The room is dark and quiet. The other three patients stir in their corners, startled by our raucous arrival among them. They quickly settle, realizing as we make our way to the fourth bed that it is not their time.

Our patient starts awake as we approach. He is small and frail, a mere shadow with physical form. He looks at me with fearful eyes, and recoils when I touch his arm. The staff member says they called because he was hypotensive, but she cannot provide any more information. She hands a stack of papers to my partner.

Demographic sheet, valid Do Not Resuscitate orders, list of medications, and a notation that the patient has dementia.

The patient shows signs of dehydration; the staff admits that he hasn’t been eating or drinking well lately. I prepare to give him IV fluids, and I explain each step of the process. The patient returns a blank, interested stare, like a dog listening to its master.

When the needle penetrates the skin of his arm, he screams out; whether from pain or fear I cannot know. “Mommy! Help me!” We speak soft soothing words, calming him again.

Downstairs in the ambulance, he begins to communicate with me. He asks me where we are going and why. I explain, and he seems to comprehend. For ten seconds. “Mommy! Where are you, Mommy?” I explain again, and again, and again; he seems to understand for a few seconds.

“Mommy! Mommy! Please help me.”

I try a different tack, gently touching his shoulder and asking him where his Mom is.

His eyes focus on me for a second. “She’s dead. Why?”

My heart breaks a little more.

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