Perinatal loss and stillbirth

Perinatal loss and stillbirth appear in Adam Kay’s account not as a single medical outcome but as experiences that reshape care, responsibility and the doctor who witnesses them. In 2008, he accompanies a couple through the delivery of their baby after its heartbeat has stopped. In 2010, he is the senior doctor during a far more acute catastrophe: a baby dies, the mother suffers a life-threatening haemorrhage, and Kay’s confidence in his own clinical judgment is profoundly altered. Together, the episodes show the distance between knowing what must be done and knowing how to live with what has happened.

Recognition and the first loss

On 2 June 2008, a midwife calls Kay to see a healthy woman near the end of pregnancy because the baby’s heartbeat cannot be heard. Such checks often end without bad news, but the room’s atmosphere signals a different outcome: the midwife is pale, and the woman and her husband, both doctors, appear to have understood that something may be wrong. The screen confirms that the baby’s heart has stopped. The diagnosis arrives in a scene of shared recognition rather than prolonged uncertainty.

The woman remains calm and turns toward the practical composure of work, while her husband cries. Their different responses are presented without being treated as contradictory: the loss has reached both of them, but not in the same visible way. The husband’s grief gives the moment an immediate human scale, while the woman’s composure recalls the professional mode she and Kay both know. The diary does not claim that composure means she is unaffected; instead, it records how a familiar working posture can persist inside a devastating situation.

Three days later, Kay encounters the same doctor on the labour ward. She has to give birth there, and the couple seem relieved to see someone who already knows what has happened. His familiarity spares them from having to begin their explanation again. For Kay, the return visit changes the loss from a diagnosis on a screen into an ongoing passage through labour and delivery. The rarity of seeing the same patient twice makes this continuity notable: in a hospital where patients usually pass quickly through a doctor’s care, being remembered becomes a modest but meaningful form of support.

Care when the words are uncertain

Kay understands the practical next steps more readily than the emotional language of the encounter. He reflects that his training has not taught him how to speak to a couple whose child has died. He considers the risks of offering hope about another pregnancy, expressing his own sadness, or offering physical comfort, but none presents itself as an obviously correct response. The uncertainty is not merely personal awkwardness; it marks a gap between clinical instruction and the work of accompanying bereaved parents.

He settles on what he can explain with confidence: what is going to happen next. The couple ask many questions, and he does his best to answer them. Rather than claim that this resolves their grief, the account locates his help in clear information and continued presence. He returns about once an hour, and after 8 p.m. decides to remain until the birth. His attention is measured in practical acts—coming back, answering questions, staying—because he has no prepared script for making the loss less painful.

That decision also enters his life away from the ward. H is waiting at home, but Kay sends a misleading text saying that an emergency requires him to stay. Later, when the patient asks why he is still there after 11 p.m., he gives her a different explanation: that he has to cover for someone. He recognises that he is lying, yet does not explain why he cannot simply tell the truth. His presence feels as if it is helping the couple a little, though he cannot make that judgment certain. Care here is both an act of staying and an inability to account plainly for the personal choice behind it.

The baby is born shortly after midnight. The couple ask for all the available tests to investigate the cause of death, and Kay explains what can be done. Taking the necessary samples is among the hardest tasks he describes; although he has become able to look while doing it, he still finds it extremely sad. He dresses the baby, then makes a private appeal for the child to be looked after, despite not believing in God. The moment does not offer an explanation for the death. Instead, it shows professional procedure reaching its limit: the tests may seek a cause, while the small gesture expresses a grief that procedure cannot settle.

A second catastrophe

On 5 December 2010, Kay is working with a junior doctor on a patient whose baby is in distress. The couple are having their first child and understand why a caesarean section is needed. The junior doctor asks to perform the operation with Kay assisting. Once the womb is opened, an extraordinary amount of blood appears, and the junior doctor cannot deliver the baby because something is obstructing the way. Kay takes over and realises that a serious problem should have been detected during the pregnancy scans; in his view, the patient should not have been allowed to go into labour.

Kay delivers the baby, but the baby is dead, and the baby doctors are unable to revive it. The mother continues to lose blood as attempts to stop the haemorrhage fail. Kay calls urgently for help; the husband is sent out of the room. The mother loses five litres of blood while Kay holds her womb in an effort to control the bleeding. When his boss arrives, her attempts also fail. The team is warned that the mother’s organs may be damaged, and the most senior doctor eventually has to remove her womb. By then, she has lost twelve litres of blood. The sequence moves from an operation intended to deliver a baby safely to simultaneous bereavement and a struggle to save the mother.

The patient is moved to Intensive Care, and Kay is told to expect the worst. His boss speaks to the husband. Kay begins writing his notes but instead cries for an hour. Unlike the 2008 episode, when he could remain with a couple through the birth and explain tests, this crisis leaves him confronting death alongside a mother whose survival is uncertain. His account supplies no later outcome for her, so the immediate ending remains suspended at the transfer to Intensive Care and the warning he receives.

Aftermath and altered practice

Kay had seen babies and patients die before, but he identifies this crisis as different because he was the most senior person on the ward when it happened. Everyone had turned to him, and he felt that he had failed. He also states that he had not broken rules or acted wrongly, and that other doctors would have made the same decisions with the same result. Those facts do not quiet his self-questioning: he keeps considering what might have happened differently and whether he could have prevented the tragedy. The distinction between being blameless by the rules and feeling responsible for the outcome becomes central to the account.

He returns to work the next day, but describes himself as a different doctor. From then on, even a slight drop in a baby’s heart rate would lead him to perform a caesarean section. He knows this approach means some women will undergo operations they do not need, yet judges that risk acceptable if it keeps everyone in the room alive. The change is a direct consequence of the catastrophe: fear of repeating an outcome pushes him toward intervention, even when intervention has costs of its own. He can now understand why senior doctors fear taking risks, because he has experienced how a bad outcome can leave a clinician absorbed by thoughts of what might have been.

The diary places this response within a working culture in which terrible events are frequent and recovery time is scarce. After the 2010 crisis, people ask Kay whether he is all right, but the expectation remains that he will return to work the next day. He describes a rota without enough room for a sick day and a professional habit of telling oneself that tragedy is simply part of the job. Elsewhere, he links exhaustion during long hours to danger for staff and patients. These details do not establish that fatigue caused the December catastrophe; they show the limited space the workplace provides for processing events of this magnitude.

The December entry is the last diary entry in the book, and Kay directly connects the catastrophe to the end of its jokes. Perinatal loss thus changes the form as well as the subject of his account: humour gives way to the record of an experience that cannot be made ordinary by calling it part of the job. Across the two episodes, his care takes different forms—staying with bereaved parents, explaining what comes next, carrying out requested investigations, and making decisions amid an emergency. Neither presence nor expertise can undo the losses. What the diary can show is how those losses remain with the doctor, altering both his practice and his ability to continue narrating the work in the same voice.