How Scared Should I Be of Choking to Death at Thanksgiving?

Note: In the column “How Scared Should I Be?” VICE staff writer and generalized anxiety disorder sufferer Mike Pearl seeks to quantify the scariness of everything under the sun. We hope it’ll help you to more wisely allocate that most precious of natural resources: your fear.

Not long ago, while I was at home alone eating some raw vegetables, I tried to swallow too much broccoli and it got lodged in my throat. I gagged and sputtered for a few minutes, and every time I tried to swallow water, I just sprayed it all over my kitchen. Eventually, I called 9-1-1. A fire truck showed up just in time to find me standing in front of my apartment, leaning on a trash can, and very successfully puking a big green wad into the gutter. After the crew saw me breathing, they immediately left, politely waiting until they got out of earshot before calling me an idiot. Soon after, I decided to get a roommate.

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Technically, the flow of air to my lungs wasn’t fully blocked, so I probably wasn’t choking to begin with. But if that broccoli had gone down my windpipe, instead of just clogging up my esophagus, then I would have had a real crisis on my hands.

It would be easy to be glib and say “just chew your food better you idiot,” but choking has toppled down some of the world’s mightiest intellects. Christy Brown, the Irish poet immortalized in the filmMy Left Foot, choked to death during dinner; one of the greatest chess masters of all time, Alexander Alekhine, choked to death on some meat while playing chess solo; the great American playwright Tennessee Williams choked to death on a bottle top.

And according to Jonathan Epstein, a paramedic and senior director of science and content development at the American Red Cross, the menace of choking is something to keep in mind around Thanksgiving. “Anytime there’s a lot of food, and a lot of alcohol involved, we see an increase in choking,” he told me. “Around holiday dinners, there seems to be an uptick.”

In Epstein’s experience, the biggest culprit is “solid pieces of meat over anything else.” That doesn’t necessarily mean vegetarians are safe, though. There’s nothing magical about Tofurkey that makes it impossible to choke on—and nothing would delight vegan-hating carnivores more than a vegetarian like me choking on fake turkey during Thanksgiving dinner.

Apart from the meat problem, and the slightly more puzzling choking hazards posed by peanut butter, tip sheets about foods that cause choking contain few surprises. Most of what’s on a standard Thanksgiving table is on the list, including vegetables and soft baked goods. But I’m not 90, so I’m not about to puree my dinner or fill up on mashed potatoes.

Choking kills roughly 2,500 Americans per year. It’s number four on the National Safety Council’s list of causes for “unintentional injury death.” Choking fatalities are rare enough that incidents don’t appear to be broken down by demographics, but according to one Australian study, despite frequent, horrible news stories about children choking to death, people aged 55-74 are at the highest risk.

Epstein suggested the trouble for this demographic may not be age or physical weakness, but too much dignity. The scariest category of victim, he said, is “the adult who gets up from the Thanksgiving table, choking”—that is, adults who fear the embarrassment that comes from choking in front of their friends and family, pretend they’re just freshening up, and stupidly lock themselves in the bathroom. According to Epstein, this is pretty common.

“In my experience as a paramedic, those are the patients who we actually have to perform CPR on, and often don’t survive because they were unresponsive for 10-15 minutes,” he told me.

Fortunately, embarrassment isn’t one of my many fears. As for someone else who darts away from the table, Epstein advised asking them if they’re OK, and wait for a verbal response—not just a head nod. “If they don’t answer you, or they grab at their throat, follow them. Investigate,” he said. Don’t let them politely and quietly die in that locked bathroom.

“Emergency medical services will take anywhere from 5-8 minutes to arrive, depending on where you live,” Epstein said. “Brain cells begin to die at 4-6 minutes, and permanent damage sets in at 8-10 minutes. You do the math.”

So what should you do when someone starts gagging on their cooked bird this week?

You might think the first course of action should be to grab the choker around the middle, and lift him or her up in the air a la Pierce Brosnan in Mrs. Doubtfire, all the while, hoping to see a piece of food flying through the air. In all likelihood, though, there won’t be a satisfying champagne cork effect, and Epstein recommends starting by “delivering five back blows.” Per his instructions, I asked a coworker to thump me on the back from 6-10 inches away. It takes a surprisingly hard hit to make someone feel pain in that location, so thump away.

If the thumping doesn’t work, that’s when things start to get scary. Going through the familiar first aid steps for choking victims seems routine at first, but it quickly devolves into desperation and improvisation as the time runs out.

The next step, Epstein said, is to deliver “upward thrusts into the abdomen five times.” He’s referring, of course, to “The Procedure Formerly Known as the Heimlich Maneuver,” which the Red Cross now refers to as “abdominal thrusts.”

Apparently, the Heimlich, once thought to be a revolution in first aid for choking victims, has lost some of its luster in recent years. Heimlich himself—who is still alive—disputes the name change and the new reliance on thumping people in the back, perhaps fearing that it will tarnish his legacy. (It’s also worth noting that he invented his maneuver back in 1974 specifically because a few light pats on the back weren’t doing the trick.) But the Red Cross stands by their decision, explaining that back blows work not instead of, but in combination with thrusts. Where the name is concerned, Epstein argued that specifying the maneuver as “abdominal thrusts” could help bypass moments of potentially-lethal confusion.

If the thrusts and blows aren’t working, and the victim becomes unresponsive, that’s when it starts to look less like choking and more like dying. It’s time for CPR-style chest compressions—provided you know how to do them without crushing the person’s ribcage. A person’s windpipe seems to relax slightly after they lose consciousness, giving the obstruction one more chance to pop out. If that still doesn’t work, the clock is ticking, and the victim’s brain might be starting to die, so this is the point when you can pry open his or her mouth and see if you can find the offending piece of Tofurkey.

From time to time, a quick-thinking good Samaritan trying to get a few minutes on TV news stabs a choking victim in the throat, and inserts a straw or ball-point pen tube. But according to Epstein, “it’s something that a paramedic often will never do in their careers,” and normal people shouldn’t actually try it. “If you don’t do it correctly you get blood in the airway, and it causes you more problems,” he said.

In short, as unreliable as other humans can often be, they make choking much less scary. But for good measure, I asked Epstein how scared I should be of the choking first aid itself. “The risks are not life threatening, but they can cause bleeding, fractures, or other potential complications,” he said. “You’re really looking at risk versus benefit.”