Cover

How to Save a Life

Eva Carter

Dedication page

This book is dedicated to first responders everywhere, who go towards danger to help the people who need them most

A Guide to the Chain of Survival: Part 1

This is how to save a life.

Imagine a room with a hundred people in it: a packed pub, maybe, full of people you know and care about.

One by one, without warning, your friends and family members begin falling to the floor. Eventually, only six or seven are left standing.

That’s the truth about cardiac arrest. Without immediate help, fewer than one in ten people will survive.

It can happen to anyone, anywhere.

And the moment it does, the clock starts ticking. The heart no longer pumps blood to the brain and the body, starving them of oxygen.

But with the help of someone like you, many more patients could survive. Imagine thirty of those people you care about standing back up and dusting themselves down, alive and ready for their second chance.

It’s ordinary people like us, not doctors, who are most likely to be there when the worst happens. At work, in the park, at home, even in the pub.

A person’s chance of recovery depends on what happens next – starting with you.

This is the Chain of Survival. And the first link in the chain is both the easiest and the most important.

It’s simply recognizing that someone has had a cardiac arrest – and calling for help.

1: If you see someone unresponsive and not breathing normally, call 999. Every single second counts.

Chapter 1: Kerry

31 December 1999

Six minutes. I have six minutes left to be kissed.

Three hundred and sixty seconds and counting, if I don’t want to end another year – let’s face it, an entire millennium – as the only seventeen-year-old in Brighton who has never snogged another human being.

Most of the girls in the sixth form have gone all the way. You can tell from the way they move: dancing wildly on the shingle, wearing heels that keep sinking into the gaps between the pebbles, unsteady and sexy and—

‘Which do you think will implode first, the National Grid or air traffic control?’ Tim says, passing me the can of Diamond White.

When I raise it to my lips, all that’s left is apple froth. I look up at the sky. ‘You probably shouldn’t be quite so excited about the idea of Armageddon.’

He grins. ‘I can’t help it if I crave a bit of drama sometimes.’

You and me both.

‘We don’t have long to wait to get our share of it.’

This time next December, I’ll be at Manchester Uni. And, impossible as it seems now, the odds are that by then I will have been kissed – and hopefully a lot more. The prospect of finally losing my virginity isn’t even the most exciting thing about the year 2000. Because in a year’s time, I will be training as a doctor. With a bit of luck, and the right questions on his physics exam paper, Tim will be doing the same.

‘If the millennium bug doesn’t wipe us out . . .’ he looks at his Swatch, ‘five minutes from now. Makes me feel quite reckless, being on the brink of disaster.’

Reckless isn’t Tim’s style, but his eyes are bright: I can see the beach fires the hippies have lit reflected in them. Except it’s not just the flames. There’s something else in his face, an intensity . . .

Oh shit.

He’s going to try to kiss me.

He mustn’t.

Maybe it wouldn’t be the absolute worst thing, if we did it in private. We’ve rehearsed slings and burn dressings on each other, so why not kissing? Both of us want to be prepared for when it really matters. Practice makes perfect.

Except I don’t think he’s thinking of this as a rehearsal . . .

I move backwards, out of reach, and I break eye-contact, staring resolutely over Tim’s shoulder to where Joel and his mates are having a knockabout on the Lawns, lit by the Victorian lamps that line the Prom. The frost has set the earth like concrete, but the boys don’t seem to notice. They’re too busy trying to outrun Joel, even though they know they never will.

He moves twice as fast as the others, the football always at his feet. He was in the same class as Tim and me, but we stayed on to do A levels, while he got signed for a football apprenticeship by the Dolphins FC. He’s one in a million. Everyone either wants to be him or be with him, me included. I think Tim might be the only person I know who doesn’t care about Joel one way or another.

‘. . . Perhaps we can blame the Pagans. You know, for deciding New Year should happen in December,’ Tim says, embarking on a new lecture. I let the words float over me. ‘Or I suppose it might have been the Romans.’

‘Maybe.’ I shift again, increasing the distance between us. Everything has to be clear for Tim: he’s one of the smartest kids in the sixth form, but sometimes he’s also the densest, and I can’t let him convince himself it’s a good idea to kiss me.

Kiss me.

I imagine saying those words to Joel. Let myself believe, just for a moment, that instead of laughing in my face, he might do as I ask.

On the Lawns, Ant makes a clumsy attempt to tackle Joel but falls over his own big feet, and Joel vaults across his best friend’s legs to score again.

The ball flies over two Gap sweatshirts laid as goalposts.

Six–nil to Joel. I’ve been counting.

‘. . . But why didn’t they choose the summer solstice to mark a new year?’ A speck of cider foam sits on Tim’s top lip, and I’m about to lean over and brush it away. Except . . . what if he thinks I am flirting?

I want it to go back to how it’s been since we were seven: in and out of his garden and mine; every Tuesday, checking each other’s vital signs in the Scout Hall. I hate the new us: how he guffaws at my jokes when they’re not funny and gives me sideways looks as though he’s only just noticed that I’m female.

‘Summer solstice would make for a better party. Sacrificing virgins, roasting pigs. Or the other way round.’

I get so twitchy listening to his meandering monologues. I imagine walking away from him. Kicking off my sore Shelley’s heels. Heading on to the playing field, the icy blades of grass spiky through my tights.

In this other reality, I leap towards the ball like Bambi. Score a goal. Joel would embrace me in a victorious hug.

Louise Norman’s jaw – newly braced but sadly not wired shut – would drop, astonished at my daring.

My grace.

I’d settle for being surprising. For being noticed. At school, at home, here. Anywhere would do.

At the edge of my vision, Joel is running. And then he’s not.

He doesn’t trip, or throw out an arm to right himself or break his fall. Instead, he drops, face down, legs outstretched. The boy who fell to earth.

The others play on: Fat Matt does a double take when he gets possession of the ball, whoops as he propels it towards the neglected goal.

I wait for Joel to get up. What’s he playing at? He’s not a joker the way Ant is, and I can’t believe he’s risked injury by falling so clumsily. In his last year at school, before he got his big break with the Dolphins, Joel was the only one of the cool kids never to smoke or drink. Even tonight he’s stuck to orange juice . . .

Ant pivots back, calling out, ‘Come on, Joel, you knob,’ and when he reaches his friend, he nudges him with his big black shoe. Once. Twice. The third time is more of a kick.

Joel doesn’t move.

Certainty strikes me like lightning. I drop the can of cider – Tim is still waffling on about the satanic origin of Christian rituals – and though I fully intend to walk towards Joel, my legs have other ideas.

Even as I run across the Lawns, I’m cursing myself for being so obvious, but I can’t stop. After keeping my crush secret for nearly seven years, I’m about to blow it.

I speed up. Almost there.

Joel’s stillness makes me catch my breath. The other boys circle round him, shouting at him to get up. Ant frowns, and as I step into the circle, our eyes meet. I brace myself for mockery – Ant teased me on and off all through school – but instead, I glimpse panic.

‘What’s wrong with him?’ Ant asks.

‘He’s messing about,’ one of the lads says. I’m already kneeling down beside Joel, the grass sharp against my shins.

‘No,’ I say, ‘he’s not.’ My loud voice surprises all of us. ‘Be quiet. I need to listen, check how often he’s breathing.’

If he’s breathing.

ABC. The first-aiders’ alphabet flashes through my mind, anchoring me. I’ve been trained for this.

I lean in, close to Joel’s face. If he’s just blacked out, I should be able to feel the warmth of breath. But apart from the sweet smell of orange juice, there is nothing.

Airway. I tilt his chin, feeling the slight prickle of stubble under my fingertips. I part his lips with my fingers, no longer seeing him as the boy I fancy, but instead as a puzzle to be solved. Nothing seems to be blocking his throat. He should be breathing.

‘Ant. We need to move him, onto his back.’

Joel is heavy. A dead weight. But as we wrestle, I feel powerful. Joel’s on his side for a moment before he flops down onto the grass with an obscene smack.

‘Watch it!’ Fat Matt says. ‘His legs are insured for ten grand each.’

They’re worth nothing if he’s dead.

Breathing. His chest isn’t moving. Nothing is moving. Time has slowed, but my thoughts are faster, clearer than they’ve ever been.

I glance up. ‘One of you needs to run to the call box and phone 999. Ask for an ambulance. Tell them he’s not breathing. Tell them to come fast.’

The five boys stand there, goldfishing, as though I’m talking a foreign language.

‘Paddy, you go.’

He shrugs and kicks at the earth, as though he’s unsure whether to obey me and risk having the piss taken for the next year.

‘I’m serious. Go now.’ I get back to work, pulling Joel’s long, lean arms to his sides. ‘Run. And Matt – go and stand by the road. Try to flag down a police car.’

When they do what I say, we’re all equally gobsmacked.

‘Tim!’ I call out.

He’s pushed his way to the front. As I pull Joel’s sweatshirt to reveal his chest, I wait for Tim to kneel down at my side, to take over. In drills, he’s always the one fighting to step in.

But when I look up, he’s just staring at me. I don’t have time to work out why.

C is for . . . Circulation.

Am I really going to do this?

There is no one else.

‘Get everyone to move away,’ I tell Ant as I shuffle closer to Joel, my knees touching his arm.

His dark-gold skin is covered with a film of sweat. I’m trying to find the right spot between his ribs; my pale hands look like a little girl’s against his broad chest, and my nails are ragged and bitten.

Doubt fills me. He cannot be dying. Any moment now he’ll sit bolt upright. Laugh in my face. I’ll be known forever as the idiot girl who fell for Joel’s wind-up.

But as I glance down past his torso, I see a dark patch around his groin. And then I smell the sharp tang of urine and I know this is not a joke.

‘Please, Ant, nobody needs to see this. Move them away.’

‘You lot, move. Give the girl some room.’

I place my right hand over my left and push down for the first time.

No. Too cautious. The plastic training dummy always popped up and down jauntily. Joel’s ribs and muscles seem to fight me.

I do it again. Harder. There’s nothing jaunty about this. I have to be savage.

The third time feels right. I do what I was taught to, tuning into my own voice as I count out loud.

‘One and two and three and four and five and six and—’

They taught us the right, rapid rhythm using the old kids’ song, Nellie the Elephant, but right now, the nursery-rhyme pace feels wrong. Jaunty, again. The jokers in the ambulance cadets used to try to find the most inappropriate songs with the same tempo.

‘Stayin’ Alive’.

I repeat the lyrics in my head to time what I am doing, but they’re so inappropriate they sicken me. My hands feel too weak for the violence needed to force the blood around Joel’s athletic body. Was that a rib buckling? He will be so badly bruised when he wakes.

If he wakes.

It’s not the movies. Hardly anyone survives in real life.

I mustn’t think like that. Push harder. Try a different song.

‘Another One Bites the Dust’.

But the lyrics to that one are even harsher.

Fourteen, fifteen, sixteen, seventeen—

I realize I’ve been holding my breath. I try to take in as much air as I can to give to Joel.

Twenty-eight, twenty-nine, thirty.

I tilt his head back, the smooth skin of his throat taut and still warm. Pinch his nose as hard as I’ve been taught to pinch the vinyl nostrils of Resusci-Annie, to stop precious oxygen escaping.

Lower my head. Seal his lips against mine.

Close by I hear one cheer, then a volley of them. Somewhere in Brighton, fireworks explode.

It’s the year 2000.

I taste orange juice. As I look left, down Joel’s body, I wait for his chest to rise, for his lungs to inflate.

And I pray – though Tim and I have discussed this at length and are unsure God could exist – that this horrible primitive thing I’m doing might, against the odds, be enough.

Chapter 2: Tim

1 January 2000

I cannot move.

I stare at Kerry, kneeling on the grass next to Joel, and I know she needs me, they both need me, but I cannot move.

Do not panic. Perform a primary assessment: Danger? There is none. Responsiveness?

I am responsive, I can breathe, I am uninjured. But I can’t bloody move.

What’s wrong with me?

Not syncope, because if I had fainted, I would be lying next to Joel, but I am still upright.

Around me, the world is in motion, exactly as it was before midnight. The traffic lights are still in sequence, the music still blares from the clubs, the sky is still free of burning aeroplane debris. So much for Armageddon . . .

And Kerry is giving Joel CPR.

But I cannot move.

Why? Think, Tim.

Signs and symptoms. This is not full paralysis because I can breathe, and swallow, and feel my body, from the tips of my fingers to the end of my toes. So probably not a stroke or spinal injury . . .

The millennium bug was meant to bring Armageddon, but instead, I am the glitch.

It should be me doing the compressions and rescue breaths. Kerry might be cleverer at school, but she always comes second to me in cadet competitions. She’s too impetuous, which can lead to catastrophic errors, while I always analyse with clear-headed efficiency. It’s why she takes silver when I take gold. I even made it to the national finals.

But my body won’t let me, my legs are leaden. It’s like I’m in a nightmare. Sweat prickles in my armpits, my groin. I think I can smell worse. Have I pissed myself or is the stink coming from Joel?

Even when I try to open my mouth, to call out for help, my jaw seems to be locked in position.

But perhaps this is a good thing. I can’t draw attention to myself, and no one should see me frozen like this, least of all Kerry. Plus, she must not be interrupted. Nothing is as important as what she’s doing now.

Chapter 3: Kerry

As I prepare for the next rescue breaths, a horrible gagging noise comes out of Joel’s mouth. Animal, not human.

‘Joel. Joel, are you waking up? Can you hear me?’

I stop the compressions, willing his ribcage to inflate on its own, and for him to open his eyes and fight me off.

Nothing happens.

I remember something the resus instructor said. Agonal breaths are a sign that the brain is dying from oxygen starvation.

I restart the compressions.

Some girls crowded around are crying. Further along the Prom the hippies are drumming and singing, and the fireworks keep filling the sky with sparks of colour.

Unless Tim’s predictions have come true and it’s actual planes falling out of the sky.

‘What’s Kerry doing to him? Not a doctor yet, is she?’ I hear Louise Norman lisping to someone.

‘Is Joel dead?’ another girl asks.

‘Don’t be stupid,’ Ant says. ‘He was running with the ball just now. Of course he’s not dead.’

Except Ant might be wrong. Joel doesn’t look dead – yet. But if I’m right, his heart has stopped, which means my hands are the only things keeping his blood flowing, my breath his only source of oxygen.

It can’t possibly be enough.

I don’t hear a siren, but the grass around me changes colour: blue, orange, blue, orange. The rhythm of the flashing light confuses me, breaks my own pattern, and I tune back into ‘Nellie the Elephant’, pushing, pushing, pushing . . .

For the first time, my arms are tired. When I reach thirty compressions and dip down to give Joel another rescue breath, I realize how ragged my own has become. But exhaustion is no excuse.

I seal my lips against Joel’s again. Exhale. Is it my imagination, or is his face colder now?

‘Kerry. Listen. I’ll take over the compressions after your two breaths.’ Tim’s voice.

Where the hell have you been?

I don’t look up. Can’t break the cycle. Every beat counts.

As I raise my head from the rescue breath, our bodies touch, and Tim slips into position.

Like me, he looks surprised at how much effort it takes to force down the ribcage. He pumps once. That’s not hard enough. Have I done the wrong thing, letting Tim take my place?

He pumps a second time.

‘Lads, come on. Let us through.’ A man’s voice, world-weary. The edge of my vision fills with the lemon brightness of a fluorescent jacket. I think – hope – it’s a paramedic.

‘What have we got here? One too many to see in the New Year or—’ The paramedic stops abruptly. I look up just as his frown turns to understanding. ‘Jeff!’ he shouts out, ‘I think we’ve got an arrest. Get the defib.’

He understands.

‘All right, mate,’ the paramedic is saying to Tim. ‘You’ve been doing a grand job. First-aid trained, are you?’

When Tim doesn’t answer, I speak for him. ‘He’s a St John cadet . . . So am I. The patient . . . we think . . . he’s in cardiac arrest.’ I sound as though I’ve been running cross-country. ‘He collapsed . . .’ I remember the fireworks. ‘Just before midnight. We’ve been giving . . . two rescue breaths every . . . thirty compressions.’

The paramedic nods. ‘All right, love, give us some space to do our work now.’

I have no strength left to move.

‘The patient’s name is Joel.’ Tim speaks now, his voice imitating the calm tones the paramedic used. ‘He’s seventeen. On his way to being a pro footballer with the Dolphins. At least, he was.’

The man flinches. ‘Right. My name’s Roger. Who are you?’

‘Tim.’

‘All right then, Tim. I will take over after the next fifteen compressions. My colleague Jeff is coming with a defibrillator from the ambulance. You’ve done a brilliant job.’

Roger shoots me an impatient glance as he pushes in between me and Tim. I shuffle backwards as the paramedic takes over. Tim looks shell-shocked, even though he’s done less than a minute of CPR. I did ten, or longer.

A hand reaches for mine, steadying, pulling me up.

‘Is he going to be all right?’ Ant’s hand is strong but his voice is small. ‘Kerry?’

I’m surprised he remembers my real name, after years of calling me nasty nicknames. ‘I hope so.’

Ant is still looking at me, but his hand has dropped to his side. ‘What were you doing to him? I feel like I’m in an episode of Casualty.’

‘I was . . .’ It seems unbelievable already, what I just did. ‘I was making sure Joel’s blood kept circulating. To keep the oxygen reaching his brain.’

Ant nods. ‘On telly, they wake up. Why hasn’t he woken up?’

My hands are starting to shake. The paramedic continues CPR. A second crew member runs towards Joel’s prone body, carrying a bulky bag.

‘The cardiopulmonary resuscitation can’t wake anyone on its own.’ Tim brushes his hands against his jeans. ‘They need to shock his heart back into the correct rhythm, using a defibrillator.’

I don’t think Ant will have understood Tim’s answer.

‘Everyone move back, please,’ one of the ambulance men calls out.

‘You heard them!’ Tim shouts, shooing the other kids away.

‘How did you know to do that?’ Ant asks me, shaking his head.

‘I do first aid. For a hobby. Tim and I both do.’

‘Weird hobby.’

I hear an electronic beeping, followed by a robotic female voice. There’s a gap where the other kids have broken the circle and I move so I can see Joel again.

Analysing . . . analysing.

Shock advised.

Stand clear.

It’s impossible not to look. Will this work? If it doesn’t, am I to blame?

Joel’s body buckles upwards from the grass as the shock is delivered. How many thousand volts is it? They told us in cadets. It’s enough to create movement where there was none. As he crashes back down to the floor, I hold my breath.

Analysing . . . analysing.

Shock advised.

It hasn’t worked. Joel is still dead.

For the first time, I hear sirens. They must have sounded before, but I was too preoccupied to hear them. A second ambulance and a police car mount the pavement and drive across the grass towards us.

Stand clear.

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