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 a stop, riding their fire truck, followed shortly by an ambulance, right by my position on the sidewalk. Several firemen (also known as emergency medical technicians) jumped out and headed for an open garage door on the other side of me. Looking in, I saw them quickly surround an old lady sitting slumped in a chair, others of them talking to a neighbor inside, as they roused the sweet-looking elderly dame and tried to ask her questions.
She couldn’t give the answers yet. She was slow in her advancing years anyway, and just coming to. A neighbor lady said someone had been calling this eighty-year-old womanʼs daughter, in another city somewhere, without being able to reach her. Several other neighbors were milling about, and I struck up a conversation with a middle-aged woman looking intently at the goings-on. It turned out she had the key to this nice old ladyʼs 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 about what the soon-to-be-patient might have wanted if she were found on a hot day after a fainting spell. Would she want to be rushed into the hospital? Did she have any serious illnesses, and did she have any special wishes, like a “do not resuscitate” request? She didn’t know.
The old woman still couldn’t quite process the questions either. She was tired after fainting by her home and being seen by another neighbor, who had called 911. She was 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 there was 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 sweet elderly woman — who very likely would respond quickly with something for her dehydration — with a team of themselves, a loud fire truck, an ambulance, and a stretcher to take her, scared and strapped down, to the hospital. They knew that taking time for a trial of a little water, or tea and cookies, might have prevented an enormous use of resources, but there was no way they could make that call. The assumption had to 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 neighbor had 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 she had experienced several awful and unnecessary hospitalizations, one of which had given 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, she had 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 she wanted, the default action had to be all-out. Maybe it was for the best. Maybe it turned out 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 of scenario happens all the time. As the weather warms, maybe itʼs time to get out and talk to the people you know.