Different techniques were developed and experimented with. The open-heart resuscitation that I witnessed being applied to Dr Hyem, was the first method adopted by the medical profession, and its popularity lasted for around ten years. It has been replaced by electrical impulses, or shocks, directly administered to the heart, which are no less violent, but more effective. The giant international drug and engineering companies started competing with each other for the huge financial gains to be accrued from producing ever more powerful cardiac stimulants, and manufacturers of surgical equipment bent all their efforts into resuscitation technology. It was big, big business.
From the 1970s onwards in the UK (earlier in America), the intensive care unit and resuscitation became central to clinical practice, and no hospital could afford to be without the latest techniques and equipment. ‘Crash’ was all the rage. Everyone was very gung-ho about it and cheerfully tried it on almost any dying or dead patient. Young doctors, nurses, and technicians had to be taught the techniques and older ones needed to practise. Pompous old consultants and starchy old ward sisters who questioned the technique were told to get up to date and live in the real world. Those who warned about ‘playing God’ were told they were religious fanatics and everyone would be better off without them.
Those were exciting days to be in medicine. Anything was possible. We could conquer death itself. Job vacancies appeared in the Nursing Times: ‘Be in the Front Line. Be a Life Saver. Join the Resuscitation Team. Work in the Intensive Care Unit at Hospital. Apply in writing.’ Adverts like this were quite common, and I attended a conference where this type of wording was strongly condemned by the RCN.
Exhilaration was in the air; but then, slowly, the demoralising feeling sneaked up on us that something was not quite right. Respect for the dead had been thrown out of the window.
The speed with which resuscitation swept through the medical profession was astonishing, and it was far too quick for it to be properly thought through. Drugs were introduced with bewildering haste – too hasty for proper trials to have been conducted. I gained the impression, in those days, that new cardiopulmonary drugs were tried on patients, the attitude being, ‘He’s dead, anyway, so there’s nothing to lose.’ The equipment and the voltage of electricity was hit or miss because no one really knew how far to turn up the dial. Medical and paramedical staff had to master techniques that could only be learned on the job.
When I was a staff nurse at the London Hospital, we had a death on the ward. I was off duty at the time, but the next day the ward sister told me that she went behind the screens about twenty minutes after the patient had died to ensure that the eyes were closed and the chin supported, and found two young doctors trying to insert a central line into the iliac vein in the groin.
‘What are you doing?’ she demanded – ward sisters had a presence in those days. The young men looked up at her guiltily.
‘Have you no respect for the dead?’ she said contemptuously, as she covered the body with a sheet. They said nothing, and went away.
My sister Pat is a Queen’s Nurse (Queen Alexandra Royal Army Nursing Corps). She trained from 1965–69, mostly in Singapore. She returned to England in 1969, to Aldershot Military Hospital, and was put straight on to night duty. The first night, she took the report and was told that if an emergency occurred she must press the AMSET button (Army Medical Services Emergency Team), but she was not shown where the emergency button was situated.
She did the usual drug round and noticed that a man was not in his bed. Thinking that he would return later, she finished the drug round, which took about half an hour. By then, he still had not returned, so she went to look for him. She couldn’t get into the lavatory, and so she crouched down on the floor to peer under the door, and saw two feet sticking up. Her first thought was to press the AMSET button, but she didn’t know where it was. She searched everywhere, poor girl, but still couldn’t find it. So she telephoned the night sister, who called the emergency team. They came with mobile resuscitation equipment and dragged the dead man out of the lavatory.
Pat told me that he was quite cold and stiff, and must have been dead for some while, because she had done a complete drug round and then spent time searching for him, then more time searching for the AMSET button, before the team arrived. Nonetheless, with all the drugs and equipment at their disposal the team attempted to resuscitate.
Pat said, ‘He was an old man, bless him, over seventy, and he was sick. I watched it all with horror, all that violence. There was no way they could get him back to life; he was quite dead, stiff and cold. But they carried on. Eventually, they gave up, of course. He had had a ruptured aortic aneurysm.’ A ruptured aneurysm is not cardiac arrest, so resuscitation attempts in this situation were futile and inappropriate.
When I trained at the Royal Berkshire Hospital in the 1950s, there was no resuscitation. My niece, Joanna, trained at the same hospital twenty-five years later, and I asked her how much of it went on. She said,
‘It was relentless, every day on every ward throughout the hospital. Every bed had a crash button beside it. There were half a dozen crash boxes around the ward, and the crash trolley placed centrally. If anyone died the nurses had to rush to the bed, press the crash button, detach the top and bottom of the bed, lie the patient flat with no pillows and start banging hard on the chest, pumping the sternum up and down to force a heartbeat, whilst a second nurse had to do mouth to mouth resuscitation until the crash team arrived. Then they started intensive resuscitation with drugs and electrical equipment. All nurses had to do this; it was a rule and was absolutely enforced. There was nothing we could do about it. We young nurses would ask the sisters, “Why? Why old Mrs C or why Mr S? Why is he not No Crash? He’s terminally ill. He’ll never get better.” The sister would say, “I don’t know, but we’ve got to do it. All I can say is don’t rush, don’t be in too much of a hurry to press the crash button, don’t bang too hard on the sternum – if you can delay things for a few minutes, he might be able to die before the crash team can get at him.”’
I told Joanna about the solemnity in a ward that had accompanied a person to their death when I was a young nurse. She said, ‘Well that’s all gone. When I trained it was rush, noise, panic, even shouting sometimes.’
I asked Jo what the success rate was. She thought a bit, then said, ‘Very low. I can’t really put a percentage on it, but very low. The trouble was that very often the body would twitch, and they thought this was a sign of life, and when the electric current hit the heart the body would really jerk – again, taken as a sign of life. But it’s not, at least not necessarily. There can be a twitch, more than one, after death, which I think is part of the nervous system shutting down.’ I agreed with her, and said that quite often I had seen someone die, and then, a minute or even two minutes later, suck in a great noisy gulp of air, which is called an ‘agonal gasp’.
She laughed and said, ‘I’ve seen that too; and heard it. It can be really scary, especially if you are a young nurse in the middle of the night, and you are not expecting it … spooky!’
I joined her laughter and commented that medical people are known to have a black sense of humour.
‘Too true. We need it,’ she said.
These are just a few examples from a family of nurses to illustrate the frenzy that overtook medicine during that period of medical history. It also illustrates that medicine, like any other profession, is prone to fashions. Today, in the twenty-first century, there is more discrimination in undertaking resuscitation, but even so, the prognosis is poor. Nuland stated that only fifteen per cent of hospitalised patients below the age of seventy would survive cardiac arrest and resuscitation, and almost none over that age. That proportion has remained unchanged.