Tuesday, January 01, 2013

the wind across the fields

I race across town faster than I’ve ever driven before, the back of the car kicking out as I accelerate hard down a clear stretch. The address on the screen for this cardiac arrest – surely it’s Frank’s house? I want to call Control to check, but I figure it’s best if I concentrate on the road and get there as quickly as I can. Another ambulance car appears behind me from a junction and tucks in behind. We drive in mad convoy out of town to the outskirts where Frank lives, falling onto the cars ahead of us like ravening blue devils, scattering everything left and right. We make the street and pull up outside his house. I’m dragging bags out of the boot when Malcolm says:
‘It’s his neighbour.’
There’s a porch light on and the door stands open. I leave a couple of bags for Malcolm to carry and we both hurry down the path towards it.
There’s a woman standing in the lobby, hanging on to the bottom post of the stairs. She’s so upset she can’t talk. Instead she points with her free hand, then gives a guttering sob and collapses on to the bottom step. We squeeze past her and hurry up to the bedroom.
It’s a dreadful scene. Frank is there, standing with his bare arms covered in blood, astride a woman on the floor who has suffered a catastrophic haemorrhage. Her face is a mask of blood, clots where her eyes should be, bloody matter extruding from her nose, a stream of blood running out of the side of her mouth, the tip of her tongue clamped outside of her blue lips. The double bed is liberally splattered, a pool of blood gathered in the central depression, something like finely chopped liver scattered across the bottom sheet, and a sodden trail of blood to the edge where the poor woman was dragged and dumped on the floor.
‘Close the door,’ says Frank, holding his bloodied hands and arms out to the side, touching his nose with the one clear space available to him on the back of his right hand. ‘It’s non-viable,’ he says. ‘Jesus Christ – what a mess.’
The woman is his neighbour. She was diagnosed with lung cancer about a year ago, metastases in the brain and bones. Palliative care, a DNAR in place.
‘Helen came round and got me. Apparently Jean started coughing an hour or so after she’d gone to bed...’ He pauses and we all take in the scene, imagining the horror of that.
‘Arrested soon after. Helen got her on the floor – God knows how – then came to fetch me. I didn’t know about the DNAR to begin with, so I tried a few compressions, but it was never going to work. I may as well have been working a pump handle. Poor thing. I think Helen knew it was hopeless from the start.’
We find some clear space to put our bags down.
‘Let’s do what we can to tidy things up. Then we can put her back to bed and it won’t be so hard on the family.’
We spend the next half an hour making Jean look more presentable. I use some clinical wipes to clear as much of the blood from her face and hair as I can. I talk to her as I do it – as much for my own benefit as hers.
‘There we go...’ (gently easing her tongue back into her mouth)
‘Sorry, Jean....’ (using the corner of a wipe to hook away the congealed blood from her eyes).
‘Let’s just get this... there...’ (rubbing her hair clear of blood, drying it off with a towel).
But Jean’s lungs are so corrupted, the slightest tilt of her head is enough to tip a fresh stream of blood down the side of her face. There’s nothing to be done about that, though. Our only hope is that when she’s lying on her back on the bed, she won’t be moved for a while.
Whilst I finish cleaning Jean up, Malcolm strips the bed, folding up all the spoiled bed linen and putting it in a discrete pile over by the window. He finds a couple of inco pads and we use them to wipe the parquet floor clean. Anything that’s tainted with blood we roll up and put aside with the linen.
There’s a cowbell near the headboard.
‘That was what she used to ring when she needed anything,’ says Frank, turning over the pillows to hide the stains. ‘It was their little joke. It’s such a shame it ended like this.’
When I put it aside I’m careful to hold the clapper so it doesn’t accidentally ring again.
We lift Jean up and settle her back on the bed. I clean her face one last time to catch any new spillages. We arrange her arms by her sides, and then drape one of our own blankets over her.
Frank goes downstairs to comfort Helen whilst I finish the paperwork. Malcolm calls the family undertakers and arranges for collection. We take one last look around, and then carry our bags back down.
Frank is standing in the hallway with Helen.
‘Thanks for all you’ve done,’ she says.
I tell her I’m sorry for her loss – the usual awkwardness – then leave.

Outside, the night has deepened. It comes rushing towards us across miles of open field with a tail of pin bright stars. It’s exhilarating, standing here outside the house like this. Dizzying, like we’re feeling the way the world moves for the first time, the spin, the implacable momentum of it all.

I stow the bags back in the car. We chat a little, make a few cracks, talk about this and that, head back to base.


Mike said...

None of you folks deserve the cut backs and extra pressures being heaped on you. If only you could have the Sec of State 3rd manning for a few shifts.

Happy New Year Spence.

Spence Kennedy said...

I wouldn't mind having the SoS along for a night. Or any politician, come to that. It'd make for some interesting discussions (and they could make themselves useful for once, carrying the bags).

Happy New Year, Mike! Hope it's a good one for you.

Lynda Halliger Otvos (Lynda M O) said...

Happy New Year, Spence, may each step we take lead the way to Peace. Thank you for Siren Voices.

Laura Elizabeth said...

Wow, that gave me goosebumps...beautifully written once again!

Spence Kennedy said...

I very much like that 'every step' approach, Lynda. It's quiet and practical and doesn't worry too much about the bigger picture. It's difficult to make sense of much of the suffering I come across, but writing about it helps put it in some kind of context. A very Happy New Year, Lynda - thanks for reading & commenting all this time.

Hi Laura. Thanks very much! Happy New Year to you, too. Hope it's a good one.

R said...

I learned more about catastrophic terminal haemmorhage than I ever wanted or needed to know, last year when my mate's wife was dying of a very, very aggressive fast-growing cancer in her neck; it was threatening to erode her carotid artery and so it was expected that she would die of a 'bleed' - when that's a known probable outcome they get given a huge dose of ?midazolam or something drawn up to keep by the bed, advice about dark towels to handle the bleeding and so on. I can't begin to imagine how many towels you'd need for 6 litres, though... thank heavens, Lily managed to die *without* bleeding so Russ didn't have to face that particular nightmare along the more general one of losing his new wife just weeks after they got married.

:( Poor neighbour, poor caregiver and poor Frank - what a horrible thing to be facing. Hopefully the neighbour was well away before she had time to realise what was happening (we were told that the patient generally is in such cases).

jacksofbuxton said...

Such a shame that you get to see Frank in such sad circumstances.

I'd better not let Mrs Jack know about the cow-bell.She might get ideas.

Health,wealth and happiness to you and yours for the New Year Spence.

Spence Kennedy said...

That's a horrendous story, Becca. Unimaginably difficult for Lily and Russ. I've not heard of the dose on the side before, but it sounds like a humane consideration.

In fact, I have to say that despite a few years in the ambulance now, this is the first time I've come across such a catastrophic end with cancer. I've come across triple AAAs and such, but nothing related to terminal Ca that was so sudden and awful. I suppose the comfort from that is that it's probably a rare presentation.

Anyway, in the spirit of those sudden and incongruous changes of mood that we live with in the ambulance: Happy New Year, Becca!

Hi Jacks
Yep - not ideal. Great to see him, though. I have to say (and speaking as an atheist) if there did happen to be something with a beard up there looking down, they must surely smile and recognise Frank as an angel doing good work down here on earth (I'm a fan, as you can prob tell).

Happy New Year, Jacks: pours something golden & peaty into two tumblers - which sounds disgusting, but you know what I mean. clink / glug / smash

Hesperus said...

As ever, such clear,human writing, best wishes to you and yours for the year to come and thankyou so much for your words..

Spence Kennedy said...

Thanks v much, Hesperus. Much appreciated. A very Happy New Year to you and your family, too.

Gerry said...

My father suffered a ruptured aortic aneurysm. He, by some miracle, survived the 50mile dash to hospital and the subsequent 14hrs of surgery. I've never had the chance to ask anyone the following, I hope you don't mind and completely understand if you'd rather not answer.

He didn't bleed out, as far as I know. The blood was all internal. He did need massive amounts of transfused blood and obviously was on bypass but I've always wondered, when his surgeon opened his chest and abdomen, did the blood just pour out onto the floor?

His aneurysm was massive, approximately 14cm. Someone was looking down on him that night. He is still alive, 15.5yrs later.

Spence Kennedy said...

Hi Gerry

I'd say someone was definitely looking out for him! That's a tough thing your Dad went through - not least the 50 mile trip to hospital.

It's worth saying that technically speaking 'bleeding out' doesn't mean losing it all over the floor. So long as the blood is out of useful circulation it's as good as lost. So you can actually bleed out internally without spilling a drop. And then of course there's the effect all that free fluid has on other organs.

As far as the aneurysm itself goes, I'm guessing it was an Abdominal and not a Thoracic aortic aneurysm. They're both medical emergencies, but a ruptured thoracic aortic aneurysm is more problematic - given its position.

When they opened him up they would have had some aggressive aspiration to hand to prevent any gross spillages, but some would've occurred, no doubt (I've not been in theatre when they've opened someone up, so it's a bit of a guess).

Hope your Dad's fit and well today, Gerry. Sounds like he's doing fine.
Happy New Year to you both - and to the rest of your family!

Gerry said...

Thank you for replying and for answering my question. It was an abdominal aneurysm, I saw him in the ITU and seriously thought I'd lost him, he'd been cut from the bottom of his neck to the bottom of his stomach (sorry i don't know technical terms). He held on in there and aside from his age catching up on him he is doing really well.

There is zero doubt in my mind that the actions of the paramedics that night saved his life. They were in the house and got lots of water(?) into him incredibly fast. They and the police got him to hospital and within the hour he was ready for surgery. I was able to thank the paramedics, the place my Dad lives is small and everyone knows everyone. They told me the only thanks they need is knowing he was ok. They were amazed.

We don't have any other family, it's just me and him. Every day I thank the medics and whoever was looking down on him for giving me an extra 15yrs with him.

Spence Kennedy said...

No worries, Gerry. A desperate situation for your Dad and you, but it sounds like the system worked really well, which is brilliant news. I also like the sound of a place where everyone knows each other. It makes it all much more personal. Anyway - great stuff. And thanks again for writing.

Elizabeth McClung said...

Thank you for your clear writing. I am glad you weren't backed on calls, thanks for taking the time to clean up. I was unclear if the 'finely chopped liver' was lung tissue or fecal?

I asked an optomistrist how bleeding from the eyes occurs, if it is through the nasal cavity. They said primarily a rupturing of the fine tissues around the eyes. Though it sounds like not in this case.

Thank you for the details. I try to understand that EMT's and like are outside the disease, non-identifying. I can only think, from the blood in lungs and lips, of how many minutes she spent suffocating - I hope it was only five.

Spence Kennedy said...

Hi Elizabeth

I know some of these details can be pretty grim, but the blog tries to look at our work straight on, and sometimes that means some unpleasant stuff. I hope it doesn't come across as prurient in any way.

I'm afraid it looked to me like lung tissue. I don't think she bled from the eyes, it was just where it pooled after coughing it up.

We try to stay objective for the sake of what needs to be done, but I hope I'm not 'non-identifying'. In fact, I try to be as 'identifying' as possible - 'there but for the grace of God' and all that!

Thanks very much for the comment, Eliz.

Anonymous said...

Gosh what a horrible job, poor lady.
Having lost my big brother a few months ago to lung cancer, I even more thank the hospice that looked after him at the end.
My love and best wishes to you all.

Spence Kennedy said...

One of the shocking things about this incident was how sudden and unexpected it was. I think up to that point the family had been coping with the illness pretty well at home. I don't know that much about the subject, of course, but my impression is that acute and catastrophic presentations like this are pretty rare.

Very sorry to hear about your brother, Lollipop. I think hospices do an amazing job. I'm glad your brother was well looked after in the final stages of his illness. x

Eileen said...

I think it was Medic999 described the scene when it happened to someone in their kitchen.
And a colleague of OH's is a vascular surgeon who always had a go and saved several AAAs. One went on the table. The entire theatre looked like your lady.

Spence Kennedy said...

I thought it might be a bit optimistic talking about having aggressive suction to hand in the operating theatre - or at least, sufficient to cope with a major bleed. Distressing & desperate stuff. Fantastic that your friend had the skill to save those lives like that. :)

Ursula said...

Oh gosh, this brought back memories ... A close family friend died of a haemorrhage like this when I was about 16, and even though I didn't witness it, my grandmother did (she had been caring for this person for some time - I suspect the shock of witnessing the death contributed to my grandmother's terminal cancer that killed her the following year four months after diagnosis.) When I got home from school that day no one was there because they were all at the dead person's house sorting things out, and when I called my dad, he asked if I wanted to come over to "say goodbye" and I was horrified. Of course the body had been cleaned up by that point but I didn't understand this. I still want to break down whenever I think about what our friend must have gone through or what my grandmother went through, she would never talk about it in detail, she just said the person called out for her and my grandmother brought a bucket over but then it was too late

Spence Kennedy said...

Hi Ursula
It sounds as if your family were pretty involved in all aspects of this person's care, which is a lovely thing - particularly your grandmother. A traumatic event for everyone, though. I hope the funeral went well, and everyone had a chance to say goodbye together.
Thanks for the comment, Ursula.