A Sense of Urgency

It's been a relatively quiet night. My usual partner has switched off, dinner is long past, and all that remains is to read a bit and try to fall asleep, always a difficult task while on call. However, it's a nice, cool night, and I'm tired, so I manage it relatively quickly tonight.

At exactly 0300, I'm awoken by the familiar sound of the pager buzzing angrily on the desk beside my head. The dispatcher chimes in with a common, and uniformly unhelpful, "please respond to [one of the local nursing facilities], 66 year old male patient." No further information. This is a relatively common call, and with the usual lethargy I haul myself out of bed and into my boots. My partner for the night similarly takes his time; we know that at the nursing home, nurses are on hand, and conditions are generally good. We weren't given a code 1 or other information that would lead us to hurry.

However, upon arrival we find nurses that look unusually concerned. Our patient, an elderly man, was breathing at an unbelievable 60-80 times per minute, and was shockingly unresponsive. I had taken this man back to this facility the week before, and found him to be a good patient. Now, he was breathing fast, loud, and with a rough noise that made me think of the training I've recieved concerning agonal respirations , which of course these were not. Our sense of urgency increased. A weak, thready pulse, low blood oxygen saturation , and a complete inability to control his muscles in any way didn't make me feel any better. We got him started on Oxygen, and started driving.

Things went uphill from there - his breathing normalized a bit, his sweating relaxed, and while he didn't regain what I'd exactly call consciousness his vitals approached normal again. How he fared in the long term I don't know, but from the episode I've certainly come to know that a call to the nursing home can be as much of an emergency as a call anywhere else, no matter how little the dispatcher tells you.