I recently bought an ebook, on Amazon, entitled “The Angina Monologues”. I bought it because it was written by my old next door neighbour in Cambridge, Samer Nashef (a Cardiothoracic surgeon at Papworth Hospital). I was greatly surprised to find the following passage, recorded for posterity, in Chapter 17, entitled “The many Forms of Lazarus”, of the book:
“Cardiac arrest is truly appalling when it happens out of hospital, at home, on the road or in a public venue. Even if a bystander witnesses the arrest, has a reasonable idea of how to conduct resuscitation and cardiac massage, and begins to implement that immediately while waiting for the ambulance, only 1 in 10 such people will leave hospital alive, and this takes me to John Keegan.
I am not here talking about the eminent military historian, but about my next-door neighbour who ran a company which manufactured industrial catering machines. I used to tease him by referring to his work as ‘the sausage-making business’. A lovely and sociable man, with a well-developed sense of humour and an intact inner child at the age of 60, he used to play cricket, rollerblade round his drive and build model airplanes. My younger son Ramsay would often knock on his door at weekends to ask Maureen, John’s wife, if John was ‘allowed to come out to play’.
John also smoked about 80 cigarettes a day, frequently lighting one cigarette from the butt end of the previous one. One evening, after a long day’s operating, I settled with a beer in front of the television to watch the evening news. Suddenly, there appeared to be a commotion with a lot of noise coming from outside the house, with shouting and wailing, so I reluctantly got up to investigate. I opened the back door to find Maureen wandering around our shared driveway in a state of near hysteria. ‘It’s John,’ she said. ‘He doesn’t look right.’
I walked across the drive to their house and there he was, in the kitchen, slumped over the table with a stopped heart. I tried to find out from Maureen how long he had been in this state, but she was too distraught to say with any certainty. I had to make a quick decision between doing nothing and letting him die or starting resuscitation, and, if successful, possibly risk ending up with John alive, but with serious brain damage, because the brain will not survive a stopped heart for more than a few minutes. It was a difficult call with very little time available to make the decision. I decided to give him a chance. I shouted to Maureen, who was still wandering about in a state of agitated distress, to call for an ambulance, give her address and specifically to use the words ‘cardiac arrest’ when speaking to the operator. I then moved John off the table on to the floor and began the chest compressions for cardiac massage.
The kitchen television was still on and was blaring a particularly intrusive set of hard-sell commercials. I was pondering whether it would be considered ethical to stop the cardiac massage for a short while to switch off the TV, since the remote control was not within reach. Then an exceptionally irritating advertisement for a toilet cleaner came on and I abandoned the resuscitation briefly, got off the floor, went to the TV, silenced it and resumed cardiac massage.
Maureen came back into the room, slightly calmer now. She had made the call and the ambulance was on its way. I asked her to go outside and stand at the end of the driveway, and, as soon as the ambulance arrives, to ask the paramedics to bring the defibrillator with them and guide them to the kitchen. Some 15 minutes later, while still doing the chest compressions on the kitchen floor, I saw the reflection of the blue flashing lights through the door to the hall and two paramedics walked in carrying the defibrillator. ‘He’s in cardiac arrest,’ I said. ‘His only chance is if it is ventricular fibrillation, so let’s connect the defibrillator now and shock him if it is.’
‘And who the hell are you?’ said one of the paramedics. ‘Hang on,’ said the other, ‘I know you,’ and to his colleague: ‘That’s Mr Nashef. He did that aortic dissection I took to Papworth last week.’
We connected the defibrillator. The cardiac arrest was in fact ventricular fibrillation, the type that can be treated by an electric shock. We administered one shock and the heart restarted instantly. Within seconds, John had started to breathe again. They were short, gasping and irregular breaths, but where there’s breath, there’s life
We moved him on a stretcher to the ambulance, which sped towards the coronary care unit at the local hospital, only a mile or so away. An hour later I thought I had better go to find out how he was, and I was still very worried that he might have sustained brain damage.
I drove to the hospital and walked into the coronary care unit to be greeted with a loud shout: ‘You bugger! I think you’ve broken half my bloody ribs! But I knew that one day it would be useful to live next door to you!’ John was sitting up in bed and smiling. Later, he was investigated at Papworth and found to have just the one coronary artery narrowing in a branch of a branch of the left coronary artery. The branch in question was of very little significance and his heart had continued to work well despite the blockage, but the tiny heart attack he had sustained had caused a near-fatal but temporary disturbance of his heart rhythm.
Somehow the tens of thousands of cigarettes he had consumed had had only a very minor effect on John’s coronary arteries. Nevertheless, the consequences of that tiny blockage were a wake-up call. This was enough for John to stop smoking completely, sell the business and retire to the north of England. Before he did so, he tried to claim on his life insurance. He telephoned the insurance company and said to the hapless insurance claims handler: ‘I’m calling to claim on my life insurance, having died a few weeks ago.’ The claims handler did not know quite how to handle this particular claim and referred the matter to his manager, who was smart enough to demand a death certificate. Of course, John was not in a position to provide that document, and the claim was not successful.”
I never expected to appear in print, but there you have an authoritive record of the last time that I died.