We're called for an unresponsive at the movie theatre, but are soon updated that the patient is conscious and breathing. As we pull into the parking lot, we see a police car next to a green Oldsmobile, and the officer looking in the passenger door.
The officer comes over and talks to me as I step out of the ambulance. "He doesn't want to go," the officer says, "But his wife says he wasn't breathing and she gave him rescue breaths and did CPR."
I look at him dubiously. He shrugs as if to say, "I'm just giving you the information."
The man, in his seventies, has good color and is fully alert. He looks good for someone who had CPR done on him. I introduce myself by name to him and his wife and ask how he is feeling.
"I'm fine," he says quickly. "I just passed out for a moment in the theatre, but I'm fine now, really."
His wife starts to speak, but he cuts her off. "This really isn't necessary," he says.
"Well," I say. "I understand you don't want to go to the hospital, but anytime someone has what you had -- what we call a syncopal episode -- someone passing out -- it is very important that you go to the hospital to get checked out. If it happened once, it can happen again, and the next time with a different, perhaps more ominous outcome."
"No, really, thank you for coming, but I am fine," he says.
"He didn't just pass out," his wife says. "You weren't breathing. I had to breath for you. You were dead and I had to push against your chest."
He looks at me and rolls his eyes. "I just want to go home."
"He had no pulse," a woman standing by me now says. I turn to look at her. She appears also to be in her seventies.
"His wife and I are nurses. He wasn't breathing. She saved his life."
"You couldn't feel a pulse?" I hint.
"He had no pulse."
I don't argue with her. I have my opinion, but I wasn't there. And I suppose anything is possible.
"How long did this episode last?"
"I don't know. It was all so scary. Maybe thirty seconds. Maybe a minute. His eyes rolled back into his head. He was gone and then she brought him back. He must go to the hospital."
"I was only out thirty seconds," the man says. "I just want to go home."
"If you were out. How do you know how long you were out for?"
"It was at least a minute," the wife says. "I gave him two rescue breaths and pressed twice against his chest." She looks right at her husband. "You were dead. My breath...." She tears up. "...my kiss -- brought you back. Please, for me, go to the hospital."
"How long have you two been married?" I ask. I am clearly expecting her to say in excess of fifty years.
"Three months," she says.
He looks at me, pleadingly. I get the sense that this young marriage seems much longer than three months to him. "I just want to get out of here and go home," he says.
"You wife is really concerned about you. I'm concerned about you. How about just going in the interest of marital bliss?"
He shakes his head again.
"You won't do it for me?" she says, and she begins to cry in earnest. "Please, do it for me."
I have a vision of her, dressed in black, grieving in another empty home.
I check him out from top to bottom. His vitals are good. His EKG is normal. He just tells me he felt weak at the knees and got lightheaded and passed out briefly. It happened to him ten years ago and they never found anything wrong. He was at the doctor this week and everything checked out fine. Please, can he just go home?
"My advice, as it is in every episode of syncope, is to go to the hospital. We don't really know what happened. We'll take you down there and they can either give you a clean bill of health or else find out what the problem is and hopefully correct it." I turn to the tired standard line. "Better be safe than sorry."
"I'm not going," he says.
"You must take him," the other woman says again. "He should have no choice. He must go. Think of his poor wife."
I explain that we can't take him against his will. If, despite our strongest medical advice, he refuses, there is nothing we can do. We cannot kidnap him.
"Thank you," he says. "Now, can we leave?"
He signs a refusal and she reluctantly signs as a witness. I remind her she can call us back if anything happens or she has any more concerns.
But then, I say, "And don't forget, right now you are sitting in the driver's seat. He is in the passenger seat. There's nothing to keep you from driving right to the ER."
I see one of her eyebrows raise. He looks at her as if to say, don't you dare.
We leave the two newlyweds to decide their own course.
***
Later, I hear from a woman who happened to be in the theatre when the episode occurred. She laughs when I describe the account of the wife's heroic efforts. "He just passed out," she says. "There was no CPR."
