Read all About It

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.

John Keegan

8 thoughts on “Read all About It”

  1. Great story; the end of one life stage and the beginning of another – shows we need defibrillator update training annually as you never know when you may need to use it, unless you live next to a heart surgeon of course.

  2. When we moved to Whittington, Mike, we exchanged the heart surgeon for the retired Bishop of Whitby, Gordon Banks, who lived at No.2 Loyne Park.

    It indicates my house buying philosophy. F**k the property. Who are the neighbours?

    Having lived, exclusively, in one cul-de-sac or another, since 1966 my belief/reliance in neighbours is paramount.

    JK

  3. John,

    Great story. The Defibrillator as you know is a great asset to the Village and was recently deployed.

    Mike great point you make about training, without putting you on the spot, what is your feeling in taking over the responsibility for the defibrillator? Would you consider being the Whittington first responder? Simon currently looks after it and does the relevant checks but he doesn’t have time at the moment to be a first responder or sort out training. Any help would be appreciated.

    The defibrillator was very recently deployed by two of the Villagers assisting a family and the nearest first responder was a lady from a farm at Barbon.

    Misses R

    1. Surely, the fundamental question is “Where does the responsibility for the defibrillator lie”?

      It was purchased by the Parish Council, using residents’ money ,of course, and surely, before they spent the funds they would have ensured that it could be used properly.

      So the real question is “What is the Parish Council’s proposal for ensuring that they have not wasted our money”?

      Agitator #2

  4. I disagree. Firstly, it wasn’t provided by the Parish Council. It was a joint project between the PC and the Village Hall. It is the Parish Councils money, not residents. The Parish Council levies a precept and has the power to determine where and how the funds are used.

    Secondly. Instructions on using the machine comes with it. When you connect with the emergency services you are instructed in its use.

    First responders deal with CPR + defibrillation. It is the CPR part of the process that benefits from a first responder, not specifically the use of the defibrillator.

    The heart pumps blood at 5 litres per minute. CPR keeps blood flowing to the brain, ergo it keeps the brain alive. Otherwise, you will end up with a living person who is brain dead. 5 litres per minute needs 100 chest compressions every minute during which multiple ribs are broken. (in my case 9)

    The faster you can get the brain pumping again (the job of the defibrillator) the sooner can you stop doing CPR.

    These are two different matters. But – having access to a first responder is going to add a level of support that is of massive benefit. First responders are a community matter, not a Parish Council one. However the PC can be, and in my view is, supportive.

    Agitator #1

  5. I disagree. Firstly, it wasn’t provided by the Parish Council. It was a joint project between the PC and the Village Hall. It is the Parish Councils money, not residents. The Parish Council levies a precept and has the power to determine where and how the funds are used.

    The points that John has made about parish council funds leave me rather confused!

    Surely the Parish Council should represent the community it serves and therefore the Parish Council funds are held on behalf of the community and so belong to the community.

    If we accept this, before granting any money surely the Parish Council needs to ensure that the organisation receiving the money is able to manage its use.

    From John’s observations this means that the Village Hall committee is responsible for the maintenance of the defibrillator.

    As to the use of the defibrillator, my understanding was that it was designed so that it could be used by anyone who followed the instructions given and this seems to be confirmed by the British Heart Foundation whose website gives the following advice:

    “Who can use a defibrillator?
    You don’t need to be trained to use a defibrillator – anyone can use it. There are clear instructions on how to attach the defibrillator pads. It then assesses the heart rhythm and will only instruct you to deliver a shock if it’s needed.
    In a recent survey, three quarters of people said they wouldn’t feel confident enough to act if they saw someone having a cardiac arrest. With more CPR training and greater awareness, we can change that.”

    Clearly, if the British Heart Foundation is right, anyone using the defibrillator in an emergency would feel more confidence if they had been given basic training.

    Where do we go from here?

    Perhaps the key issue is for the Parish Council and the Village Hall Committee to decide which of them has responsibility for the defibrillator.

    When they have reached a conclusion the appropriate body can nominate an official “caretaker” and inform residents of the conclusions they have reached.

    This of course brings us to the question of keeping residents informed which is another issue altogether.

  6. The PC has no obligation to consult over the use of the Precept that they receive from their District Authority.

    The PC hasn’t “granted” funds to anyone. They have jointly funded a cooperative project.

    To date, the VH has undertaken responsibility for the maintenance of the defibrillator and are currently seeking, jointly with the PC, to establish a long term solution.

    Whilst it may help to have “confidence” in using the defibrillator this is not a condition of being capable of using it.
    First responder “basic training” is in CPR rather than simply the use of the defibrillator. The two issues, defibrillation and CPR, are related but separate subjects and stand alone in their purpose. One keeps blood circulating whilst the heart is stopped and the other endeavours to restart the heart.

    First responders generally have their own mobile defibrillator. Public ones, like that at the VH are for use by people who are not trained, first responders.

    The more people who are trained in CPR the better. They stop people who’s hearts have stopped, from becoming brain dead whilst they wait for an ambulance or first responder to come on the scene.

  7. Gentlemen,

    Whilst I am sat here at the Churchill Hospital in Oxford with a very sick relative all I wanted to know was whether another person who was interested in ongoing first aid training would be interested in maintaining the Community defibrillator.

    Mr Raistrick will continue to do so until a willing volunteer does or does not come forward. It will along with a local first responder save lives. Thank you both for your contributions to my comment. Mr Barr sorry for putting you on the spot.

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