Read In the Midst of Life Online
Authors: Jennifer Worth
It was a couple of months before I managed to speak to Kelly. I had asked, but perhaps she did not want to talk to me or anyone else so soon. But a couple of months later, after she had been on holiday, she felt ready to re-live that fateful morning.
Kelly told me, as Beatrice had, that she had driven to the house to take her mother shopping, and found her dead in her chair.
‘She was sitting quite still and peaceful, but absolutely dead – there was no mistaking that. I reckon she had been dead for quite a long time, because she was in her nightie. When she was expecting me for our weekly shop, she would always be up and dressed by about 9 o’clock. But it was 10.30 and she was still in her nightie … so I reckon she died before 9 o’clock.’
Her voice was very quiet, and it faltered several times as she spoke. She continued:
‘I didn’t know what to do … I suppose the shock made me panic. My first thought was,
I must get help,
so I rang 999. I spoke to a man, who said, “I have ordered the ambulance crew, and until they get there you must start resuscitation.” I said, “It’s too late, she is blue.” He said, “No, you must.” I repeated, “It’s much too late. She’s quite dead.” He ordered, “You have
got
to. Get your mother on to the floor, and do as I say. I’ll talk you through it, until they arrive.” I struggled to lift my mother, and told him, so he said, “You
must
get her off the chair and on to the floor.” I ended up pulling her. It was an awful thing to have to do.’
I gently asked, ‘Why did you do it? You don’t have to do what a voice on the telephone tells you to do.’
‘No, I know. But I suppose I was numb with shock … I don’t
know …’ Her voice trailed away. ‘Then he said, “Start firm, hard pressure on her breast-bone, rhythmically, about two beats per second. I will count you through, start now – one, two, one two.” I did … and then … I heard that crack, from her ribcage.’
She couldn’t speak after that for a long time. I didn’t know what to say. I think I murmured, ‘You poor soul,’ or something like that. Eventually she was able to carry on.
‘Two men came and took over. They pushed a tube down into her windpipe and pumped in air, or perhaps it was oxygen. They cut open her nightie and wired her up to a machine, which they switched on. I couldn’t bear to see her like that, on the floor, she was so modest, her nightie pulled away, and two men over her. I tried to cover up her lower parts, so she wasn’t too exposed – it was silly, really – but I kept thinking how mortified she would have been.
‘I went and telephoned Beatrice. There was nothing I could do. The men carried on for ages. They were talking to each other and I heard the words “an atrial response”. My sister arrived, and asked them to stop, but they wouldn’t. Mum’s colour began to return. She had been very grey, but the pink colour was returning to her skin. Then the ambulance arrived. Two paramedics came in with more equipment. I don’t know what it all was. They started injecting her feet, about one injection every few minutes, and Mum was looking much better, in fact she looked quite normal; she just wasn’t breathing.
‘Beatrice was getting quite upset and begged them to stop – they said they could detect a response – she shouted that it was the oxygen making her look better, and there was no response because she was dead, couldn’t they see that? But they took no notice and carried on. They must have been at it for more than an hour, because it was getting on for 12 o’clock when they finally gave up.’
Kelly was so distressed, I felt that perhaps I had been tactless, and shouldn’t have asked her to re-live that morning. I said something to that effect – it was hard to know what to say. But she replied, ‘That’s all right – I agreed to speak to you, so I will.’
‘Next,
the police arrived. The paramedics told them what they had done, and packed up. They covered my mother with a spare duvet cover on the floor while the police took a statement. Then they wanted another one from me, which they wrote down. After that, they did a full body examination of my mother. This has to be done in the event of an unexpected death, they told me, in case of foul play or homicide.
‘The policewoman phoned the undertakers, and they arrived. They asked if we wanted to say goodbye to our mother before they took the body away. We did, of course we did, but, you know, it’s not so easy when there are two police officers in the room, and pagers bleeping and voices talking, and undertakers wanting to get on with their job. So we didn’t really get to say goodbye to her. The undertaker took her, and we never saw her again.
‘She had to go for post-mortem, because it was an unexpected death. Even though Mum had a known heart condition, and had had a previous severe heart attack, a postmortem had to be done because she had not seen a doctor for about six months.’ Apparently, if you have not seen a doctor for a fortnight before death, the law is that a post mortem must be carried out to discover the cause of death. In fact, it is very rare for any sudden death at home not to be referred to the coroner for postmortem examination.
‘We were asked if we wanted to see her after the postmortem when she was back in the undertaker’s parlour. But I didn’t want to. I knew all the time I would be looking for the incision marks of what they had done to her. I saw the postmortem report – every part of her had been opened up and examined. I didn’t want to see what they had done.
‘The coroner reported the findings on autopsy:
1. Ischaemic heart disease
2. Old myocardial infarction
3. Acute myocardial ischaemia.
‘The coroner said that establishing the exact time of death was always difficult, but it could reasonably be stated that death had
occurred before 9 a.m. – that was one and a half hours before I found her, and before resuscitation was started.’
We talked a little about the sadness of it all, and Kelly said:
‘I think she had a peaceful death – there was no sign of a struggle, or anything like that, and her face looked comfortable and happy, not anguished, as though she had been in pain or distress. By the time all that resuscitation was started she wouldn’t have known, or felt the pain of those electric shocks, the tube being pushed down her throat, or the injections. In spite of what they called “an atrial response” I don’t think she would have known anything about it, and felt no pain or shock.’
Then Kelly told me something that interested me greatly. She said:
‘I was talking about this with an acquaintance, and she told me that her mother had died one Christmas lunchtime, and that the family called no one. The men of the family simply carried her to her room, and laid her on her bed. They did nothing, because four years previously she had suffered a heart attack and had been successfully resuscitated. After that, she was so brain-damaged that she had to be looked after constantly. The family didn’t want it to happen a second time.’
I don’t call it ‘doing nothing’. I call it respecting the dead in an appropriate and humane way, and enabling the family to say goodbye to their mother.
I am grateful to Beatrice and her sister Kelly for their kindness in giving me this information, knowing that it was for publication. My sympathies go to them both for the troubled memories they retain. But I am sure that Kelly was right when she said that her mother died peacefully – she died quietly in her own home, in her own armchair, which is what we all hope for. It was what happened afterwards – events for which they were not responsible – that was grossly disturbing.
Beatrice’s words to me, when she told me what had happened, stick in my mind. She’d said, ‘The trouble was, we’d never discussed it. We didn’t ask her what we should do if she had another attack.
We
should have done, because we knew she had a weak heart, and it could happen any time. But we didn’t. I think everyone should talk about these things.’
Beatrice is right – everyone
should
discuss these matters, and make their wishes known. But accurate knowledge of the reality of events is in short supply. Most people get their information from the media, especially television hospital dramas, which portray a fantasy world in which resuscitation is usually successful and has no side-effects. There is a lot of debate amongst medical ethics committees, which is valuable, but their efforts are hampered unless the general public knows what the real issues are.
Everyone
should have proper information about what resuscitation involves; what the initial success rate, the long-term success rate, and the possible side effects are.
Cardio-Pulmonary Resuscitation may be more carefully monitored and restrained in hospitals today, but the incidents in the community are increasing. For example, in 2010 St John’s Ambulance started a national fund-raising campaign to raise money to purchase thousands of Automatic External Defibrillation (AED) machines. This is just one of the many initiatives in the community.
Anyone involved in healthcare, however loosely – police, ambulance crews, clinicians, social workers, Red Cross volunteers, care assistants, first aid workers – all are shown how to use the AED machine, and the rule is that an attempt to resuscitate
must
be made unless there is a clear and unequivocal order not to do so. This is the DNAR order (Do Not Attempt Resuscitation) commonly used in hospitals. However, in the wider community such an order is not generally available, even if it has at some time been made. A person may have a living will, but if they collapse at the shops, who is going to know?
In country areas, where a hospital may be some distance away, lay people are trained and given the equipment to resuscitate, so that they can be immediately available. These people are volunteers, called Community First Responders, and they are linked to the ambulance service. I think Kelly and Beatrice’s mother must have
been treated by such people at first, because two men arrived within a few minutes of Kelly’s phone call, whereas it took about thirty minutes for an ambulance to get to the house, which is in the countryside.
Since the turn of the millennium, portable defibrillators have been developed and are being used in the community. They are monitored electronically, and require no training. You simply open the lid and all the instructions are clearly printed: lay the collapsed person flat on their back, expose the chest, attach the pads to the points indicated, and switch on. The machine will pick up the extent to which the heart is fibrillating. At a signal from the machine, everyone around must stand back, and a shot of electricity is directed into the heart, which will stop the heartbeat altogether, thus stopping the fibrillations. This can be repeated several times, and will usually allow the heart to restart a rhythmic beat, at least temporarily, until an ambulance arrives with trained paramedics who can administer more aggressive treatment.
These defibrillators are now available on the open market, and there is a great deal of interest and excitement about them. Supermarkets, shopping centres, sports arenas all have them. Before many years have passed, health and safety regulators will no doubt require every public place to have one. Our love affair with machinery ensures that, once it is available, it will be used – regardless of whether it is appropriate or not.
Old age is no protection, because this would be described as age discrimination, which is, of course, illegal. I can envisage an old lady, of eighty-five or more, collapsing in a church service. The churchwarden rushes to get the defibrillator. Should the vicar be the one to say, ‘Wait a minute. We all know this lady. Isn’t this what she has said she wants? She is old and ill and lonely. She has told many of us she wants to join her husband, who died ten years ago. She should be left to die in peace. Put away your machine, and in the presence of Death, let us pray.’
Pity the vicar who has the guts to say such a thing. It would split the parish down the middle. Half the old ladies would say he is a
hero; the other half would call for a public unfrocking. Special meetings of the PCC would be needed; the police, magistrates, the local paper, the bishop – it might even reach the ears of Canterbury or Rome!
The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) issues guidelines to their members on when
not
to start resuscitation. They are in cases of:
I suppose it is some small consolation to be told that if I have been decapitated, no one will try to resurrect me!
The ambulance team has an unenviable job. They do their best, but they get a lot of blame from the general public, which is demoralising. In a situation such as the one just described, with Kelly and Beatrice so clearly upset, it must have been profoundly distressing for them. But, legally, no relative can say what medical treatment should or should not be given to another person.
Success for the ambulance team is defined as ‘admission to hospital alive’, and they are duty bound to strive for as long as necessary – up to one hour – to achieve this objective. They are empowered to declare ‘life extinct’, but as long as there is the smallest electrical response it can be argued that life is
not
extinct, and they must continue. Even if the ambulance crew get the patient to hospital alive, the side-effects can be severe, especially if the
brain has been starved of oxygen. Some people in long-stay geriatric wards and care homes are there because of brain damage following a successful resuscitation (see also Appendix I).