Resuscitation in nursing care homes is quite another matter. The people in them generally do not have what is termed ‘known terminal illness’. They are old and frail, but with the advent of the National Service Framework for Older People (DOH 2001), age discrimination is illegal. They may have a condition such as Alzheimer’s or a neuro-muscular disease, but these are chronic, and a known terminal time span cannot even loosely be ascribed. Some people in nursing care homes have a DNAR order, issued by a doctor. Some people sign living wills that include a DNAR order. For the majority of people, however, no advance decision has been made, in which case whether or not to resuscitate is entirely up to the staff of the care home, and whoever happens to be on duty at the time. There are very few trained, registered and experienced nurses working in nursing care homes these days. These homes are run by managers, who may have no clinical experience, and care assistants, who may have a very skimpy training in basic nursing. But they all know how to use an AED machine.
I have a friend, Sue Theobald, who does a great deal of voluntary work for the elderly and disabled, including running a music therapy group. She tells me that the group was in a small, specialist home that houses about six people with severe advanced Alzheimer’s disease. Whilst the group was there, a woman actually died. Within seconds, the staff had her wired up to an AED machine. Sue tells me the speed of their movements was incredible. The electricity was switched on and the woman’s heart jerked back into some sort of beat.
Why? The answer is nearly always fear. Fear of litigation haunts the medical world from top to bottom, from the most exalted professor of medicine to the humblest paramedic or care assistant. ‘Cover yourself,’ is the first rule of practice, ‘and if in doubt, resuscitate.’
Today resuscitation in the community is burgeoning, with a 5–8 per cent success rate. However, this figure includes young patients and success in the resuscitation of older people is not evaluated separately. The latter is predicted to be 0–2 per cent in the very short term, and even when resuscitation is successful brain damage may occur. Automatic External Defibrillators (AEDs) can now be obtained on the open market, anyone can use one, and this is causing great excitement. Soon every public place will be required to have an AED, and once they are available, they will be used. The force, violence and pain inflicted never seems to be considered.
I was talking on BBC Radio South on Sunday, 6 February 2011 – it was a phone-in. A lady who said she was sixty rang to say she had died fifteen years earlier and had been resuscitated. She told listeners she had experienced an exquisite sense of beauty and peace and then ‘suddenly there was pain. I could never tell you how dreadful it was, like a great wooden stake being rammed through my chest.’ That must have been the CPR – entirely justified on an otherwise healthy woman of forty-five, but not justified on a failing old body for whom there is no chance of return to a meaningful life.
Five per cent of the population die in an ambulance, but this statistic can be misleading. Ambulance paramedics are required to get a patient to hospital alive, so they use every means available to keep the heart going for the duration of the journey. Something must be done to protect the elderly who, like me, want to be able to die quietly without first being subjected to well meant, but intrusive attempts to resurrect us.
A Commission of Enquiry is needed. I have approached all members of parliament and many members of the House of Lords. I have approached DEMOS, the government think tank that acts as a secretariat for commissions concerning social and medical issues. In this age of electronic tags and instant access to personal data surely it should be possible to prevent inappropriate resuscitation attempts.
1980
TIME TO GO
The Appalachian Mountains in 1896, the year Harry Randolph Truman was born, was a wild, rough place and it was hard to scratch a living out of the rocky soil. In a land of rolling valleys of oak and sycamore, beech and birch, it was natural for generations of Trumans to be woodsmen or loggers, and in later years Harry used the skills learned as a boy to construct the lodge, log cabins, boats and boathouse for the visitors’ centre he built on the edge of Spirit Lake beneath the brooding presence of Mount St Helens, in Washington State, USA.
Truman possessed a daredevil streak and in 1917, lured into the war in Europe by dreams of adventure, he enlisted in the 100-Aero Squadron of the American Expeditionary Force. He learned to drive and to fly, and trained as an aero-mechanic and electrician – all skills that he would use in later life. Under a veil of secrecy the squadron was sent to Halifax, Nova Scotia, one of the Canadian ports shipping troops to France during the First World War. The boat on which he sailed was hit by a torpedo, and although many died, Truman was one of the survivors. His dreams of adventure were replaced by the cruel reality of war.
In France, he worked first as a mechanic and then as a combat pilot. In later years, at St Helens Lodge, he would tell of flying the French biplanes in an open cockpit, ‘a leather cap on my head, a silk scarf round my neck flapping in the wind’. Like many such tales, they improved with each telling.
But war changed Truman, as it did many young men. A friend said, ‘He became a kind of loner, I think. He never discussed the war, he wanted to forget it.’
Truman was demobilised in 1919 and he returned to a very different America. He worked as a mechanic for a Ford dealer, but although always polite and courteous, he kept to himself, and seldom confided in or even mixed with his fellow workers. He seldom revealed his deepest feelings to anyone. It was not until later that they learned that he had married a girl called Helen Hughes during this time and that they had had a daughter.
In 1921, Prohibition, forbidding the sale or consumption of alcohol in the United States, became law. Truman was deeply offended. He had fought for his country, and now that same country was telling him he couldn’t have a drink! He saw it as a crisis that must be opposed. Besides, the humdrum routine of being a car mechanic, for low pay, was proving irksome; bootlegging offered better prospects. In many ways it was the perfect match of man and occupation. He was adventurous, ambitious, and full of initiative. Taking risks, bending the law, was just a well-paid game for him. He became a rum and whisky runner, picking up supplies smuggled illegally into the port of San Francisco, and running it into Washington State. What his wife had to say about this is not recorded! But bootlegging started by small entrepreneurs like Truman soon came to be controlled by organised and ruthless gangsters. With inevitable disputes over territory and money, Truman escaped just a few steps ahead of a gang who were after him. ‘I got in trouble with some big guys. Things got hotter than Hell,’ he said later.
He had to leave rum running and tried several low-profile jobs in which he hoped not to be noticed, but the boys were after him and he could not hide. Eventually, he decided that the wilderness was the only place where they would not find him – and that is how he came to Spirit Lake, beneath Mount St Helens, where he remained for fifty-four years until the mountain blew up.
Spirit Lake was over three thousand feet above sea level, and the land belonged to the Northern Pacific Railroad Company. Truman rented fifty acres from them and the rights to boating and fishing. He built his first cabin on the shoreline in 1926, and life was hard, but he had always responded well to a challenge. Few people could live in such isolation, and, inevitably, his marriage suffered. There were no schools for thirty miles, so his daughter had to live with her grandparents. His wife could not stand the separation so she joined her daughter. Divorce followed.
But Truman stayed. Like everyone, he had to earn a living, and he guessed that the beauty of the area would be a draw to visitors. Slowly, he built a holiday centre – cabins for visitors, a boathouse and jetty – offering fishing, riding, and trekking. The dramatic landscape and the solitude drew people from when the snows melted in spring until the cold of autumn. Winters were snowbound, and then he was alone.
Truman was a tall, handsome man and his carefree spirit, combined with rugged inde
pendence, made him extremely attractive to women. He tried marriage again, but the loneliness of the winters, being snowed up for months on end with one man – however attractive – proved too much for the poor woman, and she, too, left him.
Somehow, through the 1920s and ’30s, Truman managed to continue his bootlegging, and he always kept a supply of illegal spirits for his tough, outdoor friends. He also constructed a still, and made good money from selling moonshine (a home brew, distilled into a spirit of rotgut potential). Truman was hardworking, hard-drinking and hard-swearing. ‘That ol’ sinner,’ said a friend after his death, ‘he was just a goddam, hell-bound ol’ sinner. Up there in Heaven he’ll smuggle whisky in one door and ice and shakers in the other, an’ carry on like he always did. Jeez, I really miss that ol’ son-of-a-bitch – sure miss him.’
In 1946 Truman married Eddie. She was the woman for him, and they loved each other deeply. Friends said that he worshipped her. Not only did she seem to enjoy the long, cold winters, she could handle his somewhat tempestuous nature, his hard drinking, and his autocratic ways.
When she died, thirty years later, he was devastated. The loss nearly destroyed him. He ceased caring for himself, or his lodge, or the visitors’ centre. A friend said, ‘If he hadn’t been so tough, it would have killed him right away. But the old bugger was tougher than a boiled owl.’
*
Truman would walk to his boathouse as dusk set in, the warm evening wind whispering in his face. Trees, hundreds of years old, surrounded the lodge. ‘Bear and cougar, deer and elk grazed in the underbrush, the dense carpet of fir needles silencing any footfall … He could see the wild orchids and shooting-star wildflowers growing between the low bush huckleberries, the beautiful maidenhair ferns and delicate violets, yellow, white and blue. Monkey flowers and kingcups bloomed on the banks of the lake.’* Quite often a fisherman would be whipping his line for a cast upstream from the dam. An otter would surface, see the fisherman and dive, splashing the water with its thick tail. As the sun dropped behind the hills, Spirit Lake, the place Truman knew so well, assumed an air of mystery. The light would change, and the snow-capped Mount St Helens would show a different mood before it was swallowed up by purple darkness. The distant snowfields would become incandescent, dimly reflecting a pinkish glow. Then the moon would rise, and the mountain, holding her secrets close, would look as if she belonged to another world.
But in winter the temperature would drop to well below zero for months on end, as snow followed snow and the ice on Spirit Lake froze to five feet deep. Animals and birds would move to warmer grounds, bears would hibernate, and many creatures would die. Storms would come one after another, and the snow would fall six, or eight, sometimes ten feet deep. After every fall, Truman had to climb on to the roof of his lodge to shovel it off, or the weight of snow would have made the roof cave in. The winter months were a constant battle to survive, and Truman turned his talents to trapping and poaching. He had bought in sacks of beans and rice and flour, bacon and salted beef; he had dried fruits and herbs, and stacked wood for the fire.
People who live close to nature have a different take on life from urban dwellers, who think they can control everything. These people recognise the rhythm of life and death in the changing shifts of the natural world. Truman’s years of reflection beside his lake, beneath the shadow of the mountain, had surely formulated his philosophy of life.
In March 1980, Truman was eighty-three years old, fit and strong, but nonetheless old and getting older. Eddie had been dead for five years and he was lonely. He had kept the place going because, if he hadn’t, he would not have survived the winter. He had no enthusiasm for the idea of summer visitors, but that was the business upon which he depended for an income.
On Friday, 20th March, at 3.45 p.m., the ground under his feet shook slightly. He was glad, and thought it was a sign that the spring weather had loosened an avalanche down the side of Mount St Helens.
But scientists at the University of Washington, twenty miles to the north, were not so blase. The seismographs showed an earth tremor measuring 4.1 on the Richter scale, and the location was close to Mount St Helens, which gave cause for real concern. Three days later the earth moved again, measuring 4.4 on the Richter scale, and the quakes were even closer to the mountain. Visitors were urged to stay away, and by the end of March the authorities were considering possible plans for an evacuation. The forest service closed all roads to the area above the timberline. Truman’s lodge was eight miles above the timberline.
On the last day of March, a state of emergency was declared. Rob Smith, an old friend who lived further down the slopes, was having a drink and a quiet conversation with Truman when ‘all of a sudden the whole building seemed like a little cardboard box, rocking backwards and forwards,’ he remembered. They went out on to the porch and saw Mount St Helens spit a plume of ash thousands of feet into the air. Quite soon afterwards, the Deputy Sheriff’s car came screaming up the approach road, his voice booming from the loudspeaker: ‘The mountain’s erupting. Everyone out.’ Rob quickly made ready to leave, but Truman was not prepared to go. Rob went out and returned with the Sheriff. The two men tried every tactic from threat to guile – ‘We’re standing on a dynamite keg with the fuse lit. If it goes up, we will die’ – but they couldn’t persuade the old man to go with them. They left, and Truman was alone.
Mount St Helens was much changed the following day. A crater had appeared on the summit, two hundred and fifty feet in diameter, surrounded by a dirty black ring of ash, disfiguring the purity of the snow. Large fissures, more than a mile long, were visible, and Truman must have been not just awestruck, but tremblingly afraid. Yet it must have been then that he formulated his unshakeable resolve: ‘If that mountain goes, I go with it.’ He was eighty-three years old, his beloved wife was dead, he was lonely and he frequently wondered what he had to live for now that she was gone. He had lived beside that mountain since he was a young, virile man of twenty-nine, and it was as much a part of him as his own hands and feet. His soul was in that mountain, and there was no life for him elsewhere. He would stay.
This resolve, spoken by a man in his right mind, started a bureaucratic and legal battle that was to rage for the next eight weeks. It also brought in the press, which exacerbated the sheriff’s headaches, and was the cause of many sleepless nights.
The West Coast of America is on a known geological fault line, and tremors and small eruptions are quite common. But a dormant volcano, threatening to erupt, was big news, and all the papers wanted a story. When word got round that an old man was living halfway up the mountain and refusing to leave, editors were ecstatic and ordered their reporters to get the ‘human story’.
A ‘no entry’ zone had been marked out by the authorities. Did the reporters take any notice? Of course not! They swarmed up the roads in droves, panting for a good story. When they met roadblocks, they proceeded on foot, cameramen and all, along the forest paths. If the sheriff’s forest rangers ordered them off, they stuck up two fingers and ignored them. Helicopters came in, and so many flew over the roadblocks that, at times, the highway in front of St Helen’s Lodge resembled an air force landing pad.
Truman turned out to be a journalist’s dream. He was old and gnarled, he was fast-talking, heavy drinking, and his language was too ripe to put into print. His views were extreme and his contempt for authority was equal to, or indeed exceeded, that of the average reporter. He also proved to be photogenic. At first he was wary of the press boys, and refused to have anything to do with them. But then he began to see the advantages of their attention. They were a lively bunch, mostly young, full of enthusiasm and daring. Their company was stimulating and entertaining, and Truman was lonely. They all had an amusing tale to tell about how they had got in, how they had fooled the sheriff’s men. The situation was heady for an old man who had spent much of the winter alone, and Truman reckoned he could afford to lavish his entire whisky supply on these men. They all drank a toast to the damnat
ion of that goddam Sheriff and his goddam rules and regulations.
But Truman was not doing all this just to be kind or hospitable. He was a wily manipulator with a well-honed talent for getting what he wanted. For one thing, the reporters helped keep his mind off the situation – one big quake prompted him to say, ‘You know, I’m scared as hell about earthquakes. I just wish it would all stop’ – but, more importantly, he realised the press coverage would be of help to him.
Truman quickly became famous in the Western States, and when the New York Times ran a two-page article on him, complete with quotations and pictures, he became a national celebrity.
For the law-enforcement officials charged with keeping people out of the Red Zone, it was a nightmare. The pressure to interview Truman grew as the quakes and avalanches continued, and lightning bolts, some two miles long, flashed above the mountain. A second crater opened up on the summit and blue flames could be seen leaping into the air. But still the press boys continued to dodge the roadblocks.
Truman made his intentions absolutely clear – he was going to stay at the lodge, no matter what. ‘You wouldn’t pull me out with a mule team,’ he said. ‘That mountain’s part of Truman, and Truman’s part of that mountain,’ it was reported in one paper. To another, he said ‘I tell you; I’m no brave soul. Those goddam quakes scare the living Hell out of me. But hell, I’ve lived here fifty-four years. I might as well stay; I’m not leaving my home now. You know, the people down town, they don’t understand. They think I’m putting on a false front. Well, Jesus Christ, I’m going on eighty-four years old. When you’ve lived fifty-four years in one place and it’s the only home you’ve got, well, you don’t just walk off and leave it. Well, Christ no. People just don’t understand.’
In the Midst of Life Page 27
