“307 please respond for an 85yr old female, chest pain, one nitro taken”

“307 copy, updated en route”

The address is located on a main thoroughfare and the fire rescue at the curb marks the spot. Generally we try to do our backing as we arrive, utilizing our partner for spotting then rather than at time of leaving. This ensures safe backing practice, since one of us will be with the patient as we leave the scene.

Greeting us at the front door is a quiet gentleman of a fire fighter, he of the acoustic mic nights I always seem to be working on, so I never see him perform. He gestures up the steep staircase, “she’s in the bedroom up there with her daughter”. I generally take my cue from the firemen, if from their body language if nothing else. If they’re concerned, especially this one, I get a little more hitch in my giddy-up. Today though, the fire fighter just calmly smiles, so my partner and I get our cardio on, hoofing up those turn of the century restored oak stairs with our gear like we’re not a couple of NFL couch potato fans. The house is gorgeous, welcoming and warm, the sunlight streaming through the windows. Adding to the homey ambience is the unmistakable smell of chocolate chip cookies reaching their gooey perfection somewhere unseen.

Emerging onto the landing we follow a voice into a scene of scrambled up tense energy. Another fireman in turnout pants and suspenders over his blue tee is writing on a clipboard, glancing up as we arrive. He keys up his portable and tells his dispatch our company is on location. Seated on the bed are two women. One is speaking calmly and soothingly, and the other is having no part of it. Hyperventilating and shaking, mouth like a drawstring purse and clenching the hand of the younger, eyes squinched tightly shut.

A TA named Don taught my paramedic classmates and I back a fair number of years ago that when you walk in a room, take a good look at your patient and get a gut impression: sick or not sick? This lady isn’t pale, isn’t diaphoretic, but she’s a long ways from ok. I can’t get a read. All this while, I’m putting the monitor down and introducing my partner and myself.  She nods, answers appropriately. I get a blood pressure, put on the three leads and see perfect normal sinus rhythm. I ask if she’s having pain, “no”. I ask if the nitro took away the pain. She stated she had some heaviness while walking up stairs, after reading a book downstairs.

The daughter tells me later the book in question was of a mother who died early and left her children. The patient in front of me tells me that she’s afraid. I am able to coach her to slow her breathing. I tell her if she opens her eyes, she will see all the nice people in the room and to see we are here to help. That her daughter did the right thing to call us and we will go see the doctor to make sure everything’s ok. She slows her breathing, and opens her eyes. I say “hello there! Nice to meet you” and she grins shakily.

We make our way to the cot, and she stops at one point to look at me earnestly and say “I was so afraid” and her chin wobbles a bit. I nod and bending my head, say, “you know what I’m worried about? I bet you didn’t even think” and she furrows her brow in concern. “the cookies”, I say, “who’s watching them?” She laughs in relief and arriving at the side of the first fireman, he calmly tells her that he took them out, and turned off the over.

We get out in the truck and establish that her daughter will drive to the emergency room; I start an IV in case something changes. By now, she’s relaxed and decided we’re a fun bunch. She tells me she’s had sudden cardiac arrest twice in her life – many years ago, both times, now. She doesn’t recall any symptoms either time, just wakening to be told what had happened, post resuscitation. Once while driving, another while spending time with another daughter. Transport begins after repeat EKG and vitals show textbook perfection.

I visit with her en route, she tells me of raising her children in the Deep South, and I tell her that the slow drawl of her speech makes me smile because my mama sounds like that, too. We compare her Georgia to my mama’s North Carolina and she laughs in delight as I tell of my mama’s gardens full of vegetables none of my northern childhood friends had ever heard of. Things like ford hooks, lima beans, eggplants and okra, and of the mama with braids who grew them all to lush green bounty. She tells me of her children who all have established mini-residences for her inside their homes, and how they fight over her extended visits to each.

I give report, hang up my mic, and return to her side. Giving her my spiel about arriving in the emergency room and all the questions repeating, she takes my hand and with sparkling eyes and a warm grin says, “so that’s not what dying feels like?” I honestly tell her I won’t know until right before I make the journey myself, and she laughs in delight. “Well, not today” she says with determination. I thank her for her presence in my day, although it wasn’t under such auspicious beginnings, and she pats my cheek. In the dialect of my youth, she says “such a sweet pretty girl, what are you, about 20?” and she captures my heart for certain. I tell her twenty plus another nineteen, and she refuses to believe it.

Parking in the garage, she signs the consent of treatment on my tablet in elegant script. The rear doors open to reveal my partner, the triage/charge RN, and admissions lady. “Oooh, such beautiful women you have here!” she claps.

And we all fall in love with her. Eighty-five years of southern charm in her eyes, dazzling gracious ladylike smile, and the song of the south in her speech.

Chest pain. You could say that.