Mike, fifty-eight years old
Cause of death: Drowning
Cause of life: Together, we are stronger
Mike didn’t go fishing to catch fish. It was a slice of time carved out from his everyday life and his everyday job in the insurance industry. Despite there being no Wi-Fi on the ebbing tide between the land and the sea, being here gave Mike a sense of connection. He didn’t go fishing to catch fish, but he also didn’t go to drown.
Mike first held a fishing rod aged eight during a family holiday to the Isles of Scilly. There he caught his first fish – a brightly coloured wrasse, dark cyan, green and blue with purple accents. Fifty years later, Mike himself turned purple as he was swept away by a wave hitting Wales’s rugged coast.
On a grey October Saturday, Mike’s wife and children had plans. It was a perfect excuse for him to make a solo fishing trip. He drove two hours towards the coast, picking up a sandwich for his lunch, one that he would never eat. The tidal estuary at Ogmore (meaning ‘swift surge’) was Mike’s favourite spot for bass fishing. He purposely chose a deserted spot away from the concrete causeway, wet and as grey as the sky. He felt nicely alone. Not lonely, but solitary. He would soon learn that we are seldom really alone, rarely an island even when at sea, that we all need a community of strangers around us to live even if we are not drowning. Because Mike hadn’t noticed the woman walking her dog near the shore, or the friends who played water polo together parked on the headland above, or the tall, strong man who happened to be a CPR instructor, walking on the beach. He didn’t notice the wave that swept him off his feet and caused him to drown.
I met Alicia, one of the people who would save Mike’s life. Storm Isha was battering the UK as we spoke, helping to bring her story to life.
Alicia really was a water baby, starting swimming lessons at just six weeks old. As she grew up, her parents drove her to the local swimming pool five times a week to train as a competitive swimmer. At fifteen Alicia’s coach, who had played water polo at the Olympics, introduced her to the sport. She quickly fell in love with water polo, joining the Welsh squad soon after university.
Alicia joined the police as a civilian forensic officer. She specialised in CCTV analysis, helped by her photography skills, which she’d gained by taking photos of her friends playing in bands. For all of these reasons, Alicia was the perfect person in the perfect place the day Mike went fishing.
Similarly to Mike, Alicia had grabbed a sandwich for lunch before driving with her friend Amy, a fellow water polo player and physiotherapist, to look at the sea. But Alicia’s special skills in noticing tiny changes in scenes, honed by her police CCTV work, played a very different role that day. Sitting in the car park with Amy, overlooking the sea and about to bite into her sandwich, Alicia noticed a tiny dot in the ocean far away.
‘Wow, look how high the estuary is… what’s that man doing? Is he waving?’
Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
These lines are taken from Stevie Smith’s poem ‘Not Waving but Drowning’. Its central metaphor, mistaking a drowning man’s desperate signals for waving, encapsulates a truth about human suffering and misinterpretation. Perhaps a lived experience of the author after her mother’s death when she was just sixteen years old.
Unlike the dramatised flailing in movies, drowning is typically silent and subtle. Calling for help is difficult as you struggle to breathe. But so too in many forms of mental health issues or personal crises. Much like the silent drowners, cries for help are often misunderstood or overlooked by those around. Yet in other circumstances, people can bring attention to their plight or issues, not to shine a spotlight on them but as a call for help.
Both perspectives converge on a critical insight: the importance of looking beyond appearances to understand the true nature of someone’s experience. Just as recognising the real signs of drowning requires knowledge and attention, so too does recognising the nuanced signals of someone in emotional or psychological distress. Smith’s poem serves as a reminder that what appears as attention-seeking may, in fact, be a desperate plea for help, urging us to listen more closely and look more deeply into the lives of those around us.
Mike would not be the first person that Alicia had saved from the water. When Alicia was just eleven years old, her younger sister became trapped under an inflatable structure at a local swimming pool. Flipping it over, Alicia saw her sister’s gasping face just in time.
A second glance at Mike’s distant face a few seconds after she first noticed his waving confirmed her worries. He looked like her sister had years ago. And then he was gone. Mike had been swept out to sea by unusually high rainfall, a strong tide and a huge wave. He was drowning.
Alicia threw her sandwich into the back seat and burst out from her car. There was a woman running up the slipway, wearing a bright yellow coat and waving her arms towards her. This was the last thing Mike remembers seeing. The woman in the yellow coat had already called the coastguard but no one knew how long they would take.
Alicia was used to seeing trauma in her day job with the police, sometimes having to watch recordings of people dying on monitors and video screens. But today it wasn’t a recording. She could do something about it. Arriving at the end of the slipway, and now breathless herself, Alicia could see Mike’s purple, lifeless body drifting further from shore. The sea was as familiar to her as the swimming pool. She had done a long sea swim in the same area only a few weeks before. And seeing the coastguard’s boat still at the launch site around the headland, Alicia knew that waiting for them would be too late to save Mike. He had stopped moving and his purple skin had turned to grey black. Alicia became one of many strangers who would save Mike’s life that stormy day.
She pulled off her coat and boots then waded into the biting cold ocean in jeans and a T-shirt. As Alicia battled the waves, another stranger reached Mike at the same time. They pulled his stone-heavy body towards the shore, but with water filling his waders they made little progress. Then from the shore stepped forward a tall, muscular man, who managed to drag Mike’s body on to the sand. As Alicia coughed on the seawater she had taken in, her friend Amy sprang into action. She led the CPR efforts, telling people to rotate and press harder or quicker or slower. Many around her thought it was too late. Mike’s lifeless body looked dead. And it was. But we’ll see the power of hope in many of the stories in this book. And sometimes sheer bloody-mindedness is what can sustain someone and bring them back for a second act.
Nirmal Purja, the Nepali mountaineer and former British Special Forces Gurkha soldier, gained international recognition for his extraordinary achievements in high-altitude mountaineering. He did things that many felt were impossible, all because he refused to give up. He is most famous for his ‘Project Possible’ campaign, in which he aimed to climb all fourteen of the world’s 8,000-metre peaks in a single season. Most said it just couldn’t be done. That is when his bloody-mindedness was put into words. In the documentary 14 Peaks: Nothing Is Impossible, he is shown giving a motivational speech to other mountaineers, in which he says: ‘Sometimes you feel like you are fucked, but when you say you are actually fucked, you are only like about 45 per cent fucked.’
In 2019, Purja successfully completed Project Possible, summiting all fourteen peaks in just six months and six days, shattering the previous record of nearly eight years. He found hope when there was little and so, to him, Mike was only about 45 per cent fucked. Alicia was similarly bloody-minded. When many thought Mike had died, she focused on hope.
After the stranger, who Alicia called ‘the Mountain Man’, finished dragging Mike to shore, he took over doing high-quality chest compressions at Amy’s instruction. He was very good at it, not least because he was actually a CPR instructor. Nothing happened for what seemed like ages, until suddenly a gush of cloudy seawater poured from Mike’s mouth. But yet another person from the village of strangers was needed to save Mike.
But you don’t need to be a CPR instructor to save a life. You just need to finish reading this chapter. The history of cardiopulmonary resuscitation (CPR) is a colourful journey through time, filled with quirky methods and remarkable innovations that have shaped the life-saving techniques we rely on today.
In the 1500s, resuscitation methods were more imaginative than effective. Techniques included using fireplace bellows for ‘fumigation with tobacco smoke’. Now that would be a bad idea even when the smoke is directed towards the lungs, but the recommended technique was to administer it rectally to revive drowning victims. Needless to say, few lives were saved despite the Royal Humane Society, founded in 1768 to help drowning victims, installing smoke enema kits along the River Thames. It did birth the phrase ‘blowing smoke up your ass’, and they even published a rhyme in 1774 to help doctors remember what to do:
Tobacco glyster, breath and bleed.
Keep warm and rub till you succeed.
And spare no pains for what you do;
May one day be repaid to you.
By the nineteenth century, humane societies across Europe were establishing better protocols to revive drowning victims. These methods often involved warming the body and stimulating breathing. External cardiac massage was first reported in 1892, although it didn’t become accepted practice until the ’60s. Pressing in the middle of the breastbone literally pushes and then pulls blood in and out of the heart. While the compression of the heart between the breastbone and the spine squeezes blood out, the changes in pressure around the lungs then sucks blood out from the heart. High-quality CPR can eject around a third of the normal output of blood from the heart.
Then in 1958 Brooklyn-born William ‘Wild Bill’ Kouwenhoven combined CPR with his passion for electricity. His fascination was originally sparked by railway linemen dying from abnormal heart rhythms after receiving electric shocks. Despite Glen Campbell’s romantic version of working on the telephone exchange wires in the high plains of the Oklahoma in his song ‘Wichita Lineman’, it was actually a very dangerous job. Kouwenhoven worked out that these deaths were due to an abnormal pattern of cardiac electrical discharge. Rather than the linemen’s heart chambers contracting in a neat sequence allowing blood to be ejected, the cardiac muscle would frantically dance around in a useless fashion. Today we call this ventricular fibrillation, or VF. Applying an electrical DC current sufficient to reset this faulty circuit, yet not too high that it would damage the heart tissue, can revert a heart’s rhythm back to normal.
Today, using electricity can form a key part of resuscitation along with external cardiac massage when abnormal heart rhythms are present. The widespread adoption of automated electric defibrillators (AEDs) allows the public to not only provide essential bystander CPR but also apply electricity safely to these abnormal rhythms. These self-contained machines automatically assess for deranged electrical signals, resetting them safely with a controlled electric shock. The Danish word given to this equipment, hjartstarter, gives a great description. AEDs can even be delivered by drones to remote areas, allowing lives to be saved where the delay waiting for an ambulance to arrive would prove fatal.
But as well as the ‘C’ part, there is also the ‘P’ in CPR, which stands for ‘pulmonary’, or artificial breathing and oxygen delivery to the lungs. The ancient Babylonian Talmud includes a story in which a lamb with an injury to their neck was rescued by making a hole in their windpipe by inserting a hollow reed. Mouth-to-mouth breathing was first described in the Old Testament, where the prophet Elisha saved the life of a young boy by placing his mouth on to the mouth of the child. Sadly, this sensible approach made way for new techniques including rolling patients upside-down in a barrel after water submersion. Unsurprisingly, this was not terribly successful and (hopefully) is no longer used.
It was surgeon William Tossach who first published in a medical journal about mouth-to-mouth when, on 3 December 1732, at Alloa in Scotland, he resuscitated a coal-pit miner. The worker had been ‘in all appearances dead’ after being carried up 34 fathoms (60 metres) from the bottom of the Scottish coal mine before Tossach ‘applied my mouth close to his, and blowed my breath as strong as I could’.
After the discovery of atmospheric oxygen, mouth-to-mouth was stopped due to concerns that exhaled breath was ‘empty’. This is true to some extent, although our exhaled oxygen content of 16 per cent compared with atmospheric 21 per cent remains enough to save a life. Instead, arm-lift methods of artificial ventilation were used and even included in Arthur Conan Doyle’s short story ‘The Adventure of the Stockbroker’s Clerk’. After Sherlock Holmes discovers a business owner hung from the neck by his braces, Dr Watson successfully performs the chest-pressure arm-lift, saving the man’s life. The practice continued to be recommended until the ’60s.
After studies involving thousands of cardiac arrest patients, we now know that chest compressions alone done by the public are more beneficial for most adult victims than combined with rescue breathing. This is because compression-only techniques reduce pauses to blood flow. While there are exceptions, it is only when specialists arrive that more advanced techniques for artificial breathing will now be used.
Drowning can cause a cardiac arrest in several ways. First, our bodies have an instinctive gasp reflex when submerged, especially in cold water. This sudden big inhalation can suck in a full breath of water into our lungs, leading to hypoxia, where the body is deprived of oxygen. Then our body’s ancient response to cold water, known as the ‘mammalian dive reflex’, can slow the heart rate drastically, especially when our face is submerged. In some other cases, laryngospasm –where the vocal cords suddenly close – can prevent water entering the lungs but also blocks air, causing asphyxiation. Finally, even after rescue, secondary drowning can occur when water in the lungs causes delayed respiratory complications like swelling or infection.
The coastguard’s lifeboat screamed on to the shore, carrying a nurse from the hospital where Mike would later be taken, who volunteers for rescue service. She added to Mountain Man’s CPR with oxygen and rescue breaths using medical equipment. Next an ambulance arrived, and Mike coughed up more seawater, moving and twitching as he tried to breathe. Mike remained critically ill but was on his way to hospital as Alicia peeled off her muddied jeans. Amy patted her bleeding feet, which were cut up from the sharp rocks. Turning on the heating in her car, Alicia stretched back to reach her sandwich from the back seat, wiping down the BBQ sauce from the seat. ‘Shall we go home then?’ she said to Amy.
Mike had been given a chance at a second act thanks to a collection of people. The woman in the yellow coat who had called the coastguard, Mountain Man who had done CPR, the volunteer nurse in the boat, the stranger who had also gone into the water, Amy the physiotherapist, and Alicia. Even more people would then care for Mike in the intensive care unit. He had gone fishing for solitude but was saved thanks to a crowd. It is easy to forget in today’s society of digital solitude that we all need a village of strangers, every day, even when we are not drowning or dying. You can’t make a toaster without them…
Thomas Thwaites was not a typical student. Yet the questions he asked affect each of us in life and in death. During his time studying design in London in 2010, Thomas didn’t restrict his projects to conventional challenges. Instead, he used design to answer more fundamental questions asked by generations before: What does it mean to be human? Can we exist alone?
Thomas decided for his final master’s design project to build a toaster. His choice of a toaster as an aim was genius – an object emblematic of modern convenience and individualism. But Thomas didn’t want to make a toaster by ordering parts and putting them together. No buying tiny electrical components or even copper wires. He wanted to make a toaster from scratch. And I mean from scratch. Thomas wanted to mine any raw materials and engineer all the parts from first principles.
First, Thomas turned rocks and sludge into materials. Although a modern toaster, costing just £3.94,I has 400 different parts and is made from 100 constituents, Thomas turned his rocks and sludge into just five: steel, nickel, plastic, copper and mica. Steel was made from iron dug from a mine in Wales. His smelting method employed a microwave and a leaf-blower. He extracted copper from run-off water from a deep underwater cave, fashioning the resulting red metal into pins of an electric plug. Mica from cliffs in Scotland acted as a primitive insulator and plastic made from potato starch was moulded using a hollowed-out tree trunk.
Nine months later, standing on the table in his kitchen was something that looked like a cross between a medieval torture device and a loaf of bread. It had cost over £1,500 and seconds after being plugged in, exploded and melted. No toast was made. In an even more barmy project that followed called ‘How I Took a Holiday from Being Human’, Thomas lived among goats in the Alps, using prosthetic legs and eating grass using an artificial stomach. The toaster may have been a failure, but it was put on display in the Victoria and Albert Museum in London, for Thomas had succeeded in answering a fundamental question.
The toaster project was an important journey, illustrating our profound reliance on community and the collective wisdom forged through generations. But this doesn’t, and shouldn’t, mean that life is all milk and honey. Living shouldn’t be easy and convenient with no rough edges. In fact, as Oliver Burkeman describes in his BBC Radio 4 series Inconvenient Truth, a comfortable life can be an unfulfilled life.
The limitless progress and reduction in the friction of existence carries risks as well as benefits. Ordering a pizza now needs just a swipe on an app. This feels like progress. But the loss of that slightly awkward conversation with a stranger by phone with a misheard postcode is a minor primer to the bigger annoyances that life will throw at you in the future. Burkeman suggests we should sometimes choose the less convenient option, choose the human interaction. Because these are not really that awkward in the first place and bring with them connection and engagement! Inconvenience is even sometimes part of the reward through these smaller interactions. Discomfort can grow like a muscle; strength you will one day need for the really discomfiting experiences that define life. People are inconvenient.
And, in fact, seemingly convenient approaches are often more inconvenient. The ‘unexpected item in the bagging area’ at supermarket self-checkouts or the mobile phone app that has replaced your bank but doesn’t recognise your face are common examples. Extreme convenience, seen through the long lenses of life, can make life worse.
Maybe this is why I love working in ICU. The struggle and the sadness are the hard bits that also make the highs, the times when people pull through, even better. So next time you are in a restaurant, order by talking to staff not pressing the app, walk past the self-service counter to have inconvenient small talk at the supermarket till and ring for your pizza delivery, knowing that your order may not be quite right – but it will taste better regardless.
No man is an island can be translated into ‘no man can build a toaster’. And even if he could, it is less fun than doing it together. Drinking with a stranger is better than drinking alone. It is a parable of modern civilisation’s intricacies, our under-appreciated interdependencies, and the lengths one might go to to understand where we fit within the grand tapestry of human achievement. It is about the invisible village of strangers that carry us every day, unseen, unheard and unthanked. Mike was saved on the beach that day by such a group of strangers, all coming together for a very human purpose. Although he went there to be alone, he left alive because he was surrounded by others.
Thomas himself was created by a community of strangers. Although born in England to a children’s author mum and professional DIYing dad, he had distant family who had emigrated to New Zealand in the nineteenth century. Upon arrival, these pioneers found themselves in a land both beautiful and daunting. Their survival hinged not on individual prowess but on the collective effort of communities formed by people who were once strangers. These early settlers, bound by shared challenges, built a network of mutual aid and generosity. Neighbours, regardless of origin, became akin to family, sharing what little they had – be it food, tools or knowledge of the land. This spirit of communal support and kindness became the bedrock upon which they carved out their new existence, transforming wilderness into home. Through collaboration with a community of strangers, Thomas’s family survived and thrived, laying the foundations for his future exploration into this need for others through the story of a toaster.
From metallurgists to electrical engineers, our lives are enriched and sustained by the invisible threads connecting us to farmers, doctors, artists and countless others. So too, the ‘toaster project’ is a poignant reminder of our shared humanity, underscoring that the strength of our society lies not in rugged individualism but in our collective vulnerability and collaboration. In fact, our greatest achievements are not solo endeavours but the fruits of communal effort and shared vision, compelling us to acknowledge and cherish our place within the vast mosaic of community.
And even when the community cannot or will not answer difficult questions, this still has value. Often, people don’t actually want advice or a problem to be solved. They already know what they should be doing, know the solutions. Often people want instead people to listen and support them. Our strength and survival as a species are not predicated on the individualism celebrated in many modern myths but on our ability to collaborate, share knowledge and stand on the shoulders of those who came before us. So let us stop. Don’t try to reach the top by standing on other people. Or put in another way, Thomas’s toaster project was inspired by a quote from Douglas Adams’s 1992 novel, Mostly Harmless:
‘Left to his own devices he couldn’t build a toaster. He could just about make a sandwich, and that was it.’
And do you know what, that is a very good thing.
One month after Mike drowned, the village of strangers who gave him another life were reunited. A small gathering at the coastguard’s building had been arranged with Mike’s family. Although Alicia knew Mike had lived, she was unsure what life was now like for him. She had been told by the coastguards about people they had previously rescued who were left with severe ongoing care needs. Had he been in the water too long to make a complete recovery?
Although she had a tough exterior, her worries about that day manifested in poor sleep and a severe migraine. But Alicia struggled through and just about made it to the event. Entering the room, she first saw Mountain Man, then the woman in the yellow coat and a group of people who she guessed were Mike’s family. But there was no Mike. Before she had time to ask, Alicia heard a voice behind her. ‘Started without me, have you?!’
Mike’s journey to his second act had been tough. A week in the intensive care unit, with very sore ribs thanks to the efforts of Mountain Man, and then a long recovery at home, with recurrent dreams about and flashbacks to the event. Too often we retain the memories we would rather forget, and lose the ones we most want to remember. Mike was back at work, but it had probably been too soon. After an emotional embrace, Mike said thank you to Alicia for saving his life and told her that he had returned to fishing just two months after his cardiac arrest. His wife now wishes him well by saying, ‘Drive carefully, don’t drown.’ The first time he fished again, a shallow stream of water flowed across his boots, and he had a tingle up his spine. But he was soon back to his solo ventures knowing he is always surrounded by a village of strangers. Alicia too returned to her open water swimming, being back in the ocean around the lifeguard station the following spring. The BBQ sauce stains are still on her back seat. As they left the reunion, Mike said, ‘I’ll never give up fishing, but I have given up drowning.’