Tuesday, May 25, 2010

soundtrack

Ray’s wife Anne meets us at the top of the steps.
‘He’s lying on his side. I can’t move him. I think there’s something wrong with his breathing.’
‘Where is he?’
‘In the kitchen. But he’s big …’
We hurry in to the flat. Ray is lying on his left side on the floor of a narrow, galley kitchen, a pool of yellow vomit around him on the vinyl tiles. He is gasping spasmodically like a landed fish, his hands and nose and lips already a mottled grey blue. I feel for a pulse at his neck.
‘Nope. Agonal. We need to get him on his back.’
‘You be careful,’ Anne says, peering in over Frank’s shoulder. ‘He must be eighteen stone.’
I’d guess at least twenty-two. I grab his belt with one hand and guide his head with the other whilst Frank reaches in and uses Ray’s crooked legs as leverage. We manage to turn him on to his back in one haul, then reposition our grips and slide him a couple of feet away from the mess to a clearer space near the entrance. I pull his shirt up and start chest compressions; his eighty year old chest immediately snaps and cracks, giving beneath my hands like an old wicker basket.
‘Anne? When was the last time anyone saw Ray on his feet?’
‘I should say about half an hour ago.’
‘So he’s been down at least twenty minutes or so.’
Frank sticks the pads on and sparks up the defib.
‘Off’ he says, then after a moment: ‘PEA – on you go.’
‘Is he going to be all right?’ Anne says, one hand abstractedly plucking at the loose folds of skin beneath her chin.
‘He’s very poorly at the minute, Anne. His heart’s not working properly. This’ll be difficult for you to see. Why don’t you go out into another room whilst we do what we can? Is there anyone around who can sit with you?’
Just then a deep male voice sounds from along the corridor.
‘Stanley Green! says Frank, looking up from the head end where he takes care of ventilations. ‘I didn’t know you lived round here.’
A thick set guy with electric white hair and Fifties sideburns shows his face around the corner.
‘I live upstairs, Frankie. It’s Ray, is it? I saw the ambulance.’
Stanley watches me working on him for a second or two. Then he takes Ray’s wife by the shoulder. ‘Come on,’ he says. ‘Let’s go next door for a bit.’
‘Just before you go – Anne? What’s Ray’s medical history? What does he suffer with?’
‘Oh you name it,’ she says. ‘Do you want me to fetch you his appointment card? He’s supposed to be going in for a check-up in a couple of days. I suppose I’ll have to cancel that now.’
‘And how was his health today? Was he complaining of anything particularly?’
‘No. He was in a good mood. We were going out later.’
She frowns, watching me compress her husband’s chest but not seeming to connect with the desperate nature of my actions.
‘I’ll have to have a ring around,’ she says absently.
‘Come on, Anne. Let’s go and wait outside and let these guys do what they do.’
‘Do you want to know anything else? Towels? Water?’
‘No. Thanks. We’re fine. You go with Stanley and we’ll carry on. There’ll be another crew arriving in a moment to help us out. Maybe you could talk to one of them and give them all Ray’s details.’
‘Will do,’ she says, and Stanley leads her off.

***

An hour later and we all agree there’s nothing more to be done. Ray had a brief moment when it looked like his pulse might make a comeback, but it proved to be a false, adrenalized dawn (as they often are). We stand back from his body and begin to organise a clear-up. Frank goes to speak to Anne. After a few seconds I hear an agonised howl from a room out back. After a moment Frank re-appears.
‘I told her she could come in after we’ve cleaned him up,’ he says.
We drag him out of the kitchen and onto the carpet. It looks more comfortable than lying on the bare lino. We wipe his face, adjust his clothes, lie him neatly, place a clean white blanket over his length.
‘Are you going to extubate?’ I say to the paramedic.
‘No. I’ve got to leave it in situ for the coroner.’
‘Fair enough.’
But it seems a shame. Stanley comes in to the room and blanches when he sees his friend lying on the floor. But then he motions behind him for Anne to come in, and she takes her place by his side. After a moment she says weakly:
‘What’s that sticking out of his mouth?’
‘That was a tube to help him breathe. We’ve had to leave it in, I’m afraid.’
‘Oh.’
‘For the post mortem.’
‘Oh.’
We start to ferry our kit out of the way, discretely moving around Ray as he lies there, massive, motionless, jarringly out of place, run aground on the threshold of his kitchen. As I retrieve a scattering of drug packets from just the other side of him I notice the small bookcase, a CD player on the top shelf, rows of neatly stacked CDs beneath it. There is a tall, faded looking CD box leaning against the player where Ray left it: Dean Martin, posing in an open-necked, black silk shirt and rumpled cream jacket. Memories are Made of This.

11 comments:

Rach said...

Very poignant Spence, though I wish I had not read about yellow vomit with my tea on my knee....xx

Spence Kennedy said...

Sorry Rach. I must admit I'm often snacking n'surfing - but I wouldn't even risk a dry biscuit if I was visiting Siren Voices! I think I should rename it. Siren Vomits, maybe. :/ x

Wayne Conrad said...

‘He’s very poorly at the minute, Anne. His heart’s not working properly. This’ll be difficult for you to see. Why don’t you go out into another room whilst we do what we can? Is there anyone around who can sit with you?’

I am in awe of this simple ability: to tell the truth, leaving room for hope, if there is any, but not building up false hope. You probably think nothing of it, an ordinary tool of your trade. But I find the truth can be a very difficult thing to say in difficult times. I see this in your writing and that of other EMT workers, this ability to say the truth just so, with the same adroitness a practiced expert might exhibit starting an IV.

Spence Kennedy said...

Thanks Wayne

I suppose it is a tool, in many ways. Over time you come to develop your own little phrase book, using bits and pieces according to the situation. Certainly that's one I've used in the past when we're on a resus and the relatives are around. What's more difficult is talking to them after the event, if you have to tell them them it hasn't worked and the patient has died.

I'm very glad we don't do that many resus jobs (although what usually happens is you have a long period when you don't do any, then go straight from one to another!)

Thanks for the comment, Wayne. I really appreciate it.

Christine said...

Lovely piece of writing, felt that I was looking over your shoulder as the story unfolded. Then I got to the end and I filled up when you mentioned the poor man's CD of Dean Martin. He was my mum's favourite and we played his songs at her funeral. Ambulance crew were brill then too as I found her dead in her flat and had to call them. Keep up the brilliant writing xx

rheumablog said...

Being unable to save a person in Ray's situation must be very hard for you, too, Spence. I know that frequently the attempt at resuscitation really does come too late, or the illness is simply too far along for it to help at all. Still, you must try each time, and hope, just like the family members. Have you discovered a way to make this easier to take, yourself? I've been with paramedics, in my job as a reporter, when it was clear that nothing they did was going to give the injured person another chance or save their lives. They were, to a man, solemn, the pain clear on their faces. How do you work that through?

Thanks for another beautifully written post.
-Wren

Spence Kennedy said...

Thanks Christine

I didn't know whether to use that detail or not. When I read it back it sounded a bit made up. But sometimes it's those coincidences that stick.

Sorry to hear you had such a traumatic time of it. I'm glad the crew helped out. Dean Martin is one of those performers who had such a strong identity, the mellow, boozy crooner. Fantastic! x

Thanks Wren

Quite often you start on a resus having a pretty good idea of the outcome. In Ray's case, at least he still had agonal breathing, which is some sign of hope however slim. The complication was that he'd aspirated a great deal - plus he had a range of health problems which in the end stymied our efforts.

The coping thing is difficult, and I suspect the longer term consequences are more serious than the short term. But I think what I do to cope during the job is to wrap myself in a protective layer of super-normality.

Actually, serious as a resus is, there's often periods - handling the ventilations or the compressions - when you're able to talk over the patient. Dull stuff, mostly: gossip, trivia, stuff that seems glaringly inappropriate out of context, but stuff that acts as insulation from the stress of it.

You have to keep reminding yourself sometimes of the need for tact. And often you have to watch out that outside the address you don't stretch and look at the sky and make cracks about this and that and generally look like bus drivers on an outing. It must look absolutely awful sometimes if a crew is caught out acting like this, but the thing to realise is that they're not being callous or disrespectful. They're doing what they need to do to keep themselves grounded, and healthy enough to run to the next job.

Of all the aspects of ambulance work, I think this is the most difficult to talk about. It doesn't easily conform to expectation. But I've seen it so many times, and use it myself to stay sane.

Thanks for your comment - and for your support all this time, Wren. xx

uphilldowndale said...

Sigh........
I wonder, there must be a comfort for the family, later, when they can perhaps realise that everything that could be done was done....

Spence Kennedy said...

Hi UHDD

I hope they think that. We did our best, and I suppose it's a fact of life (difficult to accept of course) that sometimes people will reach a point from which they can't recover.

I imagine they'll find it hard to get over the fact that they were out when he collapsed. But so many times it happens that someone dies a number of hours (or days) before being found, so it could be worse!

lulu's missives said...

Hi Spence,
It must be so hard having to go through the process, knowing what the inevitable outcome is....except when there is that 1% chance that the process might work. But to have the wife there is equally distressing.
Beautifully written.
x jo

Spence Kennedy said...

Thanks Jo.

The awful thing was, his wife didn't realise how serious things were for quite a long time. There was a marked change from the beginning, when she was calm and matter of fact, and the end, when it suddenly hit her and she went to pieces. Dreadful, really. But you do what you can. xx