It was early evening on a warm summer's day. It had been a slow day (don't say the “s" word around a paramedic or you are likely to get hit with something.) Tones dropped for chest pain. The address was familiar, a home we responded to often for alcohol-related domestic disturbance. We were met at the door by a frantic male, obviously drunk, saying his wife was having a heart attack.

A typical visit to this home usually involved both husband and wife drinking excessively and one assaulting the other. His drink of choice was brandy and hers was beer. He would drink an entire bottle of brandy and she would drink a 12-pack of beer.

We would usually be met at the door by one of them in tears saying the other hit them. Police were usually there, but nobody ever wanted to press charges against the other.

I recall one occasion where he said she hit him. She was walking around the house without any pants on. He showed me an empty trash can with a large bottle and a large number of empty cans.

The fight was over and she seemed calm. After speaking with the police officer we were cleared and returned to the station.

This night, however, things were different. He was in tears, frantically explaining that his wife told him she thinks she is having a heart attack.

We found her seated at the kitchen table in no obvious distress. She was drunk, of course, and said her chest was hurting, but it had passed. I asked all of the standard questions for chest pain.

Where is the pain? In the center of her chest. Are you having any trouble breathing? She was but not anymore. Did the pain radiate anywhere else? No. What were you doing when it started? Nothing. Any cardiac history? “I don’t think so.” And the questions went on. Vital signs were perfect and EKG was normal.

All the while he was still upset and walking around nervously saying she is having a heart attack and needs to go to the hospital.

As we dug deeper, the story changed. I asked her straight out what had caused her chest pain. The answer “he told me a joke and made me laugh so hard it hurt!”