When “Man Up” Turns Deadly

By Terry Loerch

Saturday evening, July 5, felt like any other sun-splashed, Southern-California gathering of athletic overachievers, actors whose job is to look immortal, and stunt performers who train as though gravity were optional. The playlist was upbeat, the talk was light, and nobody imagined that a man in prime physical condition would suddenly crumple like a marionette whose strings had been cut. Yet that’s exactly what happened. One moment, the 38-year-old stuntman was chatting; the next, his knees buckled, his head lolled backward, and a harsh, snore-like rasp crackled from his throat. That rattling sound wasn’t drunken slumber; it was agonal breathing, a last-ditch, brain-stem reflex that often signals cardiac arrest or severe hypoxia.

Instinct overrode conversation. I slid an arm behind his shoulders, lowered him flat, elevated his legs, and opened his airway. Cyanosis deepened from rose to storm-cloud gray, a visible confession that oxygen saturation was plummeting. When skin turns that shade, the brain is already pleading for air and every second matters. Healthy athletes do, sadly, die of silent killers such as pulmonary embolism, clots that travel from a leg vein to the lungs and choke off circulation in an instant. Even in elite sports, the first symptom can be collapse, and in roughly a quarter of cases, the first symptom is death.

While I coached slow, steady breaths and another stranger counted a faltering radial pulse, his closest friend, eyes on the women nearby, not the gray hue on his buddy’s lips, kept repeating a cocktail-napkin diagnosis: “He just needs to man up, it’s his birthday, don’t ruin the vibe.” That refrain is the marketing slogan of toxic masculinity, a cultural script that shames men into dismissing pain, skipping doctors, and in this case, refusing an ambulance that had already been summoned.

The paramedics arrived after what felt like an hourglass turned sideways, closer to twenty minutes, yet long enough for cerebral hypoxia to etch lasting damage. The stuntman roused, fought the oxygen mask, and prompted by the same friend, signed a refusal of transport. Pre-hospital medicine calls this a “high-risk refusal,” a decision so fraught with liability that entire clinical guidelines exist to warn first-responders what comes next when a patient in crisis walks away from definitive care.

Color crept back only slowly.....two hours later, his pallor hovered between dusk and dawn. When I said goodbye, he stared blankly and re-introduced himself, no memory of the conversation we’d shared half an hour earlier, an ominous hint of transient cerebral ischemia. Whether the original insult was a paradoxical cerebral embolus, a pulmonary embolism masquerading as syncope, or an arrhythmic arrest punctuated by anoxic seizure, the takeaway is identical, deprived brains do not forgive wasted minutes. Agonal breathing and seizure-like spasms are red sirens, not nuisances to be “slept off.”suddencardiacarrestuk.org

Driving home, I kept replaying a tableau that felt less like a medical emergency and more like a morality play. On stage were two archetypes: the wounded man, whose physiology begged for help, and the self-styled alpha friend, more terrified of appearing weak in front of women than of burying his wingman. The Greek chorus party guests, who looked to one another before acting, embodied the modern bystander effect amplified by performative masculinity. Studies show that rigid adherence to the “be strong, don’t fuss” ethos dampens men’s willingness to intervene and even their confidence to call for help.

Society often romanticizes stoicism, yet in emergencies, stoicism kills. Blood clots don’t negotiate; arrhythmias don’t pause while you finish a shot. A pulmonary embolism large enough to turn lips violet can strip consciousness in seconds and life in minutes. Immediate anticoagulation or thrombolysis in an emergency department is the difference between walking out under your own power and never waking up at all. heart.org

I wish this story ended with a text confirming he was fine, laughing about the scare. The truth is I don’t know if he ever reached a hospital, or whether Monday morning dawned for him at all. What I do know is that the next life-and-death drama you witness may not include professional rescuers in the first act. It will include you, your instincts, and the culture you bring to the moment. Ditch the “man up” mythology. Listen to skin tones, not bravado. Call the ambulance, even when the birthday playlist is still thumping, because oxygen, unlike swagger, cannot be faked.