I recently responded to two different patients with the same complaint: shortness of breath.
As soon as we walked in the door she filled our ears with tales about how “I’ve been short of breath for a few days but today was worse and my blood pressure is all over the place when I gain or lose weight and right now I’m heavier so it’s higher and there’s some tightness in my chest and which hospital am I going to and can my significant other come and what about my cat.”
Verdict: Not sick.
As I walk in the door I can see the long tube for her supplemental oxygen snaking its way down the hall to her small bedroom. As I walk past the kitchen a hissing catches my attention: an oxygen concentrator running. The bedroom is equipped with a recliner, TV, and walker. She doesn’t get around that easily. I can hear her gasping for air from the doorway. She says nothing, she can’t, but the panic in her eyes tells me all I need to know. Her name was only a couple syllables, but that was too much to get out in a single breath. The normal light-hearted atmosphere we bring to calm a patient is gone. I do as I’m told to assist in stabilising her before we whisk her off to hospital. In my robot mode of getting a d-stick, I unintentionally make eye contact with her as she attempts to sputter out a few syllables. She wants me to wipe her bloody nose – the oxygen we put her on has dried her out. I clean her up and try to make her comfortable, asking for a humidifier. While I’m doing this the medics are running a 12-lead and making a pin cushion of her arms trying to get a line. I’m asked to bring in the gurney. As I cross the room my mind has a moment to wander. I look around and see pictures of children and grandchildren. She isn’t in any of the portraits. Home blood pressure monitor. Caregiver says something about physical therapy earlier. She’s been clearly been sick for a long time. This is someone’s family member, and my heart pangs for a brief second as I realise these could be some of her last moments on Earth, shared only with me and 4 firemen. These thought’s, while humanising, are ultimately unhelpful to providing emergent patient care. Engage reptilian brain: rescue doors open, trolley release, pull, drop legs, in front door, re-orient in the kitchen so it’s facing the right way when I get to the bed, down hall, in bedroom. Use the sheet she’s on to get her over. 1-2-3. Back to the rescue. Load and Go.
It never ceases to amaze me how readily people who don’t need ambulance services will call 9-1-1, but those who truly need them seem to wait until it’s almost too late.
Patient 2 is part of a dying breed (literally) – an older generation with a little something called self-reliance. They don’t want to be a bother. They just want to have their peace. I respect and applaud them for that, especially when put in contrast to today’s attitude of entitlement.
Talk to your grandparents if they’re still around. You’ll learn things too valuable to ever be committed to any book: teaching that transcend both language and generations.