End of the line.

As paramedics sometimes we have to assist patients in their final stages of life. These jobs can prove to be challenging but extremely rewarding. It is an honor to enter someone’s home and ensure their comfort and dignity is maintained in those last moments.

“45 YEAR OLD MALE – DIFFICULTY IN BREATHING” The mobile data terminal in the car flashed up. I put the TV series I was watching down, fired up the engine and headed toward the address.

It was a Friday evening, the sun was setting and their was a warming orange glow to everything – the perfect night to be sat in the garden after a barbecue watching the world go by.

As I pulled up outside the address I quickly noted a couple of things – firstly, there was a lot of cars on the drive. Secondly, there was a boy – around 10 years old. Waving me down.

“My dad isn’t very well, mum is in there with him. I wanted to see if you came with flashing lights – you did!”

After greeting the boy I walked through the hallway of this well kept house – it was very homely. There were pictures all over the walls showing holidays, weddings and birthdays. In the centre of most of the pictures stood a tall man, smiling and happy.

Through here!” A woman’s voice shouted from further down.

I walked into what would have been the living room and took in what was in front of me. The room looked like your average front room. However, one side of the room was partitioned off and there was a hospital bed.

On the bed, sat forward was the patient. He was in trouble. I could see that he was in pain, his breathing was fast. Too fast. With every breath he was struggling. Next to him, the figure of calm. The woman, who I would later learn was his wife was calm and coaching. She turned to me and smiled.

“Its ok Brian, someone is here now” she said. Sometimes you wonder who is more reassured – the patient or the relative. However, she was like a rock in a storm. Totally calm.

She quickly told me what was going on. Her name was Alison – she was Brian’s wife. She explained softly that Brian has terminal lung cancer and recently had been struggling to breathe due to the amount of secretions he was having to clear from his airway.

Secretions is a medical term for build up of fluid that comes from systemic failure. It is normally a lot like saliva and can be very hard to clear. It is described by some as drowning from the inside out.

Brian had been a train driver for most of his life, until he had started coughing up a little bit of blood a mere 6 months before. I could see the toll this had taken on the family. I knew then that I had to rethink my strategy. My goal here was not to save Brian’s life, it was to help him have a good death.

This was something that at that moment – he was not having. His breathing was erratic, shoulders heaving and I could hear his chest bubbling from where I was stood.

Most patients who are end of life within the UK have a box known as a “Just in Case Box”. Within this box their are various medications that have been prescribed for exactly this scenario; when it is out of hours and medication is needed in order to control symptoms and the patients distress. This is exactly what Brian needed.

I asked for the box and Alison took it out. She had read into the medication in there and wanted Brians secretions reduced; however, did not want any of the medications for agitation.

“At the moment he is still here, we don’t want him sedated”.

I drew up the drug she needed to be given through an injection. As I was doing this Alison was telling me about Brian. I heard all about his life and his family. I knew he had two kids who were currently upstairs doing their homework and with the mother in law who was staying to help look after Brian. They knew what was going on and the whole family had been honest with them throughout. I thought back to the boy who had been waiting for me earlier. He was so calm. I admired their way of dealing with this.

We have called it Terminus”. Alison said.

She was referring to the cancer. I had heard of cancers being given names before. This name; however, was a new one to me. She must have sensed my confusion.

“When a train driver finishes their day working. The train returns to the end of the line. Terminus.”

This was how Brian’s family were dealing with this. This was their journey. Brian was a train driver. My job was to get Brian back on track.

I gave Brian the medication that would help reduce the secretions and assisted him in taking the oral morphine that would help with his erratic breathing. As he started to calm down and fall into a peaceful sleep Alison called the children.

Two boys came downstairs. The young one from earlier and an older boy. Around 15. Both of them kissed Brian and said goodnight. Brian was able to mumble a good night back, following it with a tender “love you”.

Alison dimmed the lights and pulled Brian’s duvet up.

“Thank you”

Being a paramedic isn’t about all the life saving interventions and fast pace. Although, this is the job we train for and we all get excited attending those jobs. Patients like Brian are just as rewarding. Getting in my car after this job knowing that Brian was comfortable, that the boys said goodnight and that Alison was reassured makes this job the best job in the world.

I managed to get Brian back on track following a minor delay. He is heading comfortably to Terminus and whatever awaits him after that. I just hope the rest of the journey is comfortable.

For Brian.

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