I want to share a couple of experiences with you all and talk about the directions that those experiences have sent me in emotionally and cognitively. Here goes.
About a year ago, I was involved in my first ever “crash-call”. A crash-call in a hospital setting basically means that a patient who you are not expecting to die has a cardiac arrest, and every medical professional within the sound of an emergency alarm goes into action to try to save their life. To a layperson it probably seems like all hell has broken loose, but when you know what’s going on it’s actually very impressive to see it done well (in hindsight, anyway: at the time your adrenaline is so ramped that you physically shake and it’s the fact that you are trained and drilled in this stuff until it’s second nature that keeps you doing the right things). One person runs the whole thing; contrary to what Scrubs teaches you, that is not usually a doctor (because there often isn’t a doctor around at that point) – it’s usually whichever qualified nurse gets there first or the most senior nurse present; the whole thing gets taken over by the crash team when they arrive, but that can be up to fifteen minutes, or even longer if it’s the middle of the night and there’s another crash going on, or if you’re in a small hospital with no permanent doctor cover and have to wait for paramedics (fun fact: You’re more likely to survive a heart attack if you’re in a shopping mall than if you’re in a hospital – this is absolutely true).
I’ll take time at this point to big-up the crash-teams; those dudes are some seriously under-appreciated folks, and odds on one day they’ll save the life of you or somebody you know. Remember that next time you see a sleep-deprived looking junior doctor sprinting down a hospital corridor, and get the hell out of their way!
Anyway, on the day in question I walked past a patient’s room in time to see my ward manager pull the emergency alarm for a patient who I’d been nursing for about six weeks. We collapsed his bed back and I dialled the number for the crash team. Even this is a standardised, drilled, rehearsed procedure: The number is the same for every UK hospital that has a crash team (I’m not going to tell you what it is – the world is full of sick people who think prank calls are funny). You dial the number, it gets answered immediately and you say:
“Hello. Cardiac arrest, Ward [insert name of ward]”
Then the infuriatingly calm lady on the other end of the phone says:
“Cardiac arrest, Ward [insert name of ward], thank you.”
Then you thank her back and you both hang up. I can absolutely promise you that that is the shortest, most frightening ‘phone call you will make in your entire life.
By this point, there will be two or three other staff in the room, one doing chest compressions, another with a bag and mask, ventilating the patient (though I understand that in non-hospital emergency life support in the US they don’t do rescue breaths anymore, just chest compressions). A third nurse will be preparing the crash trolley or sticking defibrillator pads on the patient (they’re not like the ones you see on ER; the new ones are all singing, all dancing – and they tell you what to do. You just stick the pads in the right place and do what you’re told). The rest of the staff will be staying the hell out of the way. There might be a fourth ready to take over chest-compressions (which are bloody hard work after twenty minutes or so, let me tell you) when the first gets tired, but that’s it.
My abiding memory of the experience is this: Watching my patient’s body and face go from taught and alert to slack and dead in under half a second. I watched the moment of his death, and I’m sure I will remember his name and his face for the rest of my life.
I didn’t know how to react after it was all over; I just worked non-stop until the end of the shift and then went and ‘phoned my mother to talk about it. Mums are awesome like that. The hard part for me was grasping that sudden transition from something to nothing happening right there in front of me.
Recently, this was brought home to me even harder by the sudden death of one of my best friends; he took an accidental overdose of insulin and fell asleep before the symptoms of hypoglycaemia set in. He subsequently fell into a coma and died, to be found by his partner the following morning. I cannot even imagine her pain at having to do CPR on his cold, dead body until the ambulance crew arrived.
What struck me from that experience was the incredible sense of disbelief that I felt; last time I saw my friend, we were sitting in the sunshine watching cricket and drinking beer. He had a very secular funeral, where we listened to his favourite rock music at the crematorium and said our goodbyes.
I find myself wanting to talk to him a couple of times a week, to the point where I drunkenly texted his ‘phone one evening to berate him for dying. Me. A staunch atheist. Weird.
And then I thought about it:
I have no framework for grieving. Different religions and cultures provide for different routines in grieving – ways to dress, rituals to follow, time-scales to adhere to. African Caribbean people in the UK sometimes still have open-casket funerals (something I maintain would have helped me to say my last goodbye to my friend properly), Muslims and Christians have their various traditions, Hindu people wash and dress their dead relatives as a final farewell.
I genuinely understand why people find comfort in religion. I would love to think that I’ll get to see my friend again one day and to finish all those silly conversations that we had while drunk and philosophising (well, drunk anyway) and to be able to tell him how much he meant to me as a friend. Problem is, I don’t believe that. Neither did he.
As an essentially culture-less, Caucasian, middle-class atheist, how should I grieve? I honestly do not know. The lesson I learned in my first crash-call was that one second you’re alive and the next you’re dead, so you’d best make the most of the first part – because the second part lasts a long time and you don’t get a do-over. Applying that to a close friend (who wasn’t yet thirty, by the way) is a very difficult thing to do. I miss him tremendously and I know that it’s going to be a long time before the pain of his absence is lessened. In the meantime, if I figure out a secular grieving regimen, I’ll let you know.