Not Quite Saving the Day...

I experienced a serious incident this past Monday. It was the first time I was truly called to act while off-duty, and I didn't expect it to effect me in this way. My husband , 4-yr old daughter and I were shopping at our neighborhood supermarket when a frantic voice came across the PA announcing, "There is an emergency in the seafood department, call 911". My husband looked at me and I said, "I'll be right back". I ran across the store and found a middle aged man lying unresponsive on the floor. His face was flushed and his lips were starting to turn blue. He was breathing, but not very well. I adjusted his airway and asked the bystanders if anyone had seen what happened. One employee told me that the gentleman was pushing his cart when he suddenly proclaimed, "Oh my!" and fell backwards. I instructed the store manager to search for the man's wallet and look for a list of medications, while another bystander looked for a medic-alert bracelet and lifted his shirt (I was looking for signs of heart surgery, pacemaker or even hives). It is important to try to figure out the underlying cause of the present illness so that it can be corrected as quickly as possible, but that can be difficult to do when you have an unconscious patient. I learned his name was Tom* (*changed to protect his privacy) and that he had several medical problems that could be contributing to his poor current condition.

The adjustment of his airway seemed to help because his respirations improved and suddenly he looked up at me. "What are you doing?" he asked me in a strained but quiet way, his eyes searching for some understanding of what was happening. I told him, "I'm a medic and I'm trying to help you, you passed out and I need to know if you are having pain anywhere." Tom tried weakly to sit up, but I told him he should remain lying because he was ill and could be injured. I asked again if he was in pain or had any medical problems. He began gasping and said one or two words that were impossible to understand. I repeated my question and again he made a few guttural sounds that were straining to be words but were yet incomprehensible. At that moment, as I was holding his head in my hands, he looked up at me and his eyes got wide, he took one last labored breath and then there was nothing - he had stopped breathing and I lost his pulse. I immediately started doing compressions on his chest. My husband stepped in and took over the compressions as I delivered mouth to mouth ventilations. I asked the manager for an AED, but the store did not have one. I was helpless to do anything more for this man than to offer him what air I could. Had I had my equipment, I could have seen what his heart was doing on my cardiac monitor, I could have given him high-flow oxygen and I could have established vascular access to provide him with emergency medications. I felt powerless and frustrated. I knew there was more that I could be doing but I didn't have the tools I needed.

We continued performing CPR, and a Deputy Sheriff arrived with an AED, but an electrical shock was not what this man needed. He needed more advanced lifesaving measures than what I could provide as a lay rescuer with limited resources. The medics arrived after several intolerable minutes and advanced measures were taken. We were able to get a pulse back, and Tom even started spontaneously breathing on his own for a brief few moments, but no sooner than we got him to breathe he began seizing and then we lost him once again. His body was fighting, but it was a battle that would not be won. Tom died as a result of his sudden illness in spite of the measures we took to try to save him. I believe that his passing was the result of a pulmonary embolism that blocked the flow of blood from his heart to his lungs, and unfortunately the mortality rate of such a sudden condition is almost 100% fatal. Even in a hospital setting with unlimited resources, such a massive complication often cannot be overcome. Even knowing this, I was greatly saddened to hear that he had not survived. A part of me was foolishly optimistic because he was fighting to live and he had started breathing again.

I encounter a fair amount of death through the course of my job. I have seen people die, and I have even had to let people die but the circumstances are usually very different and they often include an unconscious individual, advanced in age with a DNR (Do Not Resuscitate order). We standby and offer supportive measures to make the person more comfortable as their heart slowly winds down and they drift away. Moments such as these are expected at work. When I put on my uniform I am mentally prepared to deal with the challenges of the day. Even when a call hangs heavily on my heart I can usually leave at least some of that burden at work. I get in my car and the ride home cleanses my psyche, the longer I drive the lighter I feel. But I didn't have my impenetrable uniform on this day at the market with my family. My work life had crossed over, intersecting with my private life on my home territory and I was caught off guard.

After Tom was whisked away by the medics and I had provided my personal information to the remaining rescue crew my husband and I looked at each other. The question ringing in my ears was "What now?". We finished our grocery shopping where we had left off - in the dairy aisle. My beautiful little girl looked at me and said "Mommy, you saved the day!". I only wish she was right. I looked for Tom's obituary but I haven't been able to find it. I don't know what it is I am trying to learn from it, I just want to know. I wondered what happened to his car in the parking lot and if he had a hungry pet waiting for him at home. Death is a funny thing because life goes on in spite of it, seemingly without missing a step. When I am at work everything is so much more controlled. There are procedures and protocols we have to make sure all the loose ends get neatly tied. I am not usually left having felt so helpless with so many unanswered questions.

Due to privacy laws and patient confidentiality I will probably never know more about Tom than I do today, but I know I will carry this incident with me. I am glad I was there and tried to help. I hope Tom found some comfort in knowing that he had several concerned people trying to help him as he left this world, I hope he did not suffer greatly and I hope he is at peace.