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A Little Something in My Throat

When I finally coughed it up, it was no bigger than the head of a pin. It was a minuscule bit of cheeseburger that I had accidentally aspirated while polishing off dinner over Futurama re-runs. All that panic over something so small; all that terror in such a tiny package.

All day, I’d been telling myself to attempt to walk the four hundred yards to the beach. I’d been going to pulmonary therapy for a couple weeks, so I was trying to push myself physically in ways I wouldn’t have before. I’d decided to try it after I swallowed that last bite, so maybe I was rushing it a bit.

I have to pay unusually close attention when I swallow –even just saliva– because I have to time it carefully with when I breathe –to which I also have pay unusually close attention.

It’s a dance that feels increasingly fraught as my disease gets worse. Nearly every breath feels as if it’s the first one after staying underwater just a bit too long, so I don’t have a lot of time to play around if something goes awry.

If I’m honest, that feeling never goes away. When I’m breathing normally, what it feels like is just after you break the surface, and finally exhale –no more panic, because you know you can breathe now– but you haven’t inhaled enough oxygen to have relieved that craving yet.

I never get to feel that sense of having breathed deeply enough. It feels as though I’ve perpetually started to take that first cleansing breath and stopped halfway through.

I live one missed breath away from panic, all the time.


But I’m not thinking about that as I sit munching my burger. I’m thinking about the beach, and how hard I’ll be breathing when I get there, and wondering, absently, how many times I’ve seen Bender do the same bit. And then…

As soon as I feel that tiny crumb slide the wrong way down my throat, I know I’m about to miss a lot of breaths.

My lung capacity is so slight that I lack the back-pressure to cough up the particle, so my body keeps triggering the reflex over and over, until my eyes water, and my earlobes sweat –long after my lungs have given up their scant contents to the cause– and in a few short seconds, I’m in real trouble.

My body doesn’t care that my lungs have nothing left to give, so coughing gives way to gagging and retching, as it pushes to evict the offending speck.

My brain is already telling me that it is long past time to take a breath, and the dread builds, because I know I have to try and inhale, and I know it won’t matter, it will just trigger more coughing. I try and pull in a breath anyway, but my body rebels and responds with more gagging, and I collapse on the floor instead, all my appendages twitching like I’m having a seizure.

I’m trapped underwater.

I’m fighting panic on multiple fronts. The tickle of the tiny crumb is triggering a reptilian response, and my brain is screaming at me that I must get that out —now! A broadcast on some other channel is telling me that I have to breathe —now! Past experiences with aspiration fly like shrieking banshees into my mind’s eye, reminding me what I’m in for.

No, no, no, no, no, I think.

When I say I’m terrified to die of emphysema (and I am), what I’m actually saying is that I’m terrified of what happens to me when aspiration triggers a coughing fit, and the automatic impulse to cough goes to war with the automatic impulse to breathe.

At its worst, it’s a battle that leaves me hollowed out and shaking like last year’s leaves. When I sit and calmly contemplate which method of suicide will be best, it is the terror of those moments that I’m trying to avoid. Just the memory of some episodes makes me feel nervous and jittery and more than a little like crying. When those memories come rushing in, I always feel as though I’ve been strapped into a roller coaster I’m desperate not to ride.

But there’s no getting out of it, and all I can do is try to hold on. So that’s what I do.

I get up on my hands and knees, with all the grace of a newborn fawn, and grab whatever is in front of me. Things are gray and cloudy, and every retching gag causes explosions of sparks in my eyes.

My hands are splayed out and gripping the coffee table’s edge, almost as if I were gripping the handrail of an actual roller coaster car. I push myself up so my weight is on my hands. They call it ‘tripod-ing’ and it’s an instinctive response that helps relieve pressure and open up the lungs, making it easier to inhale deeper breaths.

I haven’t been able to take one, though, because every time I try to inhale, it triggers a cough-then-gag response. I try harder to pull a breath, causing me to gag and retch with even more force –on and on, in an excruciating loop, until I’m frantic to clear my airway and desperate to inhale.

My body is frantic, too. It wants that bit of burger gone and has concluded that the reason I can’t bring it up is because it’s stuck, so it ramps up the production of spit, snot, mucus, and tears to help flush out whatever is in there. Soon, every airway is plugged tight with an oozing, viscous sludge that I’m unable to get rid of.

My brain is screaming at me to ‘Do Something!’ but I’m glued in place, locked in my body, a mere passenger, hiding in a dark corner as a predator paces the room, watching events unfold.

I blink away the tears and focus on my hands, all trembling and white-tipped, digging at the coffee table’s lip. I tell myself to hold on and wait for my chance. I remind myself I’ve been here before.

After a couple times around the loop, the real panic starts to set in. I always know when it shows up, because after it arrives, it forces me to move.

You’re going to die here, it announces. It’s time to go.

Sometimes it’s just as many steps as I can take before I collapse: other times it’s crawling until I can’t go further; still others, it’s just spinning in place on my knees, like a dog after its tail, until I fall over. However it manifests itself, I’m never in control of it. It’s my brain forcing my body to try and get the hell out of there, and I’m just along for the excruciating ride. It’s never a long one, though –you don’t make it far on empty– and it’s not far tonight, either.

I stumble to my feet and make it eighteen inches to the armrest of my couch, where I tripod out again, hands splayed like I’m about to be frisked.

Then I lock it down. I go into what I think of as ‘panic management’ mode.

I tune everything out –the howling fear, the need to breathe, the sweat, the snot, the spit, the whole room, everything.

I focus on an object or a point in space, doesn’t matter what it is. Right now it’s the armrest, but I’m not seeing it. I need to get deep in my head and focus on what my body is doing. I visualize my body’s interior and what I’m trying to accomplish.

I’m trying to clear my airway so I can inhale; to do that, I need to get rid of that crumb. I focus on the crumb.

Where is it? What does it feel like? Which way is it moving? What can I do to make it move? How can I help my body?

My brain taunts me as I work the problem:

You’re going to die right here in your living room.

No, I’m not, I think. I might pass out, I might feel like I’m dying, but I won’t die. This won’t kill me. It just feels like dying. Like waterboarding. Can I move the crumb if I strain harder and longer when I gag? Let’s try that.

You’re already out of time. How do you know it can’t kill you? People die from choking all the time. You’re gonna be one of ’em. Your heart is racing, you’re pouring sweat, you’re shaking and trembling. You can’t even open the door, and it’s right there! Move your hand and open it! You can’t do it!

I think I feel the crumb slide up, the tickle subsides a bit, and I try to gasp in some air around a mouthful of goop. I get a breath so small that it’s cruel, before the crumb slides back and the coughing resumes in waves that wring me out.

It’s so hot and still, it feels like my clothes are strangling me and the air is a shroud. I rip off my beanie like it’s radioactive. I’m pouring sweat. I reach to my right and rip open my front door, letting the cool sea breeze pour in through the screen.

I can do it, I think.

I push through the door and cross all three tiny feet of my front porch in a stride, so that I’m standing at the waist-high gate that separates the porch from the concrete front steps.

I grip the soft arc of the wood gate like I want to splinter it in my hands, listening to the latch rattle every time I heave and rack my body, trying to free myself from the grain of sand that wants to kill me.

I focus on the steps and a dime-sized dot of moss clinging to a corner. I get back in my head, tell myself to focus on the moment, to capitalize on opportunities to clear my airway or inhale, no matter how brief or painful.

My brain is still taunting me:

What happens when you can’t clear it? How long can you keep this up? You can barely stand up now. You’re thirty minutes from a hospital, and it wouldn’t matter if you were sitting in the ICU. What are they gonna do? Your body is fighting itself and they can’t stop it. It’s not a blockage for them to clear. Your body is waterboarding itself.

Long runners of snot and spit are trailing out of my mouth and nostrils, pooling on my steps. I want to reach up and wipe them away –to reach in and pull the globs out with my fists– but I’m scared that if I take a hand from the gate, I’ll fall down.

On and on it goes, cycles of coughing and gagging interspersed with diminutive breaths, stolen around globs of mucus.

My oxygen canula isn’t doing anything in my plugged nose, so, out of long habit, I pull it down to my lips, like a SCUBA diver’s regulator, letting the oxygen hiss into my open mouth.

I stay in my head: Cough hard, now! Bring it up! Grab a breath. Hold on. Ride it out. Pick your moments. Inhale! Get it up! Wait. Wait. Wait. Grab a breath! You’ve got this. You’ve been here before. In an hour you’ll be back on your couch, like it never happened.

A couple is walking back from the beach down my street, and I’m inexplicably worried about what they’ll think of me rudely gushing bodily fluids all over my front stoop. I try to step inside but can’t make it, so I turn my body at an oblique angle, as if I were wearing a T-shirt I didn’t want them to see.

I lean against the cheery, teal exterior of my bungalow, feeling the woodgrain of the siding bite at my forehead as they pass.

I’m so exhausted. My body is trembling.

I’d kill to take a whole breath; to stop this ride. I turn back to the gate.

More coughing, then, excitement, as I feel it break loose –the tickle disappears. I spit into my cupped palm.

A dot. Something you wouldn’t even notice on your picnic plate.


An hour later, I was sitting on my couch, like it never even happened. As I evaluated it, I felt lucky. Rated honestly, it wasn’t even in the top five in terms of worst aspiration experiences I’ve had. But still, it rattled me.

The next day, at pulmonary rehab, I’d still been sore. When they asked me to rate my breathlessness for the day, I told the truth, because I was still rattled and wanted to talk about it.

“Nothing compared to last night,” I said.

“What happened last night?”

When I told the staff hanging around the desk, immediately suggestions begin to fly about how to self-Heimlich, and I knew I hadn’t explained it well.

I knew I hadn’t communicated how a minuscule morsel had brought me to the brink, and how the spectre of it haunted me.

It doesn’t take a Heimlich-sized hunk of steak blocking my airway to break me, I wanted to say.

All it takes is a little something in my throat.

By Brian E. Holbrook

A terminally ill writer and musician, Brian lives on the north Oregon coast.

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