Don't Choke (September 21, 2009. Issue 9.)
“On my very first call, the patient died,” I say.
Twelve paramedic students stare at me from their desks. Tomorrow is their final exam. Today, they want the story of this death. They want to hold it in their hands, dissect it and find its flaws, so they can dismiss it. Another’s mistake. Not theirs.
While I have their attention, I pull a blue rubber bouncy ball out of my pocket. The ball is big around as a quarter, pocked with teeth marks. I hold the ball between my thumb and forefinger, high enough so that even Robbie, who sits in the back under his Firefighters Do it With Big Hoses hat, can see it.
“Anyone know what this is?” I ask.
In the front row, Darcy raises her hand. She will make the kind of paramedic you see on TV programs. Pony-tailed and sexy, even with blood on her blues. She will crack open a chest without breaking a nail or a sweat. She gives me hope.
“Gumball?” she says.
Somewhere in the depths of my chest, my hope has a small, quiet heart attack.
“Good guess,” I say. It is something of a trick question, after all. “Anyone else?”
Twelve faces look back at me. This is the way it’s gone all semester. I’ve taught paramedic classes for fifteen years. By the first week of each new class, I can pick out the one or two students that I would trust with my life. I don’t mean that in any sort of good old boy we’re-in-the-same-freemason-club way. I mean the ones I would trust to rise out of their chairs and shove their empty ballpoint pen casing into my trachea if I was choking.
But not this class. They’re book smart. Smarter than I am when it comes to memorizing the bones of the foot, understanding sequences—Airway, Breathing, Circulation. They can recite the parts of the spine without error in their sing-song voices. They can tell me whether a patient in insulin shock smells like Cyanide or almonds, or both. But can they save me? Not so much.
I put the ball in the center of my palm and hold it up to the light. The tooth marks are not the sharp slices of front teeth, but the deep indents of back molars.
“Let’s give the resuscitation skills one last go,” I suggest. “After that, I’ll tell you what this is.”
In the corner of the training room, the students kneel around Resusci Annie. They take turns with breaths and compressions, check their results. Sigh and shake their heads.
When everybody finally gets a result that is close to passing, I pair them up to go over the Heimlich one more time.
“Sharp, upward thrusts,” I remind them.
Darcy puts her fist in her partner’s chest, heaves upward in a way that makes him gasp. I correct her hand position. “You’ll kill somebody if you push on their xiphoid process like that.” I try not to let my voice shake.
When the students sit in their seats near the end of class, they are worried. Not about the right things. They are worried about passing the test.
My students would disagree. They would say this room belongs to life. That will be their first mistake out in the field. They will leave this large, well-lit room with its second chances and believe they know something about death. And then they will step into their first ambulance. They will knock their head on the roof. They will freeze when their first real live patient bleeds or pukes in their mouths. They will see death, the choking, shitting, angry release of it. And they will know failure, again and again.
I hand the rubber ball to the student closest to me, tell him to pass it around. The students turn the ball over in their fingers, try to find the right answer on its pocked surface.
“Today’s final lesson,” I say. “Any guesses?”
The ball comes back to me in silence. The students shift in their seats.
I place the ball in the center of my open palm and raise it toward the light. “This is the first thing I popped out of someone’s throat with the Heimlich,” I say. “Perfectly throat-sized.”
Nervous smiles, giggles. A few lips wrinkled up, showing teeth. They are thinking of their own throats.
“When you get out in the field, remember it’s just like baseball,” I say. “Keep your eye on the ball. Don’t choke.”
“See you tomorrow for the final.” My voice goes higher and higher. If you weren’t listening closely, you’d think it was an uplilt, a sense of excitement. If you were listening closely, you’d hear it for what it was—all my air sliding out in one final, tidal breath.
These student haven’t listened at all. They’re already out the door.
Before the test, the students smile and whisper. They crack the spines of their textbooks one last time, looking up that one thing they’re sure they’ll forget. Still, they are secure in their knowledge, in their ability to rescue Annie, to give each other Heimlichs, to fill out circles of ABCAB.
The chalk squeaks on the blackboard as I write. Final test. Keep your eye on the ball. My handwriting drops at the end.
The blue ball is soft and warm in my palm. I hold it up until all of their eyes are on me.
“Ready?” I ask.
They nod. They believe they are.
“Begin,” I say.
I place the ball in my mouth, letting my teeth close around it, letting my molars sink into the teeth marks that are already there.
My students sit, waiting for me to tell them what to do. Come on, Darcy, I think. My one hope. But even she doesn’t move. Not one of them has learned yet the important thing: that they must trust their own judgment, that they must know themselves what to do.
I tongue the ball toward the back of my throat. Drop it down. The ball lodges against my epiglottis, that protector of the trachea, saver of small children. I flatten my tongue. The ball slides against the first rings of cartilage. My lungs give a little hitch, an involuntary cough. The ball doesn’t move.
In a few seconds, my hands will go to my throat. My knees will buckle. In less than two minutes, my lips will turn blue from lack of oxygen. In five minutes, my brain cells will begin to die.
A gray film seeps into the edges of my vision. Through it, I see my students. They are sitting at their desks. Their mouths are open. They are gasping.