In the Midst of Life

succeed in its furious efforts.
     
    It has probably been known for centuries, even millennia, that the heart can stop, and be restarted, although nothing was written about it for posterity. Nearly two hundred years ago, a Dr Silvester described how it could be done, by laying the patient on his back and raising the arms, to aid inhalation, then lowering the arms and pressing them against the ribs, to aid exhalation. It is not recorded whether anyone believed him in the early 1800s.
    A century later, the idea was taken up by several doctors, and a similar technique described, combined with mouth-to-mouth resuscitation. This technique was included in
Scouting for Boys
by Baden-Powell, published in 1908. Few other people took it seriously, and certainly not the conservative medical profession, who always take decades to accept a new hypothesis. But, for the whole of the first fifty years of the last century, it was vaguely known that if you fished someone out of the canal, or something like that, mouth-to-mouth puffing and rubbing the chest could sometimes be effective in restoring life.
    Eventually, in the 1950s, the medical profession got on to the idea, and the modern techniques of cardio-pulmonary resuscitation (CPR) were developed at the Johns Hopkins Medical Research Faculty in Baltimore, USA – although many other medical teams in other countries were working on the same theories. Within adecade, their findings and teaching had gained widespread acceptance throughout western medicine.
    Different techniques were developed and experimented with. The open-heart resuscitation that I witnessed being applied to Dr Hyem, was the first method adopted by the medical profession, and its popularity lasted for around ten years. It has been replaced by electrical impulses, or shocks, directly administered to the heart, which are no less violent, but more effective. The giant international drug and engineering companies started competing with each other for the huge financial gains to be accrued from producing ever more powerful cardiac stimulants, and manufacturers of surgical equipment bent all their efforts into resuscitation technology. It was big, big business.
    From the 1970s onwards in the UK (earlier in America), the intensive care unit and resuscitation became central to clinical practice, and no hospital could afford to be without the latest techniques and equipment. ‘Crash’ was all the rage. Everyone was very gung-ho about it and cheerfully tried it on almost any dying or dead patient. Young doctors, nurses, and technicians had to be taught the techniques and older ones needed to practise. Pompous old consultants and starchy old ward sisters who questioned the technique were told to get up to date and live in the real world. Those who warned about ‘playing God’ were told they were religious fanatics and everyone would be better off without them.
    Those were exciting days to be in medicine. Anything was possible. We could conquer death itself. Job vacancies appeared in the
Nursing Times: ‘Be in the Front Line. Be a Life Saver. Join the
Resuscitation Team. Work in the Intensive Care Unit at Hospital.
Apply in writing.’
Adverts like this were quite common, and I attended a conference where this type of wording was strongly condemned by the RCN.
    Exhilaration was in the air; but then, slowly, the demoralising feeling sneaked up on us that something was not quite right. Respect for the dead had been thrown out of the window.
    *
    Thespeed with which resuscitation swept through the medical profession was astonishing, and it was far too quick for it to be properly thought through. Drugs were introduced with bewildering haste – too hasty for proper trials to have been conducted. I gained the impression, in those days, that new cardiopulmonary drugs were tried on patients, the attitude being, ‘He’s dead, anyway, so there’s nothing to lose.’ The equipment and the voltage of electricity was hit or miss because no one really knew how far to turn up the dial. Medical and paramedical staff had to master techniques that could only be learned on the job.
    When I was a staff nurse at the London Hospital, we had a death on the ward. I was off duty at the time, but the next day the ward sister told me that she went behind the screens about twenty minutes after the patient had died to ensure that the eyes were closed and the chin supported, and found two young doctors trying to insert a central line into the