We got a tone to go over to a nursing home to transfer a patient to the ED ‘for evaluation’. Mrs. Turquoise and I hopped into the ambulance and off we went.

We pulled up to the nursing home and went in. The nicest part of this nursing home is grim; our patient was in back, in the locked part where they keep wanderers.

We were buzzed through the door and into the locked-down dayroom. Vacant slack-jawed humans were propped in various seats around the room. Each was wearing a small electronic device tied by a string to the seat they were seated on; apparently alarmed in case of unauthorized movement.

In the distance, a hoarse voice screamed over and over.

We were ushered into a patient’s room. A woman was lying supine on the bed. She was visibly having difficulty breathing; we could hear her gurgling from the door and she writhed as she tried to get a good breath.

“She’s been like this since Thursday,” the nurse said. Two days before.

“We haven’t been giving her oxygen because of COPD.”

EMS staffers tend to not have a high degree of respect for the skills of nursing home caregivers. I’d been in the room for fifteen seconds and was already mad.

“Any history?” I asked the nurse.

“Hypertension, CHF.”

I was outraged. CHF, congestive heart failure, is positional. A supine CHFer starts to drown in the backed-up fluids. A nurse should know that. Any other respiratory insult only compounds the problem.

“Let’s get her on the stretcher and sit her up.”

We moved her quickly. We sat her up and her breathing immediately improved. She was still gurgling but wasn’t having to move her body to try to get air to flow.

The nurse handed me a sheaf of papers while Mrs. Turquoise started to buckle the patient into the stretcher.

A treatment record was on top of the stack of papers. The last entry, eleven hours before, was for an albuterol nebulizer.

“She hasn’t been nebbed since 0300?” I asked, incredulously.

“No, she’s had three since then… I just haven’t updated the paperwork,” the nurse said defensively. “We don’t just call you guys without trying anything.”

I bit my tongue and wrote the times of the previous undocumented nebs on the treatment record.

As we wheeled the patient out of the room, we could hear the screamer still screaming.

We got the patient into the ambulance and got underway.

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