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Medical Judgment

By Richard L Mabry, MD

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Acrid smoke assaulted her nostrils and nudged Dr. Sarah Gordon out of a restless sleep. Was that really smoke? Or had she dreamed the whole thing? She sat up in bed and sniffed the air around her. No, the smoke was real.
Her sleep-numbed brain struggled for only a few seconds before it hit her. Her house was on fire. She had to tell Harry. Then she’d run down the hall and get Jenny. The family had to reach safety.
Sarah reached to her left across the king-size bed, but when her hand touched a bare pillow she realized her husband wasn’t there…and why. He was dead. He’d been dead for eight months now. So had Jenny, her daughter. Sarah was alone… in a burning house.
Or was she alone? Hadn’t she also heard a noise? Was someone there, waiting for her to come down those stairs? Should she stay up here? No, the “someone” might or might not be real, but the fire wasn’t the product of her imagination. She needed to act, and quickly.
Rules and admonitions, read or heard in the past and almost forgotten, swirled through her mind, paralyzing it with indecision. Sarah forced herself to stop. You’re a doctor, Sarah. You’ve faced countless emergencies. Fast isn’t good unless you’re accurate.
She threw on a robe and shoved her feet into slippers. Sarah dropped her cell phone and keys into the pocket of her robe. She took two steps away from the bed, then turned back and picked up the flashlight that had sat on her bedside table since Jenny’s birth. She flicked it on, and in a few strides that displayed more confidence than she felt Sarah covered the distance to the door leading to the hall. Feel the door. If it’s hot, find some other way out.
Cautiously, she pressed her palm against the door. When she discovered it was cool, Sarah let out a breath she didn’t know she was holding. She opened the door and saw no flames. Then she sniffed, and there it was again—a faint aroma of smoke wafting up the stairway—not enough to choke her, not an amount capable of blocking her vision, but sufficient to send her hurrying down the stairs.
Guided by the flashlight, she descended to the first floor. As she got lower, she coughed a little, her eyes watered a bit, but she could breathe, could see through the tears. The smoke still wasn’t bad.
At the bottom of the stairs, she stopped to listen. Was that a noise? She strained her ears, but heard nothing more. Maybe there was no intruder. Maybe it was all in her imagination. Maybe.
But the smoke wasn’t. It was real. Where was the fire? There was no crackle of flames. She turned her head right and left, and felt no pulse of heat on her face. Then she blinked away a few tears, evidence that the smoke was there. And where there was smoke, there had to be fire.
She needed more light to aid her escape. Sarah flipped the switch at the foot of the stairs, illuminating the area. The power was still on—good. She turned off the flashlight but held onto it. It might be a useful weapon.
Sarah started to exit the house the way she habitually did, through the kitchen into the garage. She turned to her right, but stopped when she saw tendrils of dark smoke drifting under the door from the garage into the kitchen. That’s where the fire was. She couldn’t exit there.
She turned back and scanned the area straight ahead of her, the living room. No smoke. No heat. No noise of flames. Best of all, there was no movement or sound that signaled someone there…at least, no one she could see. She could hurry through to the front door and make her escape.
Stop and call the fire department now? Was there any reason to further delay that call? Wasn’t it important to call them immediately? Get out of the house first. Call for help when you’re safe.
Sarah hurried to the front door, threw it open, and felt the fresh night breeze on her face. Her instinct was to run, to get out of the house as quickly as possible, but she stopped as the voice in her head spoke once more. Keep doors and windows closed. Air can feed the flames and make the fire grow. She closed the door behind her.
Sarah hurried to the end of the sidewalk, her slippers making a soft shushing on the concrete. Wait! What was that? She stopped and turned. Had she seen a flicker of movement in the shadows at the corner of the house? Or was it her imagination, fueled by the adrenaline of the situation, turning wisps of smoke into the shape of a prowler?
She watched for perhaps half a minute more, trying not to blink, looking with unfocused eyes into the middle distance. Let your peripheral vision pick up faint images. She saw no figures, no movement.
Enough. Get help. She pulled her cell phone from the pocket of her robe and stabbed out 9-1-1 before hitting “send.”
“911. What is your emergency?”
“This is Dr. Sarah Gordon. My house is on fire. The address is 5613 Maple Shade Drive.”
There was the briefest of pauses, during which Sarah heard keys tapping. “I’ve dispatched first responders. Is anyone injured? Are you in the house?”
“No injuries. And I’m outside, on the lawn.”
“Is anyone else there? Or are you alone?”
Sarah hesitated before she answered.
“I’m alone.” At least, I hope so.

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