April 24th, 2010

Life and death: it’s a thin line

A few days ago I was visiting New York for my brother’s birthday—a big one, but I’ll not reveal the exact number. The official celebration was at a wonderful restaurant in a private room, featuring one of those tasting menus where all the ordering is done for you, and all you have to do is sit back and eat each beautiful and tasty morsel as it’s brought in and placed in front of you.

I don’t even recall half of what we ate. But everything was delicate and wonderful and a lot of it was green, in honor of spring. Although I’m not a drinking person, the wine was so fabulous that even I could tell it was something special, and I drank about three tablespoon’s worth rather than my usual one.

Asparagus. Avocado. Hearts of palm. A small piece of salmon that was more meltingly delicious than any I’d ever eaten before. A pasta with tips of rhubarb (or buds of rhubarb? I have no idea which). And on and on in a succession of very light and succulent tiny dishes.

My grown nieces and nephew were there with significant others, as well as the woman who’s been my sister-in-law for over forty years. There were joke gifts and serious gifts, funny cards and touching cards. I had prepared my usual bit, which is to write a multi-verse poem for the occasion. I’d practiced my delivery and figured out the best way to recite the lines I thought might draw laughs, and my plan was to wait until the pause just before dessert and coffee to read it.

The last course prior to that was a supremely tender steak with some wonderful sauce and morels. Till then, all the courses had been very small. But this one seemed more daunting. I was mulling over whether I might not just take it home in the upscale equivalent of a doggie bag when I noticed a commotion to my left, where my sister-in-law sat at the foot of the table.

It wasn’t clear at first what was happening. But she appeared to be ill, perhaps nauseated. A slender woman, she ordinarily has a very small appetite and usually eats quite sparingly, and she had certainly not overeaten that evening, although she probably was the only one there who could have made that claim.

After just a few seconds it became apparent that she was not sick to her stomach; she was choking and could not breathe.

“Choking” is actually a misleading term, because our common conception of such things is that the person undergoing the process would be making a great many sputtering and strangling noises. But, like all true choking victims, my sister-in-law was quite silent—in fact, shockingly silent. Her son sprung to action and performed the Heimlich maneuver several times, but (and this is where the merely frightening turned to the terrifying) it did not work.

The only previous place I’d ever seen the Heimlich maneuver done was in the movies, where it seems to work perfectly. A few heaves, and out would pop a chunk of meat. But my usually-stoic sister-in-law remained disturbingly silent, and her eyes widened in fear as various people took turns working on her and then some of the staff came in and said they were calling 9/11.

My brother went white as a sheet. One of my nieces turned away, put her head in her hands and could not watch. The other started shaking and looked stricken. I wondered whether I was going to stand and observe my sister-in-law expire in front of the whole family.

And then the head chef began to do the Heimlich on her and I heard the blessed sound of stricken wheezing. It was slight but unmistakable; there was now some air exchange. After a few more Heimlich thrusts from the chef she was breathing well enough for him to stop, and then she managed a few words—the first of which were apologies for having caused such a fuss.

And just like that, the evening became a normal celebration again. Except it was not. For one thing, instead of eating more, we packed up most of the rest of the meal to take home. For another, everyone had become pretty emotional. We took turns giving my sister-in-law a hug.

She was relieved and embarrassed and exhausted. We—well, we were just relieved and exhausted. We invited the hero chef in for a glass of wine and chatted with him about his life—including the fact that he had once been a park ranger and had gotten first aid training in connection with that job. I finally read my poem, which was very anticlimactic but good for some comic relief.

And we went home thankful that we had not made the pages of the Times, but aware of how thin a line divides life from death and celebration from tragedy.

35 Responses to “Life and death: it’s a thin line”

  1. Romey Says:

    This is a chilling story, thankfully with a happy ending. There is truly a thin line between celebration and sorrow. It is good that you did not have to cross it. Bless you all.

  2. Sergey Says:

    The success of the chief and failure of previous attempts was due to the fact that he had real professional training. It is not enough to see something in a movie or read about it to do it properly in real life: actual training makes all the difference. One need to know where exactly to apply pressure and in what manner. The movement must be sharp and abrupt, and applied directly to the breastbone. Just squeezing of the chest would not make the trick. Sometimes it is enough just to slap at the back really hard: it produces a pressure pulse, which is the only thing capable to remove the obstruction. Really chilling experience.

  3. Cap'n Rusty Says:

    Somewhat along these lines is this
    first-person story in the UKTimes.

  4. jon baker Says:

    I was reminded of this last weekend. Though not human, so nowhere near as potentialy tragic as would have been your sister-in-law’s death, I saw my niece’s dog disappear under a pipe fence, and pass out of site onto the below grade road in front of a passing car from whence a telling thud could be heard. Unfortunately my niece, who is about 10 years old,who previously had been trying to get the dog to return to the house, was positioned in such a place where she had line of site to observe the event. Her screams confirmed what my ears told me. Only moments before the happy go lucky dog had been running around near my feet.

    The following morning I was on the way to church on a wet road. A pickup in front of me lost control, went off the road and struck a pile of rocks. The rocks acted as a ramp and sent the truck airborn in such a way as the cab crashed into the bottom of a large oak limb, smashing in the passenger side of the roof significantly. My first thought as I was stopping to evaluate the situation was I hoped no one was in the passenger seat. Thankfully only the driver was present- shaken but ok.
    How quickly that situation could have been different!

  5. Sergey Says:

    I turned out that Heimlich himself was a slicky con man, who suppresed evidence to promote his technique, which was not as safe and efficient as movies makes us believe, and slapping at upper back is actually less intrusive and produces better results.

  6. Tatyana Says:

    All well that ends well. With age, I’m being reminded more and more that life is not an Indiana Jones’ movie – and there are situations where only blind luck separates life from death.

    Glad your chef’s training presented such lucky coincidence to your family.

  7. Tim P Says:

    I’m glad your sister in law finally coughed up the piece of meat and was ok. You’re so right about , “how thin a line divides life from death and celebration from tragedy.”

    I have to agree with Sergey about training. Actually practicing it is so much better than reading about it or watching it. It’s worth considering taking a first aid class. Such a simple thing can make a world of difference.

  8. CV Says:

    It happened to my husband. He was on a religious retreat and choked on a piece of meat during dinner. The sixteen-year-old son of a fellow participant happened to be there, and successfully performed the Heimlich.

    I wasn’t there when it happened. I don’t know how to perform the Heimlich (and would likely have been paralyzed with fear anyway).

    When we saw this young man later, at another event, I had the opportunity to thank him personally for what he had done, but words seemed inadequate. All I can say is, my small children and I thank God he was there and knew exactly what to do.

  9. bandmeeting Says:

    Sergey,

    I’d be interested in some more information on the “Heimlich as a con man” theme. I’m trying to figure out why slapping on the back, if it is more effective, has not become the norm for this sort of situation. I’ve not heard a word of this.

  10. Artfldgr Says:

    when i was young, i took and paid for the classes and got my license and became an EMT (volunteer).

    one of the sader things as to our society is that we actually suffer from our false expectations.

    CPR actually doesnt work most of the time. it sometimes works. but on tv, they recorded it to work over 90% of the time.

    people thrust into this position, then go on to tear themselves apart thinking that they did it wrong (not unlikely), and that if they did better it would have worked, so its their fault. its not.

    ultimately people have died given people assistance, and yes even cpr as the person giving it refuses to give up, and ends up needing the help themselves (and thats young people too)

  11. bandmeeting Says:

    Artfldgr,

    If CPR does not work most of the time it is likely because the recipient has been so gravely injured that it can’t work. If it works 90% of the time on TV it would likely be that the episode would end with that person’s life. Since “House M.D., et al, needs to fill a full (what is it? 48 minutes?) show, voila, the person is resuscitated and the show gets to play out the plot.

    I fail to understand how either of these situations cause us to be any less well off.

  12. G6loq Says:

    I had a similar situation at home, in a new far abroad town.
    We had for dinner a group of people I didn’t really know.

    One of the female guest quietly got up from the table and went to the powder room.

    My wife on a hunch went to check on her and we had time to intervene.

    I since learned that many chocking victims go quietly …

  13. Scott Says:

    I wonder if the moral of the story is that tough cuts of meat are safer? You are forced to eat smaller bites and chew tough cuts longer.

    Glad the story had a happy ending.

  14. The Road Not Taken Says:

    [...] posts a remark­able story about a birth­day party that nearly turned to a funeral but was saved by a Heimlich-​​savvy [...]

  15. Jed Skillman Says:

    “Therefore, send not to know
    For whom the bell tolls,
    It tolls for thee.”

    That may be your point here.

  16. br549 Says:

    Thank God.

  17. Artfldgr Says:

    Study Finds TV Portrayals of CPR are Misleading
    http://www.dukehealth.org/health_library/news/783

    Cardiopulmonary Resuscitation on Television — Miracles and Misinformation
    content.nejm.org/cgi/content/full/334/24/1578

  18. JohnC Says:

    Thank goodness she’s fine now! What exactly did the chef do that your nephew didn’t do? Was he just more forceful with the thrusts?

  19. neo-neocon Says:

    John C: three people did the Heimlich maneuver on her, and as far as I could tell they all did the same thing.

  20. SteveH Says:

    Glad all turned out ok. I guess choking like that when you’re alone means you’re a goner?

  21. neo-neocon Says:

    Steve H: if you’re alone, you can do the Heimlich yourself on the top of a chair or the side of a table (see this).

  22. E.M. Crotchet Says:

    In Australia the Heimich manoeuvre is not just not encouraged, it is actively discouraged as dangerous.
    The Health Report:

    “In the early 1970s a new procedure for treating choking victims burst on to the scene in the United States and soon it was famous around the world. The procedure was called the Heimlich manoeuvre, named after the man who created it—Dr Henry Heimlich. It has never been used in Australia. Despite the claims of the extremely charismatic Dr Heimlich, Australian resuscitation experts believe that there isn’t enough scientific evidence to support its use. So how does a medical procedure become so widely adopted without any serious scientific evidence? Australian doctors are not alone in their criticism of Dr Heimlich’s methods. The most surprising and vocal critic of all turns out to be Dr Heimlich’s very own son, Peter Heimlich.”

  23. John Says:

    Thankfully the end of your story turned out good. Thank goodness your sister in law survived.

  24. Foxfier Says:

    Possibly why it worked when the chief did it?

    We were told in the Navy that you could break bones doing it properly. Especially if you do the self-attempt version.

    Ditto CPR.

  25. Foxfier Says:

    chef

  26. Sergey Says:

    “The majority of protocols now advocate the use of hard blows with the heel of the hand on the upper back of the victim. The number to be used varies by training organization, but is usually between five and 20.
    The back slap is designed to use percussion to create pressure behind the blockage, assisting the patient in dislodging the article. In some cases the physical vibration of the action may also be enough to cause movement of the article sufficient to allow clearance of the airway.
    Almost all protocols give back slaps as a technique to be used prior to the consideration of potentially damaging interventions such as abdominal thrusts,[2][3] but Henry Heimlich, noted for promulgating abdominal thrusts, wrote in a letter to the New York Times that back slaps were proven to cause death by lodging foreign objects in to the windpipe.[4]
    The findings of a 1982 Yale study by Day, DuBois, and Crelin that “persuaded the American Heart Association to stop recommending back blows for dealing with choking…was partially funded by Heimlich’s own foundation.”[5] According to Roger White MD of the Mayo Clinic and American Heart Association (AHA), “There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in.”[6]”
    That is from wiki article “Choking”. I can add to this that any kind of treatment of choking is not a simply mechanical procedure. Mechanically you can do nothing. The real goal should be to provoke a powerful coughing reflex, a convulsive spasm of diaphragm, like occuring in whooping cough. The most safe way to do this is percussion at a point between shoulder blades. It works like knee-jerk reflex. Abdominal trusts advocating by Heimlich also can provoke this, but less reliably and in more traumatical way. It also requires inordinary physical strength and is ineffective when patient is fat with lots of extra fat tissue at abdomen.

  27. jhankey Says:

    Yes it is a thin line indeed. To see it in person as you did is quite vivd. My experience from many years ago showed just how ephemeral life really is. It leads one to belive in something more durable, such as a soul.

  28. jhankey Says:

    Also thank God you sister is still in the land of the liveing.

  29. Jim Sullivan Says:

    Thank God she’s OK. I love happy endings.

  30. NeoConScum Says:

    THANK GOD and a lifesaving Pro.

    It’s a damned miracle that any of us survive childhood.

  31. kcom Says:

    I’m glad she’s okay. I’ve gotten myself out of a couple of potential (and momentarily scary) choking situations by remaining calm and methodically working whatever it was out of the way.

    In the more prosaic grammar department, you should have said they were calling 911, not 9/11. 9/11 is a date, or, unfortunately, a historical event, but not an emergency number.

  32. bluewaterneocon Says:

    If the Heimlich doesn’t work, try the back pounding. Whatever it takes to induce the victim to choke-up. That is what I learned as a member of the ski patrol and I have not seen it work but I have seen CPR work once. I have also seen someone die after using CPR and know that nothing would have helped him survive. Thank God Neo that your sister in law survived. This will be a moment for all of you to remember. The other side of the story would have been remembered as well, but more painfully. I held my husband when he died and it was a glorious moment as we were alone which is what we wanted. We knew he would die but it was nice to be together. Your sister in law did not want to die in such a public forum and you helped to keep that from happening by your presence and the grace of God. He answers to our prayers. Prayer saves lives.

  33. bluewaterneocon Says:

    Okay. Praying saves life.

  34. saveliberty Says:

    Oh wow! Thank goodness for the chef!

    Please let your sister-in-law know that we are relieved to know that she escaped what we feared. Please also let her know that we wish that she would not be embarrassed.

    (I am still recovering from brain surgery and I have a whole different perspective on what embarrasses me these days, which is precious little.)

    Prayers for healing for your sister-in-law, your brother and you and your family.

  35. pgp Says:

    Thanks for posting this. These days it’s easy to forget the importance of the quiet, steady, personal things.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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