Straight after starting my shift in the ER, a 70 year-old man is brought into the hospital by the paramedics. His wife noted that her husband started to act strangely in the car on their way to the supermarket, so she stopped in the car park and called the emergency services. Once in the trauma room, I get the short story from the paramedics and start my assessment. The nurses check the vital signs but nothing is abnormal; the patient is not in septic shock or has any trouble breathing. The ECG looks normal and a blood gas that I draw looks good. The patient is very tired and confused, can’t answer any of my questions and keeps making gestures with his hands towards the ceiling as if he is trying to catch hold of something. I ask for some lab tests, a urine sample and grab the ultrasound machine in order to examine the heart, lungs and abdomen. After a lot of thinking, I turn towards the medical student standing behind me and ask:
“I think I know what it is, do you?”
I sometimes feel like I’m Doctor Jekyll and Mr Hyde, mostly both simultaneously. When I’m working at the hospital, I present myself as a doctor, but my brain is working as a criminal investigator. The patient presents with a complaint – the crime – and I start my assessment – the crime investigation. The patient tells me his/her story and I look for clues as to what the disease behind the symptoms might be. If the patient can’t speak, I rely on my examination, the blood tests, the radiology I order or the ultrasound findings I can see get. I use these as a crime technician uses his gadgets. In the end, we both have the same goal: to crack the puzzle. For me, what is the diagnosis behind the symptoms? For the cop, who is the perpetrator behind the crime?
I started writing short stories for my family and friends about my experiences in the field when I was working for Doctors Without Borders in a number of African countries at the beginning of the year 2000. My ambition was to eventually write a book featuring the world’s slums, which I in fact started. In due course, however, I noticed that my writing became more and more fictive instead of documental. I ended up creating my first main character, a surgeon who got dragged into various action stories based in Africa and Europe. This lead to my first three novels.
My next step was to bring my writing closer to home, which is why I created my next protagonist, Tekla Berg, an ER-physician working at the Nobel Hospital in Stockholm. Tekla has two main goals in life: to save as many patients as possible and to help her brother survive his reckless life as a drug dealer. In order to achieve her goals, Tekla is willing to sacrifice her own health and every ounce of personal life she has left.
For the past fifteen years I’ve been working at the distinguished Karolinska University Hospital in Stockholm, home to the Nobel Prize but also the venue for a gigantic experiment instigated in 2011. The New Karolinska Solna (NKS) has been constructed at a cost of around six billion Euros and advisors from the Boston Consulting Group have dissolved the traditional clinic organisations and replaced them with “themes” and “functions”. The medical staff haven’t been involved in decision-making and many have left. All these startling changes provided fantastic material for an author to use in a medical crime series like the one about Tekla Berg at the Nobel Hospital. So in the end I was able to channel much of my frustration about the bad management and organization at the hospital into my writing about Tekla, a catharsis I very much appreciate in my role as an author.
The corona pandemic then made things even more fascinating for me bearing in mind that I was working at a hospital with fifteen hundred beds and sixteen thousand employees where so much can happen. Nurses and doctors in the front line have cooperated in an unprecedented way as in hospitals all over the globe. Working during the first phase of the pandemic took me back to my days working for Doctors Without Borders; patients had to be triaged with limited resources saved for those in most need for ICU treatment. But this type of human prioritisation came at a cost for the personnel involved, many experiencing symptoms of burnout and many left with the question in their heads, did we make the right choices?
The corona pandemic is hard to write about or to put into a novel since we all have been there, we all know the details. Yet, on the other hand, Tekla has also been there. She has also had to face the bad management at the Nobel hospital and, when she puts up a fight and goes her own way, she does it so much better then I could ever have done, so I am inspired when entering my own hospital. Or is it Teklas, I really don’t know anymore …
Back to the patient in the ER, he is still waving around his hands and has strange noises coming from his mouth. The medical student shakes his head, he has no clue.
“I think we have a case of anticholinergic syndrome. Let’s try Anticholium, the antidote,” I say.
The nurses give the patient the antidote and within a couple of minutes the man sits up in bed and looks around with a sceptical look on his face. With a clear voice he then says:
“I’d better hurry to the shop, my wife and I are having some friends over for dinner.”
(c) Christian Unge
Hell and High Water by Christian Unge is published by MacLehose Press.
About Hell & High Water by Christian Unge
The first in a new Swedish crime series featuring Tekla Berg, a fearless doctor with a remarkable photographic memory
With 85% per cent burns to his body and a 115% risk of dying, it’s a miracle the patient
is still alive.
He only made it this far thanks to Tekla Berg, an emergency physician whose unorthodox methods and photographic memory are often the difference between life and death.
Convinced that the fire was a terrorist attack – and that the patient was involved – the police are determined to question him. Almost as determined as those who would silence him at any cost. And while Tekla battles to keep him breathing, she can’t shake the thought that something about him is strangely familiar . . .
Tekla has always hidden her remarkable mind from her hospital colleagues, resorting to amphetamines to take the edge off the endless whirl of lucid memories. But now she’ll need to call on all her wits as she’s drawn into a mystery involving corrupt police, the godfather of the Uzbek mafia, and her beloved but wayward brother.
“A taut and blistering thriller with the most memorable protagonist ever. Christian Unge is in total control of his environment. It deserves to be huge” Imran Mahmood, author of You Don’t Know Me
“Watch your blood pressure! A tense and clever thriller” Lilja Sigurðardóttir
Order your copy online here.