After a quiet day, we were toned to a difficulty breathing call on the outskirts of town.

Becks and I got in the rig and headed out into the driving rain, lights and sirens. We reached the turnoff and headed up a rough dirt road towards the call address. The road was one big washboard and the ambulance bounced from bump to bump up the hill. The road became narrow and finally ended in what looked to be a junkyard. Looking carefully we realized that the road had turned into a driveway leading to a yard cluttered with debris. Ten or fifteen discarded water heaters were identifiable; other piles of metal and scrap were less recognizable. I realized that we would not be able to turn around in the dooryard so I backed down the hill to the previous house, turned around in the driveway, and backed up the hill as far as I dared. I could tell that access was going to be challenging.

Becks grabbed the first-in bag and we headed towards the dilapidated house. It took a minute to figure out where the door was; another minute to pick a path through the maze of scrap metal to the door. The door was at the top of a flight of rickety steps; a thin man with the largest mustache I have ever seen stood at the top of the steps.

“What’s going on?” I asked the man.

“It’s not me; it’s him. He’s inside,” the man responded.

My partner and I walked up the rotting wood steps. The steps bounced under our weight. I thought about getting a patient out of the house and through the maze. Becks and I had a fighting chance of dealing with this ourselves if the patient was small.

We got to the top and went inside. The interior of the house was a mess with stacks of boxes, rotting garbage, and papers on every surface. We passed numerous rat traps; one was on the kitchen table.

“He’s in there, at the far corner,” the mustachioed man said.

We made our way through the kitchen and around a partition. A large, seemingly naked man sat on a chair. From across the room we could tell that he was having a bad time. The man looked like a grimy Buddha. He had a nasal canula; home oxygen. He was surrounded by papers and trash.

“What’s going on?” I asked. The man did not answer.

“He’s having a hard time breathing.” I looked around; a woman sat nearby. Although I had walked right by the tired-looking woman, I hadn’t noticed her for all of the disarray.

The woman explained that the man was a COPDer and that his difficulty breathing had been coming on over that last two days. I asked how much oxygen the man was on; he grunted that he was on three liters per minute. I asked about other medical problems; they initially denied any other problems.

It was clear that the patient was going to be transported and that Becks and I were not going to do it by ourselves. I asked Becks to start the assessment and stepped outside to call dispatch. I asked dispatch to tone the station for more assistance. I went back inside and gathered history from the woman while Becks continued the assessment.

I didn’t like the way the guy looked. He was tachycardic, hypertensive, sweaty, pale. He was clearly anxious. In addition to the difficulty breathing, he was complaining of chest pain that he described as 7/10. I was starting to get the impression that this was more cardiac than respiratory. I went outside and called the hospital to let them know that we had a serious case that was going to take time to transport; then I went to the rig and grabbed the monitor. The rain had let up though it was still drizzling. As I started back inside, Ambulance Two pulled up.

The guy’s state of undress made it easier to hook him up to the monitor. I realized that the patient was not naked; he was wearing shorts though his body covered most of the fabric. The rhythm looked pretty crappy; tachy and irregular.

Greenie and one of the twins came in; they had arrived in A2. Greenie is much senior to me but apparently felt I had things under control; he went back outside and started to clear a path to the ambulance. The twin went to get the stairchair. I was growing concerned that the guy was going to code before we got him out and I wanted vascular access; I set about installing a saline lock. After I popped the catheter into the guy’s arm, I drew four tubes of blood for analysis at the hospital.

The twin and I got the guy onto the stairchair; luckily the patient was able to stand and pivot for us. Everything was complicated by the extreme clutter. I didn’t want to touch anything.

We got the guy into the chair and started towards the door; the twin pushing, me pulling. We had to stop every few feet so that I could rearrange the clutter to allow passage of the chair. As we neared the door, I noticed an electrical panel for the first time; the household breaker panel was open and multiple extension cords lead into the box, spliced right into the breakers. Lots of exposed copper wires ran back and forth inside the box. The layout of the house was such that we had to squeeze within about three inches of the exposed wiring to get the chair outside.

We got out and onto the steps. Greenie had finished clearing a path and came over to help guide us down the stairs. The stairs were shallow enough that we could not use the handy stair-descending treads on the chair; we had to carry it down. I pointedly ignored the thought of going through the steps with the large man and the stairchair; Becks later said that she saw the step under the twin sagging under the combined weight of the patient and the twin and was concerned that the stairs would collapse. We all breathed a sigh of relief when we got off the steps and into the maze. We got the patient to the driveway without too much difficulty and transferred him to the cot, then into the ambulance. Becks and I got in back; the twin got in front.

We left immediately for the hospital. Along the way, I gave the patient nitro and aspirin; I considered a neb but decided against it due to the tachycardia.

The patient became much less apprehensive as soon as we arrived at the hospital. We gave what history we had to the ED staff; the patient remembered some other pertinent medical history; CHF, diabetes, a laundry list of medications. I helped the staff get the patient started while Becks and the twin dealt with the cot and the rig.

As I went to leave the room, the man stopped me. He had been very terse and withdrawn on scene; he was much more relaxed and friendly now.

“Thank you very much for your help,” the man said. “I really appreciate it.”

“Any time, sir, glad to help.”

“I’m really sorry about the mess.”

“That’s okay, sir, I know you weren’t expecting company.”

The patient seemed happy with that response.

Becks, the twin, and I drove back to the station.