I entered the market, trying to mentally review my grocery list. Suddenly a woman walked briskly by, tapped my shoulder and said “Hi, Hui-wen!” but then kept moving. I was completely confused by who was saying hi to me and why they were moving so unusually quickly. I kept looking to my right in the direction where the woman had gone.

Then, I heard a commotion to my left, and saw a gentleman lying face-down on the ground next to his shopping cart, his left hand still awkwardly raised and clinging to the side of the shopping cart. His wife stood quietly and calmly, while a couple of employees walked over, unsure as to what to do.

I went over and introduced myself as a nurse. I assumed the man had lost his footing and fell, and simply needed help getting back on his feet. His wife stated he had fallen before she was able to stop it from happening, but did not hit his head. The man was moving gingerly, clearly disoriented, and I decided he didn’t seem to have broken anything in his neck that would require immobilization. Together with a market employee, Joseph, we gently pried his fingers off the shopping cart and rolled him onto his back. Joseph and I managed to get the man up into a sitting position, and someone ran over with a cup of water. The man took the cup shakily and took a couple of sips, so I felt reassured he was moving purposefully. After a couple moments, however, he slowly started to lean backwards. Joseph quickly removed his jacket to serve as a makeshift pillow, and we lowered the man back onto the ground. I asked the wife if he usually had a hard time getting up. She shrugged nonchalantly and said “Yeah, it’s hard for him to get up.”

His wife, still as calm and seemingly unconcerned as could be, stated that he had had a mini-stroke a few months ago, but insisted he had been compliant with his medications. I asked the man if he could tell me his name, and he mumbled his name partly, but was clearly becoming less responsive. I asked if he could tell me where he was, or who was with him, but he wasn’t responding any more. I kept thinking perhaps he was having another stroke or some kind of head bleed, but nothing was clear.

At this point, I asked if anyone had called 911. Joseph got on the phone with the 911 operator and began to relay to her the details of what was happening.

In the meantime, I kept trying to assess the man’s neurological reflexes and responsiveness. He wouldn’t squeeze my fingers in his hands. He wasn’t talking or moving purposefully. No immediate corneal reflex when I moved my hand quickly towards his eyes. He was still breathing, so I knew he was alive, but didn’t he seem a little more pale? 

I put my fingers on his wrist. His pulse was present but so thready. It was hard to tell, and I couldn’t count his heartrate with all the chaos around me. I should have checked the carotid and called for an AED. My own adrenaline was racing and I was out of my element. The emergency scenario is so different when you are the sole healthcare worker at the scene. I knew the paramedics were very close. I wondered at what point I should just start CPR, right there in front of his very calm wife and the whole supermarket. I realized just how much the market employees around me were deferring to me as the expert. “She’s a nurse, she’s taking care of it.” 

Then, a confident couple appearing to be in their 30s walked by, and I heard the young well-dressed man ask if the guy was diabetic. I looked up and the guy pressed us to ask the wife, and said “He looks hypoglycemic.” The wife stated “His diabetes is well-controlled” and I felt both relief and shame that I hadn’t thought of this possibility. The young man asked the wife when her husband last ate. She said he last ate in the morning, and by now it was about 1:30pm. I asked the young man if he was in the medical field. “Yeah, ED. We see guys come in like this all the time. He’s hypoglycemic. Oh there are the paramedics! I bet for sure they’ll give him some glucagon.” 

Even still, I kept my fingers on his pulse and just about jumped on his chest as the paramedics surrounded us all and took over the situation, asking us all to step back. I tried to relay what had happened but no one seemed to be listening to me. I imagine they were already going through their algorithms and plans in their heads. 

One paramedic started to hand-ventilate him with their ambu-bag. Another put EKG leads on him and I stared at the monitor as I saw a HR in the 40s-50s. I kicked myself for not starting CPR. I wondered how these guys would approach it. Would they do CPR and intubate him there on the market floor?

As if talking telepathically, they quietly but swiftly moved the man onto the gurney and rolled him to their truck, right out in front of the market. One of them told the wife, “His heart is in bad shape, so we’re going to work on him in the back of our truck there.” I knew they were going to be doing CPR and would be intubating. 

The store employee asked me to write a witness statement. The initial woman who had quickly said hi to me when I first entered the market found me again. An old high school friend I haven’t seen in years! She had seen the guy on the ground and was trying to find help. She was so thankful I was there and was a nurse. A couple of customers came up to me and thanked me for my help.

But for me, I was shaken. How did he deteriorate so quickly? How hard it is to get your mind sharp when there are so many detractors, so many unknowns, so much adrenaline. How was his wife so calm? She made it feel like so much less than the emergency it actually was. 

I still run through the scenario in my mind and review what I could have done better. I hope he is ok, and gets some more quality time with his wife.