A Quiet Acceptance

It's a couple of minutes before we officially start our shift when Control phone us and ask us to go on an 'early job'. It's a cardiac arrest so we agree and jump into the ambulance.

Two FRU are already there, we are met at the door by a very calm looking elderly lady.

“He's upstairs, so are the paramedics. I'm sorry I shut the door, I didn't know anyone else was coming”.

From upstairs I can hear the bump, bump, bump of the patient's head hitting the floor as one of the FRU drivers is doing CPR.

I bound up the stairs and ask the other FRU, who is currently intubating the patient, what he wants me to do.

I can hear my crewmate talking to the wife downstairs, getting a history. The FRU has finished intubating the patient so I put a pillow under the patient's head to stop the banging.

We settle into the familiar rhythm, IV access, drugs every three minutes, constant CPR, check the heart rhythm, check the pulse, repeat from start.

It's obvious that we aren't going to get him back, so I take the time to talk to the wife.

“Your husband's heart has stopped”, I explain, “We are doing everything that we can for him and we need to make a decision now. Do we take him to hospital, or do we continue here and stop if there is no chance of getting him back. We are doing everything that the hospital would do for him”.

“What would you like us to do?”, I ask her.

And she replies, and my heart just breaks, right there on the spot.

“Well, we are both in our eighties – so we have spoken about this before especially after his heart attack. It's not a surprise and I know that he's going to stay dead. I think it's best if you continue here and stop when you think it's right”.

She calmly stands there watching us working on her husband until we get a rhythm change and are forced to take him to hospital. While my colleagues work on the patient I offer to take the wife to the hospital in one of the FRUs.

I help her tidy up the bedroom, we make a mess when we are running a resus. Packaging everywhere, bloody needles*, discarded equipment. She offers to help me tidy up and gets a plastic bag for me to put the rubbish in.

Still she remains calm.

Her son arrives to take her to the hospital – he is also calm and thanks me for my help.

Driving the FRU to to hospital my eyes are damp as I think of the complete acceptance of this sudden death. The British reserve, the “we'd spoken about it in the past”, the quiet thanking of everything we'd done.

Death and bad news affects everyone differently, so cry, some beat their chests, some get angry. But this quiet acceptance is one of the saddest responses I've ever seen.

*None of us had a sharps box as we'd run out on this job before we had a chance to check our motors.

12 thoughts on “A Quiet Acceptance”

  1. Why did quiet acceptance make you sad? From an outsiders perspective it seems that quiet and acceptance of death would be a welcome relief to someone who must frequently deal with difficult situations.My husband and I have a similar agreement, one reason being we think it would be easiest on everyone to just “go” when it's our time.

  2. It is sad when people are accepting of death but SURELY its better that they have had the conversation and it made the conversation you had with her that much calmer – I am in my 30s, may parents in their 60s and my Granddad died last week aged 92. We ALL know what our wishes are and know that we can raise DNR status with carers when appropriate.

  3. Tom,Sometimes it's the right thing to do, the person knows it is and it is their defence mechanism. Doesn't mean they don't hurt any less than someone crying hysterically, or fighting the people who are trying to help. No doubt later she will cry and let the pain in, but for now it is all she could probably do to hold herself together…that great british reserve (backbone I call it) helps to get you through the initial pain.

    Been there, done that…. never easy and at the time I had a very sympathetic policewoman and doctor who were surprised that I was as calm as I was… only later when I was home and with family did I cry and then cried for 3 days.


  4. I think that is the thing isn't it, the fact that you have time to chat to them and take in that they are in essence some of the nicest people that you have met. And although it is only a few minutes or so that you have known them, your mind seems to take over and tell you that had it been a different time and situation, you would probably have been good friends with them, or liked to have been, so it makes it that little bit harder to stop those “damp eyes”

  5. I agree, and there's actually comfort to be had, contrary to the “let it all hang out” philosophy, because when you're in the thick of it and concentrating on staying calm and composed, it does help keep the immediate impact away.That said, I teared up a bit reading this.

  6. I've just come in from the shift from hell that has left me running home to hug my kids, who are thankfully here to hug back. Heart going out to you mate.

  7. The worse thing about quiet acceptance is hard to understand. When we give news of a sudden death you generally expect the relative to react in some way be it cry, deny, shout scream beg… etc. All of these, while being upsetting, is somehow never as upsetting as someone who quietly accepts the fact.I had a patient who was diagnosed with terminal brain tumour. Her reply on hearing the news was as follows:

    “Oh well, Im in my 90's, I've had a good life and im ready to go”. Her family were the same, asking that we just keep her comfortable. The news was unexpected. She had come in to the hospital with a long lasting head ache.

    We can't explain why it's more upsetting, it just is. =(

  8. I hope this isn't too off-topic but I would like to know what your thoughts are on the MPDS system used by most North American Ambulance Services. I'm minly interested in what you think of the Post Dispatch Medical instructions that the call taker gives over the phone. I refer specifically to cases of the elderly who have long standing chronic and in some cases terminal illnesses, unless the family has a signed and current DNA order, the call taker must give CPR instruction over the phone and in many cases, it is the elderly spouse who must perform CPR. The current MPDS questions do not illicit enough information about the length of time the patient has been VSA or the patient's medical history and unless the elderly spouse volunteers information such as he is cold to the touch or can't extend his jaw because rigor has set in, then CPR will be initiated.In instances where the family has been expecting the demise of the patient, I think it is cruel and emotionally traumatic to expect them to start CPR and also robs the patient of a peaceful and dignified death.

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