There's a saying that the way to avoid getting impaled on the bull horns of a dilemma is to grab one of them vigorously, and hang on. A patient sat in a chair near the door gasping for air last night. I had just gotten the skinny from the Resident working with her. She had been to E.R. at a sister hospital for her pain the night before. She received an injection which she claimed did not work.
I walked over to her and told her that I was ready to see her. She struggled to get up out of her chair, holding her legs, and gasping how bad they, and her back hurt her. We walked slowly to my office. I took her intake, delivered in shallow bursts of fitful information. I walked out to her Resident and said he was right, I could not do much for her. I told him I was going to do Battlefield points on her ear, to try to take the edge off her pain, which might be contributing to her difficulty breathing.
But in the end I grabbed the "shortness of breath" horn, and after little relief to show from peppering her ear with ASP darts, like a clove covered baked ham, had her transported by wheel chair to the Emergency Department to address her worsening struggle to breathe.
This morning the Resident told me that the ER's dx. was anxiety. And that resolved, he planned to work her into his rotation for a procedure for her pain later in the day.