Thursday, February 13, 2014

old trees

One of the carers is waiting for us at the doorway to the house.
‘Front room,’ she says, pointing to her right.
Her colleague is pumping up and down on May’s chest, at the feet of May’s husband Geoffrey, who sits watching the whole thing from his armchair by the window. I take over compressions whilst Rae quickly unpacks the bag and sets to work.
‘This might be distressing for you to watch, Geoffrey,’ I say to him over my shoulder as I feel May’s ancient ribs crackle and snap beneath the heel of my hand. ‘Wouldn’t you rather go next door for a while?’
Both carers come over to help him up. We pause compressions just long enough to move May down sufficiently to give them room. They shuffle off into the kitchen, the two carers either side, Geoffrey in the middle with his frame.
‘I think she’s been down a while,’ says Rae when they’re out of ear shot. The defib shows a resoundingly flat line, and although May still feels warm, her pupils are fixed, and there’s a torpor to her eyelids and face.
The first carer comes back in.
‘Anything I can do?’ he says.
‘So what happened, exactly?’
He tells us they’d only just arrived themselves, found May unresponsive in the armchair beside Geoffrey.
‘Geoffrey thought she’d gone,’ says the carer. ‘But I wasn’t sure when. She was okay at breakfast, but that was a couple of hours ago.’
‘How’s May’s health?’
He waggles his hand from side to side. ‘Not eating and drinking all that well the last few weeks. Antibiotics for an infection, but nothing major. It’s all a bit of a shock.’
‘How old is she?’
Rae has the laryngoscope in May’s mouth now, pushing down the tongue to visualise the cords.
‘She’s definitely been down a little while,’ she says.
But we’ve started, and with no absolute certainty about times, we’re obliged to continue.


Twenty minutes later we stop CPR and record the time of death.
We start clearing up the room, making May comfortable and presentable. A cushion and a blanket.
The carer brushes her hair.
‘She was a character,’ he says. ‘A bit sharp sometimes. You were never in any doubt what she thought. But once you got used to her ways she was brilliant. A heart of gold.’
He straightens up and takes a last look at her.
‘Goodnight, May,’ he says. Then he quietly put the brush back on the side table, and goes back out to the kitchen.


Geoffrey has a tartan rug over his shoulders, a cup of tea in his hands.
‘She’s gone, hasn’t she?’ he says when I walk in.
‘I’m so sorry, Geoffrey. We did everything we could, but I’m afraid May has died.’
He closes his eyes, not crying so much as blindly absorbing the shock of the word, powerfully sharp and sudden, like I’d just shot an arrow into an old tree.
‘I held her hand,’ he says after a while. ‘I didn’t want her to go.’
The carers are sitting either side of him. One takes his tea so he doesn’t spill it, the other hands him a tissue.
‘Thank you for all you’ve done,’ he says. ‘You’ve been kind.’

Just beyond the three of them is a large patio window. It’s been raining all morning, but it’s got progressively worse and now a storm has come in. The black and twisted branches of an ancient apple tree just beyond the terrace whip violently back and forth, and fierce gusts of rain rattle across the glass.

‘Oh my good God’ says a carer.

Everyone but Geoffrey looks up.


jacksofbuxton said...

A certain amount of dignity there from Geoffrey,as well as a touch of heartbreak.

md said...

I am curious about what the "rules" are in the UK regarding things like CPR. I understand that, once you had started you had to continue and that, in this case, someone else had already started CPR before you had even arrived, but are there circumstances when, even in the absence of any specific written legal or medical directives, that you are allowed to just not start at all and leave things as they are?

Spence Kennedy said...

Morning Jack - I suppose as far as end of life circumstances go, dying at home holding your partner's hand must rate as one of the best. Absolutely heart-breaking for Geoffrey, of course. Lovely guy - and lovely carers, too.

Hi MD - In situations where there are clear signs incompatible with life you don't do CPR. But sometimes it's equivocal, and it's only when you're actively engaged in CPR that you become aware of the 'discrepancies' (quite subtle things that you may have missed in the bustle of the emergency situation). In those cases, where you're not sure, it's easiest and safest just to continue the full 20 minutes of ALS and worry about it afterwards. At least you can always say you did your very best. So far I have to say it's pretty clear when you turn up. The most awkward detail tends to be the DNAR form - whether it can be produced or not etc. Hope that helps.

Thanks for the comments!

Anonymous said...

Spence, I lost my mother last week, but unlike May the carer told Dad to call 999 and then after the car arrived her heart attack peeked and she lost rhythm. While the career and crews at the sceen brought her back when we got to the hospital they warned us it was just the drugs keeping her alive and did we want them to keep going. That I think was the hardest time.

I been reading your blog for 4 years and just wished to say the crews I have meet over the last few months have been amazing.

Spence Kennedy said...

I'm so sorry to hear about your mother, Anon.

I think Advanced Life Support is so effective these days it quite often happens we get a return of circulation, but unfortunately it can be difficult to maintain. I can't imagine how difficult the decision you had to face in the hospital must have been.

I'm so glad you've had a good and positive experience with the crews you've met over the last few months. It's so kind of you to mention it, especially given what you've been through.

Thanks for the comment, Anon - and for reading all this time. I very much appreciate it.