I park the
ambulance as close to the EMI unit as possible so we don’t have far to walk in
this downpour, but by the time we’ve pulled all the equipment we need out of
the back of the truck and jumped across all the puddles in the driveway, we’re
soaked.
‘God that’s awful!’
‘Bloody hell!’
We take what
shelter we can from the little canopy over the door, until one of the care
staff opens up for us.
‘Follow me,’
she says. ‘Stella has a DNAR.’
She leads us
through a couple of security doors, then down a corridor with a carpeted floor
that gives a little and creaks as we walk. Past closed doors with colour-copied
pictures of each resident sellotaped below the number; past the nurses’
station, the sluice, the laundry. Past the games room, where a number of
residents are sitting in small groups quietly playing cards or board games, or
painting pictures. They don’t look up as we pass.
‘Here we are.’
The carer knocks
and shows us in.
Stella is lying
on her back on the bed, making feeble, agonal gasps. She’s terribly emaciated, her
arms and legs drawn up, all the hollows of her body accentuated, the mortal
structure of it, the iliac crest of her hip pushing up beneath a meagre
covering of skin.
‘Could we see
that DNAR please?’ says Rae. The manager – a small, powerfully-built man with
the air of someone more used to receiving forms than handing them out – passes her
the red-margined document.
‘Dated and
signed,’ he says. ‘As you can see.’
‘Fine. Thank
you.’
Stella’s gasps
fade to nothing as the arrest proceeds.
‘Shall we sit
her up?’ says one of the carers.
‘No. I don’t
think so,’ says Rae.
She feels for
Stella’s pulse, then takes out her stethoscope and listens to her chest. I
stick on some ECG dots and watch the line run flat on the printout, clear and
unequivocal.
After a moment
or two, Rae says: ‘Stella has died now.’
I write the
time down.
Rae questions
the staff about the sequence of events whilst I tidy up the equipment and start
filling in the ROLE form.
The room is stuffy
and foul-smelling. Stella collapsed on the toilet, and the faecal smell, along
with the heat from the radiators and the heavy, plaid curtains drawn across the
windows, gives the room an unpleasantly closed-in feel.
‘Let’s finish
this paperwork in the office,’ says Rae. We leave the carers to clean Stella
up, and follow the manager out into the corridor.
He leads us back
to the nurses’ station, where Rae rests on the counter to finish up.
‘Would you like
a cup of coffee?’ says the manager.
‘That’s very
kind, but we’re fine, thank you.’
‘You’re sure?’
‘Yep. Thanks.
Almost done.’
The station is
just a long, narrow recess with a series of windows along the back that look out
onto an overgrown garden. Even though the rain is still coming down hard, there
must be a break in the cloud, because the room is suddenly swept with a clear,
hard light – so intense, that every detail in the office stands out, like a
painting on a broad canvas: the browning tips of a potted dracaena, a black
SuperDry jacket and black nylon satchel hanging on a hook; an old style fax
machine with a note that says: Feed
sheets separately; a drugs company calendar with a cute quote about doctors
for May; a shelf above a low filing cabinet with a bag that says in big red
letters: Emergency Bag, and
underneath, taped to the front of the shelf, another sign, saying Emergency Bag, in blue, with an arrow
pointing straight up.
The burst of
sunlight passes, and the room becomes dim again.
Rae finishes
the paperwork.
She hands him
the forms.
‘Thank you. We’ll
notify the doctor,’ says the manager. ‘I’ll show you out. You need the code.’
We follow him
back along the corridor.
Everyone in the
games room is sitting as before, the patients absorbed in their games, the
staff encouraging them. One of them looks up from his hand of cards as we pass.
‘Thanks again
for all you’ve done,’ says the manager, holding the front door open for us.
It’s pouring
outside.
We move as fast
as we can, but our gear slows us down. We stow the bags, slam the doors, squeal
as we jump in the cab.
‘Jesus!’
‘Christ!’
But we’re safely
out of the rain now, the wonderful, tumultuous rain, roaring and rattling a few
inches above our heads, on the roof.
6 comments:
Spence, how difficult are these? Must be awful to have to stand essentially idle as somebody dies next to you.
Spence, Good writing here. I like the rain, and the cursing about it, as bookends to the story.
When someone has a DNAR and they arrest, are EMTs always called?
Hi Alan.
It is difficult, but then again, Stella was so ill that death was an inevitable outcome. The DNAR is a humane and pragmatic response to that, and gave her a dignified death (rather than the trauma of a resus whose outcome was inevitable).
Wayne - Thanks! Yep - they always call an ambulance. Essentially the DNAR is specifically about cardiac arrest, not treatment, and it's not always clear to the staff at the time what stage the patient is at. It's also about recognising death and administrating the next stage.
It's a little confusing that this is a nursing home. You'd think there might be other ways of dealing - but I think that's probably it. And ultimately, it's protecting themselves against any accusations of neglect / legal action. Easier and safer to have some kind of buffer.
Cheers for the comments!
Did someone hold her hand?
It must go against all your training to just watch over someone dying,but I suppose a DNAR means at least everyone knows where they stand for all that follows.
TV - That's a good question. And I really wish I could say that someone did. But for whatever reason, between us all - the carers hurrying around fetching folders and forms and such, the manager overseeing things, us collating the information and making the clinical observations - such a profoundly important, basic human action got overlooked. It's of small comfort that Stella was unconscious and wouldn't have known; spiritually, I think it's still a vital connection to make.
But of course, things don't always go as they should. Rae and I talked about it afterwards. We're both annoyed we let it happen like that, and we're both determined we won't make the same mistake again.
Jack - I think DNARs are a positive development. They avoid a lot of unnecessary intervention, and let people die when they need to. It's a difficult conversation for the clinician to have with a patient in advance, of course, but I'm glad it's happening more often.
Cheers for the comments!
Post a Comment