Last evening during rescue squad duty we were called to the house of an elderly man who had fallen. A friend had helped the man to his bed and, concerned about possible injuries, called 911. He reported that there was blood in the patient's mouth and also some on his arm.

The patient wasn't complaining of any pain. I did a brief physical examination and didn't find any injuries. The blood on his arm seemed to be from an unrelated scrape which was bandaged but leaking out a bit. The corners of his lips appeared to be crusted in dried blood, so I asked him to open his mouth while I peered inside with a penlight. There were no cuts that I could see, but his tongue and teeth were coated in a sticky dark substance. My first thought was that it resembled coffee grounds. If he'd been vomiting "coffee grounds" it could suggest internal bleeding. But something didn't seem quite right. It almost looked like...

"Sir, have you eaten any chocolate today?"

"He eats Oreos all the time," his friend said.

"Did you happen to eat any Oreos today, sir?" I asked.

Yes he had, he said. I was still leaning close to him, and as he spoke I smelled a faint whiff of chocolate on his breath. (He'd also had a delicious fudge dessert at the retirement community dining hall, he added contently.)

Because he'd fallen, we transported him to the hospital to get checked out. At one point during the ride, I was taking his blood pressure as another EMT was trying to call ahead to the hospital. But the ambulance's cell phone wasn't charged.

"Dead," the EMT announced, holding the cell phone. "Dead as a doornail."

I glanced up at him, a bit surprised (and amused) by what he'd said, knowing he had no clue how it sounded. And before I could reassure our patient, he said from the stretcher, "I sure hope you're not talking about me."