A middle-aged male calls 911 because he doesn’t feel well. We find him sitting in a chair in his bedroom, looking terrible. Pale, cool, diaphoretic, cyanotic, and in obvious distress.
What my father would call “looking like death eating a cracker.”
He had a CABG a few years ago, and has high blood pressure. His wife says he has never had a heart attack though, and only did the CABG after an abnormal stress test.
He’s having one today though.
The 12-lead shows a big anterior infarct, with lateral involvement, and with lots of ectopy on the continuous ECG. His blood pressure is low, too.
Lots of bad things are going on.
“Sir, let’s get you on to Local Hospital.”
“No, I want to go to Southside Hospital.”
Southside Hospital is thirty minutes and two counties away. And this guy doesn’t have thirty minutes.
“We really need to go to a closer hospital, and Local is only five minutes away.”
“I will not go to Local Hospital. Take me to Southside” he says between breaths.
“Sir, you are having a heart attack. Southside is half an hour away, and that is just too far. We need to go somewhere a lot closer.”
“I don’t care. I am NOT GOING to Local Hospital.”
Slimm was wise, as usual, and had the patient sign a refusal form on which Slimm wrote ‘Patient refused closest hospital.’
I hated to take a firefighter so far out of the county, but I really didn’t have a choice. We told the other guys on the engine that we would bring him back. I really don’t like to take riders, but I felt like something bad was going to happen, and I would need the help.
Something bad happened, and I needed the help.
About six minutes after passing Local Hospital, the patient went into v-fib. Even though my defibrillator pads were already on, and it took about 5 seconds to deliver the shock, it didn’t work. After Amiodarone and two more defibrillations, he was in asystole.
Slimm diverted us to Local Hospital, and the patient never came out of asystole.
If he would have gone to Local Hospital, the outcome would likely have been the same, but I can’t help to think that it might have been different. If he would have listened to the advice of the providers on scene, he might have survived. But he made a bad decision.
Someone once told me something very wise.
“People have the right to make bad decisions.”