In the Midst of Life

ACKNOWLEDGEMENTS

My appreciation and gratitude to all the people who have helped me in writing this book.

My husband, Philip, whose love and loyalty, wisdom and humour have kept me sane throughout

Dr David Hackett, Dr Richard Lamerton, Dr Michael Boyes

Dr Robin Moffat, President of the Medico-Legal Society Susan McGann, Paul Vaughan and Susan Watt of the Royal College of Nursing

Louise Massen and Madeline Bass

Patricia Schooling, for her several readings and invaluable suggestions All those who have supported me in prayer, especially Sister Christine and the Community of St John the Divine, Birmingham; Sister Elizabeth and the Convent of Our Lady, Kettering; the Sisters of the Love of God, Oxford

The Chaplains of the Methodist Homes for the Aged, and St Francis Hospice for the Dying

Colin Rivett, Eve Griffin, Jeremy Buckman, Counsellors

Anna Powiecki, Eugenie Furniss and Claudia Webb at William Morris, Endeavour Entertainment, John Saunders, Kirsty Dunseath, Sophie Buchan and the team at Weidenfeld & Nicolson, Carole Lewis, Sue Theobald, Christoper Howe

David Hart, poet, priest and dreamer

Patricia Birch, Joanna Bruce, MBE; Sue, Jayne and Jane, my sister and nieces who are nurses and care assistants

Lydia Hart, Eleanor Hart

Shelagh and her family in Israel, and Steve and Sandy, Wendy and Philip.

— and the many people who have told me their stories but do not wish to be named.

Excerpt from Nurse on Call by Edith Cotterill, published by Ebury, Reproduced with permission of The Random House Group Ltd.

Excerpt from How We Die by Sherwin B Nuland, published by Chatto & Windus. Reproduced with permission of Random House Group Ltd.

Excerpt from ‘Do not go gentle into that good night’ by Dylan Thomas from Poems, published by JM Dent, a division of the Orion Publishing Group. Reproduced with permission from David Higham Associates.

Excerpt from Four Quartets by T.S. Eliot reproduced with permission of Faber.

Excerpt from Malone Dies by Samuel Beckett reproduced with permission of Faber.

Poems by David Hart reproduced with permission of the author and Five Seasons Press.

All efforts have been made to obtain permission for the use of the excerpt from Truman of St Helens by Shirley Rosen. Anyone with rights to this book is invited to contact the author.

1* from How We Die, Sherwin B Nuland, Alfred A. Knopf, New York, 1993

2* It is very difficult to remove a feed-peg because it is a life-maintaining device. It requires a major medical/legal decision and this is not easy to come by.

3** Ahronheim, J C, Morrison, R S, Baskin, S A, Morris, J, Meier, D E. Treatment of the dying in the acute care hospital. Advanced dementia and metastatic cancer. Archives of Internal Medicine, 1996; 156: 2094-100.

4* A joule is a unit of heat, energy and force – in this case electricity.

5* For an update, see Appendix I, Medical Aspects of Cardio-Pulmonary Resuscitation, by David Hackett, MD, FRCP, FESC.

6* From Shirley Rosen,‘ Truman of St Helens’, published by Madrona Publishers, Seattle, Washington State, 1981

7* Dylan Thomas, 1951.

8* The Resuscitation Council. http://www.resus.org.uk/SiteIndx.htm

9* The Resuscitation Council. http://www.resus.org.uk/pages/mediMain.htm

10* Gwinnutt C, Columb M, Harris R. Outcome after cardiac arrest in adults in UK hospitals: effect of the 1997 guidelines. Resuscitation 2000; 47: 125-135. http://www.resuscitationjournal.com/article/S0300-9572(00)00212-4/abstract f National Cardiac Arrest Audit (NCAA). https://www.icnarc.org/

11* Diem SJ, Lantos JD, TulskyJA. Cardiopulmonary Resuscitation on Television - Miracles and Misinformation. New Engl J Med 1996; 334: 1578-152. http://content.nejm.org/cgi/content/short/334/24/1578

12† Stiell IG, Wells GA, Field B et al, for the Ontario Prehospital Advanced Life Support Study Group. Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest. New EnglJ Med 2004; 3 51:647-656.http://content.nejm.org/cgi/content/short/351/7/647 £ HerlitzJ, Bang A, GunnarssonJ, EngdahlJ, Karlson BW, LindqvistJ, Waagstein L. Factors associated with survival to hospital discharge among patients hospitalised alive after out-of-hospital cardiac arrest: change in outcome over 20 years in the community of Goteborg, Sweden. Heart 2003; 89: 25-30. http://heart.bmj.com/content/89/1/25.abstract

13* Sasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of Survival From Out-of-Hospital Cardiac Arrest. A Systematic Review and Meta-Analysis. Circulation: Cardiovascular Quality and Outcomes. 2010; 3: 63-81. http://circoutcomes.ahajournals.org/cgi/content/short/3/1/63

14† The Public Access Defibrillation Trial Investigators. Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest. New Engl J Med 2004; 351: 637- 646. http://content.nejm.org/cgi/content/short/351/7/637

15* Morrison LJ, Visentin LM, Kiss A, Theriault R, Eby D, Vermeulen M, Sherbino J, Verbeek PR, for the TOR Investigators. Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest. New Engl J Med 2006; 355: 478- 487. http://content.nejm.org/cgi/content/short/355/5/478

16* Neumar RW, Nolan J P, Adrie C et al. Post-Cardiac Arrest Syndrome. Epidemiology, Pathophysiology, Treatment, and Prognostication. A Consensus Statement From the International Liaison Committee on Resuscitation. Circulation 2008; 118: 2452-2483. http://circ.ahajournals.org/

17† Fischer M, Fischera NJ, Schuttlerb J. One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the ‘Utstein style’. Resuscitation 1997; 33: 233-243. http://www.resuscitationjournal.com/ X http://www.karenannquinlan.org/

18* The Resuscitation Council. http://www.resus.org.uk/pages/DNARrstd.htm

19† Allowing a Natural Death: http://allowingnaturaldeath.org/

20† The NHS National Gold Standards Framework Centre. http://www.goldstandards framework.nhs.uk/

21* The NHS Gold Standards Framework. http://www.goldstandardsframework. nhs.uk/

22† Avon, Somerset and Wiltshire Cancer Services Allow a Natural Death (do not attempt resuscitation) Order. http://www.aswcs.nhs.uk/

23† Dignity in Dying. http://www.dignityindying.org.uk/

24* Treatment and care towards the end of life: Good practice in decision making. http://www.gmc-uk.org/End_of_life.pdf_32486688.pdf

25* Mental Capacity Act 2005. http://www.opsi.gov.uk/acts/

26* The Resuscitation Council. http://www.resus.org.uk/pages/witness.htm