A whistle in the throat

It was a month before my master’s exam. I had opted for the Casualty duty as it gave me free time to study. The duty hours were fixed and I did not have to do ward rounds and the OR. Not operating was painful. But it was compensated by plenty of free time to study. The salary was higher than that of a registrar.

I was in the casualty room poring over the surgical procedures of the head and neck areas. I was feeling bored, over worked and sleepy…”Hey Guru”, a voice interrupted my labors…It was Deepak, the on call surgical registrar…”Sweta and I are going to nip across the road to have a cup of chai..Handle anything that comes to the trauma ward for some time, will you?” Sweta was his fiancee of two days… “OK” I winked at him, “Pick up some of those sweet buns on the way….I feel hungry when I study”…Deepak entered the details of our arrangement in the locum book kept in the casualty and left whistling…

I was on the chapter of Airway Management..I was trying to understand the standard flow of procedures to be done in cases of airway obstruction. High flow oxygen: check; Look for worsening: check; Try and intubate: check; If you cannot intubate, then do an emergency cricothyroidotomy….I tried to imagine how it would be to attempt a cricothyriodotomy in an emergency situation…I pulled a sheet of paper and started to jot down the steps of cricothyroidotomy…

“Doctor” called out the casualty nurse. ” There is a patient for you”. I sighed and put away my books and examined the patient..

Pranav was a two year old imp of a boy who had been brought by his mother. “Doctor, Pranav has swallowed a part of the toy that he was playing with” Pranav was playing with a teddy bear that had a whistle on its bottom. The child had worked out the whistle and was blowing through it when it suddenly went in and he gulped it down. “Did he cough, gag or choke?” I asked…No, he had not..

I reassured the panic stricken mother..Foreign body injestion is common in children less than 3 years of age. Almost all foreign bodies will go down the esophagus and are harmlessly passed out. No special care or hospitalization is needed.

I thought I would do some x-rays just to reassure the mother…I kidded with Pranav, tickling his tummy and pretending to listen to the whistle inside him…The child was absolutely normal, giggling helplessly while being tickled. Pranav went to the radiology next door and I went back to the cricothyroidotomy…

Sudden pandemonium from the next room galvanized me…It was coming from the radiology….Pranav had suddenly stopped breathing…

When I saw him, he was struggling to breathe …All the muscles in his neck had become prominent. He was sweating…Ominously, a tinge of blue had appeared round his lips…He was desaturating fast…The anesthesia registrar was trying to oxygenate him with an Ambu bag..”Try intubation” I told her…After two ineffectual efforts, it was clear that we had a “Can’t intubate, Can’t ventilate” situation. The only thing to do was an emergency cricothyroidotomy…By this time Pranav’s face had turned black with cyanosis..We needed to open his airway fast…

The next half hour was a blur for me….Extend neck…Palpate thyroid cartilage…Inject local…Disinfect skin…Where is the damned number eleven blade?…Make a stab right down to the cartilage..Identify the crico-thyroid membrane…Make a small cut..Insert trach tube…Connect to Ambu bag….Whew!! Pranav’s color had returned..He looked comfortable…I had not even heard the mother wailing outside radiology…As a matter of fact, I had heard or seen nothing except for Pranav’s struggle to breathe….

Deepak bulled his way through the doors of radiology…..”OK, I will take it from here” “Thanks Guru”

I met Pranav again in the ENT ward….They had done a bronchoscopy on him and removed the whistle…The trach tube was to be pulled after a week….I tickled Pranav and pretended to listen to the whistle…He giggled uncontrollably….



Author: drshirahatti

I am a surgeon, specializing in Gastrointestinal Surgery...I have headed the Departments of GI surgery, General Surgery and Medical Education.....I also was the Dean of two large government hospitals in Mumbai.....I like reading about cultures and like to travel....

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