Our patient has called for chest pain. He looks uncomfortable, seated in his home surrounded by his family. He’s a normally healthy middle-aged male; a prime candidate for one of those big heart attacks that sneaks up and unexpectedly creates a widow. Nothing like this has ever happened to him before.


We begin our treatment regimen. Oxygen, IV, cardiac monitor, full 12-lead EKG; aspirin and nitroglycerin. Nothing screams Big Bad One, but something is not right.


In the ambulance, he confides in my partner that all is not well. He’s recently experienced a major tragedy; the kind that can drive a man deep into the arms of his wife or deep into the depths of a bottle. He doesn’t say which way he’s going. He’s been having some intermittent chest pain for a while now, but usually it goes away if he forces himself to relax. Not today.


We treat his physical pain the best way we know, as he stares out the rear windows into the middle distance.


The woman is well known to us, a ‘frequent flier.’ She stands with the firemen outside her city-owned building, leaning lightly on her cane.


Today she admits she’s been drinking, and that she feels depressed.


She’s calm, quiet, and polite. She always apologizes for taking up our time, and she offers to climb into the ambulance without our assistance. Of course we assist her anyway.


She folds her cane into her lap, and she too stares past the Star of Life decals into the middle distance behind us. She’s never told us of her demons; but deep in her eyes there’s a void, as if someone has just told her that her childhood dog has died.


Always, always the grief.

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