I’ve been thinking today that one of the most valuable things we can do in a potential survival situation is to actually make the decision to call for help. Whether someone is embarrassed to admit they’re lost, or worried about the cost of the ambulance ride, often the impulse to “tough it out” or “go it alone” turns an unfortunate situation into a dire one.

This morning at 5am I was awoken by my pager going off for an EMS call. We arrived at the scene to find a 79 year old man complaining of severe abdominal pain. He had a history of a small abdominal aneurism that his doctor had recommended monitoring closely over time.

For those of you who do not know, when abdominal aortic aneurisms rupture it is a true medical emergency. This patient had all the classic signs – extreme pain, a pulsating mass in his abdomen, and a falling blood pressure. The fact is that even though my patient was completely lucid and in full control of all his faculties, there was a distinct and real chance that he was going to die.

As we quickly loaded him onto our ambulance to try and get him to an operating room ASAP, I asked him how long he had been in severe pain. His answer broke my heart: “Since about midnight. I haven’t been able to sleep at all.” That’s five hours during which he could have sought treatment for a life-threatening ailment, but he did not, because he did not want to inconvenience anyone in the middle of the night.

Folks, if you’re in extreme pain, and it hasn’t gone away on it’s own relatively quickly, it’s probably not going to go away. It’s your body’s way of telling you something is wrong. I learned this lesson myself six weeks ago when I suffered needlessly for several hours before going to the hospital with what turned out to be a kidney stone causing the worst pain I’ve ever experienced.

I know a lot of discussion on this board focuses on folks who needlessly tie up resources by initiating rescues for less-than-good reasons. I wanted to use my experience this morning to remind us all that it’s OK to call for help when you need it.

Most rescuers do what they do because they want to help people, and we accept that there will be a certain number of “over-reaction alarms.” If it turns out that my patient actually was suffering from severe indigestion, I will not hold it against him at all.

Stay safe.

Good job man. A triple-A is no joke. Many EMS providers overlook it and categorize the pt as a whiner.

Yes. Often the first step in giving first aid is - Call 911, then....

My thinking about the emergency room and calling 911 was changed a little over 10 years ago after reading Emergency Medicine by Dr. Stephan Lynn. One of the only reasons I actually bought the book was because he is an ER doc at a NYC hospital and I was living in NYC at the time, but I'm glad I did.

Anyway, I think many of us who have had some sort of first aid training and also feel a duty not to unduly burden the EMS system have long considered an emergency to not include severe pain, if that was the primary debilitating symptom. I mean, pain never really fit the standard definition of what a medical emergency is. More enlightened definitions do explicitly mention pain, but many still do not.

Dr. Lynn's book was the first time I was exposed to someone within the ER who was saying that severe pain is also an emergency and as Jesselp points out, your body is usually trying to tell you something. So it's OK to go to the ER for pain. Honestly, that was a small turning point for me in my thinking.

A couple years ago, I also had a sudden bout with extreme abdominal pain at home in the middle of the night, the most pain I had ever experienced. My wife was out of town so I was by myself and I couldn't even move far enough to reach a phone due to the pain. I spent a few hours frozen in place, hoping to keep still enough to avoid triggering that next wave of pain in my belly, so I had a lot of time to think about whether I should call 911 if I could eventually get to the phone. My only real complaint was the pain, so a part of me kept thinking that it's not really a "true" medical emergency.

However, as soon as the pain subsided enough to move around, I called 911, took an ambulance ride and got checked out. One thing they eventually did was inject me with some narcotic that relieved the pain and get some blessed relief. They never did pin down a diagnosis for me, and just chalked it up to an unusually painful bout with a viral gastroenteritis. And I did have to deal with, even two years later, with a billing problem for that trip to the ER, but I don't regret making the call.

Arney,

Really small world. I actually know Dr. Lynn. Really nice guy, and super smart. He is (or was) the head of emergency medicine at St Lukes - Roosevelt Hospitals, and I went to high school with his daughter.

He has some great stories to tell (as you might imagine). The most famous of which is that he is the doctor who treated, and ultimately pronounced the death of John Lenon. He had to give the nurses a moment to stop crying and compose themselves before allowing the family to come in and see they body. (He wrote about the experience in the NY Times on one of the anniversaries of Lenon’s death.)