A turn for the worse

The night before the meeting was awful, Mrs Watt said. ‘The man was literally shaking in bed and pouring sweat.’ She demonstrated at the inquest, hands quivering at the end of outstretched arms. ‘Our duvet was so wet. I had to strip the whole bed down,’ she told the BMA.

This isn’t Alastair, she added.

‘I’ve been with him for 21 years. We’ve done our finals together. He got a bit anxious then. I was with him through his MRCP exams, which were hideous. IVF, which is hideous. We’ve coped with all of that.

‘I’ve never seen him like he was that night. Never.’

She called Dr Moody, his mentor, about the state he was in. Dr Kyle joined him at the meeting, as a colleague and friend. He arrived smartly dressed, as usual, but very agitated, the inquest heard.

‘He was slightly incoherent in his speech, flitting from one thing to another,’ said Dr Kyle. ‘We should never have done it. It caused a lot of anxiety to Alastair when he was already in an anxious state.’

Ms Smith agreed to reduce his workload, remove from the plan his on-call, and his role developing an ‘integrated diabetes service’. It was agreed that a mentor outside the trust would be sought for extra support.

He was off sick with stress for the rest of the week before a trip to the Alps with his cycling friends, Dr Kyle said. He was anxious at the airport, struggled up the first few hills but by evening was laughing, smiling and chatting.

One of the last pictures of Dr Watt in the French Alps in September 2017 One of the last pictures of Dr Watt in the French Alps in September 2017

‘We had nights when having a few beers, and he was crying with laughter,’ Dr Kyle told the inquest. Then they were back in the UK, waiting for luggage.

‘He turned to me and said, I can feel my anxiety coming back, my anxiety rising,’ his friend recalled.

He was back at work in September, catching up, and soon saw a different occupational health consultant, Mark Critchley. Dr Critchley ‘strongly recommended’ that Dr Watt ‘doesn’t return to on-call work for six months,’ the inquest heard.

He was now ‘anxious and depressed’ about future working arrangements, Dr Sarangi said. The same month, he saw his GP who noted rising anxiety ‘as a consequence of work stress’.

By early October, he was off sick for good.

On the 16th his ‘stress at work is still apparent’, his GP statement to the inquest said. Days later, he was ‘angry, fearful, sobbing’, added his therapist. Two days on, his GP prescribed antidepressants.

Dr Watt sent a new job plan to Ms Smith, raising concerns again about being single-handed. She forwarded his email to colleagues, suggested a ‘catch-up’ to tackle his concerns. By this date ‘it was unclear’ who his line manager was, following a trust management shake-up, Ms Smith told the inquest.

That November, he was at his GP’s with ‘increasing, regular’ thoughts of suicide.

He was referred to Amaury Delgado, a consultant psychiatrist in the community mental health team.

A day later, he was back at occupational health. Dr Critchley noted increased symptoms of anxiety but saw ‘no reason he couldn’t return to work in a few weeks’ time’. There was no mention of suicide, the inquest heard.

The next day, he told his therapist about ‘urges to end his own life’.

The next one, he saw Dr Delgado who put him at ‘mild to moderate risk’ of suicide. He changed Dr Watt’s medication, referred to a care coordinator, and put him on a talking-therapy waiting list as his own private therapist was soon taking a break. Contact with his GP and therapist continued.

Towards the end of November, on pay day, Dr Watt found his salary was dramatically cut. ‘Are they trying to punish me?’ Mrs Watt recalled him saying in our interview. ‘He was absolutely distraught. I advised him to email them. It’s probably a catastrophic mistake, not malice,’ she added.

It was an administrative error, the inquest heard. Payroll had without warning stripped months of ‘overpayment’ for its previous failure to adjust his salary, following the disastrous September job-planning meeting.

Dr Delgado noted a ‘significant deterioration’ in Dr Watt in early December, the inquest heard. He was yet to start NHS therapy.

By this time, he was barely leaving the house, he was so ashamed of being off sick.

The weekend after the pay cut, he watched his son play rugby, a game that he loved, having once trained with the Saracens and played for Barts and the University Hospitals, London team.

Days later, he was unusually anxious about a furniture delivery. His care coordinator visited the next day, offered advice, and left him some worksheets, the inquest heard.

‘He was shaking, beside himself. It was off the scale,’ Mrs Watt told the BMA.

The next, his wife found him highly agitated at home. ‘He was saying, I’m going to prison. I have caused harm. I am single-handed. My patients with diabetes insipidus, I’ve done the wrong thing,’ she told the inquest.

She texted his friend and colleague, Dr Kyle, for advice. ‘He said, this is nonsense.’

‘I went around the house to look for him. He was gone.’