had a vision of Mr Smith collapsing in the middle of the corridor: ‘Please, wait a moment and I’ll grab you a wheelchair.’
To make things easier, I used a portable shower chair, so that once I had him seated I could just roll it straight over the toilet and he wouldn’t have to move one bit. As I wheeled him down the corridor I noticed he was still wheezing, not nearly as badly as he had been on admission, but I still set him up with some portable oxygen to help things out.
Naturally, I wasn’t keen to leave Mr Smith alone, so I waited discreetly outside the partially open bathroom door, calling out every 30 seconds, ‘Are you okay in there?’
To which he responded, ‘Can’t a man take a crap in peace?’
But on my fourth call, Mr Smith was silent, and then I heard a thump. My heart leapt into my throat as I rushed in.
Mr Smith was still sitting in the chair, but he had slumped against the wall with his eyes staring sightlessly ahead. His nose and lips were a bluish purple, and darkening before my eyes.
This was it: my first arrest.
I’d actually felt a little envious of fellow student nurses who had been involved in an arrest during their training. I’d also heard experienced nurses casually talking over lunch break, ‘Oh yeah, Mr Brown, he was in VF and we shocked him a number of times; we got lucky – he pulled through.’
But this wasn’t exciting like I’d imagined. I couldn’t ever envisage casually discussing this over a sandwich. This was a nice old man whom I liked and who seemed to like me. A man who had been getting better.
An arrest can refer to arrested breathing, or an arrested heart. In Mr Smith’s case, he definitely wasn’t breathing, and if his heart hadn’t already stopped, it would very soon.
I called out for help, shouting down the corridor, and kept my finger on the call bell, until the doctor and another nurse came running.
The bathroom is not the easiest place to begin CPR and neither is a shower chair.
‘Grab his shoulders and don’t let him fall,’ Dr Jackson instructed as we wheeled him back to his room.
Between the three of us we literally threw him on to his bed and the doctor barked at me to push the arrest alarm.
The alarm was in the corridor. I walked past it dozens of times each day – in fact, I’d often wondered if I would ever get to push it – but suddenly it had disappeared. It should have been right in front of me, but the wall seemed so damned big at that moment.
It could have only been about ten seconds before I found it, but each of those seconds was one more in which the life was draining out of my patient. I jammed my finger on the button – which, of course, had been in front of me the whole time – and raced back into the room.
The doctor yelled at me to begin compressions. Holy shit, compressions. I jumped on Mr Smith’s chest and began pumping up and down at a furious rate, while the other nurse used an Ambubag to pump air into his lungs. The doctor was trying to get some intravenous access, because Mr Smith’s old line wasn’t working – what a horrendous time for a line to pack up. I hoped they wouldn’t blame me for that; he was my patient after all. I could see the swelling around the old IV site where the doctor had tried to inject some medicine.
‘Not so hard,’ the other nurse said to me, as I felt a sickening crunch as a rib or two cracked under my hands.
Within a minute, the arrest team arrived and the professionals took over. They asked me to stand back while they did their work, and in my hurry to get out of their way I knocked over the drinks bottle that was sitting on the bedside. It’s a strange thing to remember at a time like this, but it was a glass bottle full of black-currant concentrate, and when it hit the floor it splattered bright red everywhere, like fresh arterial blood.
As the arrest team got underway, I was amazed at how calm, quiet and confident they all were whereas I was shaking from all the adrenaline pumping through me. I watched as they hooked Mr Smith up to a monitor and wondered if they were going to shock him with the defibrillator, but it was too late for that. He had no electrical activity left in his heart.
In a lot of TV shows, someone yells ‘Stand clear’, and they shock the patient with some paddles, but Mr Smith didn’t need this. In fact, most TV shows get it wrong. Those shocks don’t start the heart, they actually stop the heart. When a heart arrests, the electrical activity which once made the heart beat doesn’t stop immediately: it goes haywire, shooting in all directions. It makes the heart a quivering jelly, shaking with all that uncontrolled current. When we shock someone, we’re trying to briefly stop this craziness, in the hope that the patient’s own heart will start again in a healthy rhythm. Another way to think of it is a lifeguard who swims out to rescue a drowning swimmer, but the swimmer is so panicked, the rescuer can’t do his job, so the rescuer slaps them really hard, to shock them into calming down.
Sadly, Mr Smith died that night and it was not a nice way to die; he was sitting on the toilet for goodness’ sake. The nurse with me during the arrest was Rose. She was in her early fifties, and had been a nurse all her life. She could see how shaken I was and took me aside for a quiet word.
‘There’s nothing you could have done,’ Rose said to me, ‘it’s quite common for people to die on the toilet.’
Registering my surprise Rose told me that it’s not unusual for people to want to empty their bowels before having a heart attack. She then explained that the effort to try to pass a bowel motion was often the trigger that set it off. She even said she’d lost a few in the toilet over the years.
But, instead of feeling better, I began to feel guilty. I shouldn’t have let him go. I knew he should have stayed in his room and used the commode.
‘It’s not your fault,’ Rose repeated, then let out a brief chuckle. ‘There’s no use feeling guilty. When it’s your time, there’s nothing we can do.’
Rose’s words helped a bit but there was still a sense of guilt. I was determined never to let any of my elderly patients use the toilet again; they could wait for the next shift to come on.
Rose offered to help me prepare Mr Smith for his family, who would arrive shortly. This was another new experience for me.
As we began to wash Mr Smith, Rose did something unexpected. Every time she did something to Mr Smith’s body, she would use his name and explain what she was doing, just as you would with a living patient. She was gentle, and spoke softly. You could tell she still cared.
‘I’ve learnt my lesson,’ Mr Holdsworth said, pausing to look me in the eye for emphasis, before continuing. ‘I’ve learnt it the hard way.’
I nodded my head in sympathy, even though I’d heard the story at least three times. He seemed to think of himself as some self-sacrificing guru of wisdom; wisdom gained through pain and suffering. Well, I guess he was at least part right.
‘Don’t make the same mistakes I . . . arrrgh—’ He never finished his sentence because he was clutching his chest.
Having looked after Mr Holdsworth during his last two admissions, I was quite used to his frequent attacks of chest pain.
I placed an oxygen mask on Mr Holdsworth’s face, told him I’d be back shortly, and left the room. When I returned I was armed with morphine. ‘This should do the trick,’ I said as I injected the narcotic directly into his vein.
Often providing oxygen can be enough to relieve a patient’s angina, but if this isn’t enough, then morphine is another option. It not only relieves pain, but helps reduce the workload of the heart.
I watched Mr Holdsworth’s expression as the pain slowly eased from his chest and an almost calm, albeit glazed, look came over his face. It’s sometimes hard to believe that medicine can have such an amazing effect.
‘How