No Complaint

A tiny dog with three legs rounds the corner nervously. I bend down to let it sniff me, and it cowers away from my hand. Drew shuts the clipboard noisily and the dog scampers away quickly, peering back at us from the safety of the hallway. It whimpers quietly and disappears back into the dark.

"So, let me get this right," I hear Eric say again, "you have no chest pain, no difficulty breathing, no complaints whatsoever." The man nods, and his wife weeps louder into her handkerchief.

"I...just...want...you to...get...check...out," she manages through sobs. I look at my partners and then back at our patient. Blood-speckled tissues line the table.

"Swear to god, Martha," he says under his breath.
"So no complaints at all?"
"Just my wife," he says sharply. She sobs harder and I get anxious.

"Sir, she says you have some gum bleeding?"
"Yuss."
"Why's that," I ask casually, nodding towards the bloody tissues.
"Cut my gum eating."
"How long ago was that?"
"Three hours."
"Been bleeding ever since?"
"Yuss."
"And no chest pain?" He pauses, looks around, and quickly tells me he's been feeling fine. He's a really bad liar.

I look at Drew's notes. Cardiac history: three heart attacks in six months. He's got some kind of "fluid on the lungs," most likely CHF; I see the Lasix on the table as well.

"Well if you don't want to go, we can't force you. Based on what your wife was telling us, we'd really like to take you. You have an extensive medical history, and even though you're seeing your doctor tomorrow, it'd be good to get checked out now."
"I'm not going."

Eric breaks out the patient refusal form and explains it. His wife is uncontrollable. I kneel to her level and put a hand on her knee.

"Martha," I say gently, "I know we're not taking him now, but if you think he gets any worse, please call us back. We're more than happy to come again; we're here all night. Okay?" She wipes some mascara off her cheeks and nods, trying out a little smile.

Our patient notices this little interaction, and she moves her gaze back to him.
"Please, John, please go. Please go, I don't ask you for anything, you know I don't. But I'm asking you to please go."

There's an uncomfortable pause smattered with "Jesus," and "oh hell."

"Fine, I'm going." She cries again, relieved now.

Drew and I head back for the stretcher and talk on the way.
"Sam, something's just not right here."
"Abuse," I offer.
"How do you figure?"
"Dog is terrified of humans, scared by loud noises. Wife is fearful of her husband, doesn't 'ask him for anything,' and he is pretty rude with her in front of us."
"Yeah. That's so messed up."

We get him situated on the stretcher and loaded into the back. Drew is teching this one, since it's been a while since he was on a BLS call that was his.

"Drew...do you see that blood?" I mouth to my partner over John's head. I'm not sure he'd hear us if we spoke; he's asleep.
"What blood?" I point to the non-rebreather. Blood and clots have collected in the bottom of the mask.
"That blood."
"Clean him up?" He looks puzzled, and I explain to our patient that I'm going to take the mask off for a moment so I can clean it.

"Mmph," is all he answers.

Moments after cleaning it, it's blood-filled again.

"What the--"
"I don't know," I cut Drew off. We break out a flashlight and check inside his mouth again. Blood clots fill his mouth.

"Hey John, could you spit in this gauze for me?"
"Mmph."
"John? Hey, buddy, you with us?"
"Mmph, yeah."
"Can you spit in this?"
"Mmph."
"Hey John. Do you know where you are?"
"Yuss."
"Where?"
"Ambulance."
"Okay, just checking."

We get to the hospital and tell the nurse what we've brought him. I look at Drew a little concerned. He's deteriorated since we've been with him, even though his vitals are textbook, and he has "no complaint."

"So what should I put down," the nurse remarks.
"Chest pain per wife?"
"Sure. He's definitely got something wrong with him."

"What do you think happened," I ask Drew.
"'Dunno," Eric interjects, "but I should have ALS'd it."