Only one call. Slow night again. What do I expect from a Tuesday? Of course the call came in after 11. That's why I always stick around after I'm due to go.

So the call came. 32 y/o Male, trouble breathing, BLS (us) and ALS units dispatched. We arrive on scene, a 2nd story walkup apartment, and we are greeted at the entrance to the building by someone directing us to the apartment. As we go up the stairs, the guy says something along the lines of wanting to go inside.

"Duh!" I think to myself, "That's where the patients is!"

WRONG!

The PATIENT met us outside the building and walked up the 2 flights of stairs to his apartment with us. Okaaaay. Trouble breathing, Hm. I ask him, "Where's the patient, sir." He looks at me confusedly. "Are you the person with the trouble breathing?" I ask, kindly. Sure enough.

He opens the door to the apartment, I let him go first. I never know what I'm going to find and I'd rather it bite him first. The place looks like a semi-sloppy bachelor pad. Ok, no dogs or crazy roommates so far. I get the patient seated and start asking a few questions. Right away he's asking us whether he's going to die and do we know about sleep apnea. Oh boy!

This guy is pink, talking up a storm (patent airway), Oriented X3 (1. Knows his name, 2. knows the date, 3. Knows where he is). Well, I always get vitals and, hell, I'm here already, I could always use the practice. At this point, I'm already thinking (a little guiltily) about my blog for the night.

Pulse 106 and strong, SO2 96% before oxygen, I get a nasal cannula and 6lpm of O2 going. The ALS unit arrives and they start chatting him up. I keep taking vitals. BP 162/110, Clear lung sounds skin warm and dry and good perfusion. This guy's a little worked up but doesn't seem to be dying.

So, the medics leave and us BLS guys are trying to figure out what to do with this guy. Every time we ask him if he wants to go to the hospital he deflects by asking if he's going to die, whether people just stop breathing in their sleep and so on. I keep telling him that we're not doctors and he really should see one. He seems to be having trouble making a decision or focusing on the idea. He just keeps asking us if various ailments can kill him and if he's going to die.

I remember my sales training when dealing with an indecisive customer. Give them only 2 choices at a time. I had found that this had also worked really well in law enforcement when talking down a passively resistant subject. OK. I ask him if he wants to see a doctor or just go back to bed. He wants to see a doctor. I tell him he can either go to a doctor tonight or go to a doctor tomorrow. I ask him which. "Doctor tonight" he says. Does he want to drive himself to the hospital or does he want us to drive him. He thinks about it and asks, "Will you guys bring me back home?" No, we tell him, we're only a one-way service. He decides to drive himself.

Great! I present him with the patient refusal form. He's got to print his name in one place and sign in another. He signs, and then asks us if we think he's going to die tonight. "Print your name here, Please, sir." He does. Once the paperwork's signed he becomes a regular guy, thanks us for coming, gets his keys and coat and gets ready to leave.

We're outta there. I felt kinda bad for the guy. After we had talked to him for a while I figured out that he had eaten a huge greasy dinner and then immediately went to bed. The reflux probably came right up his esophagus and scared him out of sleep. I've actually had that happen to me once or twice. It certainly feels like you've stopped breathing. This patient also seemed to have other problems. Depressed? Just lonely? I don't know. My heart went out to him but I didn't want to be trapped in his apartment all night while he was deciding what to do.

Poor guy.

--maddog