Saturday, October 20, 2012

Circles and Cycles

This is undoubtedly the strangest thing that has ever happened to me…

One of my little schemes for paying the mortgage is to train people to speak in public. A surprising number of people need this skill, and a lot of them don’t realize until they make fools of themselves. Candidates for the oral part of civil service exams, young employees wanting to impress the boss, salesmen who need to stand out at a conference, people running for public office, they all want help, and some of them call me.

It’s mostly academics and professionals, and it’s mostly in English, although it doesn’t have to be. The techniques are different when you are not using your mother tongue, but the basic problems and skills to be practised are the same.

One man who trains with me is a doctor, who is sometimes required to address congresses and other demanding audiences in English. He is a good communicator in many ways, but his English is not quite up to some of the tasks he undertakes, and  so together we seal a few of the cracks and give him a little extra confidence.

This doctor, who we shall call Santos, for no particular reason, doesn’t live in the small city which I adopted some years ago and which has, in turn, adopted me. He works at a small hospital in a town some 20 miles away, and lives about another 20 miles beyond that. Nevertheless, he thinks it worth his while to drive here twice a week after work to learn and practise with me.

Not long ago he was asked to give a talk, in English, on some aspect of emergency procedure. A gathering of medical and administrative personnel from around Europe had been invited so they could show off our new teaching hospital, and they wanted something didactic, dramatic, bloody, and theoretically useful. It had to be worthwhile for the doctors to sit and listen to it, but it also had to convince them that the non-medical people present would learn from it. It had, in short, to be professional, clinical, smooth, it had to look and sound good. His sponsors were looking for a performance, of which the practical benefit was only a part.

He had decided the topic by the time he spoke to me about it. He wanted to explain how to do an emergency tracheotomy, which is nicely dramatic and bloody. I questioned him in detail about the likely audience, which should be the starting point for any speaker, but is often forgotten. We discussed the language and terminology he would need, ways of structuring the text, styles of presentation, and how to fit it all to the time. And he went away to produce a draft.

The next day we looked at it, I corrected it, we discussed the pronunciation of certain difficult but essential terms, and removed some difficult, non-essential words. You don’t want to spend half the time worrying about whether your attempt at some key word is going to be taken off the bat. We trimmed it a bit, I reduced it to a larger number of smaller conceptual units- the difference would be more in his mind than in the text itself, but it makes a difference- and he went away again to make a final version.

When it was ready and he was happy with it, we did a dress rehearsal, in which I was the audience. Reading from a sheet gives great confidence to the speaker, but it can very easily distance the speaker from the audience. To read as though speaking ex tempore in one of the skills they come to me to learn.

His performance was superb. He is, I am certain, a fine doctor. He brings competence, responsibility and hard work to everything he does. He had practised diction, delivery, interaction, he was aware at all times of the speed and intonation of his voice and he never forgot that he was there to tell people things that they wanted to hear. Even without the slides- he had prepared a bit of visual support, but we decided for the run-through it wasn’t worth setting anything up; pressing a button every so often wasn’t going to affect him in any important way- it was gripping. I pronounced him ready to face his public.

We cut to the following Saturday morning. I was walking in the country, as I do. Just outside the city, as I passed an isolated and apparently abandoned house, I heard a form of screech. My expert ear immediately identified it as a young female Homo sapiens expressing strong emotion. But this was not the strong emotion produced by seeing a friend approaching, or hearing about what A said B did with C in the broom cupboard, or noticing a lovely pair of boots in a shop window. It was a different kind of screech, and it that made my blood run cold. Something was very wrong, and there was no one else about.

I ran around the corner of the building. There were two girls, in fact, both about 12, one bent over, screaming, the other on the ground, twitching horribly. The screaming girl grabbed my arm and managed to say ‘she can’t breathe… she can’t breathe…’ I had expected to find a wild animal, a big dog or a wounded boar, perhaps, or a man attacking her. I would have known what to do. I might have done it badly, but I would have had a plan. This was beyond me.

I dropped down beside her. No, she couldn’t breathe. She wasn’t wheezing, asthmatic, drunk, drugged or anything like that. No air could enter her lungs. None. Why not, I asked the friend. She had been licking a kind of gobstopper when she laughed and sucked it in, and she fell down. I had to do something very, very fast. But what?

I had dialled the emergency number almost as I heard the first scream, and I gave the phone and the GPS I carry to the friend, and told her what to tell them. The girl’s eyes were turning red, and the rest of her blue. The words Heimlich manoeuvre swam before my eyes. I could feel the ball in her throat, it felt big and hard and a long way down. I sat her up as best I could, squatted behind her and tried to squeeze her firmly just below the diaphragm. Even if I’d known where the diaphragm actually was, the sweet wasn’t going to move. It was too firmly lodged.

The word tracheotomy swam before my eyes. I knew how to do one, at least in theory. But does she need one? She needed something. The ball wasn’t coming out and she couldn’t breathe. Oddly enough, it was the face of the friend that cooled my brain to the point where it could do something like thinking. I saw in her face what I should have seen in the choking girl’s: in 30 seconds she would be dead, and I had to save her, because I was there. The logic of children can be compelling. Her friend could not die, because that sort of thing doesn’t happen, and as I was the only adult there I would be the one who would save her. I could see it in her face and so it had to be true. I took the phone and heard a distant, commanding voice which sounded a little like mine that I was about to perform a tracheotomy and the ambulance crew should be ready to treat the consequences. And I went to work.

The principle of the tracheotomy is very simple. If the windpipe is blocked and air can’t enter, and you can’t unblock it, then you make a hole belong the obstruction, keep it open with a tube, and the patient breathes once more. In the rucksack I always carry when out walking or riding I carry a large number of things, on the grounds that you never know. I took out the first aid kit, a small hunting-knife, a lighter, and a ballpoint pen.

I thought back to the lecture I had heard. Dr Santos was a very good performer indeed. When we had done the rehearsal I was more interested in the sound of it, the interaction of the speaker with the audience, the use of the voice and the eyes, the length of sentences, the authority of the speaker, with the performance as a whole, rather than with the content, but it had got over. It was there in my head. Despite the lack of slides, I could picture every detail of the operation as it should be performed. I could see the folds of muscle I had to use to navigate, the cartilage I must avoid, the point I had to find where the bleeding would be minimal and the introduction of the tube easiest. There was also some stuff about severing the flesh in several stages to avoid the larger veins and the isthmal gland, but dismissed it as fussy and irrelevant. I put the blade of the knife in the flame of the lighter and prepared to act.

All of this took much less time than it takes to tell. Disturbing as it is to watch a young girl die before your eyes as you prepare to slice open her windpipe- and believe me it is absolutely bloody terrifying- everything changes when you have a plan, a purpose. You become calmer, at least calm enough to act. You think of nothing else. Time moves slowly but smoothly. Your responsibility is no longer to save a life that is draining away as you watch- a daunting job to thrust upon anyone- but to plunge a knife through flesh. That, you think, I can do. Easy, no problem. This is done and dusted.

The details are blurred, for which I’m grateful. But it was messy. If you’ve ever cut uncooked meat with a knife, or prepared a rabbit for cooking, you’ll know how hard it is. The flesh slides away from you and refuses to be controlled. When you have 10 seconds to make the cut this can be quite nerve-wracking. But the knife went in. It reached the place it had to reach, and went no further. It avoided major arteries and other vital organs. By the purest of chance, I should think. I pushed the sleeve of the biro through the hole, and she breathed.

It sounded like nothing on earth, it looked more like death than the convulsions and the blue skin, but oddly enough it was the sound of life being grasped, firmly, by a hand that wanted it badly and would get it. It became stable, still not anything like normal, but stable, and her eyes opened. She seemed to see me.

Her friend, who had breathed little more than she had in the last two minutes, fell half on top of me, and then completely on her, and cried. A relaxed, uninhibited kind of crying. Her tone told me that her friend would recover. I knew it because she was breathing. The friend knew it because she could read the other’s mind, and understand those parts of the universe that understood what was and what would be. The girl’s face at that moment was beyond my understanding.

What I do know is that nothing I have ever felt in my life is comparable to the moment when I knew she would live. It was simple relief. The obligation to do something so momentous was over, and it been successful. I could relax. No more than that. I didn’t know the girl. If I hadn’t passed by just then I would have read of her death in the paper and not batted an eyelid. But I was there. I did it. And it felt good.

She was conscious when the ambulance turned up, still breathing strangely, but conscious and calm. She didn’t know what had happened to her, and she felt some discomfort, but she could see her friend’s face which told her she was ok, and she was with people who knew what they were doing, so she would be fine. The ambulance crew cleaned her up, stuck tubes in her, and took her away. They wanted to take me with them, to treat me for shock, but I said no. I was ok. I was more than ok. I felt terrific. They even had the courtesy to congratulate me on the competence of my butchery. I knew they were lying, but what the hell.

Which lasted a couple of miles. I had to sit down by the path, call a taxi to take me home, and consider the matter with the help of two large Scotches (in Spain, large means biiiiig). It’s just life, I was managing to persuade myself. The poor girl will have a nasty scar, which she will hate me for, but she’s alive. It all worked out right, because by the purest chance I had just learned the basics of the exact technique she needed. Sometimes life works like that. It ended well. Be happy about it.

That afternoon I got a call from Santos, the doctor, my student. Of course, that was the day he was giving his lecture. He would be calling to tell me how it went. But no.

He never gave that lecture. He was in my little city, at the hospital. He had been about to take the stage when the call arrived. His 12-year-old daughter had suffered some kind of attack while visiting a friend. She had been given an emergency tracheotomy, which had saved her life. I wished him the best, her a swift recovery, and finished the bottle of whisky.


Petr said...

Oh my goodness. How can this be? This is either your most powerful post or your best fiction ever!

CIngram said...

Wow! That was quick.

I confess that it's fiction. I waz hoping no one would ask, at least not quite so soon.

Brett Hetherington said...

Fiction! You bastard! Bloody great story though, and written in such a captivating way. Believing it to be true at first, makes it stunning. I only started to doubt you (a bit) in the final paragraph but I so wanted it to be true. In a way it is true because you played it out in your mind and inserted in the minds of the reader. It has believability though, which makes for the best fiction. And powerful, yes.

CIngram said...

Thanks for the good review, Brett. Yes, in a way it is true, exactly in the way you say. There is no butchered girl, thankfully, but there is a doctor client who gave such a presentation which stuck in my mind so clearly that later I was sure I could perform the procedure if I had to. From there to imagining the situation around every corner is not much of a step.So much of it existed in my mind as 'a form of true event' before I thought it might make a good story, that it got written that way. Then I realised that to make it work I had to close the circle at the end, hence the last paragraph is in a slightly different style.