In the Midst of Life

OPEN HEART RESUSCITATION (also known as Direct Manual Compression)

I returned to the male medical ward to resume my vigil with Dr Conrad Hyem.

Tread softly as you draw near to the bedside of a dying man, for the space around him is holy ground. Speak in hushed tones, with awe and reverence, as you would in a cathedral. Let not the mind engage in trivial thoughts. The awesome majesty of Death can only be met in silence.

As I approached the ward, I was aware of light and commotion coming from within, and when I entered, I saw that it was coming from Dr Hyem’s bed. The curtains were drawn, but brilliant light was shining and half the men in the ward seemed to be awake.

I pulled aside the curtains and found a full-scale open-heart resuscitation being carried out by three doctors, one of whom, the registrar, had a scalpel in his hand.

Dr Hyem was lying flat on his back. His chest had been cut open on the left side, from the sternum to the lower back ribs. Blood was oozing out, and the smooth chest muscle was glistening in the bright light. Rooted to the spot, unable to breathe or make a sound of protest, I watched the registrar with a swift, easy movement slice through the pleural muscle, revealing the ribs.

‘Retractor,’ he demanded.

I found my voice. ‘No! No! What are you doing? Stop! Stop it, I say!’

He ignored me. He inserted the retractor between two of the ribs, and turned the ratchet to open the double arms of the instrument to their full potential. I heard a rib crack.

‘Stop it!’ I shouted.

Perhaps he had not heard, as he continued with the ratchet, and I heard a second rib crack.

‘Scissors,’ he demanded.

By then I was getting close to hysteria. I took a couple of steps forward.

‘What are you doing? Stop it. He’s dying – can’t you see that? Leave him alone.’

The doctor was cutting through the pericardium with surgical scissors. He muttered, ‘Who the devil are you? Get to hell out of here.’

He inserted his hand through the open chest wound and grasped Dr Hyem’s heart; then he began a series of steady, firm compressions.

There was blood all over the place, dark venous blood, black and sticky, covering the doctor’s white coat, and the sheets and pillows scattered across the floor.

‘It’s fibrillating badly, but at least there’s some movement,’ he said as he continued his compressions. ‘How long have we been at it?’

‘Two minutes twenty,’ replied one of the housemen.

‘Not bad. If we keep it up, we should win. Here. You take my place. Then you will know what to do next time.’

He withdrew his hand and stepped backwards. One of the others took his place and inserted his hand through the hole in the chest wall.

‘Can you feel the heart?’

The young man nodded.

‘The ventricles fibrillating, like a jellyfish wriggling?’

Again the houseman nodded.

‘You can? Good. Now just squeeze the lower myocardium – regular – firm – steady; one squeeze about every second. That will force the blood upwards, out of the ventricle into the upper chamber and into the circulation.’

This was obviously a teaching exercise.

The older man stood up and stretched his back. He wiped his bloody hand down his coat.

‘That was good,’ he said with satisfaction. ‘We are winning. I can feel a pulse in the jugular.’

Then something spine-chilling occurred. Dr Hyem, lying flat on his back, opened his eyes and stared into the brilliant light shining directly on him. His mouth hung open, and a rasping roar was emitted from the depths of his throat. It was a ghastly noise, like the whoop or howl of an animal in agony. The sound rose to a crescendo and then stopped abruptly, and the silence that followed was almost more dreadful than the roar.

I ran around to the other side of the bed and took Dr Hyem’s head and shoulders in my arms in a futile attempt to protect him. He looked at me, I swear he looked at me, and in his eyes was reproach. He had said, ‘When my time comes I want it to be the end. I don’t want anyone messing about with me.’ I had promised that he would die peacefully, and I had let him down.

I have lived with that look of reproach all my life.

‘I told you to get out of here, woman. Now clear off and don’t interfere,’ barked the registrar.

‘I am the night sister,’ I exclaimed, ‘and Dr Hyem is in my care!’

‘Bloody fine care you give, trying to be obstructive.’

Then to the team, ‘He’s coming round. Excellent. Ah! There’s the porter with the machine. Splendid. Bring it over here.’

He spoke to the two younger doctors. ‘Fix it up, and it can take over the massage. Now, we will want a central line through the iliac vein, and another in the subclavian, but try the iliac first, and a shot of adrenaline direct into the myocardium. Get a tracheal tube down him, and fix up the oxygen supply.’

Then again, to me: ‘Look, I told you to clear off.’

‘I am the night sister.’

‘I don’t care if you’re the Queen of bloody Sheba! Get out of the way. I want to get a tracheal tube down him.’

I was pushed aside, and one of the young doctors tried to insert the catheter into the lungs. It is not an easy thing to do, and he had to make several attempts.

‘Arch the neck. It will go down easier. More than that, pull the head backwards; you’ve got to locate the trachea. It’s no good if the thing goes into his oesophagus. We don’t want to oxygenate his guts.’ He laughed at his own joke, and the others laughed in unison.

‘Have you no respect for the dead?’ I bleated, despairingly.

‘He’s not dead, you stupid cow. He’s coming round. This has been highly successful.’

There was nothing I could do. I covered my face with my hands to hide my tears and fled to the office. The nurse whom I had left sitting with Dr Hyem only half an hour earlier came in.

‘Are you all right, Sister? You look dreadful. Can I get you a cup of tea?’

I couldn’t look up. ‘What happened?’ I moaned. ‘How did this happen?’

‘I was sitting with him, like you said, Sister, and he stopped breathing, and I couldn’t feel a pulse, and I didn’t know what to do, so I rang the emergency button.’

That was all that was needed. A young, inexperienced nurse, seeing death, possibly for the first time, and quite possibly frightened at being alone, and me, her senior, unavailable. So she had pressed the emergency button, and a resuscitation team arrived. Once started, the process could not be reversed. And, as the registrar had proudly stated, it had been highly successful.