If symptoms
persist . . .
LAST week the police arrested one of my patients when they found a kilo of heroine under his pillow. Of course, this put me in mind of the Tooth Fairy, which in turn led me to think — while another patient was drivelling on about her alleged symptoms — of another super- natural being whom I shall call, faute de mieux, the Antiresuscitation Fairy.
What exactly does the AF do? (It's about time we got scientific and started using a few acronyms.) Well, she goes round second-rate hospitals — the kind I generally work in — removing one tiny piece of equipment from the emergency trolley (a plastic connector, say, or the bulb for the laryngoscope), whose abs- ence renders all attempts at resuscitation futile. It doesn't matter how often the trolley is checked, the AF has always visited it before the next emergency.
Resuscitation is a tricky business, even at the best of times. First there is the question of whether to do it or not. I don't mean the technical question, though this can present difficulties to the inexperienced, and I once saw an old man taking a post-prandial nap suddenly hurled from his bed to the floor by two zealous young nurses, who proceeded to snatch him from the jaws of sleep by giving him a good beating on his chest. Luckily, he suffered only a broken rib. No, I'm talking about the ethical ques- tion. 'Thou shalt not kill but needst not' etc, etc. When I qualified, the decision was still taken by the consultant, who stood at the end of the bed and looked at the patient the way one looks at a painting to see whether it is hung correct- ly. `Iimmm,' the consultant would say sagely, and then scribble the letters NTBR in the notes — Not To Be Resuscitated. Thus the penalties for being a bit below par on the day of the weekly ward round could be consider- able, if you were over 65.
But not as considerable as all that. There were just too many stages at which a resuscitation attempt could be foiled, even before the malign intervention of the AF. For example, the switchboard operator might have been watching the football with the sound turned up, or the batteries in one's bleep might have been dead (I knew one doctor who put his bleep in a tumbler of water whenever he was on duty, just to make sure). The patient might have been five or ten minutes away, ample time to sustain permanent brain damage. And it was only after the patient survived these hazards that the AF came into her own.
The wonder was that anyone survived an emergency. I was particularly proud of my restoration to life of a rich old man who had suffered a heart attack. He was so grateful to me that he said he was going to change his will in my favour. Alas, he had another heart attack before he got round to it. In the meantime, the letters NTBR had appeared in his medic- al notes. They weren't in the consultant's handwriting. I don't think it was the Antiresuscitation Fairy, either; I suspect it was the relatives.
Theodore Dalrymple
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