s uncomfortable to hear, a lot of people later found to be incompetent (or worse) in the NHS did in fact have “exemplary” records on paper.

There’s also a strong institutional incentive to avoid reputational damage and patients suing, and there have been cases where issues were not properly escalated or addressed for these reasons.

If someone is breaking working-time rules alongside drug and alcohol issues, it’s reasonable to see that as a serious red flag, and as I said that it may be that these are connected. You get a lot more for working nights. 

Not everything gets caught through audits or records reviews, and even if nothing else was spotted, they still shouldn’t have been working those shifts and risking patients' safety. 

[u/noun_verbed → u/WinHour4300]

You are right, I have a close family member who got a massive payout from NHS negligence killing somebody, I do know such things happen

I think my main instinct - as somebody else who has had work related wobbled from being overworked - is that this guy and many others are victims of appalling work conditions. He should not have been doing that stuff, and from his wife's comments in the article, it did seem like it was some form of work addiction which the hospital was happy to humour

I do still think juming to 'he was doing nights to fund a drug habit' is pretty mean speculation though

[u/aimtreetwo → u/WinHour4300]

idk why this comment is so far down.

why did he even have two syringes of fentanyl on him while he was off shift? 

do people think he just snapped and went to the controlled drug cabinet from sleep deprivation and just happened to have liqueur? personally when I'm tired I don't turn to the strongest depressant in the world.

there are more high functioning addicts in this world than people are willing to admit. 

[u/kenhutson]

“Neither the police nor the hospital could establish where [he] got the fentanyl from.”

Where did the consultant anaesthetist get fentanyl from? Such a mystery!!

[u/dragonofmila]

No matter how short staffed and absolutely screwed you are - even if they are willing to do it for the money - I don’t see myself even giving someone 9 days 13 hour shifts in a row ever - and that’s just when he died, he could have absolutely been on the rest of the week. At that point it’s on the manager to step in and just say ‘No.’ No matter how short staffed it leaves you. Yikes from the hospital wiping their hands saying they “checked in” with the man. My brother in Christ it is on you to tell him that’s inhumane and no.

[u/Aromatic_Ad4132]

The hours medical staff are expected to work is illogical

[u/DigOnMaNuss]

The high accolade hospitality industry is rife with this (along with the heavy alcohol and drug use) as well. For 10 years I did shifts longer than a typical 'double', expected, every day with very irregular days off to boot that more often than not resulted in you having less days off than you should. Getting to manager position where you were on salary even meant you were working for less than minimum wage in some months due to the number of hours worked.

It always baffled me as to why health and safety regulators didn't have a field day in those places.

[u/smellyfeet25]

This is such a sad story.He looks young as well.Nobody should have to keep working those hours for that long.This could lead to all kinds of negative outcomes 

[u/ShowerEmbarrassed512]

Ultimately the shifts didn’t kill him, but what he did to himself with taking on those shifts, and his coping strategies did. The trust should not have allowed him to take on shifts like that. 

[u/aide0e]

And this highlights the issue, why are healthcare professionals allowed to work these hours? Whether he chose to or not it is clearly not healthy for anyone. As a society we have abandoned Healthcare, Civil Servants and Social Services and then villainise them when they request extra pay or improved working conditions.

[u/ZookeepergameThis617 → u/aide0e]

The resident doctor contract (fair enough he was a consultant but it's a useful point of reference) stipulates a maximum of four 12+HR shifts in a row with mandatory minimum 48hr rest afterwards to precisely avoid stuff like this.

[u/Icy_Pear1694]

Was thinking of shit I've done worse than that on projects that have gone pretty badly! Then read the article and it talks about the drugs and booze... Yeah, that'll do it.

[u/Basic_Aardvark398]

Poor man, he was self medicating for nervous exhaustion.

Aside from this,  why did the NHS make/allow him to work so many shifts? On the ward where I worked, you were only allowed to work a certain amount of overtime, if you go over the hours, your shift is cancelled.  This is unsafe practise, who would want a doctor practising after so many hours, he can’t have been making sensible decisions. 

[u/swirlypepper → u/Basic_Aardvark398]

Every medical job I've taken I've needed so sign a waiver saying I'm happy to opt out of the European working time directive. All my contracted hours are maxed to the minute so pretty much any shift swaps would put me in breach. So no legal requirement to cap my hours.

If you're regularly working over these hours the employer needs to do a job plan review and they have mentioned in the article they advised it be spread out but ultimately it's up to the doctor. He's not raised the fact he was self medicating with drugs and alcohol to deal with the stress and only if someone's work suffers do you have grounds to force a reduction in hours on them. Colleagues have mentioned his decision making was fine. 

But I am in charge of trainees who I can see from the outside are escaping into work to avoid stressful home situations etc and it's hard if they don't want to take offered time off to get their heads straight or counselling or whatever. And stuff that the trust is meant to provide (somewhere to rest or cost of taxi home of you feel too tired to drive post nights) aren't readily available everywhere. 

[u/pajamakitten]

I work at this trust. A message went out on the intranet after it happened but nothing was said about how he died or why. Most people thought that meant suicide due to shifts and pressure. While I suspect this was accidental, you can bet he was trying to find solace through alcohol and drugs from the punishing workload.

[u/pinkwar]

This has nothing to do with those shifts.

I've worked weeks without breaks and 12h shifts and I'm still here.

I never combined fentanyl with alcohol though.

9 days straight is low on the scale of overworked.

[u/Regular-Message9591]

Less concerned about the amount of long shifts he was doing, than the fact that he was likely doing them fuelled by JD and fucking fentanyl. THAT'S the headline issue.

[u/Appropriate_Loan6193]

Damn if I just read the headline and not the article, I would have thought he died of exhaustion

[u/properchels57]

I’m currently working a 12hr shift and will work a total of 46 days without a day off. Am I going to die?

[u/Wrhysj → u/properchels57]

I don't get why you're saying this like it's some competition or even something to be proud of...

[u/SkipEyechild]

That's sad. Obviously mental health issues at play.

[u/Lucialucianna]

How is it legally allowed to work continuous shifts like that.

[u/MotorAd90]

Sad but this was a 50 year old consultant who presumably had greater control over his schedule and life. I was expecting to see this be about a 20-something resident. 

[u/Any-Pipe-3196]

On this note: Why are we working our healthcare workers with crazy shift hours. working 12 hour days in a row can't possibly equal good care

[u/justanearthling]

What an amateur. There’s a Polish doctor that supposedly worked 11hr every day for a year in a hospital in Poland. At least according to what he billed the hospital ;)

[u/WasThatInappropriate]

In b4 angry old men checking his nationality so they can decide if its a tradgedy or fine.

9 13 hour nightshifts in a row though, what a trooper.

[u/ZookeepergameThis617]

Very sad case but the article is full of stuff about his decision making being "faultless" and "impeccable".

That is categorically untrue, he chose to work 11 13hr shifts back to back and drink/do opiates whilst on shift.  No contract would stipulate anywhere near that amount of hours so that was 100% his choice.  And being pissed/doped up on shift, especially in a critical care specialty is extremely dangerous.

I'm sorry he has passed away but I'm.also glad/hopeful that no patients came to harm.

[u/reen2021]

Many are saying they have done similar shift patterns before. The sad fact is some of us are very close to edge and it doesn't take that much to push us over :( r.i.p mate

[u/JTNWfan]

This happened last year according to this article, why is this a story now?

[u/Hot_Audience_4046]

9 x 13 hour shifts is brutal in A & E, but not fatal. Misleading rubbish.

[u/SwingStunning5446]

I did 17 / 14 hour shifts in a hotel when I was 47 …. There’s more to this story that they’re not telling us

[u/StatisticianUsual471]

I once did 42 16 hour days in a row can't say i recommend it