...for the respiratory distress...

Rarely is a call a twofer. I have only, in half a dozen cases, gone from thinking "I hate this crap" to "Wow, I'm glad I paid attention in class." This one was indeed a twofer.

THE EMERGENCY

A caretaker has called stating that one of her Erma's (See Glossary of Terms) is having trouble breathing.

THE ACTION

I'm new to this area of town and the crew is moving slowly to the engine.
"Come on guys, someone could be dying!" I shout out sarcastically.
En route they begin to share with me the stories of Bubba, who we're apparently going to see.
Bubba is in the neighborhood of 350 pounds, rarely wears pants and has not been sober in recorded history. He is able to accomplish these feats since he is a Bubba and lives with Erma, who does everything for him.
Bubba has always called 911 saying his mom is sick but they've never even seen her sick. Not tired, nor upset, she often just stands there, arms crossed while Bubba begs for a ride to the hospital.

As we arrive, I see him on the front landing in all his pantsless glory. His belly sticks out from under a T-shirt that might have fit him 15 years ago and the tiny underpants are almost comically funny, but they were sad funny in real life.

As he spits unknown food particles from his mouth while yelling for us to hurry everyone is slowly gathering their things. Then it occurs to me. He's yelling for us to follow him, not help him.

We tried to hurry upstairs to the source of the audible wheezing but Bubba is quite slow on the uphill and decides to stay in the room when we get there.

Erma is SIck. Capital S, Capital I. And she's considering the capital C.

Tripoding position on the edge of the bed, pale skin, look on her face of impending doom and an expiratory wheeze that could have hailed a cab in another part of town.
She's unable to speak more than one word at a time and she doesn't speak clear english so we have to treat what we see.
Getting a blood pressure, even though I knew she would be hypertensive, proved difficult as Bubba decides to become a rescuer as well and is rifling through my kit looking for God knows what.
She's remarkably hypertensive for a frail 90 something year old woman and as the EMT places the oxygen mask the officer tries to convince Bubba to let us work.
The monitor shows her in a narrow complex tach in the 160s and she is starting to have an extended inspiratory phase.
Her level of compensation is dropping, her little heart can't take much more of this stress.
A bit of relief from some NTG and her pale look of death softens to more of an off white look of panic.

Suddenly, she lays back straight onto the bed, still.

Monitor shows no changes and I'm up at her side in a flash to intervene and she's got a small smile on her face.
"I breath" 2-3 deep breaths, the deepest yet.
"better."

We sit her up and then onto the floor so she can rest against the side of the bed. Her color continues to improve as I get an IV going and we hear ambulance sirens. The crew chooses to have the CPAP ready in case her difficulty worsens, but carrying her out there was no regression to what we had seen earlier.

Bubba was in hysterics. Usually he's the one getting taken away. He's asking us who will cook for him and wash his clothes.
"Your mother is very sick, she needs rest. Have you ever lived alone?"
He has not. In his 50 something years, he has never left his mother's house. Maybe because he has no pants.