Slow Medicine: One Fine Day in the City

I was walking cheerfully down the city street on a beautiful, unusually warm day after along cold spell, when the raucous blaring of air horns chased after me and pulled to astop, riding their fire truck, followed shortly by an ambulance, right by my position on thesidewalk. Several firemen (also known as emergency medical technicians) jumped outand headed for an open garage door on the other side of me. Looking in, I saw themquickly surround an old lady sitting slumped in a chair, others of them talking to aneighbor inside, as they roused the sweet-looking elderly dame and tried to ask her questions.

She couldnʼt give the answers yet. She was slow in her advancing years anyway, andjust coming to. A neighbor lady said someone had been calling this eighty-year-oldwomanʼs daughter, in another city somewhere, without being able to reach her. Severalother neighbors were milling about, and I struck up a conversation with a middle-agedwoman looking intently at the goings-on. It turned out she had the key to this nice oldladyʼs apartment, and considered her a friend who she checked on from time to time.

I asked her, while not divulging that I was a doctor, whether she knew anything aboutwhat the soon-to-be-patient might have wanted if she were found on a hot day after afainting spell. Would she want to be rushed into the hospital? Did she have any seriousillnesses, and did she have any special wishes, like a “do not resuscitate” request? She didnʼt know.

The old woman still couldnʼt quite process the questions either. She was tired afterfainting by her home and being seen by another neighbor, who had called 911. Shewas coming to, but was not very clear-headed. Still no one could raise her daughter,who might know. Nobody knew even whether the daughter would know — just that therewas one — even the neighbor friend with the key.

I spoke with a couple of the fire people, this time letting them know my secret identity,sharing their obvious awareness that here they were on a hot day handling a sweetelderly woman — who very likely would respond quickly with something for herdehydration — with a team of themselves, a loud fire truck, an ambulance, and astretcher to take her, scared and strapped down, to the hospital. They knew that takingtime for a trial of a little water, or tea and cookies, might have prevented an enormoususe of resources, but there was no way they could make that call. The assumption hadto be the worst: that she was having a stroke.

In these circumstances, what they were doing was perfectly appropriate. She might behaving a stroke, or a heart attack, or any number of other things. But if the neighborhad known this womanʼs wishes, she might have known that she had specifically requested that she not go into the hospital if she were ever found that way, because shehad experienced several awful and unnecessary hospitalizations, one of which hadgiven her a bad blood infection that took weeks to get over, and that it was in writing,cosigned by witnesses and her doctor, in her upstairs desk drawer, and besides, shehad a copy herself with that doctorʼs number if anyone wanted to call….

That nobody on the scene, including the neighbor with the ladyʼs key, knew what shewanted, the default action had to be all-out. Maybe it was for the best. Maybe it turnedout badly, and the poor woman was shipped to a nursing home on medications to“control her confusion in the hospital” that kept her seemingly demented. This kind ofscenario happens all the time. As the weather warms, maybe itʼs time to get out andtalk to the people you know.