If a child’s smile can light up one’s day, there’s nothing like a child’s abject misery to further darken the general gloom of a night shift. Shelly is a one and half-year old with congenital bone marrow failure of unknown cause. Her stem cell transplant was meant to have given her a new lease of life, but has so far only added to her problems. The Portacath and Hickman line she’s had in to receive her medicines have had to be removed for being a presumed source of infection. Her skin is red and angry, with sores beginning to develop – a biopsy shows she has graft versus host disease. Her hands are encased in mitts to stop her scratching. The diarrhoea means she can’t tolerate feeds, so she is on parenteral nutrition. She still retches though. She’s had transfusions of platelets and blood almost every day, and is on anti-rejection drugs – toxic to the kidneys, and not quite working. Because of her sensitive skin, she has surgical drapes for sheets. So there she lies, her downy head on bright green linen, bright red cheeks – not ruddy with health, but raw and weeping – and sad, sad blue eyes. She cries when you touch her; drifts in and out of a fitful sleep. When her temperature goes up, she chugs as she breathes, drawing her chest in – we’re trying not to intubate her, because she might not get off a ventilator again. She looks up at me, and frowns.