It was 5 am on a Monday morning, and I had been on call since 9 am on the Saturday. I had had virtually no sleep on the Saturday night and none at all on the night in question, when I was covering the casualty department as well as the wards. I was exhausted to the point where I no longer felt tired. I no longer felt anything at all. All concentration took huge effort.
The patient was a young woman, drowsy but able to tell me her name and that she had taken "lots" of unidentified tablets after a row with her boyfriend. The staff nurse was ready with the pump and we set to work.
We were half way through when I became aware that the patient's head had come off in my hands. I registered this fact quite calmly, feeling no alarm at all, no distress, not even any surprise. I struggled to think whether I had seen this happen before. I decided I hadn't. With great mental effort, I moved on to wondering if I had read about it. No, I thought, I hadn't done that either.
It was when I realised the staff nurse was smiling that I returned briefly to reality. Looking down again, I saw that I was holding the patient's wig in my hands and that her head remained healthily attached to the rest of her body. The lack of alarm I had felt was now matched by lack of relief. I simply registered the fact and returned to my sleep deprived thinking: so, OK, her head was in place, it didn't matter for the moment if I didn't know how to re-attach a head. But at some stage I'd better find out, ask my registrar, read it up.
The overall memory I have of this event is one of slow, painstaking, mechanical registering of fact, requiring great effort and lacking any consequent rational thinking. I was devoid of all emotion and of any sense of emotion and of any sense of involvement. Merely an observer, I felt completely detached from what seemed to me to be the reality of the situation.
Link to BMJ