Tuesday, May 20, 2008

the drop zone

Jozef is sitting hunched over on the side of the bed, his hands either side of him, kneading at the bed clothes as he struggles to breathe.
‘Oh God,’ he says, throwing us a desperate look. ‘This is worse than last time. Worse and worse.’
Jozef took some paracetamol in the early hours but the pain has progressed until now he says it’s like horses trampling across his chest. Rae puts the chair up whilst I fix up some oxygen, trying not to let the urgency of the situation infect the tone of our voices.
‘Poor Jozef,’ says the house manager, handing us his medical summary. ‘He’s not been right since his last heart attack. I’ll bring his stuff out to the ambulance.’
He pulls aside the hissing mask to say: ‘Please. My shaving bag. A change of clothes. My book.’
‘Yes, yes, Jozef, don’t worry about that. You just concentrate on getting better.’ She gives him a reassuring chuck under the chin. ‘He’ll be ninety one soon. You’d never think it, would you?’
We strap him into the chair, and then she leads us out to the lift.

On board the ambulance and the ECG is telling us what is obvious from his ghastly pallor and from the feeling of dread that seems palpably to crawl all over him – Jozef is suffering a heart attack.
‘Help me,’ he says, wrenching the mask aside. I spray him under his tongue with GTN, give him an aspirin to chew. He takes it like communion wafer. ‘My God,’ he moans. ‘This is worse than my wound at Arnhem, even.’
Rae is in the middle of cannulating his arm when he suddenly he seems to relax slightly.
‘I’m afraid this is it for me,’ he says, simply, then crumples in on himself with a gurgling exhalation.
I drop the back of the trolley down, snatch the pillow away. Rae punches him in the chest then begins CPR whilst I put some pads on him.

Over the next hour the early morning commuter traffic rises and flows around the ambulance as inside our grim little protocols are acted out. But the scattering of ripped packets, empty drug phials and upended kit bags, the convulsive voltages and broken ribs, all peter out, seem to fade in conviction along with the readout on the ECG, until, in the telescoping daze of these things, we find ourselves in resus back at the hospital, watching from the outskirts of the crash team as the registrar peels off her gloves and calls out a time.

Back outside, the ambulance cleaned and prepped, a cup of coffee, and the air is crisp and bright. Another ambulance parks alongside to offload.
‘All right, Spence. Rae’ says Frank. I can imagine him getting off a horse in the same trail-beaten way, tipping his hat back with a rangy forefinger. He stretches, there is an almost audible crack, then he makes his way to the back. ‘Working hard? Or hardly working.’

The coffee is strong and wonderful. I look at my watch, but it’s still too early to call home.
Rae asks me what Jozef meant by Arnhem.
‘I think it was something to do with an operation to capture some bridges in Holland toward the end of the war in Europe. It was what the film ‘A Bridge Too Far’ was all about.’
‘Never heard of it.’
‘Paratroopers. In by gliders. I think a lot of them were killed or captured.’
We climb back into the ambulance cab and clear up for the next job. Rae offers me a stick of gum. I try to imagine what it would have been like on the glider. I wondered who Jozef sat next to all those years ago as the flimsy aircraft shivered and cracked in the darkness, as they clutched their rifles, approaching the drop zone.


Anonymous said...

According to the Wikipedia entry, the Polish 1st independent parachute brigade's anti-tank unit was in action in Arnhem. This may well have been Jozef's unit.

The soldiers dropped into Arnhem had to fight two SS tank divisions. They held them off for days. Jozef was a man who deserved all of our thanks for what he did so long ago.


Dave the Dog said...

Good grief, that has made me think how time is passing for me. I'm a baby boomer. I have the utmost respect for the old Poles (and quite a few of the younger ones) having worked with a lot of the guys who fought in WW2.

Jozef. My thanks sir. And you too SV

Tsitsi said...

I wonder, do you ever wonder what is the best way to deal with a very old person dying of a heart attack. Can you really bring them back to any kind of normal life? Or would it be better to just hold their hand and hug them and whisper some comforting words? I know you have protocols and procedures. I'm just wondering what you think of it in your own heart.

Katharine said...

Stunning writing. Thank you. And RIP Jozef.

mumof4 said...

Your writing leaves me speechless once more (in a good way)

Spence Kennedy said...

Thanks for all your comments.

Tsitsi - I quite often think that, for myself, at such an age, I would want a quiet slipping away somehow. To have thought out a lovely death plan, like a birth plan, with music and dim lights &c. But I don't think it'll ever be that easy, for lots of reasons. As far as resus on the ambulance goes, we do what we can, even though sometimes it does seem as if we are making a medical crisis out of something that's actually quite normal and expected and part of life. Of course, we're not in a position to do anything else (nor would we want to be). The only time we can hold off and concentrate on making the patient comfortable is if there is a current DNAR (do not attempt resus) on the patient. It's such a huge subject, and quite emotive.

uphilldowndale said...

Pass the tissues.

'death plan, like a birth plan,'
I've long felt that there is a place in our society for the 'end of life' equivalent of NCT (National Childbirth Trust)

Anonymous said...

As a Paramedic and a Gulf-conflict veteran who has visited the battle sites and graveyards in Arnhem. I was very moved to have read your post today.
I can vividly remember my eyes watering whilst reading the names and the ages of the soldiers on the rows of immaculatly kept headstones in Arnhem`s War cemetaries.
I know from my own experiences how much physical effort goes into a resus in an Ambulance, but your writing gives your readers a wonderful insight into not only the protocols and procedures of Ambulance staff today, but also of the psych behind the EMT`s and Paramedic`s who deal with the passing of life on an all too regular occurrence.
We often fail to see the person (or the life experience) behind the patient that we ship off to A&E, but your post-patient reflections show a great depth of thought about patient empathy.
Jozef was just 1 of almost 10,000 Allied Paratroopers and Glider-bourn troops that flew in to liberate Arnhem in Sept 1944, less than 2,000 came home. I hope Jozef is now resting peacefully with his fellow comrades.
We will remember them.

loveinvienna said...

They shall grow not old as we that are left grow old,
Age shall not weary them, nor the years contemn,
At the going down of the sun and in the morning,
We will remember them.
"For The Fallen"

For Jozef.

(And you Spence, wonderful writing once again)

Liv xxx

Anonymous said...

I agree, wonderfully written.

This is the kind of job I dread, I feel I can stay detached from the emotion of an arrest when arriving and patient is already 'down' but the idea of having someone I have been having a conversation with arresting infront of me makes me think I wouldn't be able to stay quite as detached............ but I'm only 6 months out of training so who knows.

AnneDroid said...

Great post.

I've conducted many funerals and have always been fascinated to learn about the younger days of an elderly person who has died. Old people seem so weak physically that it's often easy to forget how great is their wealth of experience and how extraordinary their lives may have been even though laterally they have lived so quietly.

When I worked in a hospice, an old chap dying of cancer(who was starting to be a little bit mixed up about time and place) said that - no, he wasn't afraid of dying, but he wouldn't like to be set on fire or bayonetted. I presume he had seen things in his youth that still haunted him.

Arwen said...

Most likely he meant Market Garden - see http://en.wikipedia.org/wiki/Operation_Market_Garden

I am in the Arnhem area, quite close to where the peace was later signed, and May 4 and 5 (rememberance day and liberation day) are big events here. The parade on liberation day is always very moving, the old men driven in the old army vehicles, their wheelchairs and rollators strapped to the back. I hope Jozef came over to experience it, maybe some time ago when he was still able. Perhaps I even gave him a flower once. I hope so.

But the band played Waltzing Mathilda
the old men still answer the call
but as year follows year, more old men disappear
some day no one will march there at all