"You know, the ambulance service."

My pager buzzes.  I call back.

"This is Dr. [Me].  I'm covering this weekend for your doctor.  I got a message that you called."

"Yes, I'm calling about my husband.  I need you to send an ambulance for him."

"Okay, if your husband needs an ambulance, you need to call 911.  I'm the doctor on call, I can't dispatch an ambulance."

"No, if I call 911, they're going to take him to [Local, Terrible Hospital].  I want him to go [My Slightly Less Local, Slightly Less Terrible Hospital]."

"Can you drive him, or call a taxi?"

"Oh, he can't get into a car!  He's barely even breathing!"

"Um, you need to call 911 if this is an emergency."

"No."

"No, you really do need to call 911 if this is an emergency.  I want you to hang up with me and call 911.  Then you can call back if you still need to ask me any questions."

"No, it's not an emergency.  He's been barely breathing for weeks.  I just think it's getting slower now and I want him to be seen.  And not at [Local, Terrible Hospital], because my aunt died there."

"I'm sorry."

"Oh, it was thirty years ago."

"Okay.  What is your husband's name?  Let me quickly look him up in the computer."

"[Name.]  With a [silent letter]."

"Can you spell that?"

"You need me to do everything?  You're the doctor!"

"Please, ma'am, just spell your husband's name for me so I can look him up in the computer."

"[Name]."

"Okay.  Your husband is on the hospice service.  You should call the hospice nurse.  Do you have that phone number?"

"All the hospice nurse does is give him painkillers!"

"Yes, they're trying to make him comfortable."

"I need you to send an ambulance to get him to your hospital.  That is why I called.  You are not being helpful."

"I am trying to be helpful, but this is not an ambulance dispatch service.  Your husband is on hospice.  You need to either call the hospice nurse, or you can call 911.  But, looking at your husband's chart, I'm not sure it makes sense for him to go to the hospital.  The last note from your doctor seems to indicate the goals of care are to make him comfortable."

"He's not comfortable."

"Yes, you should call the hospice nurse."

"I want an ambulance here in 15 minutes."

"Okay, I am going to see if I can get a social worker to call you back, and you can discuss your case with him or her.  I think a social worker may be able to provide more help, since I don't know your husband, and, even if you want to get him here, I'm not sure how to arrange private ambulance services."

"Not private ambulance.  I'm not paying for an ambulance.  You need to send one!"

"Do you know how to check your husband's vital signs?"

"No, I'm not the doctor!  You tell me his vital signs."

"I'm not there.  I can't check his vital signs.  Look, I want to help, but the best way I can is to have you call 911, or the hospice nurse, or let me find a social worker to get in touch with you."

"Well, don't have the social worker call between 12 and 2, because I'll be out at lunch and my husband can't answer the phone."