Friday, December 05, 2014

bad dreams

I’m swimming out in a cold, calm sea. I catch up with Alison Moyet, who’s swimming very determinedly in a burkini. She’s heading out to a submarine on the horizon, a strange, dark vessel, like a ribbed slug with lights out on stalks. ‘Trinity House’ I think. Even though I’m worried about the distance to the ship, and how we’ll get back, I swim alongside her. When we get close enough I can see there’s a bearded man piloting the craft. The Captain? In a respectful but jokey way I call out to him: Permission to come aboard? I’m expecting him to be charmed by our pluckiness. It’s a brave, almost foolhardy swim after all. He’ll know more than anyone the danger we’re in – from the cold, the tides, the distance back.
‘No’ he says, looking straight ahead. ‘No...No...No.’
My leg starts to vibrate.
I’m not in the cold sea anymore, but a leather chair.
There’s a radio in my pocket, with a job coming through.
I stagger out of the standby room and out to the response car.


Jack meets me at the door and shows me through to the bedroom where his partner, James, is lying propped up with cushions. James is mortally unwell. His mottled skin is stretched taut across the bones of his face, and when he coughs there is a sludgy rattle behind his ribs.
‘I’m not going to hospital,’ he says, turning his head to look at me.
‘No. Absolutely. You don’t have to do anything you don’t want to do, James,’ I tell him. ‘So. How can I help tonight?’
‘James has got Basal Cell Lymphoma, metastasised to the lung from his liver. James has decided to withdraw from chemo, and we’re waiting for a call from the palliative care team later this morning to set things up so he can die at home. Unfortunately we’ve been caught out a bit. We’re between arrangements, so to speak. It’s pain relief. We’ve only got paracetamol and so on, and we really need something a little stronger.’
We talk through the options. I tell them that they’ll need a doctor to come out and prescribe what they need. I take some basic obs, but James doesn’t want much and I don’t push it.
‘I’m tired and I want to die’ he says. ‘Can’t you just put me to sleep?’
‘Well that’s not really in my code of practice at the moment, James. The best I can do is call in a doctor for pain relief whilst you’re waiting for the palliative care team.’
‘A gun or something,’ says James, gripping the duvet and closing his eyes. ‘I’m not fussy.’
‘The other thing we need to sort out is a Do Not Resuscitate order. As things stand at the minute, if you suffered a cardiac arrest, the ambulance crew would have to work on you.’
‘No...No...No!’ says James, his eyes opening wide again.
Jack gives me their home phone number; I call the out of hours doctor to discuss the situation. The doctor's extremely clear and helpful. He says he’ll check his Oromorph supply and head straight out.
I finish the paperwork and gather my things together.
‘Is there anything else I can help you with before I go?’ I say to James.
He holds out his hand to me and I take it.
‘Thank you for all you’ve done,’ he says.
‘It’s a pleasure, James. I hope you get the help you need as quickly as possible.’
I press his hand warmly. When I make to let go, he holds on a little longer, looking up at me with his glittering eyes, like he wants me to pull him up and take him somewhere.
‘Lovely to meet you, James,’ I say.
He relaxes.
I pick up my bags, say goodnight and go.


Hel said...

I'm thinking James picked up on your warmth, the same warmth that brings me back here for more stories, time and time again. I only hope that you come out to me & my loved ones in our hour of need. Long way though, we are in Hampshire.

Spence Kennedy said...

Thanks very much, Hel. That's kind of you to say so.

I know I'm biased, but I honestly think most people in the ambulance are the same. They're not in it for the money - or the hours / working conditions, these days - but because essentially they're interested in people, they care about them and want to do what they can to help. We all have our off-days, and everyone has certain things that 'push their buttons', but essentially it's about the patients.

Thanks for the comment, Hel - and for supporting the blog all this time!

jacksofbuxton said...

Couple of things SPence.

A lovely couple James and Jack.They seemed to be ready for the sad final chapter.

The other thing is don't eat cheese so late at night.

Spence Kennedy said...

Lovely couple - and so open about the whole thing. It made dealing with it so much easier. A real pleasure to meet them, even if it was under such dreadful circumstances.

Cheese? That's exactly what I'd say to a therapist. Despite the fact I hadn't had any cheese. Although I'd have eaten it if you'd offered it to me. That late at night I'll eat anything.

Eileen said...

I'm surprised you felt surprised at his reaction - though it wasn't entirely clear which he was reacting to: the DNR or CPR. I hope I'd be clear enough to understand that whatever I want I do NOT want effective CPR when I am dying anyway. It's bad enough without broken ribs etc.
I must ask what happens here - Italy doesn't like the concept of assisted dying, they might see it as similar.

Spence Kennedy said...

I wasn't surprised by his reaction to the DNAR thing, Eileen - it was because he said 'No, no, no...' - in the same way as the submarine captain in my dream earlier! (But I must admit, re-reading the piece it's not entirely clear. Maybe I should delete that bit...).

On the contrary, I was hugely impressed by James' open and frank attitude.

Sorry for the confusion!

Spence Kennedy said...

Eileen - I just realised - I didn't answer that question about Assisted Dying.

Currently in the UK there is no Assisted Dying. The emphasis is on good palliative care, either at home, in a hospice or (worst case scenario) a hospital. It's a huge issue, though. Many people think Assisted Dying should be brought in (I'm one of them). A question of personal choice. But thus far, nothing on the statute.