It may have been an overly large chunk of steak; or, perhaps, in my haste to rejoin the conversation, I didn’t chew sufficiently and hurried to swallow. Either way, I felt the food lodge in my throat.
Disconcerted, I sipped some water. The lump slid a little further down. I waited, hoping to feel the resumption of a successful swallow, something we accomplish without a moment’s thought countless times each day. Instead, there was an inexorable, stretching sensation, with associated discomfort, then a sudden urge to cough.
I didn’t have much air in my lungs. The couple of water-strewn coughs I managed were otherwise ineffectual. I tried to draw breath, get more ammo in there. Not a bit of air shifted. My windpipe was completely blocked.
I’d updated my life support training just a couple of months earlier. Bizarrely, I could hear the instructor’s voice: “You’ll be sitting in a restaurant. Another diner will suddenly start spluttering. If they’re giving effective coughs, encourage them and monitor. But if they can’t cough effectively then you’ve got to do something, and pretty damn quick.”
I couldn’t speak, of course, but my mind was screaming: I’m choking, someone help me!
I lurched to my feet. If you’re going to choke, there’s no better place than a room full of doctors. The restaurant was packed with us, enjoying an evening meal midway through a two-day conference. Those sitting closest jumped up. I heard the word “Heimlich”, and felt someone’s hands come from behind, joining together round my upper abdomen.
At the end of exhalation, a couple of litres of air remains in the lungs. Described in 1974 by Henry Heimlich, an American thoracic surgeon, the Heimlich manoeuvre exploits this “functional residual capacity”. A sharp in-and-up thrust beneath the ribs compresses the diaphragm, causing a sudden rise in air pressure within the chest. In theory, this should create enough force to expel the foreign body.
The hands from behind yanked hard. Nothing happened. With complete airway obstruction, you’ve probably got about two minutes before consciousness is lost; death follows a few minutes later. I’ve sometimes wondered how I will react when I’m told I’m going to die. Now I have an inkling. There was a degree of panic, but far stronger was the thought: what a stupid, pathetic, embarrassing way to go.
Another abdominal thrust, harder this time, practically lifted me off the floor. And – amazingly – the offending lump of steak flew right out of my mouth. I breathed again, relishing the sensation of air flooding my lungs.
It was over in a blur. People checked I was OK, I thanked my rescuer – Nick, a fellow GP from a nearby city – and we all took our seats again. I doubt Debrett’s covers the etiquette of this situation. I felt a ludicrous social obligation to remain at table. A few jokes were cracked, everyone professed themselves amazed, and someone checked both Nick’s and my pulse rates to see who was more adrenalin-pumped (Nick, apparently).
I couldn’t face eating. After a couple of minutes, another colleague, noting my pallor, gently enquired if I wanted to excuse myself.
Back in my hotel room, the shock hit me full force. I kept re-experiencing the sensation of being unable to breathe, and ruminating on what had so nearly happened. I slept poorly. I left in the morning; I had an overwhelming desire to be home.
For GPs, true emergencies occur only rarely, yet we must be able to respond swiftly and automatically when they do. We update our life support training annually. I’ve practised the Heimlich manoeuvre on resuscitation dummies many times, and invariably wonder how it would go, were I to have to perform it for real.
Corresponding with Nick afterwards, I discovered that the abiding legacy for him was as it would have been for me: relief, almost disbelief, that his training had proved so effective. With over 200 deaths in the UK from choking each year, I’m extremely glad it did.
This article appears in the 30 Mar 2016 issue of the New Statesman, The terror trail