Rat in a cage.

Sometimes I feel like a rat in a cage, with the world peering over the cardboard sides of the shoebox as I run frantically, and furiously, on the revolving wheel of life, only to break a sweat and end up where I started.

It ain't easy, sometimes. And it's even harder when you least suspect it.

The best way I can explain it is like this:

Go find yourself a large clear, Plexiglas box six feet wide by twelve feet long. In it, place yourself and two assistants. These two assistants need to have less training than yourself and should be half asleep, but will have the loyalty of a Golden Retriever and the eagerness to help like a excited student on the first day of his first clinical.

Strategically place in this box all the tools you need in awkwardly arranged cabinets. Then, as you attempt to perform possibly life-saving maneuvers, have an intoxicated loved one leer through the thin glass screaming at you to save her life. Have it shake and rattle violently, tossing you left to right, front to back, up to down as you attempt to interview the medically uncooperative, extremely short of breath patient restrained on the bed in front of you, doing her very best not to die in front of you.

You have no idea what has happened. And no one around you has the ability, or the faculties, or the breath, to explain the circumstances leading up to this event. All you see is a woman struggling to breathe, an intoxicated husband who won't let you do your job, and five other guys not realizing the urgency in your step; but want more than anything to help the best they can.

What do you do?

What is it? Is it asthma? Is it hyperventilation? Is it an assault? A choking, and the bruises on her neck are from the forefinger and thumb of the angry assailant? Is her throat crushed and her vocal chords spasming? Is it nothing? Or, is she dieing in front of you?

Quick, you need to make a decision.

But don't make the wrong one. You have a reputation to uphold, you know.

You can put her on continuous positive airway pressure (CPAP); an oxygen delivery device reserved for only the truly sick that forces air into her lungs like a jet turbine. Then give her subcutaneous epinephrine and nebulized medicine mixed with the oxygen, as you quickly start large bore IV's and think of the next line of drugs to give her.

That is if it's asthma.

Or do you hold off, and wait on the sideline to see if it's anxiety and she is severely hyperventilating?

You don't want to make the wrong decision. If you sway to the extreme; do all the invasive medical procedures and nothing is wrong, you look like that new guy in the corner with the white, pressed shirt and new blue cargo pants. The one with too many tools on his belt and pockets full of medical guides. The guy who wants to be a hero but has yet fought a day in the trenches.

Or, you can do nothing. Let your years of experience and nonchalance influence everyone into believing that this is no emergency and that you know exactly what is going on with her -you hope. You can go with your gut reaction and hope she is hyperventilating, praying it isn't a fatal asthma attack, or reactive airway disease, induced by the trauma of prolonged hyperventilation.

You can't calm her, if you can't calm yourself.

So, if you're like me, you think of the worst-case scenario and try to fix that problem. Toss the ego out the window and hope that you're making a wise decision. Better to over treat someone than let them die right in front of you.

And all this happens in a span of three minutes.

On a good day, it takes me all afternoon to decide what to eat for lunch!