Don't Forget to Call Your Mom

So yesterday I’m at work trying to get a statistics syllabus ready and failing miserably as I actually spent the whole morning on administrative crap. Around lunchtime I slip out to go home with hopes of spending time with my kids so my wife, who has just returned from a stressful trip visiting her terminally ill father, can get a nap. I climb in the car and my pager goes…

{blank} rescue, {blank} ambulance, EMS call, xxxx something road, elderly female, general illness.

“General Illness”? I guess that’s better than “unknown medical”, but not by a lot. I know the board is light so I head down to the station. There is a driver, an “S/O”, and no qualified medical personnel (besides me, I guess). I ask them to wait a minute in hopes a medic or more experienced EMT will show up, as the location of this call puts us a ways from the hospital and I have NO idea whether this general illness is the flu or a cardiac arrest. While the rescue associated with my village won’t roll without an EMT, the rescue that serves the location our call is at will go with just a CFR (certified first responder), and they have no medics or paramedics, so I know I’ll be the senior medical person on the scene. You can bet that I’m not that excited about the idea of running a BLS full arrest with no other EMTs around. The whole way to the scene the pucker factor is rising, aided by the fact that there is road construction between us and the patient (and the patient and the hospital), with only one lane open. My imagination is going wild as I try to plan a strategy for working a code with no other EMT, etc.

Boy did I get worked up over nothing. My patient is sitting in a chair with a trashcan in front of her, “vomiting”. “Vomiting” is in quotes because that’s what the patient said she was doing. Actually, she was spitting. Clear, clean, lovely saliva. There was maybe a half-cup of spit in the trashcan. She wasn’t swallowing, which at first made me wonder about an allergic reaction, but her breathing was fine. Nice clear lung sounds. Warm, dry and pink skin. And then I noticed that when I asked a question that required more than a one or two word answer, she did manage to swallow while forming her sentences.

Hmmm.

Me: How long has this been going on.
Patient: Three hours.
Caregiver: Note that three hours ago her daughter was to call and didn’t.
Me: Any chest pain, difficulty breathing, nausea?
Patient: Nope.
Me: What is bothering you the most right now?
Patient: I keep vomiting.
Me: Is your stomach upset?
Patient: No.
Me: Does your vomit taste like vomit or like spit.
Patient: Spit.
Me: Can you swallow?
Patient: Yes, but I don’t want to.
Me: Do you think you need to go to the hospital?
Caregiver: She called her doc and the doc said to bring her into the emergency room and she’d see her there.
Me: Do you want to go to the hospital?
Patient: Well…
Caregiver: Yes, she does.


The lady is 94, but she is not mentally challenged. Obviously I’m going to transport her, but I am interested in whether SHE thinks she needs to go, as I think even she knows she is putting on a show. I never did get an answer from her. What I am sure of is that her daughter will learn not to call three hours late…