In life, Inga Rublite was just another patient in a busy hospital waiting to see a doctor. In death, the 39-year-old has become a tragic symbol of how overstretched and overburdened the NHS has become.
Rublite died after being found unconscious under her coat in an A&E waiting room more than eight hours after arriving.
Learning what happened to Rublite in the hours before her death has been gut-wrenching for her friends and family.
She sat through the night at Queen’s Medical Centre (QMC) in Nottingham after arriving at 10.30pm on 19 January with severe headache, dizziness, high blood pressure and vomiting.
When her name was called seven hours later, at about 5.30am, she did not respond and staff discharged her believing she had tired of waiting and gone home.
But over an hour later she was discovered having a seizure after falling asleep, and then unconscious, under her coat.
She was rushed to intensive care but had suffered a brain haemorrhage, and the bleeding was so severe it was inoperable. She was declared dead two days later on 22 January, when her life support was switched off.
“That is the official date of death, but I think she basically died in that waiting room,” said Rublite’s twin sister, Inese Briede. “No one was doing anything for her. And by the time they found her, it was too late.”
She was very close to her identical twin, despite the fact Briede lives in their home country of Latvia. “We would talk on the phone every day, three times, sometimes more,” she said.
The pair had moved to the UK together in 2004 after finishing school. When Briede moved back home in 2008, her twin sister stayed on, gaining GCSEs, steady work in Nottingham and becoming the mother of two sons, now aged 13 and 11.
The boys are now being cared for by their father.
“She lived there for 20 years, she paid all the taxes, she worked hard and paid everything on time. She did everything right. Even that day when the headache came on, she stayed in work,” Briede said.
“In all those years, the one time she went to the hospital to ask for help, no one was looking at her. I can’t describe how that feels. That you can’t get help in the place where you’re supposed to go for help.”
Rublite was chatting to her sister on FaceTime during her lunch break on 19 January when she suddenly started complaining of a headache. She took painkillers and finished her shift at a warehouse distributing uniforms, before going home and sleeping for five hours.
She was awoken by her sister’s call in the evening. Her headache was worse, she couldn’t sit still and she couldn’t eat.
“She measured her blood pressure and it was 156. I remember that. That big number. I told her you have to call the hospital, you have to go to hospital,” Briede said.
Rublite called for an ambulance but was told none were available, and as she was too ill to drive, she asked her work colleague and nextdoor neighbour, Rasa Balzonyt, to take her.
Balzonyt described her friend as “very fit and healthy”, active and always smiling. At the warehouse where the pair worked, Rublite “did the job of two people, she worked so fast”.
“She was full of energy, she couldn’t sit still at home, she was always planning trips for us and the kids,” Balzonyt said.
On that evening, she said Rublite felt dizzy and threw up during the drive to hospital, and when they arrived at about 10.30pm she was checked over by a nurse who took her temperature and blood pressure.
She waited with her friend at A&E for two hours, until after midnight, but when nursing staff told them it would be a nine-hour wait to see a doctor, Balzonyt returned home to look after her son.
“No one saw her when I was there, her name was never called. I was getting so frustrated and angry,” she said. “I told her I would keep my phone on loud and she could call me whenever she was done, whatever the time, and I’d pick her up.
“I left her in a safe space, I thought she would be fine. I thought the doctors would help her. It should have been the safest place. We didn’t realise how serious it was.”
In Latvia, Briede repeatedly called her sister in the morning, and at around 7am the FaceTime call was picked up by a nurse who told her someone needed to come to the hospital immediately. She could see her sister’s legs on a hospital bed in the background.
“They said they had just found Inga having a seizure. I was in shock – ‘where did you find her? Where?’ No one answered me,” she said.
Briede said that she was told by doctors on two occasions that if her sister had been treated more quickly, she might have survived.
“I was told that this whole situation could have been avoided if someone had seen her, or if someone was just checking up on her. It’s so hard to know that there could really still be a person here if someone was doing their job,” she said.
“I just couldn’t believe that they had taken her off the waiting list when she didn’t answer. Did anyone look for her? Did anyone check the CCTV cameras to see if she had left?”
Briede said she had asked for the CCTV footage showing her sister’s last moments in the waiting room but her request was denied.
“When they gave me back Inga’s stuff, there was vomit on her phone, on her wallet. Her clothes were soaked in urine,” she said. “I believe she was already unconscious when they found her, but at what time exactly did she become unconscious?”
As more and more people face long wait times in A&E, research points towards a corresponding increase in deaths. Calculations by the Royal College of Emergency Medicine (RCEM) found that almost 14,000 people died needlessly last year in England while waiting in A&E for up to 12 hours.
Briede said she had sympathy for the staff at QMC after visiting the hospital when she came to the UK the following day. She saw the overcrowded waiting room, beds in the corridor, irate patients shouting at staff for having to wait so long.
“I know that it’s hard for us, and it’s hard for them as well. When I came in, I told them how angry I was, that no one was looking after Inga and you didn’t do your job right. And they’re just quietly taking all this. I feel guilty for that,” she said.
Her sister’s death will be examined by a coroner at an inquest in July, and the family hope that will provide some answers about exactly what happened, and whether her death could have been prevented.
“This is not something you can just accept,” said Briede. “How long is the hospital going to work like this? Because it has been like this for years. People are dying and everyone is just being quiet about it.”
Dr Keith Girling, medical director at Nottingham university hospitals NHS trust, which includes the QMC, said: “I offer my sincere condolences to the family at this difficult time. An investigation is now taking place and, until this has been concluded, we are unable to comment further.”