First, Do no Harm.

Actual date: 1/10/2012

This whole long distance relationship thing is hard. I’ve seen Alex every weekend so far, but this weekend was the first time we’ve not managed to see each other. I can’t afford to get the train home every weekend and Alex had to work. It’s hard because we spent so much time with each other over the summer and then a lot of time recently. It’s a lot of pressure on what is still a young relationship (Only got together officially in May). Sure we will get through it though.

We were back in the hospital again this week, this time for our Basic Life Support session. For anyone that’s ever done a first aid course, this is essentially CPR in a hospital. It was nothing fancy. We basically learned how to do CPR. Which was nothing new to anyone there. What was new was the procedures for in a hospital and some of the kit that’s available to us. Towards the end the woman leading the session asked for two volunteers, myself and Gareth volunteered. We were taken over to a bed in the corner and told to keep our patient alive for 15 minutes.

CPR is tiring. You have to do deep chest compressions (a green light comes on next to the patients head on our dummy if the compression is hard enough- about 1/3 of the depth of the body) at 120 beats per minute (2 per second) with 2 breaths delivered every 30 seconds. The breaths were delivered using an airbag. The way it works is that you do a cycle of 2 minutes (240 compressions and 8 breaths) and then swap. However that was quite difficult, so I kept going for 10 minutes before I just had to swap out with Gareth.

We managed to keep our patient alive. Though in real life, realistically someone would have asked if we all agreed that there was no point in continuing before then. About 30% of in hospital cardiac arrests are resuscitated, ie their hearts start beating again. Less than 10% of these ever leave the hospital alive. Part of the reason for this is the CPR itself. CPR is brutal. It is traumatic to the body. On a real person, ribs crack. If they don’t you’re not doing it right. There are a lot of moral issues around the use of CPR on patients, especially if they have specifically asked not to be resuscitated. However the main reason for the low survival rate is that if your heart has stopped then you are not well. You are probably in a very bad way physically and the fact is that your body just simply cannot support itself anymore, especially after the trauma of a resus attempt. The majority of the successful resus attempts are on young, relatively healthy patients, a lot of whom have suffered trauma. Car crashes and things like that. Where the body has been physically damaged, and a lot of blood has been lost but there is nothing fundamental wrong with the organ systems themselves. As opposed to a 80 year old woman with pneumonia, diabetes and osteoporosis.

A younger, healthier body is simply better equipped to survive and recover than an elderly person. It is sad, but true that even if the patients heart should restart, the chances are that they will spend the remainder of their life in the hospital and in pain from the broken ribs. This is something that I feel very strongly about. I believe that half the time in these situations CPR is attempted as a show for the relatives. So that we can say to them “We did everything that we could” and for them to believe us. I think that in a case where the patient is obviously not going to make a full recovery and leave the hospital someone needs to talk to the family and ask them who they are doing it for, is it because they genuinely think their mum/nan/uncle has a good chance of leaving the hospital, or is it because they’re not ready to let go?

Sadly however, the mainstream media condemn approaches like this as euthanasia. I swear the Daily Mail would have us all hooked up to life support machines until the power went out. Doctors are here to save lives. But we also take an oath to do no harm, and I bet there’s not many doctors that think a failed resus, or even a successful resus that only gives the patient another hour is doing no harm to the patient. Personally, I know that if I reach the grand old age of 80 I would much rather slip away peacefully, rather than having someone jump on my chest and break my ribs and I’ll make damn sure my doctors know this. You never know, someone might have some common sense by then and listen to doctors and nurses instead of journalists and politicians.

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