Dying To Help - Reflections from Jon Carter

The following story took place a while ago, in a hospital near here, with a patient you haven’t met.  Tom was 67 years old, but looked, and felt about 90.  Tough paper round would be one way of putting it.  Years of smoking, working in the pit and breathing in asbestos would be another.  Tom lived on his own.  He woke on his own; he ate on his own; he slept on his own.  He also liked to smoke on his own.  However, that Friday night he was about to get disturbed.

Tom had been fighting off a cold for a few weeks now.  Every morning, hoying up sputum.  The last few days had been tough.  He couldn’t get to the toilet.  He couldn’t really make a cup of tea.  All he could do was smoke and hope he would shake it off.  Maybe this was the end.  Maybe this was his time.  Time to re-join Betty, his beloved.  And who could forget Socks, his border collie, who passed just months ago at the ripe old age of 16.

But why are these bright green and yellow giants invading my privacy? Who told them they could come in? Was it me that phoned them? It can’t have been my family – I haven’t got any.  Scything through the thick plumes, across the tar-stained carpet, kicking away takeaway cartons and milk cartons.  And now I’m being carted away! This must be my time.

In the emergency department, I hear the crash box go off.  Another COPDer.  Here we go.  Nebs, oxygen, steroids; why do they even crash them in? A few minutes later and we’re raring to go, me, Shelly the registrar and Madge the charge nurse.  The banter takes a few too many tangents and just as we are about to change the subject, in rolls Tom with the two paramedics.  Over we go, and onto the resus trolley, followed by a handover.

And away in to the night…where are the green and yellow giants going?

Something isn’t right, I think.  Tom is dying.  He is grey.  He is vacant.  He is looking toward the ceiling and not responding.  His top clothes are taken off, revealing a sliver of a man, ribs visible, skin dry and paper-thin.  The hospital gown dwarfs him.  A…B…C…what could I do to help? I felt powerless without doing something.  Shelly stands poised, ABG syringe at the ready, bloods tray ready to roll, waiting for the nod.  Madge takes Tom’s hand.  This feels better.

Tension pneumothorax could kill him.  A quick venflon to the chest would tick that box.  A…B…C…

With a shake of my head toward Shelly I mirror Madge and take Tom’s other hand.  We shut off oxygen machines, obs machines.  Beeps vanish, whirrings fade.  It’s just Tom, me and Madge.  Tom seems to focus on something distant, a pained look in his eye, one which will haunt me forever, then his eyes relax.  His breathing changes – no longer is he fighting his last.  He is embracing it.  Keep him comfortable.  It’s ok Tom.  It’s just Madge.  You’re ok.  We’re here with you.

I no longer speak to my son.  Not after I found him stealing my money.  I wish he’d let me see the grandkids though.

You’re ok Tom.  It’s just Madge.  I try and emulate what Madge is doing but can only repeat her words.  A stroke of the forehead here.  Some human heat there.  That’s all he needs.

Minutes pass.  It isn’t long before Tom becomes eternally peaceful.  I just really, really hope he was ok during that last few minutes.  I’m so glad I didn’t grab a venflon, I think selfishly.  We stay with him minutes longer until he truly is at peace.  I’m sorry we couldn’t help you Tom.  But maybe you didn’t want helping.

Dedicated to the paramedics, Shelly and Madge for their professionalism and for showing dignity and respect in dying.  In memory of Tom, who has taught me, once again, to first do no harm.

(All clinical and patient details have been altered to preserve anonymity.)