44: FIRST AID

This “retirement chapter” is a continuation of my published book. It makes reference to some topics and people introduced in that book, including my wife Lorraine and the small town of Kaslo, British Columbia, on Kootenay Lake. 

Chapter 44:  FIRST AID

Kaslo, B.C.   Wednesday July 16, 2008 

Early last Saturday morning, Lorraine and I reported to the Kaslo Golf Club, there to attend a Red Cross CPR/AED course, one that was designed to teach us how best to attempt the provision of oxygen and heartbeats to people discovered to be lacking either. Yet what this course actually taught us turned out to be something more. It taught us more than we had bargained for about our readiness (or lack thereof) to accept death as a guest in our homes. And, it taught us how many good Samaritans there are out there who we have yet to meet. Today I understand better why I had not been looking forward to taking this course. But I’m also beginning to see more clearly why I feel very lucky indeed that I did arrange to take it.

In this age of knowing acronyms, CPR is shorthand for Cardiopulmonary Resuscitation. And AED is shorthand for Automated External Defibrillation. The former is the modern variation of that exciting and nearly taboo activity that as teenagers we once called “mouth-to-mouth resuscitation,” the stuff of television heroics and fantasy thrills. The latter is the layman’s variation of an answer to the frantic call “is there a doctor in the house?” It refers to the little black box that can sometimes restore a heart to its senses when that heart has forgotten how to beat properly. It amounts to an expert electronic cardiologist, sitting on her shelf, just waiting to advise you, to take charge, and to administer life-giving charges at the flick of a switch.

However, much of what Lorraine and I learned while kneeling on the Golf Course porch last Saturday morning was somewhat incidental to the skills we were practicing there. We were asked for instance, “What percentage of people whose hearts have suddenly stopped can be saved with timely CPR?” I guessed the answer was 50%. The best empirical estimate happens to be closer to 8%. And if we have a defibrillator at hand, what percentage can be saved then with timely AED? The best empirical estimates for AED are more like 30%. This means that even when we have the best help at hand, and have it quickly, much more often than not our attempts to revive a comatose victim are going to leave us saddened and troubled. And particularly so if our patient happens to have been a baby.

After the heart stops, the body in which it resides is dead. If the heart can be restarted, then recently that body had been dead. At our course on Saturday we were asked “In the absence of oxygen, how long will the brain survive with almost all its functions recoverable?” I guessed that it depends on the temperature of the body at the time and I guessed 3 minutes. The best current estimate happens to be closer to 5 minutes, plus or minus, but yes, certainly longer in the very unlikely event that the brain was markedly cooled prior to the heart stopping. We were also told that the last sensory function to stop working in the oxygen-deprived brain is usually hearing. A suddenly dead patient cannot respond, but for a very brief time they can probably still hear. That is why this weekend we were taught to talk to the patient and to explain what we are doing as we move or touch them, however unresponsive they appear to be.

We were also taught a surprising new rule: the best test for confirming a heart that is still working is no longer to search for an elusive and weak pulse. Instead, it is either to hear or see two breaths. If we cannot see or hear any breathing taking place in at least 10 seconds of close listening to any sounds from the nose & mouth, while simultaneously watching the patient’s diaphragm very closely, then we can safely assume the heart is not working effectively.  Our instructor told us about a trial held in a hospital to detect a pulse in patients having a weak pulse. Each one of a class of fourth-year medical students was told to take the pulse of every patient in a large hospital during the day, and to report on their results at the end of the day. Every one of the busy young doctors reported a pulse for every patient and swore they had visited every room. Did they check in room #582? “Yes,” they said, “every room.” But the two patients in room #582 were dead. The doctors managed to find a pulse (likely their own) even in these patients. A hurried test for a pulse rate, without a stethoscope, is too unreliable to be used safely, particularly by laymen at a scene with an unresponsive patient

As it turns out, much of what a Red Cross course like ours has to offer you occurs in the days immediately following that course, particularly for the older retiree of uncertain years. There are enough things to remember, enough things needing practice, that during at least the following few days Lorraine and I found ourselves reviewing most of what we had learned. Our rehearsals triggered some serious reflection on just how much healthy time we might have left together, left for ourselves, and left with our remaining older relatives, particularly with Lorraine’s mother Audrey and with my stepmother Helga. These are the sorts of reflections that signing a will can bring home for a time, but to my surprise such reflections proved to be far stronger following this course on attempted life-giving.

All of us have hearts that will stop one day. At this moment, the oxygen being circulated throughout our bodies permits me to write just as it is permitting you to read. But life transmutes. Living things decay as new living things emerge. Our familiar environment decays as new environments emerge. Societies and cultures transmute as well, and with all such changes our comfort levels frequently wane. Everything is in flux and is impermanent, and thus it may become a potential source for anxiety.

If you happen to have been putting off taking CPR/AED training, there may be some quite understandable reasons for your delay. Don’t feel guilty about procrastinating. But as soon as you can feel ready, especially if you are a retiree, you may discover, as I did, that this course can be another good way to deal with some of one’s feelings about being “useless,” about aging, and one’s natural reluctance to face the truth of one’s mortality. Sooner or later, the “work” of retirement is going to require no less. But there is comfort to be found in a community of supportive students practicing the art of helping hearts back to work before those hearts are themselves truly ready to retire.

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