SISTER'S PAIN
I had to watch my twin die after she went to A&E with a headache but was left slumped on the floor under a coat
The hospital was working at double capacity - and no one noticed Inga Rublite was unconscious until it was too late
INGA Rublite was on a break at work when she suddenly developed a piercing headache.
Less than 24 hours later, the 39-year-old was found "slumped" on the floor in A&E under a coat.
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Her identical twin sister Inese Briede then had to watch her die.
Inese, 39, told : "We had shared everything - she was a part of me.
"If she went blonde, I went blonde. If she dyed her hair black, I went black. We even had identical tattoos.
"I cannot imagine what she went through sitting there, the pressure building and building in her head.
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"To see her lying in that hospital bed, with all those tubes, it was like looking at myself.
"I said, 'This cannot be the end.' How has this happened? She only went to hospital with a headache and she was in the best place - to me hospital means 'safe'."
An inquest heard how Inga had a seizure after waiting hours in a crowded hospital.
She died of natural causes but NHS staff "missed opportunities" to diagnose a bleed on her brain, the court was told.
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Inga first complained of a headache at around midday on January 19.
While on a video call to her sister, she compared the pain to being "hit like a brick", but managed to finish her shift at a warehouse in Nottingham.
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After a five-hour nap at home, Inga told Inese that she still felt unwell - with a headache, neck and jaw pain, and blurry vision - so she was encouraged to go to A&E.
But the following morning, Inese, who said her sister "never liked to make a fuss", hadn't had an update.
"I tried phoning, WhatsApping and making normal voice calls, but she still didn't pick up," Inese said.
"I tried one last time – a video call - and this time it was answered.
"I thought, 'Oh she's picked up, but she must have been sleeping. She will give me a hard time because I have woken her'."
But it wasn't Inga - it was a nurse who told her that she needed to "come to the hospital right away".
Inese, a teacher in Latvia, rushed to Queen’s Medical Centre (QMC) in Nottingham, where she then watched her sister pass away.
Timeline of events before Inga Rublite's death
January 19
12pm: Inga complains of a headache while on a video call to her twin sister, Inese Briede. She compares the pain to being "hit by a brick" but finishes her shift before going home and sleeping for around five hours.
8.53pm: Inga tells her sister that she still feels unwell, with a severe headache, neck and jaw pain, high blood pressure, and blurry vision, so calls 111 for advice. During the one-minute conversation, she is told that someone will call her back for more information.
9.45pm: A clinician phones and Inga reports the same symptoms. After the 11-minute call, she is advised to go to A&E. She calls for an ambulance but is told the wait will be several hours, so she contacts her neighbour and friend, Rasa Balzonyt, who drives her there.
10.39pm: Inga arrives at an overcrowded Queen’s Medical Centre (QMC) A&E and has a three-minute triage assessment by a nurse. There is no senior doctor available so she is told to sit in the waiting room. No CT scan is requested.
January 20
12.01am: She phones her youngest son, who is already asleep. Her eldest boy texts her saying: "I'm going to sleep now. Love you."
2.07am: Inga, who is now alone after her friend had to leave, has observations taken more than an hour after she was scheduled to. She reports her pain as severe, compared to mild when she arrived, and her heart rate has increased.
4.30am: Staff call Inga's name but she does not respond.
5.26am: Her name is called again in the waiting room but there is no response.
6.50am: Staff receive no response a third time so call her mobile phone. When there is no answer, it is assumed she has gone home so she is discharged from the hospital system.
7am: Staff arriving for the morning shift discover Inga slumped on the floor in front of a chair with a coat covering her face. She is unresponsive, has vomited and has recently had a seizure. She is taken to the resuscitation department, where it is discovered she suffered a brain haemorrhage, and she is prepared for surgery.
12pm: Inga's family are told that her condition has deteriorated so much that medics can no longer operate, and that the bleeding on her brain is so severe that she is unlikely to survive.
January 22
10.24am: Brainstem tests conclude that her brain has sustained irreversible damage and she is declared dead.
The inquest heard how QMC was operating at almost double patient capacity; the maximum limit is 38 but at one point while Inga was there, there were more than 70 people waiting to be seen.
Staff, who did not request a CT scan, allegedly called her name three times throughout the night, and phoned her mobile, but she did not respond so they assumed she had gone home and discharged her from their system.
HORROR DISCOVERY
Tragically, no one noticed her "slumped" on the floor under a coat. And by the time Inga was found, it was too late.
The mum-of-two, whose search history showed that she had been Googling 'thunderclap headaches', had a coat over her face, "seemingly asleep", but she was found to have had a seizure.
Medics had hoped to operate, but they later deemed Inga had deteriorated so much and that the bleeding on her brain was so severe that she was unlikely to survive.
Nottinghamshire coroner Elizabeth Didcock said Inga had a condition that had "likely been present for years" which took its "naturally occurring course".
The 39-year-old suffered a "massive bleed" on her brain from an aneurysm while she waited more than eight hours to be seen by a doctor at QMC on January 20, causing "significant, irreversible" brain damage.
Inga, originally from Latvia, died two days later when brain stem tests showed "no improvement in brain function".
What happened to my sister should never be allowed to happen again
Inese Briede
Evidence presented in the inquest showed staffing levels were "depleted" during the shift and the dedicated senior decision-maker had been diverted to "help with pressures elsewhere".
Ms Didcock said in her final statements that the triage nurse should have spoken to a senior decision-maker, who could have "escalated" the situation based on her symptoms.
"I find on balance had she been seen by a senior decision-maker, she would have had a CT scan which would have found the bleeding," she said.
Ms Didcock concluded that "all was done to try to stabilise her" once Inga's condition had been found.
She added that the investigation conducted by the Nottingham University Hospitals Trust (NUHT) had been "thorough and thoughtful", and that "many of the issues that this case has identified" were out of their control.
Inese said: "What happened to my sister should never be allowed to happen again."
Dr Manjeet Shehmar, medical director at NUHT, said they were "truly sorry" they did not meet the standards they "strive to deliver".
He said: "We would like to offer our sincere condolences to the family of Inga for their loss.
"Although due to the nature of the bleed on the brain the outcome is unlikely to have been different, we accept there were missed opportunities in Inga's care and are truly sorry that we did not meet the standards we strive to deliver.
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"We have completed an investigation in order to assess and implement learning, and as a result have introduced changes in our emergency department to ensure we can deliver better care to patients and support our staff to do this in the future.
"We fully accept the coroner's findings and are determined to take all action possible to improve our care."
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