A DISASTROUS CHOKING.

In medical context ,' aspiration' is breathing in a foreign object( sucking food in to air way). The foreign body is usually coughed out as a reflex action. Rarely the cough results in suffocation. Ultimately the brain does not get sufficient oxygen and come to a condition of Hyopoxic Encephalopathy(HIE). HIE can be deadly. Brain cells start to die after four minutes without oxygen.

The long term impact of the Hypoxic brain injury will depend on the severity of the cerebral hypoxia and on how much irreversible damage has occurred in the brain . If the hypoxia is mild or shortlived , there may be recovery back to a normal or near normal level functioning.

I came in long contact with an ENT surgeon patient of Hypoxic Encephalopathy in connection with his physiotherapy. The ENT surgeon was a reputed doctor ,who was very popular for his expert treatment and humanitarian behavior. Unfortunately, he was a chain smoker for many years and he had lung collapse, which refers to partial loss of normal areation and associated loss of volume. In spite of these problems he was treating hundreds of ENT patients and was loved by the people over the area.

That disaster happened at the night previous to the Thiruvananthapuram Attukal Pongala day, a world famous Hindu ritual for women in which the highest number of women assemble and holds a Guiness record. The female servant and the doctor's wife went for Pongala, after preparing food for him and his 90 year old father. His father had loss of memory( dementia). Chappathi and chicken curry was made for dinner. The chicken curry was made hot and spicy as the doctor liked it most. The doctor and his father started taking dinner. Suddenly the doctor started coughing continuosly as spicy chicken gravy was aspirated. He became incapable of breathing and slowly fainted. His old father ran up and down crying for help but nobody heard it as it was 9 pm and the neighbouring houses were far away. At last somebody heard the sound after half an hour and he was transported to a good hospital in Trivandrum where he was put in ventillator. He was in deep coma by that time . Life saving treatments were given for many days. He stayed in ventillator for six months and there after he started breathing. But he became spastic quadruplgic(All four limbs and trunk paralysed). He was in a vegetative state. There was nothing more to do other than physiotherapy. He was transfered to Christian Medical college Vellore for better rehabilitation, where he stayed for one year. He was still in vegetative stage and was brought back to Trivandrum. He continued physiotherapy for six months with lots of mechanical gadgets supplied to him from CMC Vellore. His chronic obstructive Pneumonia deteriorated and at last breathed his last.

This case is exemplified to highlight how detrimental is choking and aspiration, sometimes amounting to death. This situation became more serious because two out of five lobes of his lungs were collapsed due to chain smoking for many years. The same disaster can happen in Asthmatic and COPD patients also.