Face Plate

Marianne and I were having dinner at a restaurant in a small New Mexico ski resort. Seated a few steps away was a boisterous table of eight men, apparently several generations of a family enjoying dinner after a day of elk hunting.  Big steaks and beer were the order of the evening, and all of them were soused. Their slurred banter and raucous laughter were loud enough to make our dinner less than pleasant. 

Suddenly the laughter stopped and chairs scraped about.  It was behind my back but the look on Marianne’s face told me something unusual was up.  I turned to see that the oldest of the group, a grandfatherly sort sitting at the head of the table, had fallen over into his plate. Most of the others sat staring dumbly, but a couple of the younger ones had pushed their chairs back and were lurching toward the fallen patriarch. 

I jumped up to see what was happening. He was unconscious; still as death. Was he having a seizure? Unlikely.   I shouted questions.  Diabetic coma? Was he diabetic; did he take insulin? In the melee of answers, I didn’t hear anyone say so, and it doesn’t occur so suddenly.  Dead drunk? He had not seemed to be the drunkest of the bunch, and an alcoholic coma doesn’t occur so abruptly. 

I grabbed him by the collar and pulled his head out of his plate, tilting his face upward so I could see his face and eyes.  After clearing away the mashed potatoes and steak sauce, I pried open his eyes.  His pupils reacted to light, so his brainstem was still functioning. Then I noticed his lips had turned blue and it dawned on me that he might be choked on food.  The syndrome is classic: older people, often with dentures, frequently intoxicated, poorly chewed steak a common culprit—the partially chewed piece accidentally moves far back on a wobbly, intoxicated tongue and reaches the point of reflex swallowing, which no amount of concentration can reverse.  The piece is too big to go down and lodges deep in the throat, blocking the airway and preventing speech—a key diagnostic point is the silence of the victim. I asked if he had complained. No. He had collapsed without a word. 

I pried his mouth open and frantically looked in. It was a mess. All I could see was mashed potatoes, gravy, and loose dentures. But no steak.  I pulled on his tongue hoping to see deeper in the back of his throat, but it was too slick to hold and kept falling back into his throat. Thinking that I might be able to dig out something deeper, I stuck my hand as far as possible into the hole, but couldn’t feel anything; and he didn’t gag, which confirmed how far gone he was. 

It was time to try the Heimlich maneuver, a procedure designed to dislodge objects lodged in the throat and block the airway. It is now widely taught but was a new concept at the time. 

I pulled him back so that his head lolled over the back of the chair and squatted down behind to get a grip around the chair’s back and his lower chest.  I gave a heave, digging my clasped fists into his upper belly beneath the lower edge of his breastbone.  The intent is to force air out of the lungs with enough force to pop out the obstructing mass. 

Nothing came out and he fell forward into his plate again. I jerked him back upright a second time, and tried again, this time not caring if I broke ribs or did other damage.  He catapulted forward and a big piece of steak plopped onto his plate as if returning to its rightful place in the universe.  He took a huge breath, and then another, and began to stir.  Meanwhile, everyone stared as if watching the awakening of a sleeping beast.  Soon he was roused enough to sit upright on his own and offered me a quizzical look.  He had no idea what had happened.  The guys who had stood up sat back down, and the meal continued with some nervous laughter.  I washed my hands and returned to dinner.  They partied on, albeit less loudly.  I’m not sure that they understood what happened.