There was nothing specific that I was doing.  There were no point of reference or triggers that made this memory arise.  Yet, there it was; a call I had taken while working in The Falls.  The patient's name escapes me, yet I can still she her face.  Worse, I can still remember wondering why the staff of the nursing home had bothered to call for help.
Heritage Manor of Niagara.  Right there on Buffalo Avenue, in the shadows of the Grand Island Bridges.  Pull down 65th Street and back into the parking lot, lining up with the ramp that runs along the building.  We always had to push the door-bell to get let in.  The home never had so much staff that they could afford to have someone waiting.
It was just after a meal.  I have to believe it was either lunch or dinner, because the sun was streaming through the cafeteria windows.  The residents were still milling around.  Some were still waiting in their wheelchairs to be taken back to their rooms.  Others were lounging about, watching TV, staring at the walls, or occasionally picking at their clothing. 
We were directly to this elderly lady sitting on a couch.  Her head was down and her chin was nearly resting on her chest.  As I got closer, the nature of her illness was more apparent.  She was dead.  And yet, here amongst the trained medical staff, nothing unusual was noted by them.  She had finished her meal and just wanted to sit for a while.  They say she never complained of anything.
And, yet, here we are. 
"Does she have a DNR?"
"A what?"
"A 'Do Not Resuscitate" order.  Does she have one on file?"
"Why?  Is she dead?"
(Oh, my God.  Why would I be asking you?)
"Well, she not breathing, and she doesn't seem to have a pulse."
"AAAAAAARGH!  OH MY GOD, SHE'S DEAD!"
As we continue to evaluate and treat the lady, we've moved her onto the floor and begun CPR.  The staff, however, does not seem to feel the need to respond to my question.  Their task, it seems, is to continue to move the remaining residents out of the room and away from the patient.  My guess is, no one is supposed to see a dead person.  Needless to say, we don't get an immediate answer.
Advanced interventions continue as we "go through the motions" so to speak.  This poor lady has been without pulse and respirations for longer than a few minutes, and I'm beginning to wonder if she even had anything to eat at all.  I get the feeling she just sat down on the couch while everyone else was coming into the room, and "fell asleep".
AND, of course, once her paperwork and transfer file is finally brought to us, there's no DNR.  No Advance Directives.  No Health Care Proxy.  ZIP.  Nadda.
We transport her, as per the protocol at the time, to the closest ED.  The doctor and staff wonder why we brought her in.  And, in due time, a DNR does get faxed to them from Heritage Manor.  Seems it was "miss-filed". 
Of course it was.