We had a wonderful time in Bucks County, but there was an incident that occurred early Sunday morning that was frightening and that raised a fundamental question:  when to ask for help and how to make good decisions under great pressure when someone else’s life is involved.

Around 3 a.m., I was shaken awake by Maria, she was very upset, she could barely speak. She said she had been in great pain for several hours, and it was getting worse. She didn’t want to wake me up, but she felt she had to. She seemed frantic.

Groggy, I got up and saw her in more discomfort and pain than I had ever seen her. It was serious, she had been up for some time but was in such unbearable pain. I could see that she was getting very worried. Maria is a stoic about health, she rarely, if ever goes to a doctor or feels poorly. And she never ever complains when things hurt.

I got dressed in a hurry. Be prepared, I told myself.

Essentially, Maria was asking me for help. She wasn’t sure what to do, the pain was getting worse. I had some decisions to make.  Our host, a good friend, was in an adjoining room sleeping. She is hearing impaired, and I was very reluctant to go barging into her bedroom and shake her awake, I thought it would scare the hell out of her. I had to decide quickly how sick Maria seemed, whether to call 911, or to drive Maria to a hospital or emergency center. There was none nearby that I knew of and I was in a strange place far from home with no sense of where to go for help.

It was difficult to see Maria in so much pain, and she was deteriorating, she wasn’t in a position to decide for  herself what to do. But she said she thought she might need help, the pain was the worst she had ever felt. I wanted to do right by her. I could not imagine living with the knowledge I had failed her in such a profound way.

I don’t want to go into the details of Maria’s symptoms, for the sake of her privacy. We had stopped at a franchise restaurant in New Jersey on the way to Pennsylvania and she’d had a salad, it occurred to both of us that this illness might be food poisoning. I grabbed my Ipad and checked some symptoms on a medical website. I also thought of appendicitis, which can be fatal if not treated quickly. I was very reluctant to call an ambulance in a strange place. I admit the thought of dealing with a hospital in another state, keeping us away from the farm for perhaps days was on my mind.

How awful that we have to think of insurance before we think of our very survival.

Her symptoms matched a number of different things, but the food poisoning seemed  the mostly likely to me. And to her.  I remember thinking I had to remain very calm, if I got visibly upset that could frighten her and make things much worse. I wanted her to see confidence and calm in my face. I told her to walk with me, take some water, that she was okay, she would be all right. I wanted her to look at me and see that message, not panic or confusion.

I felt her forehead, which was dry and normal. She was not sweating, she was not disoriented, she was coherent. The pain ebbed and flowed, got better, then worse, then better again.  When it was worse, it was very bad. She could not sit still, hold down fluids or food. I wondered how she could have spent several hours like that without waking me up. That’s how I knew it was serious. She woke me up.

The symptoms didn’t quite fit appendicitis. I decided to give it 15 minutes and set the timer on my phone. If she was not visibly better in 15 minutes, I would call an ambulance and wake up our host. I thought the safe and wise decision was to call an ambulance; first, because she was in do much pain and distress, and then,  because it was safe and sensible. Twice, I reached for the phone to make the call. I thought I would surely be canceling my book talk that afternoon, leaving 150 people and the dog therapy group that organized the talk in the lurch.

I wondered if I could throw her into the car and drive all night to get home, there was no sense to it, it was just a powerful instinct. If she was really sick, I wanted us to be home on the farm, near our friends.

I got Maria to take some water – she was very strong, brave and clear. We walked around the room in circles, had more water. I asked her to breathe deeply and slowly – I wanted to occupy her mind, help her to calm, give her body time to work things out. If it was food poisoning, that would happen.  She began to get better, the pain less frequent, less intense. Ten minutes into my 15 minute plan, she was able to lie down and also begin to feel normal. There was pain, but it was decreasing.

In another ten minutes, the pain was gone and she was asleep.  Her ordeal had lasted about five hours. It was almost dawn. We were both able to attend the talk and dinner scheduled for that night, although she was weak and very tired for 24 hours. She slept for five or six hours.

I am not certain if I made the right decisions or not. In retrospect, I think I was perhaps taking too big a risk by not calling an ambulance right away. If we had guessed wrong…

If I had called an ambulance, the worst thing that might have happened would have been for the paramedics to decide that they were not needed, and leave. Wasn’t that was First Responders do? Wouldn’t I would tell any person to call 911 if they were in extreme pain? I’ve done it more than once.

And it was not a frivolous thing. On the other hand, I did trust my instincts – and so did she. When she first woke me up, I think we both believed I should call 911 and we would end up in a hospital. But giving it some time began to resolve the situation and make it clear. I am no physician, and I never play doctor or diagnose people (or animals) online,  but there was helpful information readily available. Information wants to be free.

There was something else on my mind. I have diabetes 2 and heart disease. In both cases, I did not get help and in both cases, my life was threatened, in one case very nearly lost. The lesson for me was to seek out qualified help and not make judgments and decisions for myself. People cannot diagnose themselves, on Facebook or anywhere else. Many have paid with their lives trying. Was I doing the same thing with Maria and with her life? Since Sunday morning, that has haunted me and I don’t really have an answer for it, it is a grey question, not a black-and-white one.

And for me, so much of life is grey, the world around me is increasingly black-and-white.

How powerful an experience to see someone you love suffer so acutely and be helpless to stop it.  And to have so much responsibility. I actually fantasized having a doctor walk in the room and tell me what to do. Yet I could help and did help and in many ways, the right decision was perhaps made. Maria feels it was the right decision, she is more certain than me.

Ultimately decisions rest on instincts, the ability to trust one’s self, to say calm, keep perspective and be prepared to react quickly. Strength to me is not believing I know everything, but that I know little. Knowing when to call for help is one of life’s most profound decisions, and it is not as clear cut a thing as the movies and TV shows would have us believe.

I am a lucky person and a grateful one that the person I love so much is walking around, telling me what to do, writing on her blog, planning her beautiful quilts for tomorrow. We are not God, we cannot always know what to do.

We can only do the best we can. I will leave it there, that is the boundary. That, in some ways, is a mantra for me, the root of compassion and self-awareness.