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 dont 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.
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, Id 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 Smiths 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 Smiths old line wasnt working what a horrendous time for a line to pack up. I hoped they wouldnt 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. Its 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 didnt need this. In fact, most TV shows get it wrong. Those shocks dont start the heart, they actually stop the heart. When a heart arrests, the electrical activity which once made the heart beat doesnt 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, were trying to briefly stop this craziness, in the hope that the patients 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 cant 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.
Theres nothing you could have done, Rose said to me, its quite common for people to die on the toilet.
Registering my surprise Rose told me that its 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 shed lost a few in the toilet over the years.
But, instead of feeling better, I began to feel guilty. I shouldnt have let him go. I knew he should have stayed in his room and used the commode.
Its not your fault, Rose repeated, then let out a brief chuckle. Theres no use feeling guilty. When its your time, theres nothing we can do.
Roses 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 Smiths 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.
Heartless
Ive learnt my lesson, Mr Holdsworth said, pausing to look me in the eye for emphasis, before continuing. Ive learnt it the hard way.
I nodded my head in sympathy, even though Id 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.
Dont 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 Holdsworths face, told him Id 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 patients angina, but if this isnt enough, then morphine is another option. It not only relieves pain, but helps reduce the workload of the heart.
I watched Mr Holdsworths expression as the pain slowly eased from his chest and an almost calm, albeit glazed, look came over his face. Its sometimes hard to believe that medicine can have such an amazing effect.
How much that time? Mr Holdsworth asked.
He always asked this and every time I was reluctant to answer. Its not as if he didnt need the medicine. People rarely ask how much. Maybe it was his background that made me reluctant, or maybe it was because I was giving him more each time, which meant his heart was getting worse.
Thirty milligrams, I reluctantly replied, avoiding his gaze.
Hell, Ive never had that much in one go.
Mr Holdsworth didnt sound upset, more intrigued, as if curious about how much his body could take. You see, Mr Holdsworth used to be an intravenous drug user. Over the years that he had injected morphine into his veins, he had built up a resistance to the drug. This was also how he damaged his heart. Most of the damage occurred on the occasions he took so much that his breathing stopped (one of the primary risks of morphine). Once his breathing stopped, it wasnt long before his heart stopped. Fortunately paramedics were able to revive him. Each time, he survived, but the damage to his heart was permanent.
Not a good sign is it? he added.
Sometimes it pays to tell the truth, even when it can hurt, but its still hard. Should I tell him that Ive never given such a high dose of morphine in one push, or given it as frequently to one patient, in my entire career? Should I tell him that Im even a little nervous giving 20 to 30 milligrams pushes of morphine every half an hour? He probably already knows this, especially given his background. He probably already knows that for most people one to two milligrams is a sufficient amount.
Youre probably just having a bad day, I replied with false bravado and an equally false smile.
Now I know youre trying to be nice, but stop the bullshit. You know as well as I that I probably wont make it to Christmas.
Mr Holdsworth tried to say this as casually as if he was talking about the weather, but I could tell his efforts were as forced as mine.
Youre still young, there is a chance. Something could happen any day.
Unfortunately, Mr Holdsworth had had his first heart attack at the relatively young age of 36. It had been his first wake-up call, but now after four heart attacks, and four subsequent areas of dead, scarred heart muscle, there was very little that either drugs or a healthy lifestyle could do to help him. Christmas was one month away and unless a miracle happened Mr Holdsworth was probably not going to see it.
Still, we had to hope, sometimes its all that keeps us going, and there was one chance, one possibility, that we could help Mr Holdsworth. At the age of 47, the only thing that could save him was a new heart, but after five years on the waiting list already, it seemed a very small chance indeed.
With Mr Holdsworths rapidly declining health, the topic of conversation was often how much longer he would last, and whether a miracle would happen.
I feel sorry for him sometimes, Jenny said to all the other nurses in the office, but at other times, I think he doesnt deserve our compassion, or a new heart.
I know were supposed to be caring, but were only human, I said to Jenny. Today I felt sorry for the poor guy, but Im like you. I dont always have much sympathy for him.
As I looked around at the other nurses in the office I could tell, by the nodding heads, that we all seemed to have similarly mixed feelings. I guess it doesnt really matter what we think now, Jenny continued, hes paying for his mistakes.
Four weeks passed. It was now only a few days until Christmas Day. The girls had been busy decorating the ward, and I nearly broke my neck balancing precariously on a patients bedside cabinet to put the finishing touches to the tree. I love this time of year everyone is in such great spirits even the patients dont seem so sick.
With half the ward empty we had time to sit around gossiping and reminiscing about who was the drunkest at the Christmas party until it came time for me to check on Mr Holdsworth.