I had been warned. Just as nurses do not give the orders, neither do they discontinue the orders. Everything needs to be run by the ordering physician every time, and never discontinue the order without permission from the ordering doctor first. So the situation was this: an older gentleman, who was quite large, was adamant that he was choking. Two anesthesiologists had examined this fellow and declared him fit, but this gentleman persisted in complaining bitterly of a severe choking sensation, and would not be quieted. Eventually, in frustration and desperation, the attending physician sent the man to the emergency department. If the emergency physicians couldn’t get to the bottom of this patient’s relentless complaints, nobody could. A simple test, a barium swallow, was ordered. I pushed his impressive bulk on a stretcher to the radiology department by myself to get the test performed. He explained to me why and how he absolutely knew he was choking. The lack of an acute cough or difficulty breathing over the course of several hours was no deterrent to his bitter complaints. I listened somewhat patiently, but really, who chokes for hours and never coughs? As I delivered him to his destination, I was relieved to leave him on his own for a bit. I walked away from him to tend to other things, but then I heard it — the first tentative cough. Then another, somewhat louder, and then again. I heard the awful stridor as he began to struggle in earnest. We were the only two there at the end of a long lonely hallway in the middle of the night. I felt fear and panic suddenly strike my heart. I wanted to continue my retreat, to be anywhere but where I was. Where he was. What is worse than hearing sincere choking and struggling and feeling helpless to do anything about it? No one to call for help or reinforcements. I froze in place for a moment; was I actually considering leaving him to run for help? “Oh come on, Missy, suck it up and go help that man, for God’s sake!” So instead of leaving, I ran toward him, repeatedly reassuring myself that so long as I could hear him coughing that he was getting air in his lungs. But his cough was becoming more and more high pitched, and with a sound I instinctively knew was bad, really bad. We were too far away for me to just push his stretcher back, where the doctors were, where they could do a tracheotomy if worse came to worst. I put his head down, no, stay with me, I had a good reason. Finally, I was in position to perform the Heimlich maneuver, albeit not in exactly the way Dr. Heimlich had previously meant it to be done. To my absolute delight, after several enthusiastic punches, I realized he was no longer purple, struggling, or silent. He was making terrible noises, a cross between coughing and retching. And finally, at long last, he coughed a large bolus of packed chicken meat into the emesis basin. We both slowly caught our breaths, then eventually I said, “Well, you won’t be needing that barium swallow after all, then.” What an understatement! Then I remembered about getting an order to discontinue the order for the barium swallow. By now, there were several respiratory therapists to attend to him, so I left him in safe hands while I very nearly danced all the way back to the emergency department. I was beyond excited, I was jubilant! I had never saved someone’s life all by myself, and I knew it, the large older gentleman knew it, and now I could hardly wait to let the doctor know it, too. I carried the offending packed chicken meat bolus in the emesis basin, covered with a wash cloth. I covered it because it actually resembled a dead grey mouse, complete with a tail, floating in a shocking amount of slimy clear mucus. It was disgusting, but it was also beautiful to me for the fact that it was no longer in my patient’s esophagus, occluding his trachea. I arrived in the emergency department doctors’ office and told the doc that I wanted permission to discontinue the order for the barium swallow since the patient no longer needed it. But doctor was not understanding what I was all on about. “See!,” I exclaimed, “I got this out of his throat! I did it — I did the Heimlich!” “Got what, got what!?,” he yelled impatiently. I triumphantly pulled the washcloth off the emesis basin; it was on the desk right in front of him, and for the first time, he really looked at what I had, upon which he then grabbed the nearest trash can and proceeded to vomit. Source
