I keep thinking how in the ER when someone rolls in gasping "I can& #39;t breathe, I can& #39;t breathe" we all jump to our feet and run to assess and help them. It& #39;s #1 and 2 of our "ABC& #39;s" - Airway, Breathing, Circulation - that comes before any other concern.

"I can& #39;t breathe" is the last thing people push out before they are too breathless to say a single word. It& #39;s said with a gasp. It has a certain cadence and intonation. "I can& #39;t breathe" sets my heart racing like almost no other patient utterance, because I& #39;ve seen what follows.

"I can& #39;t breathe" from a person in distress makes us reach for the oxygen, the non-rebreather, the oral airway, the bag valve mask. Eyeball the crash cart, the boogie. Be ready to needle, to crich. Page X-ray, page RT. Every fiber of your being is focused on securing that airway.

Everything else that was paramount a minute before goes away with "I can& #39;t breathe." An attending holding on the phone, your bladder is exploding, an angry patient wants a word. No matter. "I can& #39;t breathe" means drop it all, clear your head, go and fix it.

I do not remember a time when "I can& #39;t breathe" was anything other than an elementally intolerable sound to me. No doubt my training and experiences have honed any instinct I started with, and shaped my exact responses to that signal.

But it doesn& #39;t take an ER doc& #39;s ear to recognize that signal, does it? It& #39;s a fellow human in distress. Someone who has only enough air in his lungs to say one thing, who chooses those exact three words, "I can& #39;t breathe," surely everyone can hear what I hear in that?