How to Treat People by Molly Case

Author:Molly Case [Case, Molly]
Language: eng
Format: epub
ISBN: 9780241983751
Publisher: Penguin Books Ltd
Published: 2019-02-14T00:00:00+00:00

24

Sometimes before somebody dies they get a sense it is going to happen. In nursing school we were taught about a symptom that often precedes a heart attack, a person experiencing a sense of impending doom. There is little known about this feeling, but it has been attributed to the pressure building up inside the chest from conditions such as Anna’s cardiac tamponade. The feeling of low blood pressure could provide another explanation. Anna’s blood pressure dropped rapidly, the blood barely running through the tributaries, and could have been the reason she knew before any of us that she was going to die.

The circulatory system consists of the heart, the blood and the blood vessels that branch out across the whole body. Circulation can be divided into two distinct networks: the systemic circulation, which delivers oxygenated blood to organs and tissues and then travels back depleted to refuel and be sent out once more. And the pulmonary circulation, which carries dark blue blood to the lungs to be oxygenated and returns to the heart to start the cycle again.

The heart is protected by the thoracic cavity, the hard bones of the sternum and ribcage sheltering the soft pumping organ beneath. It has its own personal blood circulation, supplied by the coronary arteries that surround it. These vessels are renowned for becoming clogged with fatty deposits that can cause the vice-like grip of a heart attack.

Arching upwards from the left ventricle of the heart is the largest blood vessel we have: the aorta, a fat, flayed red-pepper vessel that pumps oxygen-rich blood away from the heart to organs and tissues around the rest of the body. It is in the wall of this vessel that a dangerous bulge, known as an aneurysm, can occur; if left untreated, it can swell to such a size that it ruptures, causing catastrophic bleeding beneath the surface and leading to almost instantaneous death.

Bleeding on the HDU is nearly always concealed like Anna’s was, most often happening beneath the surface. We wait and watch for signs of it – a rise in venous pressure, a racing heart rate, quickened breath – but mostly are unable to see the blood as it pools in the hidden depths of the thoracic cavity, and have to rely on outward indications to detect the coming storm.

After shifts as a student nurse in the hospital on the hill, I walked from the medical wards to the birthing centre where my sister worked. Here I heard the guttural grunts and screams of women pushing their babies out into the daylight, and would stop mid corridor, startled by the sounds. I imagined the red splatter as the baby arrived, the warm puddle of blood beneath it, the umbilical cord still throbbing with life, the placenta delivered onto white hospital linen, a crimson eye staring up at the outside world it now belonged to. This blood affirmed life. It was on the hands of the midwives, streaked red on the legs of the mother, gathered in bright globs on the baby’s fontanelle like sunspots.

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