You don’t think about it unless you’re doing it. Coughing. The cough reflex is a critical means
by which your body protects your airway from blockage by irritants or foreign materials. Like
many bodily functions, it occurs without conscious intervention—until there’s a problem, and
then it’s the only thing you can think about.
An irritant in your trachea or lungs triggers the reflex, causing deep inspiration followed
by forceful exhalation to expel the foreign material. When the cough reflex cannot stimulate a
cough strong enough to expel the foreign body, hypoxemia (low oxygen in the blood) activates
the sympathetic nervous system to trigger the flight or fight response. Physiology and anatomy
may sound dull, but like many mechanisms sleeping in our bodies, the cough reflex can
immediately command all your attention when it’s necessary for survival.
On a typical Saturday afternoon, my wife, Kathleen, had worked in her art studio while I
wrote. Afterwards, we sat at our dining table overlooking the Great Smoky Mountains. Our pre-
sunset dinner included heirloom tomatoes, Mozzarella cheese, and fresh-picked basil, drizzled
with aged balsamic vinegar. The final touch was sourdough bread I had toasted carefully to
achieve the extra crispness that Kathleen adored. Our conversation bounced like a relaxed game
of tennis, gloriously slow and imprecise. This was the cadence of our lives.
That all changed in an instant when Kathleen began to choke.
First, I heard high-pitched muffled sounds as she tried to take a deep breath. Then an
eerie silence. Something stuck in her windpipe, and she was suffocating. She couldn’t mount a
cough sufficiently strong to expel it.
It was probably a chunk of bread she had dipped into the vinegar a moment before. To
think that I had made that bread for her as a treat! My mind suddenly became very clear, and my
medical training kicked in. The specter of death crystallized my thoughts. This was my wife. My
cherished partner for life.
With each additional second that she couldn’t breathe, I knew her life was dwindling. I
needed Kathleen here and now, by my side. I saw her lips turn blue and her face take on the
ashen grey of a death mask. Her body tensed in full-blown panic. Her eyes communicated
despair, pupils dilated and staring at me. I had to save her to save myself.
I performed the Heimlich maneuver again and again. More desperately each time, with
her impending death beating down on me. Finally, she coughed vigorously and victoriously. A
welcome spray of crumbs and bread fragments showered the room like confetti.
Exhausted from the physical and mental anguish of the last moments, my mind went to
places I had not explored for some time. Remarkably, Kathleen seemed in good spirits, as if
nothing had happened.
“You realize what just occurred, right?”
“Yep, but I’m fine now.”
I could hardly believe it. I watched her drink a large glass of water, and we resumed our
earlier conversation.
Two lives intertwined over a half-century. Embracing each other as we spent our final
years together. She breathed the air into my lungs that provided inspiration and stability for my
creative spirit, my work and life. I hoped that I provide the solace for her that a good partner
must. The thought of losing her was terrifying. Unimaginable.
I offered her more salad. No sourdough this time.
And the sun followed its normal cadence, a vivid splash of coral followed by the gray
stillness of night.
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