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Differential Diagnoses

When their ambulance is dispatched to a 9-1-1 call, paramedics attempt to cherry-pick a diagnosis based on the age and the one-sentence description they get of the patient’s complaint. We occasionally nail it, most times not, with humor, sarcasm, gloom or fatal cheer. There are often curveballs; it’s hard to streamline individual patients and their array of needs with our quick-and-dirty prehospital tools.

A young man having an anxiety attack, for example, also has a history of heat-related absence seizures as well as previous opioid addiction. Maybe he was simply drunk. Or having a mental health crisis. He has also been really tired the past week, working long hours, has chronic fatigue and a baby at home.

Every vital sign we check registers within normal limits, but his body is telling him something is wrong. His legs are cold and shaky. His pupils are like pinpoints—but it’s sunny out. (We’re checking him out on the street, next to his car.) Otherwise he is acting fine, giving us no reason to suspect a possible DUI. There are only so many questions we can ask and answers we can intuit based on his responses and our own detective-like observations.

Erring on the safe side, we offer him transport to the hospital. His car is parked illegally, so the cops say they are going to tow it—having decided not to pursue any charges for a medical traffic stop, seeing as the patient was already outside on the curb, and no one witnessed him driving. I hesitate a second, thinking outside this rigid box, then ask the cops if his car could be moved down the road into an official spot. The cops say they aren’t allowed to move it. So I jump in, drive it to the legal zone, give my patient back his keys, and note the location of his car so he can find it later.

We can’t do it all in an emergency situation, but we try our best to help in the short time we have before taking our patients in for more definitive care. We embrace the uncertainties. It’s always illuminating to discover the actual diagnosis from the ER staff afterward. Until then, we seek to do what is right in the present moment, making our best educated guesses.

Joe Amaral
Grover Beach, California