In the Midst of Life

iliac vein in the groin.
    ‘What are you doing?’ she demanded – ward sisters had a presence in those days. The young men looked up at her guiltily.
    ‘Have you no respect for the dead?’ she said contemptuously, as she covered the body with a sheet. They said nothing, and went away.
    My sister Pat is a Queen’s Nurse (Queen Alexandra Royal Army Nursing Corps). She trained from 1965–69, mostly in Singapore. She returned to England in 1969, to Aldershot Military Hospital, and was put straight on to night duty. The first night, she took the report and was told that if an emergency occurred she must press the AMSET button (Army Medical Services Emergency Team), but she was not shown where the emergency button was situated.
    She did the usual drug round and noticed that a man was not in his bed. Thinking that he would return later, she finished the drug round, which took about half an hour. By then, he still had not returned, so she went to look for him. She couldn’t get into the lavatory, and so she crouched down on the floor to peer under the door, and saw two feet sticking up. Her first thought was to press the AMSET button, but she didn’t know where it was. She searched everywhere, poor girl, but still couldn’t find it. So shetelephoned the night sister, who called the emergency team. They came with mobile resuscitation equipment and dragged the dead man out of the lavatory.
    Pat told me that he was quite cold and stiff, and must have been dead for some while, because she had done a complete drug round and then spent time searching for him, then more time searching for the AMSET button, before the team arrived. Nonetheless, with all the drugs and equipment at their disposal the team attempted to resuscitate.
    Pat said, ‘He was an old man, bless him, over seventy, and he was sick. I watched it all with horror, all that violence. There was no way they could get him back to life; he was quite dead, stiff and cold. But they carried on. Eventually, they gave up, of course. He had had a ruptured aortic aneurysm.’ A ruptured aneurysm is not cardiac arrest, so resuscitation attempts in this situation were futile and inappropriate.
    When I trained at the Royal Berkshire Hospital in the 1950s, there was no resuscitation. My niece, Joanna, trained at the same hospital twenty-five years later, and I asked her how much of it went on. She said,
    ‘It was relentless, every day on every ward throughout the hospital. Every bed had a crash button beside it. There were half a dozen crash boxes around the ward, and the crash trolley placed centrally. If anyone died the nurses had to rush to the bed, press the crash button, detach the top and bottom of the bed, lie the patient flat with no pillows and start banging hard on the chest, pumping the sternum up and down to force a heartbeat, whilst a second nurse had to do mouth to mouth resuscitation until the crash team arrived. Then they started intensive resuscitation with drugs and electrical equipment. All nurses had to do this; it was a rule and was absolutely enforced. There was nothing we could do about it. We young nurses would ask the sisters, “Why? Why old Mrs C or why Mr S? Why is he not No Crash? He’s terminally ill. He’ll never get better.” The sister would say, “I don’t know, but we’ve got to do it. All I can say is don’t rush, don’t be in too much of a hurry to press the crash button, don’t bang too hard on thesternum – if you can delay things for a few minutes, he might be able to die before the crash team can get at him.”’
    I told Joanna about the solemnity in a ward that had accompanied a person to their death when I was a young nurse. She said, ‘Well that’s all gone. When I trained it was rush, noise, panic, even shouting sometimes.’
    I asked Jo what the success rate was. She thought a bit, then said, ‘Very low. I can’t really put a percentage on it, but very low. The trouble was that very often the body would twitch, and they thought this was a sign of life, and when the electric current hit the heart the body would really jerk – again, taken as a sign of life. But it’s not, at least not necessarily. There can be a twitch, more than one, after death, which I think is part of the nervous system shutting down.’ I agreed with her, and said that quite often I had seen someone die, and then, a minute or even two minutes later, suck in a great noisy gulp of air, which is called an ‘agonal gasp’.
    She laughed and