Ambulate before carry

So once upon a time, there was a kid in our first due who, in the time I've known him, has weighed anywhere between 350 and almost 500 pounds. (By the way, I'm not exaggerating about his weight... he could only be weighed on one special scale in the hospital and I've seen those red numbers flashing and he doesn't fit on our "bariatric cot.") Back when he was closer to 500 pounds, he was a cardiac arrest at home. He was successfully resuscitated by some of my colleagues and walked out of the hospital like a month later. Did I mention he was only 17 at the time? I can't swear to you what caused him to code, but I'd wager that his extra 300+ pounds didn't really help the situation. We go to his house a lot, not always for him, but also for his mother and grandmother who have a variety of medical problems of their own. This kid had no chance... both Mom and Grandmom has BMIs > 40 or so.

I went there the other day for the kid. He's like 20 years old now and has lost a fair amount of weight. A trim 375lb or so? So now his BMI is only like 54...

His complaint was "shortness of breath." He clearly had a cold. Was telling me about his runny nose, his cough and never actually mentioned being short of breath. In fact, he denied dyspnea when I asked him point blank.

Because I knew his history (and really didn't want to code him again), I did my initial assessment in the house, including a 12-lead. Everything was stole cold normal, so I offered my hand to him and said, "Ok let's go to the truck." He stands up and we start walking out.

Mom and Grandmom start rushing waddling into the room.

Cue the screeching...


"What do you think you're doing?!"

"You're making him WALK?!"

"Sit down baby... you're too sick to walk!"

"Y'all better be carrying him out of here!"

"Go get that cot girl. After I call, you work for me and I say carry him out to that ambulance!"

Seriously? How do you even say that with a straight face to me? I'm literally a third of his size. And I'm supposed to pick him up?

I carry out people who physically can't walk or those whose condition could be exacerbated by exertion. Chest pain, dyspnea, bad trauma, seizing/post-ictal or unconscious patients. This does not include obesity. (By the way, at this point the kid has already made it halfway to the truck, with no adverse effects.)

The mother and grandmother continued to scream at us until finally I pointed out that the kid was in the ambulance and so it was a moot point.

And I wish I were kidding... but the mom and grandmom proceeded to sit back down on the couch, eating chips and watching TV while we took the kid to the ED. Not stereotypical at all.

I think a little more walking would do the whole family some good...