Training day – Associate Professor Paul Middleton

It was one of those late summer days that England does really well, even if the other 350-odd days of the year the weather is a bit more, well, wet. An absolutely pure blue sky, late afternoon warm sunshine and everyone feeling lazy at the end of a long weekend.

This was in the mid-80s. I was starting my second year as a medical student, studying in Newcastle, which is about as far north as you can get in England before people start tossing their cabers across the border at you. I had been enjoying a brief holiday with my family down in Cornwall, followed by a visit to friends in London before resuming my studies. Now I was standing on Kings Cross station debating the wisdom of a British Rail ham sandwich (not that wise) and wondering if I’d be able to sleep at all on the journey.

I glanced at my watch. Still five minutes to go. It was over three hours to Newcastle. I walked down to the shops at the far end of the platform and bought a cold drink.

As I was wandering back towards my chosen spot at the front of the train I noticed him. A quietly dapper man in his 80s, from the generation of men that always wore a tie. Neatly turned out even in the heat and with his immaculate grey hair parted to one side in what was probably the same haircut he’d had since childhood. A lady of the same age (his wife?) had preceded him onto the train and was pulling a heavy suitcase up after her while he pushed from below.

I reached the door to my carriage and shouldered my bag. As I reached up to grab the door handle, something made me look back down the platform. The elderly man was getting on the train too. As I watched he put his foot up on the step, grabbed hold of the doorframe and pulled himself up. He hung there in the doorway for a moment, a faintly concerned look on his face. Then he toppled backwards like a felled tree and crashed down onto the platform.

I don’t remember dropping my drink and bag and running down the platform, but a few seconds later I was crouched by the man’s side with my hands free.

He was lying completely still.

I’d done my basic life support CPR training as a nurse and used it a few times, but never with someone who I had just seen being a normal human being and who had just dropped to the ground in front of me. My hands were shaking as I took the man’s pulse.

No pulse.

I found the familiar point at the bottom of the rib cage, moved up the chest a bit, joined my hands together and began driving the heel of my lower hand into his chest at a brisk, steady pace.

One, two, three, four…

I tilted the man’s head back and took hold of his jaw and pulled it down slightly so I could blow strongly into his mouth. Very strange putting my mouth over an elderly man’s. Once. Twice. Then back to the pumping action.

Time vanished. I was dripping with sweat. Dimly I was aware of people moving around, speaking in low voices. The hushed tones that accompany a tragedy. A tiny corner of my mind wanted to shout, he’s not dead yet. I wasn’t going to stop. But there were no signs of life.

Someone was standing over me. A dark green figure with something slung over their shoulder. I’d been so focused on what I was doing I hadn’t noticed them.

“I can help.”

It was a woman’s voice. Kindly but authoritative. I risked a glance up and saw a young female paramedic. She knelt and put her hand on my arm.

“It’s OK, let me take over.”

I finished the cycle of compressions I was doing, watched closely by the paramedic. After I delivered the two breaths she moved in quickly to resume the compressions. I moved to the man’s head, ready to deliver the two breaths after she had finished delivering the round of compressions. We had become a team.

In between delivering breaths, I sat back on the platform watching my new colleague work.  My arms were shaking. I was drenched with sweat. Abruptly I thought of my bag and looked up the platform to see if I could see it, but there were too many people standing about. This part of the station had come to a halt while our little drama played itself out.

Another paramedic arrived, a man carrying what looked like a large black briefcase. He knelt, opened it and from inside took what looked like two pieces of torture equipment. Defibrillators have come a long way since then. These paddles were huge and connected to the main body of the machine by thick loops of what looked like telephone cable.

I struggled forward to help. Together we opened the man’s shirt and prepared him to be shocked. We placed two pieces of smoked salmon-like defibrillation pads on his chest, one high up under his clavicle on the right hand side, the other on the side of his chest lower down. They kept falling off with the compressions, but I didn’t think my job should involve holding them on whilst he was defibrillated!

The man exchanged a look with his colleague, and she sat back whilst he pressed a button on the defibrillator and held the paddles down on the smoked salmon pads. A high pitched whine rose from the suitcase. The whine rose higher and higher until it almost disappeared. Then there was a long, penetrating electronic beep and the button on the front of the defibrillator flashed red.

“Clear!”

The female paramedic moved well away. She had been doing CPR until the last moment before her colleague put the paddles on the old man’s chest and side, charged the device and sent the shock into him. The shock made him quiver, and his arms flung out sideways. He lay there for a long moment as though asleep. Then he took a breath. His eyelids fluttered. Another breath.

He was alive.

“Thank you.”

It was the male paramedic. He had replaced the torture paddles back in the suitcase and was holding out his hand.

I shook hands with them both and got to my feet. It was over to them now. They’d get the man into the ambulance and from there to the hospital. I was free to go. Feeling a bit dazed I wandered back up the platform, found my bag – minus the drink, which had disappeared – and climbed up into the train.

I swear that when it started I thought it must be for someone else. Everyone in the carriage was applauding. One man stood up, looking fierce and clapping hard, as though he’d just seen a really moving piece of theatre. I didn’t know how to respond. I nodded and gave a sort of embarrassed half wave and sat down on the nearest seat.

“Can I get you anything?”

It was the train guard. He was crouching next to me, his hand on my shoulder.

I thought of the three-hour journey to come.

“I’d love a cold drink.”

He returned five minutes later with two cans of ice cold Heineken and the wife of the man who had collapsed. She had wanted to thank me personally. Her and her husband had been in London for a short holiday visiting with relatives. The relatives were on the train too and the guard had also brought them back with the Heineken. By this point I didn’t mind. I was starting to feel a sense of quiet elation, not at everyone’s congratulations (although that was nice), but at the feeling of being useful. I had been in the right place at the right time and done the right thing. We exchanged our addresses in Newcastle and promised each other we’d get in touch. I doubted we would, but it didn’t seem to matter. Someone had been in need and I’d helped them. That was enough.

I sat back, dreaming of being a doctor.

* * *

Two months later I was back at medical school with my nose to the grindstone. Actually not quite to the grindstone as much as reasonably close to it. Well, to be honest, nowhere near the grindstone. Winter was approaching. Rugby was being played. The bar at the Medics rugby club was always conveniently open. Some of the older medical students told me stories about the colder months in Newcastle that made the siege of Stalingrad sound like fun and games. I was nervously awaiting the first blast of icy wind and feeling like Amundsen heading for the North Pole. The summer holiday in Cornwall seemed like a lifetime ago.

Out of the blue I got a call from the elderly lady I had met at Kings Cross. She said her husband had made a full recovery and was now back at home and feeling very well. He wanted very much to meet me, she said. Something about the way she said this on the phone made me think that perhaps she was more enthusiastic about the prospect of the two us meeting than he was. Regardless, we made a date for me to come over and visit them.

I knocked on the door of their neat little red-brick house in the middle of a long row of identical houses, and felt suddenly nervous. The last thing I wanted was gratitude for what I’d done. It made me uncomfortable to think that the man might feel some sort of obligation towards me. But as soon as I saw him standing in his living room, dapper once again in his tie and neatly combed hair, with an age-spotted hand held politely out to shake mine, I knew I’d done the right thing. My visit was giving him an opportunity to say thank you but also to understand more about what had happened. He had no memory of it at all.

We sat on the sofa drinking tea out of the best china and chatting slightly uncomfortably. I told him about seeing him climb up into the train carriage and hang there for a moment before falling back onto the platform. He shook his head almost in disbelief. He told me about the time he’d spent in hospital. He felt fine now, he said, other than a few aches and pains. That wasn’t unusual, he pointed out dryly, for a man in his eighties. His wife sat primly on the edge of the armchair, wearing her best dress and shiny shoes, with her vaguely blue hair in a neat perm and a proud smile on her face.

Eventually it came time to leave. The man shook my hand again and his wife gave me a hug. She felt like a little bony bird smelling of lavender. I wished them both well and promised to stay in touch.

Afterwards I stood outside in the street, trying to take in what had happened. I felt even more dazed than I’d been after giving the man CPR. Something about seeing him back at home in the stream of his life again had made a deep impression on me. In his quiet, dignified way he was grateful to be alive but it wasn’t just about him. It was about the effect that his continuing presence on the planet was going to have on everyone around him. His wife wouldn’t be a widow. His children wouldn’t be fatherless. His grandchildren would be able to enjoy his company for what could be years to come.

When you shock someone with a defibrillator, you need two pads. In the 80s we used the paddles like you see on old episodes of ER. The two electrodes inside create an electrical circuit. One electrode won’t do it. For me, the visit to the elderly man had been like the second paddle that closes the circuit.

The shock it delivered has lasted me my entire life.

Everyone should know how to do CPR. Everyone. It should be as much a part of our life skills as reading and writing. Kids should learn how to do it at school. In fact, they should learn it along with swimming and riding a bike. It’s obvious when you think about it.

And it’s so simple. I’ve been an Advanced Life Support (ALS) instructor for over twenty years. I’ve taught hundreds of doctors, nurses and paramedics how to save the life of someone having a cardiac arrest. You can learn the basics in a few minutes.

Since that day in Newcastle a lot has happened. I finished medical school, trained as a surgeon then as an emergency medicine physician. I became interested in research, travelled around the world to study resuscitation and in 2001, with my new wife, visited Australia for six months. We never quite managed to get back on the plane.

Last year we launched Take Heart Australia to take awareness of CPR, AEDs and the Chain of Survival to the next level, and the success we’ve had across Australia has been breathtaking. It’s been a challenging, fascinating journey and the keystone was standing in that street in Newcastle, amazed at the preciousness of a life renewed, and with a profound satisfaction deep inside that I was being trained to make a difference.

Emergency medicine – how could you not love it?

* At the time that this story took place in the mid-80s the standard practice in CPR was to deliver 15 compressions followed by two breaths. Since then understanding of the best way to deliver CPR has developed and standard practice is to deliver 30 compressions followed by two breaths.


PMAssociate Professor Paul Middleton

 

Clinical Associate Professor Paul Middleton is a specialist in emergency and prehospital medicine, and has worked in critical care retrieval in helicopters, fixed wing aircraft and ground ambulances.

He is Chair of the Australian Resuscitation Council NSW branch, was the convenor of the first Resus At The Park conference in May 2014, and is also the Chair Take Heart Australia, a public health advocacy and educational charity designed to include all Australians in a mission to increase survival from sudden cardiac arrest.

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