What about choking? Did she recall if she recently had a really bad choking episode — when her food had gone down the wrong pipe? She most certainly did. Maybe three months earlier, she was eating a salad and something hard dropped into her airway. She was home alone, and suddenly she couldn’t breathe at all. She couldn’t even cough, though she could feel herself trying to. She jumped up and ran out of the old farmhouse. She lived alone and the only other person she could think of on the property was her elderly landlord, and she couldn’t see him anywhere. Dark spots appeared before her eyes, and she wondered if she’d be found dead with a piece of her salad stuck in her throat. After what seemed like forever but was probably less than a minute, something shifted, and the airway popped open. Her heart raced. She was an Army veteran, but she’d never felt closer to death than she had right then.
A New Understanding of an Old Event
Afterward, her chest was sore, but her breathing was back to normal. So she hadn’t thought of it months later when the wheezing started. Even when the doctors at that first hospital told her she might have a mass, her thoughts went to cancer and not to that choking episode.
But after she was discharged that first time, she was still coughing up a storm. After one bad bout of hacking, she brought up something solid. When she fished it out of her mouth, she saw what looked like a piece of walnut and recalled those terrible moments when she thought the thing might kill her. She figured she’d gotten rid of the problem. Perhaps she’d been wrong.
On Day 5 of this second hospital stay, she was scheduled for the bronch. She was positioned in a chair that reminded her of the one in her dentist’s office. Once she was sedated, Rucci gently introduced the endoscope into her mouth, through her vocal cords and into her lungs. He directed the camera through the complex intersections of the large airways until he was all the way down to the lower lobe. And there it was — wedged in tight, blocking off the entire section. He could see a sliver of free space near the top of the object. He slid a tiny tool through the tubing past the camera, and then to the far side of the object. Once there he moved a switch and felt, rather than saw, a small net open behind the obstruction. He coaxed the net forward until he was certain he’d captured the thing. It was too large to be pulled out through the scope, so he slowly withdrew the entire instrument, keeping an eye on the captured object. The retrieved item clattered into the specimen container. Rucci squinted at the object. It was beige and hard. It was the rest of the snorted walnut. Suddenly it made sense. The patient had inhaled the nut, which got stuck in the middle lobe. Her violent cough broke it in two, and one part came up and the other, now smaller, piece dropped farther down the progressively narrower airways.
Swallowed Foreign Objects
While food is what’s usually aspirated, a surprisingly wide variety of items manage to make their way into the lungs. Chevalier Jackson, a physician during the late 19th and early 20th centuries, devoted his career to developing instruments and techniques to retrieve these misplaced items. During Jackson’s 75-year career, he extracted 2,374 inhaled or swallowed foreign bodies from patients’ throats, esophagi and lungs, including safety pins, buttons, screws, dentures and lots and lots of toys. More than 80 percent of those objects were found in children. The entire collection, along with details of the patients from whom they were retrieved and the techniques used, is housed in the Mütter Museum in Philadelphia.
Like most patients, this one did well after the object was retrieved. Once the airway was opened, the pneumonia cleared up easily. She went home a couple of days later. The patient tells me that she still has trouble swallowing. She recently heard about a kind of physical therapy that might help, and plans to try that — once her doctors start seeing patients again.