We respond code-2 to a residence for a complaint of a headache. As we walk inside the house, we see a man in his 40′s on floor holding his head. His wife and kids are sitting next to him, looking up at us for some kind of answer. She explains that he started complaining of a headache about 2 hours ago and it had progressively gotten to to point where he can’t function. He denies any recent head trauma, but confirms that he is feeling very nauseous.

As I kneel down next to him, I check his pulse to find that it is strong and regular and an acceptable rate. I ask him to sit up so I can do a neuro-assessment on him. He attempts to do so with much difficulty. My partner and I then notice that he is only using his right side to move around. We pick him up and carry him to the gurney. He continues to show deficit to the left side. He can’t squeeze my hands on with his left side and he has no sensation to that area.

Realizing that this is indeed a critical call, we quickly put him on oxygen and apply the ECG leads before moving out the door. “Is he going to be ok?” His wife asks as we move towards their front door. “Ma’am I can’t predict how his outcome is going to be, but he’s alert and stable right now. We are going to take him to **** Hospital and find out what’s causing the weakness. Please drive safe, we will take good care of him”.

As we load the patient into the ambulance, his wife and kid kiss him goodbye and we shut the doors. “Way to bullshit my family” he says as I switch his oxygen over to our main tank. “Excuse me?” I reply. “I’m sorry, I didn’t mean that in a bad way. I meant to say thank you for keeping them calm even though you know how bad this is”. I took a moment to think of what to say and told him that we didn’t know how bad his condition was yet and that everything could be fine. “Look man, I’m a doctor and I know damn well that I’m having a bleed” He says. “You don’t know that yet. Let’s take this one step at a time and just focus on getting you to the hospital safely” I reply as I’m checking his blood sugar and starting his IV.

I made my radio report and told the patient that we are 10 minutes out from the hospital. “Thanks for everything you have done, but we both know this is the end of the road for me. Please let my wife and son come back to the ER with me…..I wan’t to say goodbye before it’s too late”. I defensively replied, “Don’t talk that man! Even if you have a bleed, I’m sure that we caught it in time. Your still alert and oriented, they may be able to get you to surgery and start relieving the pressure if that’s the case”. “Whatever you say kid” he says as he leans his head back and stares at the roof of the ambulance.

We have arrived at the ER. His wife and son follow us as we place him in his bed. I take caution to give my report to the nurse away from the family. When I returned to gather signatures I hear him telling his wife that he is going to die tonight and that he’s sorry he waited so long to get help. “Hey!” I interrupt. “Don’t talk like that! You haven’t even been evaluated by the ER doc yet. We are all here to do everything we can to make sure you don’t die!” He thanked me for taking good care of him and wished me a safe shift.

Several hours later I transported another patient to the same hospital. While I was outside cleaning the gurney and getting ready to clear, his wife comes up and informs me that he died an hour ago. I gave her a long hug and asked if there was anything she needed. “You already did everything. You took care of him and us……that’s all that matters”.