I keep thinking how in the ER when someone rolls in gasping "I can't breathe, I can't breathe" we all jump to our feet and run to assess and help them. It's #1 and 2 of our "ABC's" - Airway, Breathing, Circulation - that comes before any other concern.

"I can't breathe" is the last thing people push out before they are too breathless to say a single word. It's said with a gasp. It has a certain cadence and intonation. "I can't breathe" sets my heart racing like almost no other patient utterance, because I've seen what follows.

"I can'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't breathe." An attending holding on the phone, your bladder is exploding, an angry patient wants a word. No matter. "I can't breathe" means drop it all, clear your head, go and fix it.

I do not remember a time when "I can'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't take an ER doc's ear to recognize that signal, does it? It'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't breathe," surely everyone can hear what I hear in that?