The Flat Line

TW // death

“Two minutes! Stop compression, check rhythm and pulse!”

I was awoken from a calm and peaceful dream. Bright lights, strange noises, and figures moving around my body in a rapid but well-rehearsed commotion. Soon a tall figure hovered over my chest and his large hands started pressing down deeply and quickly at the centre of my chest, again and again. I wanted to yell at him, bugger off!!! But I could not find my voice. I tried to move my limbs or turn my head to the side but again I could not move them. What’s going on? Where am I?

***

“Two minutes! Stop compression, check rhythm and pulse!”

PEA^1. “Darren, give 1mg adrenaline. Colin, continue compression,” Maia shouted. This was not how she had planned Christmas Eve. After twelve months of maternity leave and six weeks of phased return, she had had a fairly gentle transition back to the hustle and bustle of Emergency Department life. But not today. Today she was in charge of Resus and by 6PM it was clear that most of the adults in the north east of Scotland did not want to spend Christmas Day with their families but instead at the mercy of the staff at Aberdeen Royal Infirmary. She hadn’t even written on the notes of the previous two patients she attended when she was dragged by Pam, the sister in charge, to this bay. Standing at the foot of the trolley, she could see a young man of not too dissimilar age as her. Drowning accident. She could already see the odds were not in this young man’s favour. But nobody is dead until they’re warm and dead. She looked at Pam and asked for blankets and bags of warm fluids.

***

“Two minutes! Stop compression, check rhythm and pulse!”

I remembered going to the Co-op^2 because my wife needed a last minute bottle of milk ahead of the holidays. As it was a rare nice winter’s day, I decided to go for a walk instead of taking the car. It was still bright when I left the shop so I came by the pub around the corner to say hello to the lads. I didn’t fancy coming home too early, to be honest, not until Ethel, my mother-in-law had had a few mugs of hot toddy. We only moved to this area three months ago because Ethel needed more help at home and my wife readily offered to. Well, she was expected to as her brothers lived in Canada and Australia. She told me I would love the area as it was great for outdoor lover and adrenaline junkie like me, but I just hadn’t found a real connection with the area yet. Having a job with remote working possibility meant I was also unofficially in charge of supervising the building conversion of the garage into a granny annexe for Ethel while my wife went to work at the local school. Before I knew it, I had become a domesticated husband! I shared this with Ross and some of the lads at the pub.

***

“Two minutes! Stop compression, check rhythm and pulse!”

Still PEA. “Another shot of adrenaline please! Colin, swap places with Darren. Continue compression.” Maia glanced at the screen and read the core body temperature: 27^oC. Well, if he survived this, it might actually have helped him, she thought. She couldn’t help but compare The Man to her brother. Her brother who died after a head injury accident while working on his University project. She was still in Medical School back then and she tried not to get too involved with the complicated litigation process that ensued afterwards. But she remembered reading copies of the ambulance and hospital records, trying to make sense of everything with her limited medical knowledge at the time. Perhaps that was why she went into Emergency Medicine. Nobody is dead until they’re warm and dead…

***

“Two minutes! Stop compression, check rhythm and pulse!”

Ross pointed out that it was getting dark outside and I should be getting home. I had taken a shortcut walking across Loch Loirston earlier that day. This winter had been unusually colder than usual and the lake had been frozen for weeks with a few inches of snow on top. I stopped and sat at a bench by the lake, the winter sun was slowly dipping behind the barren trees, its warm orange glow reflected by the snow on the ground. I had never seen anything quite like it! The whole place felt ethereal. This brought me back to the time when we lived in California while I did my MBA at Stanford. We spent many weekends backcountry skiing at Lake Tahoe, followed by a relaxing soak at one of the many hot springs nearby. We were newly married then and I managed to convince my wife to come with me. Oh, the honeymoon period!

***

“Two minutes! Stop compression, check rhythm and pulse!”

Maia looked at the monitor. The man had a sluggish heart rate but his blood pressure was improving. Are you sure you can’t feel a pulse? She shifted the special warming blanket aside to attempt to feel one herself. She looked at Pam who had just finished attaching another bag of warm fluids. She wondered if they had managed to contact his family. His wife was on the way, she was told. Good. Her brother had died in hospital alone. His friends were there, the ones that were also implicated in the accident. Her parents were only informed by the Dean of the Faculty a few hours later. She found out later in the evening. Maia shook her head. No, she wouldn’t let the same outcome to befall upon The Man in front of her. She would do everything in her power… “Let’s get a central line trolley ready, and set up adrenaline infusion!” She barely took her gaze off the timer on the wall.

***

“Two minutes! Stop compression, check rhythm and pulse!”

I had resisted moving so far up north to Aberdeen for many months. For holidays, sure why not. But to live here, every single day? It took 10 hours by train from London, or 1.5 hours by plane. So far I had not managed to convince any of my mates to come up and visit. Maybe when the snow was more settled and the wind had stopped blowing at 90 mph up in the mountains, I could convince my mates to come for a weekend skiing in the Cairngorms. They had great ski touring routes as well, those rugged mountain peaks that lent itself to rock climbing enthusiasts in the summer months made for epic ski mountaineering and touring in winter. But they would just tell me to join them in the Alps. More reliable weather, I chuckled. I would tell them, there’s no such thing as bad weather, only unsuitable clothing. But nobody truly believed that, not even myself. In truth, I moved because Ethel needed my wife, and she needed me.

“Two minutes! Stop compression, check rhythm and pulse!”

We moved here just before the new school year started. I had driven my wife and I up from our little terraced house in Richmond and after many hours stuck on the M6 motorway, I could not bear the thought of having to spend the weekend unpacking. So we took advantage of the school holiday to explore the North Coast 500, a scenic 500 miles road trip in the Scottish Highlands. For a week, we drove the narrow winding roads along the stunning coastline in my Tesla. We walked down Whaligoe steps which zig-zagged down a steep 250 feet cliffs down to a secret cove used by fishermen in the past. Their wives would be waiting to haul baskets of herring, salmon, and shellfish up the steps. We hiked the three Corbetts^3 at the craggy Quinag before resting our feet deep into the soft white sands at Achmelvich Beach. After that amazing week we returned home and my world shrank to the confines of the 2000 square feet 4-bedroom house we officially purchased off my mother-in-law. I guessed both Ethel and I were slowly learning how to co-exist in the house, it would be so much better once the garage conversion was completed. Lately I had noticed that my wife was becoming more edgy as well. I felt like I had to tip-toe around her feelings, afraid I might accidentally trigger another angry outbursts. Whenever I had wanted to talk about it she would grumble that she was too tired to talk, or she would disappear off to the loo! In fact, she was always in the loo… Wait a second… Oh, crikey…

***

“Two minutes! Stop compression, check rhythm and pulse!”

Still bloody PEA, scoffed Maia. She grabbed the printed paper with blood results from the sample taken when The Surgeon inserted a central line into The Man’s groin. Maia ran the list of reversible causes in her head. It seemed overwhelmingly due to hypoxia and hypothermia. Core body temperature was now 30^oC. She glanced at the electrolyte levels on her sheet of paper, slightly elevated potassium but nothing to write home about, sky high lactate as expected… no signs of massive haemorrhage or other injuries, and now that The Anaesthetist had placed her magic tube into the airway, she could see The Man’s chest rising equally every time The Anaesthetist squeezed her bag, except she kept shaking her head to tell Maia his lungs were not compliant and she wasn’t getting enough oxygen into him. What more could Maia do?

***

“Two minutes! Stop compression, check rhythm and pulse!”

I remembered after watching that magnificent sunset, I traced my steps back home across the frozen lake. But the path was no longer clear, other people had crossed the lake too, I even saw a man and his Border Collie in the distance. As dusk was settling, my steps became less and less confident until the ice below me cracked. I panicked and struggled to stay afloat for what felt like a very long time but the icy water finally triumphed over me. As soon as I gave in and finally inhaled water, my body went limp and I was overcome by this feeling of calmness and peace. There was no pain or fear. I closed my eyes and fell into a deep sleep…

“Two minutes! Stop compression, check rhythm and pulse!”

I was now floating in this crowded bay. I could see about 10 people circling around my body. The one they called The Anaesthetist was holding my head between her hands. She was the one who poked a massive tube down my mouth earlier. She was also the one who shone a torchlight into my eyes and woke me up from my slumber. There were 2 burly men standing at either side of the trolley, they were taking turns pushing down my chest with their big hands. Ouch, I could feel my ribs cracking as I witnessed that from the end of the bed. Next to where I was standing now was what looked like the team leader. She was bossing everyone around her and I could see a nervous-looking young boy in the corner writing down everything she said on a big sheet of paper, poor boy! I heard a familiar voice not far away so I turned my head and saw a nurse talking to my wife, my wife! She was here. She was sobbing but her hands were cradling an invisible bump on her belly and I knew my suspicions earlier were right… I zeroed in on our wedding band, looking tight as a tourniquet on her unusually swollen finger.

“Two minutes! Stop compression, check rhythm and pulse!”

I desperately returned to my body. Let me in, take me back… I screamed at myself. A moment ago I was sure I was already gone and I felt ready and relaxed about it. Now I wanted to rejoin my soulless body. Please don’t reject me, please let me in, hellooo??? I felt so confused, nobody ever told you about this at school, or even Google. What was I meant to do in this situation? I wanted to live. I was dead sure about it, ha… I meant, I was absolutely sure, that I wanted… TO LIVE!!! For my wife, for our unborn child, our family.

***

“Two minutes! Stop compression, check rhythm and pulse!”

“Maia, I could feel a pulse,” Said The Anaesthetist. Suddenly she felt The Man’s head jerking between the palms of her hands. She suctioned the endotracheal tube that was full of blood stained secretions but The Man was also bringing up a lot of frothy water around the tube which she quickly suctioned off. Darren and Colin, exhausted after more than 50 minutes of CPR, gave her a wistful smile.

“Return of spontaneous circulation, 19:05. Pam, call intensive care for a bed,” Maia smiled for the first time that evening.

***

1. Pulseless Electrical Activity, a type of non-shockable cardiac arrest.
2. A brand of convenience store in the UK.
3. Scottish classification system for mountains: Munros are >3,000 feet, Corbetts are between 2,500 feet-3,000 feet, and Grahams are between 2000 feet-2500 feet.