difficult questions

‘Listen. I’ve lived here all my life. I was born here, about a thousand years ago, I should think. Hrmph! So if anyone’s heard of The Old Coach House, I’ve heard of it.’ He frowns. ‘And I’ve certainly never heard of it.’ He grips with both hands on to Ellen’s open window as if he’s tethering the basket of a runaway balloon. He blinks, heavily, and it seems to carry on into a little sleep. Ellen touches him on the arm and he opens his eyes again with a start.
‘Okay? So there you are. Good. I don’t believe it exists, sir. Madam - of course.’
He releases his grip and tries to stay upright.
‘So I suggest you get straight on to Mission Control and check your facts. Good luck.’
He takes a catastrophic step backwards that almost puts him in a hedge, recovers himself, and waves us on. I expect to see him saluting in the rear view mirror.

I drive out of the lane and pull over at the top whilst Ellen calls Control to get a better fix. It’s only then that we see the painted white sign: The Old Coach House, on an opened wooden gate between two high flint walls. Ellen hits at scene and we jump out.

A moment later we’re waiting at the door with all our bags.
A figure appears behind the frosted glass.
‘Just a moment,’ she says, struggling with a top bolt and then turning the lock. The door swings open and an elderly woman stands there, dressed in a heavy brown tweed skirt and jacket, looking so much a part of the house you would think she was struck from the quarry along with the weathered old stones of the walls.
‘Thank you for coming so quickly,’ she says. ‘My eldest daughter Karen’s upstairs. She’s fallen out of bed and I can’t get her up.’
She shows us through the house and up the stairs.
‘I’m afraid my poor darling has cancer very badly. She was discharged from hospital a couple of weeks ago to spend her last days at home, and she seems to have taken rather a turn for the worse.’
‘What’s your name?’
‘Edie. My other daughter is on her way over, but she’s had to come quite some distance.’
‘And how old is Karen?’
‘She’ll be fifty-eight in October.’
Edie stands aside at the entrance to a bedroom simply furnished with two single beds, and waves us in.
There is a woman on the floor, lying on her side between the beds, her knees drawn up, with some of the bedclothes dragged down over herself.
‘Karen – it’s the ambulance.’
She groans. Her legs poke out from under the bedclothes with the waxy white skin tones of a mannequin. There is a dreadful metallic smack beneath the otherwise soft herbal scents of the room. When we get closer we see that Karen has vomited copiously, a quantity of foul, black blood that sticks her hair to her face, stains her mouth, nose and chin, and pools out around her on the carpet. Her lips are drawn back from her teeth, and she stares up at us with eyes so round and deep and lightless it’s like looking through a window onto the abyss. She grabs my arm and tries to talk.
‘I’m dying,’ she gasps. ‘Let me die.’
‘Just hold still, Karen.’
Ellen chucks me a towel and I wipe her mouth and face clear. She clutches on to me, her breath coming in spasmodic gasps
‘Karen’s extremely ill,’ I tell Edie. ‘We need to get her to hospital right away.’
‘Oh no, please don’t take my darling away. If she’s dying I want her to die here with me. That’s what she wants. Please don’t take her.’
Ellen passes me an oxygen mask and I put it around Karen’s face.
‘I have to ask you some difficult questions,’ I say to Edie. She sits down on a low wicker stool.
‘Yes?’
‘Does Karen have a DNAR in place?’
‘What’s that?’
‘A DNAR – Do Not Attempt Resuscitation.’
‘I don’t know what that is. These are her notes.’
She hands Ellen a file.
‘District Nurse, Doctor, discharge home,’ says Ellen, rifling quickly through the file, trying to make sense of the information there. ‘Can’t find a DNAR – but there’s a section here: Karen understands the extent of her condition and wants to spend her remaining days at home with her mother.’
Whilst Ellen is reading this out, Karen stops breathing. I feel for a pulse at her neck.
‘She’s arrested,’ I say, then give her a quick thump in the chest. Ellen hands the file back to Edie, comes over to pull the bedclothes away and to cut off Karen’s nightdress whilst I compress her chest.
‘Oh, please, don’t,’ says Edie.
At once Karen is groaning again. Even before Ellen manages to put the defib pads on, she has a pulse and is breathing. I push the hair back from her face. She claws feebly at the oxygen mask, trying to pull it away.
‘Please, don’t do anything more,’ Edie says.
Ellen and I both know that without a DNAR we should make all due effort. We should be making ready to get Karen out to the ambulance, stabilising her as best we can, putting in an ASHICE to the hospital, the scenario playing itself out before us with wretched inevitability.

We have to make a decision.

The progress of her cancer is plain to see. This is a warm and loving environment. Far better to die here with her mother by her side than on a brightly lit resus trolley.

‘What do you think, Ellen? Shall we make Karen comfortable?’ I say.

We arrange things so she can rest comfortably against the bed, surrounding her with cushions and rolled up duvets. We unplug the defib, and then cover her up with soft blankets from the other bed. Edie gives us a box of tissues and a wet flannel so we can clean her face. Ellen brings the wicker stool over so Edie can sit next to Karen and hold her hand. She strokes it and presses it to her cheek.
‘This is all wrong,’ she says. ‘It should be me. It should be me. My poor darling.’
Karen seems calmer. Her breath comes in short, periodic gasps. Her head relaxes backwards and Edie strokes her forehead.

We have no way of knowing how long it may take for Karen to die. I phone Control to ask for an out of hours doctor, an ECP or paramedic practitioner to attend, but there are none available. The Dispatcher tells me he’ll get a senior manager to ring back to talk over aspects of the job as soon as possible. By the time the phone rings a few minutes later, Karen has stopped breathing again.
‘Has she gone?’ says Edie. ‘She’s gone, hasn’t she?’
Ellen checks for a pulse. After a few moments she shakes her head.
‘I’m afraid so.’
‘My poor, poor darling.’
‘Are you there?’ the manager says on the phone.
‘Sorry. It’s academic now.’ I tell him.
He says he’s logged everything. He understands the predicament, is sympathetic, says he might well have done the same.
I ring off, then contact the police number for a death at home.

I tell Edie that we’ll put Karen back to bed.
‘Would you like some tea?’ Edie says.
‘That would be great.’
I help her down the stairs, then go out to the vehicle to fetch the scoop stretcher.
‘Don’t worry,’ I say to Edie in the hallway. ‘It’s just something to help us lift Karen off the floor.’

The other daughter arrives whilst we’re finishing the paperwork in a spare room. We hear her crying along the hallway.

Later, she comes into the room and shakes our hands. She says she would’ve punched me had I carried on down the other route. She smiles when she sees the cup of tea Edie made us, asks us if we’d like another.

When the police arrive Ellen and I have to give statements. Without a DNAR this is not a straightforward death at home. We’re asked to hang on for a senior officer to come over from the station. We tell him we’ll be waiting outside in the ambulance.

We say goodbye to Edie and her daughter, and take the last of our bags out with us.

The evening has deepened into night. We sit in the cab, and wait, with only the occasional passing car and the moon to light us by.