Pathognomonic

"Dammit." Mike mumbled as we inched down a back road on a starless night. The address reported by dispatch just didn't line up with the numbers illuminated by the spotlight I held out the window. We made another U-turn to canvas the street, this time activating the siren in the hope that it might help--and fortunately, it did. A man came running out of his house at the sound, arms waving wildly in the air, his flannel shirt intermittently illuminated by the flashing lights of the ambulance. In his panic, he'd given the wrong address over the phone. His wife had fallen and had a headache, and he needed us to "check her out."

Alice was on the bathroom floor, but, peculiarly, she had fallen into the cabinet beneath the sink. Little more than a wood construct, the bottom support had fractured from the weight of her body, collapsing the side framing inward and further concealing her from our view. A guttural moan emanated from the dark within.

I remember hesitating. Would moving her out cause the entire countertop to fall? What about her C-spine? One of the EMT's greatest dictums is stabilization of those seven vertebrae, and as a brand-new provider, the horror stories of iatrogenic paralysis that had been so emphasized in school flashed across my mind. A deep breath, and I reached out for some bit of guidance, as well as a few more seconds to collect my thoughts. "What happened?"

--
You don't learn much in EMT school. Oxygen here, band-aid there, CPR when in doubt, and poof, here's your badge and radio. Armies of teenagers are let loose with little more than a stethoscope and a loose foundation from which experience and training are required to become an effective provider. For the most part, it's only with hours on the rig and hands-on training with a more experienced partner that one can become the rescuer they need to be. But...you do learn a few things.

We all know the buzzwords--the test questions and pimp sessions that confirm an instant diagnosis. India Ink. Foamy Macrophages. Tearing Back Pain. We recognize, shade in a Scantron bubble, and smile as we move to the next multiple choice question. Teachers remind us that patients hardly ever tell you all about their positive Murphy's Sign or painful hemi-circumferential rash confined to a single dermatome, but we're content with the basis, a scaffolding to build upon.
--

"It's the worst headache of my life!" Alice screamed from her concealed spot. She moaned and squeezed her one exposed fist tightly. I'd yet to scratch the surface of the years of learning that were to come, and still can't explain every facet of her condition, but both Mike and I knew immediately that we needed to hurry.

Mike and I moved quickly, pulling Alice swiftly onto the backboard. A mydriasis and deteriorating mental status confirmed our suspicions, and we radioed for help as we locked the stretcher into the ambulance. Within minutes a helicopter had landed by the guiding lights of a dozen fire engines. Advanced Paramedics had paralyzed and intubated Alice, and I watched from the corner seat as they briefed the flight crew, barely understanding, but fascinated with every action.

--

As medical students, our store of useful information is relatively small. It's rare that someone instantly needs to know the biochemical pathway of glycolysis, and likely impossible that reciting second-messenger pathways will ever save a life. But who's to say that tomorrow your best friend might not call you and casually mention that the soles of her feet burn when she gets out of the shower? Or how embarrassing it is that he's been sweating through his sheets every night, and he's exhausted because of it?

Sitting through the books every day is exhausting, and just a bit demoralizing. It's nice to be reminded sometimes that while there will always be much more to learn, every day we pick up a few facts that might make the difference when we least expect it.