Looking back, I can’t say she died in my arms.  She didn’t.  She died on the floor, half her body on the cold, linoleum tile of the supermarket aisle, half beyond the saloon-style swing door of the meat room.  I was later told her name was Katherine or Kathryn or Catharine or some derivation thereof, and the idea that her friends and loved ones called her Kitty sticks out.

Actually, that’s a lie.  What sticks out is the way her chest crumpled under my hands.

I may be getting ahead of myself.

***

I was a junior-going-on-senior in college, finishing a dual degree in biology and literature with concentrations in pre-medicine and creative writing, respectively, and I had just realized I am not a doctor.  For most of that summer, I had killed time working in a supermarket, first in the meat room and then in produce, waiting for fall semester to start, and I was about two hours into my final shift, stocking bananas, when the store’s intercom crackled a request for anyone with medical training to please find a way to the meat room.

Now, let me be clear up front: I may have studied chemistry and physics and anatomy and physiology, all in the pursuit of human health, but I did not have medical training.  I may have been a boy scout, earning merit badges in not just first aid but also lifesaving and emergency preparedness, all of which required classes lasting several hours at a time, but I did not have medical training.  I may have practiced cardiopulmonary resuscitation (CPR) on dummies and known how to procure potable water in a desert and learned how to rescue breathe and haul a nearly-drowned swimmer to shore, but I did not have medical training.

(This is probably where I should place a disclaimer like: don’t try this at home.  Unless, of course, somebody needs it and you know, however vaguely, what to do, because then it might just save a life.  Also: this post is not intended for instructional purposes. Be prepared. Take a course. Save a life.)

My lack of actual medical training did not stop me from dropping the bunch of bananas I was stacking on the sale display and striding toward the meat room, where I found three or four people standing in front of fluorescent-lit cold cases of pink meat in plastic wrap, all of those people huddled close together, looking down at the floor between them.

I’m sure someone asked if anyone knew CPR, but only because I’ve seen it in the movies.

Autopilot: kneeling next to the woman.  She was older, in her sixties or seventies, dressed in pastels and polyester like any grandmother you’ve ever met, but what I remember is that she had no color.  Not just pale, but grey.  In my head the voices of track-suited doctors volunteering at the Red Cross on their off days, of green-shirted camp counselors huddled around a wooden picnic table.

This is how you perform CPR:

An acronym—ABC.

First, airway.  One hand on the forehead, another under the chin, a gentle slide and lift (respectively) designed to fully open the trachea and esophagus while at the same time keeping the neck itself basically stationary in case any vertebrae are broken.  This motion slacks the mouth open so you can hook a finger to sweep the throat of any obstruction.  This can also trigger the gag reflex, which is why so much CPR begins with a mouthful of vomit.

But not yet.

Second, listen for breathing, ear to mouth.  Unfortunately, just adjusting the airway and clearing it of obstruction can release breath, so don’t move for a moment.  Hold steady, or try.

(What they don’t tell you: it’s nearly impossible to hold steady.  Because you want them to breathe.  You need them to breathe, and you’d breathe for them, given the chance, which you’re about to demonstrate because you’re about to—and so you’re trying not to rush but it’s so hard not to.  Hence the count: one one thousand, two one thousand, three one thousand.  Or Mississippi.  Or hippopotami.  Whatever slows you down.  Whatever makes them breathe.)

One one thousand.  Two one thousand.

The woman on the floor did not breathe.  I would have felt it, however slow, however labored, against my ear.

With one hand, I pinched her nostrils shut.  I lowered my head, pressing my lips against hers in the airtight seal I had learned, and I breathed.  Hard.  If it’s possible to breathe too hard, I may have.  This is when some people receive that mouthful of vomit.  I did not.

After that breath, I turned my head so my ear was again above her lips.  I felt air escape, but nothing else—one one thousand, two one thousand—which meant her exhalation had been my breath, and she had no inspiration.

So I repeated the breath, and repeated turning my head and waiting.

Still nothing.

Third, circulation: two fingers to the neck, or the inside of the wrist.  I sought her carotid artery with my index and middle fingers but felt nothing.

Every class I had ever taken, every course I had ever attended, every instructor I had ever learned anything from indicated the next action I completely ignored.  By every method I had ever been taught, I was supposed to tear open her blouse, or slice it open with my pocket knife, or otherwise free her upper torso to allow her internal organs room to breathe.  I did not.  I know I was supposed to, and I could hear those instructions from that phantom voice in my head, but I couldn’t bring myself to do it, there in that supermarket, under those glaring lights and surrounded by people watching so intensely.  I don’t know why I didn’t do it—maybe an attempt to preserve the woman’s modesty, or her dignity, or something else equally intangible and perhaps equally useless.

Regardless, the next thing I did was use my left index and middle finger to find her breastbone and then place the meat of my right palm above it.  I set the meat of my left palm against the back of my right hand, interlocked my fingers, locked my elbows in place, positioned my torso so I was directly above her body, and started compressing.  Ten.  Again with the count: one one thousand, two one thousand, three on—

Another thing they don’t tell you: chances are you will break whomever you’re doing CPR on.  The breastbone, the ribcage, whatever you want to call it: it’s not built to withstand such quick, blunt motions as the compressions CPR requires, and it will crumple under your hands.  Want to know what that feels like?  Imagine cracking your knuckles or your neck, initial resistance punctuated by vertebral popping but on a bigger scale, harder and more reluctantly.

I felt her chest buckle like hard wicker under my fisted, pumping hands, and I thought I broke her.  I thought that if she hadn’t died before, I’d done it right then.

But: don’t stop.  You can’t.  They tell you not to.  No matter what, you keep ten-compressing and two-breathing until either someone can relieve you or trained professionals show up, whichever comes first, with the hope that the two events are one and the same.

I tried not to stop.  I tried not to pause.  I don’t remember if I did.  I don’t remember if feeling her chest crack under my hands stunned me hard enough I slowed.

What I remember is other people.  First a friend with whom I’d grown up, a guy who’d also been in scouts, on and off, and then another man with the calm assurance of a doctor.  I conceded to their direction, letting them take over.  I watched them continue what I had begun until maybe I couldn’t watch any longer; I don’t know if I saw the paramedics show up.

In fact, the next thing I very specifically remember is how extraordinarily important I thought it was that I should sweep the floor of the produce room.  Midway through that sweeping, a friend called to invite me to a Goo Goo Dolls concert; something finally cracked in me when she asked if something was wrong, broke like I had busted that woman’s breastbone.  I felt numb, detached, took my apron off and strode through the store to find the manager, quietly thanked him for having me as part of their team over the summer but I wasn’t going to finish my shift, then walked out through automatic doors that closed behind me even as my knees buckled my ass to the hard curb in front of the store.  I started to cry and couldn’t stop, couldn’t get enough breath, just gasped and fell apart into a great, slobbering fool, which is how my friend found me when she pulled up in the family minivan.  She took me to her home, where my father met us.

***

It was that friend who told me that woman’s name, which she’d read a day or so later in an obituary.  From as much as I later heard, paramedics had said that Kitty had a massive coronary while placing an order for a cut of tenderloin, and she’d been dead before her body hit the floor.  Dead before arrival to the hospital.

I came by that information passively.  It may not be fully accurate.

CPR isn’t like they tell you, nor like they portray in the media.  I’d seen plenty of characters in plenty of television shows perform it for a few seconds before the victim on the floor sputtered a grateful cough and then stood to applause from surrounding onlookers.  In reality, people die.  Wikipedia has interesting statistics regarding CPR and its use: chest compressions must start within six minutes (so precise), and rarely result in actual revival of a patient—chest compressions, it says, are meant merely to keep blood flowing, not to restart a stopped heart.  You’re not working to jumpstart the pulse but rather to be it yourself, which is why the new guidelines call for 100 compressions in a minute, more than one per second, which sends dozens of hippopotami straight out the window.  In fact, the guidelines and recommendations have changed drastically since I learned it then, and were different even just a few years after that, when I took a Red Cross course to certify as a personal trainer.

***

I cling to the idea that Kitty was dead before she hit the floor, because I may have no medical training but hope that first I did no harm.  I hate to think that she was clinging to life until my idiot hands broke her chest in a dozen places, piercing her heart with the jagged edges of busted ribs and a shattered sternum.  I rarely think of that woman by name, in fact, just of her body, just of the object I put my hands on.  I wonder if doctors have to think of the body as a mass of organs and skin and bones to protect themselves from the idea of human beings on a table because that idea is just so terrifying.  It’s easier to think that, by the time I got to that woman, she was just a body that had stopped working, if only because the alternative breaks my heart like I fear I might have broken hers.

TAGS: cardiopulminary resuscitation, CPR, medicine, sudden cardiac arrest, Will Entrekin

Will Entrekin is a writer, professor, and Eagle Scout from New Jersey living in the New York metropolitan area. A novelist and screenwriter, Entrekin earned an MPW from the University of Southern California and is finishing an MBA from Regis University while pursuing what happens next. He can be found at his web site, willentrekin.com, and he has a self-titled collection available here. He hopes you'll check both out.

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