Fillers

MY MOST REWARDING CASE

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7045.1533a (Published 15 June 1996) Cite this as: BMJ 1996;312:1533
  1. D W Barritt

    You never forget

    More than ten years after retirement life continues to have rewards in addition to all the pleasures of a more leisured existence. One of mine has been to become involved in community affairs in our large village. Although not born here I have found myself increasingly trusted and somewhat to my surprise I am now chairman of the council.

    At a full meeting of council with 20 members present we begin to consider plans for a major extension to the village hall. One of us is on edge to promote the development. There is commotion as he falls face downwards on to the table unconscious. Over 70 years old, he had had an infarct confirmed by me more than a quarter of a century ago. My heart sinks; surely this is the end. In a moment we have him on the floor, chairs and tables removed, no pulse, no breathing. I must do something. My hands on experience was limited. In the wards others were at the scene before me. But I must massage him and it is second nature to begin at once. It is a comfort to realise that no one else in the room knows anything about resuscitation so they will not be critical of my technique.

    They fade into the background and I concentrate on the task. I stop for a moment and he makes a sigh so I continue with massage for a few more moments. He sighs again but is deathly blue. Soon it is clear that he is not breathing at all and I must start mouth to mouth resuscitation. It is a huge relief to see his chest rise and fall as I blow. More massage, more resuscitation. I sweat and wonder how long I can keep it up.

    Someone had been quick to summon an ambulance and to my intense relief help appears. Later I learn that it was a 12 minute wait. Two paramedics arrive with businesslike boxes and soon electrodes are applied. They show ventricular fibrillation. After two shocks a succession of reasonably normal complexes appear and the femoral pulse is palpable. His wife arrives and tells me that he was in hospital a few days ago for treatment of atrial fibrillation.

    He now has a good pulse and an airway and can be taken to hospital. How will his brain have fared? Have we done him the worst possible disservice? He soon fights his airway. In less than an hour I am talking to him in the coronary care unit. Two months later he has had multiple vein grafts and I see him striding around the village; he is able to attend the Christmas dinner, and no doubt he will be in his seat at the next council meeting.—D W BARRITT is a retired cardiologist in Bristol

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